Try studying on an empty stomach. This is the reality of millions of school children in Nigeria today. When Professor Uche Amazigo retired after many years of public service, she brought a few partners together to form the Pan-African Community Initiative on Education and Health (PACIEH). PACIEH is designed to enable rural communities manage a sustainable school-based deworming, feeding and health programme, offering school children the chance to maximize opportunities available to reach their full potential. Our team member, Ada Ezeokoli, visited the school-feeding programme in Enugu State to examine the impact of its multi-partner, community-managed strategy on the lives of school children and its potential to shape the education and health of the next generation of Nigerians. This is her story.
As Professor Uche Amazigo and I arrive the rural community of Oma-Eke, Enugu State, in the relentless midday heat, the students of the Community Primary School are still in their classrooms. We watch as they finish their classes and observe as they come out to wash their hands with water and soap. Then they sit together to have lunch. The meals have been cooked and are served by a group of women, made up of mothers of children who attend the school. They are all volunteers and have organised themselves, taking turns in doing the cooking and serving. The children sit together, chatting as children do, but eagerly devouring the tasty looking meal.
The free school meals have been made available courtesy of the Pan-African Community Initiative on Education and Health (PACIEH). PACIEH is a non-governmental organization committed to establish partnerships and scale up sustainable school-based deworming, health and feeding programmes in Nigeria and beyond, through a community managed, multi-sectoral and rights-based approach, founded in 2013 by Professor Uche Amazigo.
The PACIEH School-Feeding initiative is not the first school-feeding programme implemented in Nigeria. The Federal Government enacted the school-feeding programme as one of the rights of every Nigerian school-child under the UBE Act of 2004. The section of the Act that deals with meals, Section 3 (1), reads, “The services provided in public primary and junior secondary schools shall be free of charge.” Section 15 (1), titled “Interpretation”, states that “‘Services’ that should be provided free of charge are books, instructional materials, classrooms, furniture and free lunch.” This has not been implemented in many places. In 2005, the Home Grown School Feeding (HGSF) programme of the federal government was piloted in 14 states, including Enugu State. By 2007, the programme had collapsed in Enugu State and 11 other states, as communities were not involved in its governance and implementation.
To design the proposed menu, PACIEH brought together top nutritionists and dieticians from the University of Calabar and the University of Nigeria to work with the community, basing it on locally available foods. The communities were also asked to contribute financially to the programme. “We know these are generally poor communities, but we did our research and knew that parents were able to give their children 5 to 10 naira a day for sweets,” Amazigo said. “So we asked them to decide how much a family should pay for those who can afford it”. To support children whose parents could not afford the contribution, they created a community-managed ‘Community Fund on Education and Nutrition‘ to which members of the community contribute.
“The spillover effect of this programme is that after the first two months, many women came back to us excited that the programme has helped them to modify their own menus at home, which means that even children who are not benefitting from the school-feeding are benefitting at home because of their mothers’ involvement in the programme,” Amazigo said, adding that the cooks are now trying to form a cooperative to grow vegetables and get into other commercial ventures. Mrs. Felicia Ike, the Head Teacher, is enthusiastic in her praise of the school-feeding programme. “It is a wonderful thing, because you don’t see children going home unnecessarily anymore,” she said. “For this term, we have not recorded one person that was sent home because of sickness or vomiting in the class. It is only God that is going to pay the people who are organizing this programme. Some people have told me that by next term they will bring their children to the school.”
Four months after the onset of the programme, the nutrition experts came back to conduct an assessment. Their results showed that the percentage of children in Central School Eke with normal weight had increased from 60% to 91%. In addition, school attendance had improved, reaching 80% attendance, even in the rainy season. The teachers say that the attention span of students in class has improved, and not a single student has dropped out of school since the programme started.
The success of the programme has pleased PACIEH’s partners and caught the eye of the Enugu State government. One of PACIEH’s partners, Nigerian Breweries Plc, has decided to build a new classroom and dig a borehole at the Community Primary School Oma-Eke. The Permanent Secretary and the Commissioner for Education in Enugu State have all visited the school to gain more insights into the success of this programme and are considering adopting the model.
Professor Amazigo spent most of her career working for poor, rural communities in Sub-Saharan Africa. From her work with the World Health Organisation (WHO), she took away some key lessons. “I have travelled to many communities in rural Africa, discussing with them, learning from them their needs, their expectations of their governments and their health systems,” she told us, adding, “I realized the health systems in Africa would perform better if health providers involved communities in trying to solve their own health problems.” After retiring from the WHO and returning to Nigeria, she founded PACIEH with a number of her colleagues, to intervene in three main areas: health, nutrition and education of children in resource-poor communities. “We believe those are the areas that require investment and attention at the early developmental stage of a child, to give the child an opportunity to maximize his or her potential in life,” she said.
Amazigo and her team researched the nursery and primary school systems to find out how to improve the health, education and nutrition of school children. What they found gave them deep cause for concern, as they realized that many children were undernourished and lacking a balanced diet. In addition to nutrition, Amazigo and her colleagues decided to tackle health challenges that might affect school children’s ability to learn and develop properly. In addition, after a medical examination of more than 500 school children, they discovered that the prevalence of ringworm was 35%. PACIEH had found its niche.
The initial source of funding came right on time in 2012 with Amazigo’s Prince Mahidol Award for “outstanding contribution in the field of Public Health for the sake of the well-being of the peoples.” She is the second Nigerian to become a Laureate of the Award since its inception in 1992. Two other partners, the Nigerian Breweries Plc and the Ama Brewery, soon came on board. For Nigerian Breweries Plc, the PACIEH project was part of its Corporate Social Responsibility (CSR) in the area of Health. The Medical Director of the Ama Branch of Nigerian Breweries Plc, Dr. Oviemuno Obaro, was instrumental in the process of selecting the schools in Enugu State. PACIEH also got funding from other partners, such as TruValu, which supports the programme in Anambra State.
But, as with the now famous community led delivery of ivermection, which she pioneered while at the WHO, the community is at the heart of PACIEH’s work. “The communities have been incredibly important partners in this process,” she concludes before I leave.
As I leave this community, I cannot help but be proud of the incredible work that PACIEH is doing and the role that it is playing for the future of Nigeria. I wonder why programmes like this are not more common. Why is the health and education of our children not the most urgent agenda for Nigerians?