The government of Ethiopia is scaling up a school-based program that research showed had significant impacts on dietary diversity and minimum meal frequency among adolescent girls. Alive & Thrive supported the government to develop the program.

“During implementation research, the program was introduced in 59 schools, and 71 schools were added in 2022,” said Dr. Abdulaziz Ali , Country Director of Alive & Thrive’s Ethiopia program. “The government-led scale up is now reaching 280 new schools in five focus regions – Afar,  Amhara, Oromia, SNNPR and Somali – where  about 13,000 girl students are participating.”

Learn more about the Adolescent Nutrition program in Ethiopia: We invite you to join our global webinar on the program, which will include results of implementation research presented by our research partners at IFPRI, on April 11 at 9 a.m. EDT. Register here.

Greater investment in nutrition programs for adolescent girls and women is urgently needed, as noted in a recently published UNICEF report. The report reveals the slow global progress on nutrition in adolescent girls and women, and the multiple, interacting determinants that underlie this global crisis. More than a billion adolescent girls and women suffer from undernutrition, micronutrient deficiencies and anemia, the report states.

“Improving the nutrition of adolescent girls is increasingly gaining attention as a critical issue,” said Sandra Remancus, Director of Alive & Thrive. “Malnutrition among young girls affects not only their own health and education but also the survival and health of future generations.”

While the adolescent nutrition intervention targeted adolescent girls 10-14 years old, available statistics regarding 15-19-year-old girls indicate the need for action: over one-fourth (29%) of 15-19-year-old girls in Ethiopia are underweight and one-fifth (20%) are anemic (DHS, 2016); 13% have already had children (DHS, 2016). The intervention reaches girls, their parents and their communities to increase awareness and change behavior that will lead to improved nutrition outcomes, and rests upon applying four drivers of behavior change:

• Knowledge – correct information on what affects nutrition and why
• Beliefs – support for the idea that change in behavior will bring benefits
• Social norms – messages from multiple credible sources and group activities with peers
• Self-efficacy – support that the girls can change their behavior by providing access to diverse foods and an extra meal, replacing junk food and hands-on activities

The intervention strategy aims to empower adolescent girls to improve their nutrition practices, strengthen school capacity to support them and ensure repeated exposure of adolescents, parents and influential persons to key messages. At schools, girls learn about nutrition during flag ceremonies, in biology and social science classes, during peer mentorship sessions, quarterly BMI measurement and counseling sessions, via messages displayed on posters and mini-media and during club sessions.

The schools’ administrators include adolescent nutrition as a topic in the parents' and teachers' gathering, which is held four times a year. Adolescent girls are assigned responsibility for bringing key messages to their parents about adolescent nutrition (a role reversal). Similarly, community meetings are leveraged to share nutrition information and local community health workers share the information during facility and home visits.

The program also includes training on relevant nutrition topics for school principals, science teachers and club leaders from the education sector and health extension workers. For the recent scale-up, from November 2022 to January 2023, about 1,200 people received training during two-day workshops in 14 woredas of the various regions.

The new set of 280 schools are primarily in rural areas of the five focus regions. With Alive & Thrive support and in collaboration with a variety of stakeholders – government health agents, school officials, community health workers, parents and the girls themselves – a set of tools were developed for use in the schools and in communities, including a nutrition passport, posters, class guides for teachers and information guides for health extension workers, among others.

An analysis of costs of the program shows that for a relatively modest investment, many school-aged girls can be reached, said Tamirat Walissa, Alive & Thrive’s Senior MIYCAN Advisor.

“Initially, the program cost more than 212,000 ETB (about US$4,650) per school,” Walissa said. “But the scale up to 280 schools, costs less per school – about 22,000 ETB (US$ 400). The costs are mainly for transportation, covering a per diem allowance for participants, rent for training halls and covering the costs for refreshments.”

The intervention has been well received among schools and communities, stakeholders said, and they have seen positive results.

“Since the intervention, students’ awareness and practice has increased regarding the benefits of having breakfast before school and they have started to bring snacks to school to use during their break time,” said Girma Regassa, focal person for the Nutrition and School Feeding Program in the Oromia Region Education Bureau. “All these have helped them stay focused on their education.”

The scale-up of the program includes regular reporting from the schools and health posts to woreda health and education offices, Walissa explained.