Donor reliance, insufficient materials affect nutrition programmes in Nigeria’s North-central

Fateemah Salisu-Ahmed had been awake for most of the night in May 2025, pacing around the small room where her five-month-old triplets lay. Two of the babies had stopped eating, their tiny bodies burning with fever, their cries growing weaker.

In the morning, the 31-year-old mother wrapped the children in shawls and hurried with her husband, Salisu Ahmed, to the nearest primary healthcare centre in Kugbo, in the Karu area of the Federal Capital Territory, Abuja.

However, they were told that the facility did not have what the children needed.

“We were referred to another hospital, but we could not go there that day. Instead, we went back home to buy drugs from the chemist. But there was no improvement, especially for Abdulrahman, who had refused to eat and had a high body temperature,” Mrs Salisu-Ahmed said.

Eventually, they took the children to Nyanya General Hospital, where one of the triplets was diagnosed with severe malnutrition — a condition the family could have caught much earlier if the Kugbo PHC had been adequately equipped.

For many mothers across Nigeria’s North-central region, the family’s experience would ring familiar.

Nafisatu Alim arrived at the Garki Primary Healthcare Centre in Abuja one afternoon, seeking Ready-to-Use Therapeutic Food (RUTF) for her malnourished daughter.

RUTF is a high-energy, nutrient-rich food paste used to treat severe acute malnutrition (SAM) in children.

Instead, Mrs Alim was told the nutrition focal officer was not on duty. She called the officer, who told her that the PHC did not have the supplements.

The officer, Mrs Atiku, who later spoke with PREMIUM TIMES, said desperate mothers call her regularly. “When it was available, we gave them, but now that we are out of stock, I advised them to go to the nearest hospital,” she said. “But many insist on waiting until the supplements are available.”

With no RUTF in stock, Mrs Atiku is teaching mothers how to use locally available grains, such as soya and maize, and groundnut paste, to prepare alternative high-energy meals.

It is the same story at the Kuje PHC, where Christianah Sunday took her child after he stopped eating and was taking only water. When the PHC referred her to a private hospital, Mrs Sunday returned home.

Rising malnutrition cases in Nigeria

According to the United Nations Children’s Fund (UNICEF), about 100 children under five die of malnutrition per hour in Nigeria, approximately 2,400 children daily.

It also explained that an estimated two million children under five in the country suffer from Severe Acute Malnutrition (SAM), but only two out of every 10 children affected receive treatment.

The malnutrition programme in Nigeria aims to prevent, detect and treat malnutrition across the life course, especially in children under five, as well as pregnant and breastfeeding women.

These programmes operate through PHCs, community volunteers, schools, emergency response teams, and social protection systems, and are implemented by federal and state governments, together with UN agencies, NGOs, and donors.

Research shows that malnutrition in Nigeria is a multifaceted issue with several contributing factors, which include poverty, food insecurity, inadequate infant and young child feeding practices, lack of access to healthcare, and poor sanitation.

Factors like conflict, lack of education, and gender inequality also contribute.

The 2023-2024 Nigeria Demographic and Health Survey (NDHS) shows rising malnutrition across categories: stunting, wasting, and underweight children, with males slightly more affected than females.

According to the data, 50.64 per cent of underweight children in Nigeria are male.

PHCS not handling malnutrition cases

Many PHCs in the FCT and Nasarawa State lack the requirements needed to address malnutrition cases.

Research shows that inadequately equipped PHCs compromise patient care and increase stress on healthcare staff.

This can manifest as inefficient service delivery, difficulties in implementing proper nursing procedures, and increased referrals to secondary or tertiary facilities, potentially delaying or hindering access to necessary care.

Visits to PHCs in Nasarawa State show that some of these facilities lack basic amenities, including ineffective nutrition programmes.

For instance, in May 2025, Hajarah Ismoil, a 25-year-old mother of two, took her eight-month-old son to the Agwagwanje PHC in Nasarawa LGA after noticing he had stopped gaining weight.

The health worker on duty, Aperuwa Bako, took one look at the child and immediately requested that he be attended to. But after a quick assessment, she told the mother there was nothing the facility could offer.

“This baby looks pale,” the health worker told her. “You should have brought him earlier. He needs attention, but we don’t have what he needs here. Even ORS is not available. Take him to another hospital — but not a government one, because what we lack, they also lack.”

Her husband frowned at the referral. A private hospital far from home meant transportation, consultation, and medication costs they were not prepared for.

Meanwhile, the PHC Agwagwanje is a central health facility in Nasarawa State. It serves as a resource centre for nearby facilities, including PHC Gauta, Main Market, PHC Sabon Gari, PHC Jigwada, and Tudun Abu PHC, which rely on it for nutrition supplements.

While this facility lacks nutritional supplements, most patients are either turned down or referred to other hospitals for treatment.

When the reporter visited PHC Gauta in Keffi LGA, the only equipment and solution available to address malnutrition cases was the Mid-Upper Arm Circumference (MUAC), which, according to UNICEF, is a simple tool for detecting severe malnutrition.

The staff on duty said they mostly refer malnutrition cases to nearby facilities. “We don’t have supplements here. Most times, we refer them to PHC Agwagwanje since it is bigger.’’

Malnutrition prevalence in Nigeria

Nigeria ranks 115th out of 123 countries on the 2025 Global Hunger Index, with a score of 32.8 per cent — a “serious” category.

The global Index rate is based on four indicators, namely, undernourishment, child wasting, child stunting, and child mortality. With a 20.0-34.9 score (serious), Nigeria was categorised as a country with a serious hunger rate.

The hunger rate increased in Nigeria from 29.9 per cent in 2016 to 32.8 per cent in 2025.

According to the Action Against Hunger report, interconnected issues of poverty, inequity, conflict, climate change, gender discrimination, and weak government and health systems all contribute to keeping nutritious food out of reach for millions of families worldwide.

The NDHS report shows that among the six regions in Nigeria, the North-east has the highest proportion of underweight children at 10.9 per cent, followed by the North-west at 10.9 per cent. The North-central has 6.2 per cent; the South-east, 4.2 per cent; the South-west, 3.9 per cent; and the South-south, 3.8 per cent.

Regarding children with stunted growth, a condition where a child appears too short for their age, the North-west has the highest percentage with 27.8 per cent of children affected, followed closely by the North-east with 26.6 per cent. The North-central has 14.8 per cent, the South-west has 6.6 per cent, the South-east has 6.5 per cent, and the South-south has 4.6 per cent.

Child wasting is a severe form of acute malnutrition where a child is dangerously thin for their height, resulting in rapid weight loss due to insufficient food, illness, or poor nutrient absorption, significantly increasing their risk of death, developmental delays, and disease.

With 2.6 per cent, the North-east region has the highest percentage of such children. The North-west has 1.9 per cent; the North-central and South-east have 1.5 per cent; the South-south has two per cent; and the South West has one per cent.

The report also shows that among the North-central states, Plateau with 46.4 per cent, Nasarawa with 9.6 per cent, and Kwara with 24.5 per cent have the highest percentages of stunted, wasted, and underweight children, respectively.

In the FCT alone, 16.3 per cent of children under five are stunted, 13.7 per cent are underweight, and 7.0 per cent suffer from severe wasting.

In Nasarawa, the rates are even higher in some categories. 35 per cent of children have stunted growth, about 22.9 per cent are underweight, and 9.6 per cent have been diagnosed with severe malnutrition (wasting).

According to a UNICEF report, sustained investment in nutrition programmes is critical, as poor funding and shortages of essential supplements are directly linked to worsening malnutrition and higher infant mortality rates.

Meanwhile, a 2023 UNICEF data ranked Nigeria as having the second-highest under-five mortality rate in Sub-Saharan Africa, with an average of around 115 children under five years of age dying per one thousand live births. The neighbouring Niger Republic has the highest rate.

Donor effect on Nigeria’s supply of nutrition supplements

Over the years, the United States has been a major funder of nutrition programmes in Nigeria. In 2009, the US Agency for International Development (USAID) began supporting the Nigerian government’s efforts to reduce maternal and child undernutrition and improve HIV-free survival among infants and young children.

In 2022, USAID launched the $9.5 million Advancing Nutrition Activity to combat malnutrition in Nigeria.

Until early 2025, Nigeria relied heavily on USAID for nutrition support. The agency supplied RUTF, funded community nutrition initiatives, strengthened supply chains, and supported health programmes across the country.

But when the US government, under President Donald Trump, suspended most foreign aid to realign priorities in early 2025, many awards were terminated. This led to the withdrawal of several activities delivered by USAID and its implementing partners, including the World Food Programme (WFP), Helen Keller International, and Mercy Corps.

The United Nations Children’s Fund (UNICEF) warned that supplies for acutely malnourished children in Nigeria and Ethiopia have sharply reduced and urged countries to reinforce prevention strategies — including Vitamin A supplementation, breastfeeding support, and routine health services.

Also in March 2025, UNICEF warned that critical nutrition supplies for acutely malnourished children were rapidly dwindling in Nigeria and Ethiopia. The agency cautioned that nearly 1.3 million children under the age of five in conflict-affected northeastern Nigeria and Ethiopia’s drought-stricken region could lose access to treatment, heightening their risk of death as funding is removed.

Research shows that the abandonment or suspension of malnutrition programmes can cause a sudden surge in malnutrition cases, even in areas with historically low rates. These programmes are crucial for both treating existing malnutrition and preventing new cases, and their removal can quickly weaken progress made over the years.

Donor reliance and weak governance are driving nutrition crisis

Oladimeji Amos, a public health expert and Public Health Policy Researcher at African Rural Development Network, observed that Nigeria’s heavy dependence on donor-funded nutrition programmes has weakened government ownership, disrupted service delivery, and left PHCs without essential supplements and trained personnel.

“The crisis, as observed in PHCs, including absence of supplements and inactive nutrition services, is not incidental; it is a reflection of long-standing systemic failures in Nigeria’s primary healthcare and nutrition governance,” he said in a LinkedIn conversation with this reporter in December.

“In a bid to address that, first, nutrition services must be fully reintegrated into routine PHC delivery. Enough of treating it as parallel or donor-driven activities.”

Mr Amos explained the benefits and risks of donor dependence.

“On the positive side, donors have played a critical life-saving role. Programmes supported by UNICEF, WFP, and other partners have treated millions of children for severe wasting, particularly in fragile states. Donors also bring technical expertise, data systems, and innovations that government structures often lack. Without donor funding, CMAM services in many northern states would collapse almost immediately.

“However, the disadvantages are profound and increasingly visible. Donor reliance has led to weak government ownership. Many states do not budget for nutrition commodities because they expect partners to supply them. This explains why PHCs report no supplements when donor pipelines break down.

“Donor funding is also volatile and short-term, often driven by global priorities rather than local needs. When funding cycles end, programmes abruptly stop, regardless of their community impact.

“Many PHCs lack functional nutrition corners, trained nutrition focal persons, or basic commodities such as Ready-to-Use Therapeutic Food (RUTF), micronutrient powders, and vitamin A.

“A true restoration will begin when nutrition is institutionalised as a core PHC service, similar to immunisation. This must come with clear minimum service standards and must be enforced by state PHC boards,” Mr Amos said.

He mentioned the inconsistency in the allocation of Nigeria’s nutrition funds and why the government needs to utilise them appropriately to ensure the programme’s efficiency.

“The government spending does not reflect the scale of the crisis. Nigeria hosts one of the highest absolute numbers of stunted children globally, yet nutrition receives a fraction of health and agriculture budgets. Budget analyses have repeatedly shown that nutrition allocations are either absent, poorly defined, or released late,” he mentioned.

Meanwhile, the Nigerian budget shows that between 2021 and 2025, the amount allocated to the country’s nutrition programmes increased continuously.

For instance, in 2021, N10.8 billion was allocated to the programme; in 2023, it received N6.5 billion; in 2024, it received N18 billion; and in 2025, it increased to N170 billion. However, officials have repeatedly complained of poor releases of budgeted amounts in the health sector.

Mr Amos recommended that the government must treat nutrition as a development and economic issue, not just a humanitarian concern.

He said, “Nigeria must address policy fragmentation. Nutrition programmes must be at the centre of national planning, not at the margins.

“The country has a National Multisectoral Plan of Action on Nutrition, but the implementation at state and LGA levels is weak. The government needs to enforce coordination, with clear leadership, performance targets, and consequences for non-implementation.

“Additionally, food inflation and poverty are directly worsening child malnutrition. Recent economic shocks, subsidy removal, and rising food prices have pushed poor households into negative coping strategies, such as skipping meals, reducing diet diversity, and prioritising adults over children.

“Suppressing malnutrition, therefore, requires social protection interventions that are nutrition-sensitive with a clear sustainability plan, such as targeted food support for pregnant women and households with young children, not broad, untargeted programmes.

“Lastly, the government must confront regional inequality and conflict. Malnutrition rates in the Northern regions are consistently higher due to insecurity, displacement, and weak services. Without addressing insecurity and restoring basic services in conflict-affected areas, nutrition programmes alone will not succeed.”

A UNICEF Recommendation

The UNICEF recommendation also calls for improved access to affordable, safe, and nutritious diets through sustained nutrition education, community engagement, and large-scale behaviour change communication targeting infants, young children, adolescents, and women.

It emphasises the need for healthy food environments, urging governments to adopt evidence-based policies such as taxing sugar-sweetened beverages, restricting the marketing of unhealthy foods to children, and broader food system reforms that make nutritious choices accessible and affordable.

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Together, these measures form an integrated policy framework to prevent malnutrition, reduce child mortality, and improve long-term human capital development.

What the government needs to prioritise

To address the growing number of malnutrition cases, the Nigerian government launched Nutrition 774 in 2025, a government-led, multi-sectoral programme aimed at combating the high rate of malnutrition at the grassroots level and reducing it by half by 2030 across all 774 local government areas (LGAs).

Also, Nigeria’s coordinating Minister for Health and Social Welfare, Muhammad Pate, recommended an intervention to address malnutrition in Nigeria without waiting for external donor support.

Mr Pate, a professor, said: “We need to pivot from the one that is donor-recipient to the one that is investment-oriented. Those who have an interest in investing can invest in tom-brown Production.”

This reporting was completed with the support of the Centre for Journalism Innovation and Development (CJID)