African Leaders for Nutrition (ALN) Initiative Embedding Nutrition within the Covid-19 Response and Recovery - COVID-19 Position Paper

1. Background

The coronavirus (COVID-19) pandemic has created a major global health and economic shock with unprecedent impacts on people's health, nutrition and livelihoods. As a result of the pandemic, Africa is likely to experience negative economic growth primarily as a result of the sharp decline in productivity, jobs and revenues. COVID-19 will hit the poor hardest in many ways, including job loss, higher food prices, loss of remittances, reduced purchasing power, rationing of food and other basic goods, inadequate safety nets, and disruptions to health care services and education. This is expected to create a population of the new poor and push more people into extreme poverty.

The global spread of COVID-19 and the rising number of coronavirus cases in Africa are fueling anxiety about failing healthcare and collapsing food systems. Africa is already grappling with a locust outbreak in the Horn of Africa, drought and flood extremes due to climate change and increasing food importation costs of more than $47 billion in 2019. The convergence of all these sets the stage for an imminent food and nutrition crisis, unless measures are taken to mitigate the impact of the epidemic. Anti-pandemic measures like nationwide lockdowns and border closures compound food shortages - especially of nutritious but perishable foods like fruit, vegetables and fish products. Restrictions on movement and quarantine measures impede farmers' access to markets. Unless concerted and integrated efforts within a multisectoral response plan are rapidly implemented, the pandemic will reverse vital gains made in human development and nutrition outcomes across Africa, and its ramifications will be felt for years to come.

This position paper is a call upon Heads of State and Governments of the African Union Assembly to ensure the incorporation and promotion of nutrition smart interventions within COVID-19 response and recovery action plans.

2. COVID-19 & malnutrition in Africa

In the context of COVID-19, undernutrition compromises immune systems, making bodies vulnerable to infection, reducing the effectiveness of vaccines, and impeding recovery. Africa has made significant progress over the last decade since adopting commitments to address malnutrition by 2025 at the World Health Assembly (WHA) in 2012 and the Malabo Declaration in 2014. Despite this, Africa's children continue to suffer the highest consequences of malnutrition permanently reducing their cognitive capacities, leading to decreased productive and income-earning potential in adulthood. For instance:

• 78% of countries in Africa have a high prevalence of stunting among children (between 20% and 30%).
• 55% of African countries have a high prevalence of anemia among women of reproductive age (20-39.9%). About half of countries have a higher prevalence than they had in 2012, and not a single country is on track to achieve the target set in 2012.
• Approximately 27% of countries have a high prevalence of low birthweight (>15%).
• More than half (58%) of countries in Africa have a high prevalence of wasting among children under five (>15%), which is double the global average of 7.3%.

COVID-19 has shown clear threats to food security and nutrition that requires urgent prioritization to ensure that past nutrition gains are not lost while also safeguarding future nutrition efforts towards attaining the World Health Assembly (WHA) and the Malabo Declaration targets by 2025. The structural weaknesses that produce the triple burden of malnutrition are well known. ^[1] They include limited access to adequate, appropriate and nutritious foods, insufficient exclusive breastfeeding, limited access to antenatal care among women of reproductive age and inadequate access to water and sanitation facilities.

If not effectively addressed, the consequences of COVID-19 will only serve to derail Africa's development agenda and the potential demographic dividend to be gained from its young population. In the context of COVID, undernutrition compromises immune systems, making bodies vulnerable to infection, reducing the effectiveness of vaccines, and impeding recovery. According to World Food Program (WFP), COVID-19 may prove particularly fatal for people suffering from chronic or acute hunger or malnourishment. [2] These effects will be dire especially among urban populations living in overcrowded and poorly serviced slum dwellings. [3] With disrupted supply chains and inflating prices as a result of nation-wide lockdowns and a lack of comprehensive social safety nets, the livelihoods of urban populations on the continent are at stake.

3. Role of ALN and the ALN Champions

A Sound nutrition strategy and a high-level political engagement are required to facilitate the good nutrition that will allow children to survive, grow, develop, learn, play, participate and contribute. Developed by the AUC, the African Regional Nutrition Strategy provides broad guidance and articulates interventions to eliminate all forms of malnutrition. ^[4] In addition, the African Leaders for Nutrition (ALN) Initiative was established to rally high-level political engagement to advance nutrition in Africa. It is led by a group of ALN Champions, comprising current and former heads of state, finance ministers and eminent leaders with the power to catalyze and sustain high-level political leadership and commitment to increase financial resources to end malnutrition in Africa.

High-level political leadership is required to ensure that actions and economic stimulus packages developed to combat the COVID-19 pandemic include plans to ensure that nutritious foods are made available and affordable to all. The African Leaders for Nutrition (ALN) urges all Heads of State and Governments to play a critical role in ensuring that nutrition is a core component of Country Resilience Plans and Social bonds in response to the COVID-19 pandemic. Indeed, several African Heads of state and governments are already championing nutrition on the continent. However, strong leadership and additional comprehensive actions are needed to amplify nutrition within the short-, medium- and long-term COVID-19 response and recovery efforts. The ALN through the Nutrition Champions will engage political leaders and foster partnerships to influence policy influence and increase nutrition investments in the COVID-19 environment.

ALN is compelled to rally a unified voice among its leaders and champions to raise concerns about the risk and the resulting disruption that the COVID-pandemic will have on nutrition and food security on the continent. To achieve this, ALN and AUC have prepared this position paper that highlights how the COVID-19 pandemic will reshape and impact nutrition and the social economy with the aim of spearheading high-level sensitization, advocacy and resource mobilization efforts towards securing increased investments in nutrition to guarantee people's survival and as a developmental priority.

4. Key messages and a Call to Action

Nutrition cannot be left behind in the COVID-19 response in Africa. High-level political leadership is needed during the pandemic to spearhead efforts to address disruptions of food systems and the major threats to nutrition through adequate policy and resource allocation strategies during the COVID-19 and beyond. Although the resource requirement for the COVID-19 response is enormous, there are emerging funds that can go a long way to support countries in this endeavour (See Annex 1 below).

The African Leaders for Nutrition, together with the AUC Nutrition Champion call upon governments to pay attention to policy and programmatic interventions that promote nutrition while responding to the COVID-19 crisis because nutrition cannot wait. ALN recommends to maintain and even increase the level of funding allocated to Nutrition and make sure there is no gap in multi-year nutrition programmes. In particular, the nutrition champions make recommendations for the following actions to be undertaken during the immediate and medium-term response to the COVID-19 as well as during the recovery period:

4.1. Prioritize nutrition in national COVID-19 response plan and strategies.

o Ensure that qualified nutrition experts are included in planning and response efforts and effectively contribute to policy and implementation guidance for health, food, water, sanitation and social protection systems.

o Ensure sectors are integrating nutrition-sensitive actions within COVID-19 response, including water and sanitation, social protection and universal health coverage, agriculture, education and health systems. ^[5] These interventions should promote access to safe water and sanitation facilities and provide appropriate guidance on how to use them to halt the spread of the virus, particularly within vulnerable communities.

o Ensure COVID-19 response planning and coordination leverages existing nutrition capacity and multi-sectoral, multi-stakeholder coordination structures.

4.2. Prioritize nutrition in the health sector response

o Invest in programs that support infant and young child nutrition interventions including support to mothers to practice exclusive breastfeeding during the period when access to nutritious diet may be compromised. Maintaining available delivery of life-saving nutrition services during the crisis will protect vital gains made in nutrition and human development over the years.

o Support and improve access to essential health services including antenatal care services, immunization and other child-health services. COVID-19 interrupts health systems and can undermine access to and delivery of essential nutrition services such as immunization.

4.3. Prioritize nutrition in the food systems response

o Prioritize support to food systems that deliver safe, affordable, nutritious food and diets that are accessible to all by supporting the capacity of smallholder farmers (crop production, horticulture, livestock, and fisheries), farm input providers, food processers and food distributers to continue producing and delivering sufficient, affordable, and nutritious food even during the crisis. COVID-19 is having a major impact on food supply chains and logistics , both for producers and consumers, as evidenced by closed borders, national lockdowns, and the reduction in air traffic . ^[6] These will have many adverse effects on access to adequate and diverse food and nutritious diets;

o Support trade policies and food supply routes that facilitate the free flow of agricultural inputs and produce, and promote access to nutritious foods, particularly for the most vulnerable groups such as women, children, the elderly, and the poor in rural areas, urban slums and those in conflict situations. ^[7] COVID-19 will undoubtedly increase the number of poor and vulnerable people and any restriction to trade of food items will only cause price escalation of food items and reduce their availability.

4.4. Prioritize nutrition in the social safety net response

o Engage and resource social safety nets interventions that center on nutrition (nutrition value of food kits, cash transfer, etc.) to enable poor household to buy nutritious food, to generate local demand and support local markets.

o Scaling up social safety nets, such as school feeding or food for education programs.

o Prioritise WASH interventions such as handwashing, sanitation and educational messages among the most vulnerable.

Annex 1: Current financial opportunities to support the COVID-19 response

It is estimated that Africa needs $114 billion in 2020 in its fight against COVID-19 .[8] Official creditors have mobilized up to $57 billion for Africa in 2020 alone - including upwards of $18 billion from the IMF and the World Bank each - to provide frontline health services, support the poor and vulnerable, and keep economies afloat in the face of the worst global economic downturn since the 1930s. Private creditor support for Africa in 2020 could amount to an estimated $13 billion, leaving a financing gap of around $44 billion.

On the continent, the African Union Commission (AUC) has launched a continental fund called the "African Union COVID-19 Response Fund" that aims to raise $150 million to prevent the disease's transmission and a pool of about $400 million to support the procurement of medical supplies, deployment of rapid responders across the continent, and support Africa's most vulnerable populations. [9] The AUC fund operates through the Africa Centre for Disease Control and Prevention (Africa CDC) to determine priority interventions and actions, including among others: purchase and distribution of key equipment for diagnosis, treatment and protection of caregivers. This is a financial instrument to mobilize and manage funds from the private sector in Africa, and other well-wishers with the support of several African banks. [10]

The African Development Bank has put in place a $10 billion COVID-19 Response Facility, which comprises of crisis response budget support and a commitment to ensure that these operations are fast-tracked for timely response. The Africa Export and Import Bank has provided a $3 billion COVID-19 Trade Impact Mitigation Facility to support debt repayments and currency stabilization through multiple financial instruments including lines of credit, direct funding, guarantees and cross-currency swaps. Similarly, the West African Development Bank is providing soft loans up to $197 million and suspension of debt repayment on principal to about $125 million.

At the country level, efforts for leveraging resources to respond to COVID-19 are opportunistic with private sector stepping up to the plate. For instance, Nigerian private sector leaders have announced the creation of the Coalition against Coronavirus (CACOVID) which has mobilized $71 million. The coalition is spearheaded by Access Bank Group and Dangote Industries Limited, with support from Zenith Bank, Guaranty Trust Bank, MTN, ITB and others. Similar country level initiatives are being put in place in most countries, however concerted efforts and actions are needed.