The many fronts in the struggle against malnutrition
The Sahelian strip is affected by two forms of fragility: chronic food and nutritional fragility, accentuated by short-term seasonal episodes of varying severity. With the region once again hit by a food crisis this year, it is essential to both limit the impact of regular peaks of malnutrition and reduce structural vulnerabilities. Action Contre la Faim (ACF) adopts an integrated approach to this issue which aims to address all the direct and underlying factors of malnutrition at the same time.
In the last ten years, rates of malnutrition have regularly reached international alert thresholds in the Sahel, with more than 10% of acute malnutrition in numerous areas and peaks of more than 20% in the most vulnerable areas and regions.
Independently of crises, the high structural rates of malnutrition can be explained by a combination of factors: problems in relation to the availability, accessibility and variety of food, the presence of infectious diseases, limited access to water and sanitation, the lack of appropriate health services and inappropriate childcare habits and practices.
Since 2005, the efforts made to combat malnutrition in West Africa have essentially focused on improving the response to crises, without sustainable solutions having been sufficiently promoted. The frequency of these peaks has increased, as has the seriousness of their impact on communities, while people’s resilience has decreased. The current food crisis in the Sahel, two years after the crisis of the summer of 2010, illustrates how the most vulnerable people’s resilience has been gradually eroded due to the cumulative effect of different shocks. It also shows how there is a need to reduce nutritional vulnerability in the long term while at the same time arming households against the short-term peaks which weaken them so much.
Today we know more about the global causes of malnutrition and the necessary interconnections between the different technical sectors. In order to fight malnutrition it needs to be recognized as a public health issue and tackled in the same way as other illnesses. It is also necessary to implement multi-sector policies encompassing agriculture, behavioural changes, access to water, hygiene, sanitation and social security.
The lack of progress in developing these multi-sector policies is one of the 6 main shortcomings  identified by ACF with regard to the current response to nutritional vulnerability in West Africa.
 The other shortcomings concern:
1. The lack of a shared view of the nutritional context and its evolution, and subsequently the absence of forecasting of the magnitude of peaks in critical areas.
2. The continuing difficulties in responding to many emergencies in the region, in particular, mid and small scale emergencies which are increasing.
3. The multiplication of actors supporting SAM treatment current up-scaling without a quality-guarantee or link from the field to the decision makers.
4. The early actions to reduce SAM prevalence through MAM treatment or social protection require additional innovations to scale up sufficiently.
5. The lack of progress in the development of multi-sector policies in most of the region’s countries.
6. Prevention responses to reduce vulnerability of households at risks are still at a very early stage of development and require stronger evidence of what is cost-effective and replicable.