Reliance on Donors and Shortages of Supplies Hamper Nigeria's North-Central Nutrition Initiatives

Mothers in Nigeria's North-central region are facing significant challenges in accessing crucial nutrition support for their children, primarily due to the nation's over-reliance on donor funding and insufficient availability of essential supplies. This dependency has created vulnerabilities within the healthcare system, particularly impacting primary healthcare centres (PHCs) tasked with combating malnutrition.

One parent, Fateemah Salisu-Ahmed, recounted a harrowing experience in May 2025 when two of her five-month-old triplets stopped eating and developed fevers. Despite seeking help at the local PHC in Kugbo, Federal Capital Territory, the facility lacked the required resources. The family was referred to another hospital, but due to financial constraints and lack of immediate improvement, they faced further delays. Eventually, one of the triplets was diagnosed with severe malnutrition at Nyanya General Hospital, a condition that could have been addressed earlier had the initial PHC been adequately equipped.

Similar accounts emerge from other mothers across the region. Nafisatu Alim visited the Garki PHC in Abuja seeking Ready-to-Use Therapeutic Food (RUTF) for her malnourished daughter but was informed the nutrition focal officer was unavailable and the centre was out of stock. The officer, Mrs. Atiku, acknowledged the shortage and advised mothers to seek other facilities, while also teaching them to prepare alternative high-energy meals from local grains.

At Kuje PHC, Christianah Sunday faced a similar predicament when her child stopped eating. After being referred to a private hospital, which posed financial difficulties, she returned home. These instances highlight a systemic issue where PHCs lack the basic supplies and trained personnel to effectively manage malnutrition cases.

Rising malnutrition cases are a grave concern across Nigeria. According to UNICEF, approximately 100 children under five succumb to malnutrition every hour, amounting to 2,400 daily. The agency also estimates that two million children under five suffer from Severe Acute Malnutrition (SAM), with only a fraction receiving treatment. The national nutrition programme aims to prevent, detect, and treat malnutrition, involving governments, UN agencies, NGOs, and donors.

Research indicates that malnutrition in Nigeria is a complex issue stemming from poverty, food insecurity, poor feeding practices, inadequate healthcare access, and poor sanitation, exacerbated by factors like conflict, lack of education, and gender inequality. The 2023-2024 Nigeria Demographic and Health Survey (NDHS) reveals an increase in stunting, wasting, and underweight children, with males being slightly more affected.

Many PHCs in the FCT and Nasarawa State are not equipped to handle malnutrition cases. Inadequate facilities compromise patient care and strain healthcare staff. For example, at the Agwagwanje PHC in Nasarawa State, a mother was told by a health worker that the facility had no supplies, not even Oral Rehydration Salts (ORS), and recommended seeking care at a private hospital, acknowledging the public system's deficiencies.

Even central facilities like PHC Agwagwanje, which serves as a resource for smaller centres, lack nutritional supplements, leading to patients being turned away or referred. At PHC Gauta in Keffi LGA, the only available tool for malnutrition assessment is the Mid-Upper Arm Circumference (MUAC) tape, with referrals being the primary course of action due to a lack of supplements.

Nigeria's prevalence of malnutrition is alarming. The country ranks 115th out of 123 nations on the 2025 Global Hunger Index with a score of 32.8, indicating a "serious" hunger rate that has increased since 2016. The Action Against Hunger report attributes this to interconnected issues of poverty, inequity, conflict, climate change, and weak health systems.

The NDHS report highlights regional disparities, with the North-east having the highest proportion of underweight and wasted children, while the North- west leads in stunting. In the North-central region, Plateau, Nasarawa, and Kwara states show significant rates of stunting, wasting, and underweight children. Similarly, the FCT and Nasarawa State exhibit high percentages of children affected by stunting, underweight conditions, and severe wasting.

UNICEF reports that sustained investment in nutrition programmes is crucial, as poor funding and shortages of supplements directly correlate with worsening malnutrition and increased infant mortality. Nigeria has the second-highest under-five mortality rate in Sub-Saharan Africa, with an average of 115 deaths per 1,000 live births.

The reliance on foreign aid, particularly from the United States through USAID, has been a significant factor. USAID previously supported numerous nutrition initiatives, including RUTF supply and supply chain strengthening. However, the suspension of most foreign aid in early 2025 led to the termination of many programmes, causing a sharp reduction in critical supplies for malnourished children in Nigeria and Ethiopia.

Experts like Oladimeji Amos, a public health policy researcher, argue that this donor dependence has weakened government ownership and disrupted service delivery, leaving PHCs ill-equipped. He stresses the need for nutrition services to be fully integrated into routine PHC delivery, moving away from donor-driven projects. While donors have provided life-saving support, their reliance has resulted in states not budgeting for nutrition commodities, expecting partners to supply them. Donor funding is also often volatile and driven by global priorities rather than local needs.

Amos points out that many PHCs lack functional nutrition corners, trained staff, and essential commodities. He advocates for nutrition to be institutionalised as a core PHC service, akin to immunisation, with clear standards and enforcement. He also notes that government spending on nutrition remains insufficient, despite the scale of the crisis, and budget releases are often delayed.

Despite increases in budgetary allocations to nutrition programmes between 2021 and 2025, officials report poor release of these funds. Experts recommend treating nutrition as a development and economic issue, addressing policy fragmentation, enforcing coordination mechanisms, and implementing nutrition- sensitive social protection interventions to combat rising food inflation and poverty.

UNICEF recommends improved access to nutritious diets through sustained education and behaviour change communication, alongside policies that promote healthy food environments, such as taxing sugar-sweetened beverages and restricting unhealthy food marketing to children. These integrated measures aim to prevent malnutrition, reduce child mortality, and enhance human capital development.

In response, Nigeria launched the "Nutrition 774" programme in 2025, a multi- sectoral initiative targeting malnutrition at the grassroots level. The Coordinating Minister for Health and Social Welfare, Muhammad Pate, also called for a shift from a donor-recipient model to an investment-oriented approach, encouraging private sector participation in areas like "tom-brown" production.