Stronger together

In recent years, Ethiopia has made significant strides in improving child health and nutrition, with a 77 per cent decrease in under-five mortality rates between 1990 and 2023. 

Despite this progress, major issues remain, especially in conflict-affected and remote pastoralist areas where coverage, access and utilization of life-saving health and nutrition services are still limited. The impact of climate change is also taking its toll, jepordizing food security and survival.

Ethiopia has the third highest number of ‘zero-dose’ children in the world – those who have not received even a single dose of routine vaccines – with more than 900,000 children unprotected from deadly, preventable diseases such as measles, tetanus and polio. 

At the same time, only 8 per cent of children receive a minimally diverse diet, and an estimated 900,000 children are at risk of severe wasting due to drought and displacement.

These overlapping deprivations are often found in what are referred to as ‘zero-dose communities’ – where children miss out on both vaccines and essential nutrition. To confront this reality, Ethiopia has adopted a unified, child-centred approach called Immunization-Nutrition Integration (INI). By delivering services in a coordinated way, INI aims to ensure that no child falls through the cracks. This means addressing a child’s nutrition and immunization needs, while also taking into account measures to prevent and treat exposure to dangers such as waterborne diseases. 

In 2024, the CNF supported UNICEF to join forces with the Government of Ethiopia and Gavi, the Vaccine Alliance, to develop a pioneering model that combines routine immunization with essential nutrition support. The US$30 million joint initiative targets hard-to-reach children, particularly in Afar, Amhara, Oromia, Sidama and Somali, with a comprehensive package of integrated immunization, nutrition, social protection and birth registration services. 

The service package includes administering routine vaccines, vitamin A supplementation, deworming, growth monitoring, treatment for severe wasting and planned introduction of SQ-LNS, all delivered by health facilities, mobile health and nutrition teams, villagebased outreach and community health days. The goal is to reach more than 10 million children by 2026.

Since the programme began, more than: 

• 560,000 children have received vitamin A supplementation
• 410,000 have been dewormed
• 570,000 have been screened for malnutrition. 

As part of immunization outreach, 96 per cent of identified zero-dose children and 88 per cent of undervaccinated children received Penta 1 and 3 vaccines, marking a major step towards closing equity gaps. 

Early successes from the initiative set a powerful example of how integrated services can reach children in hard-to-reach areas. As Ethiopia continues to learn and adapt in real time, support from the CNF and Gavi is helping to build a practical, cost-effective model that can be scaled nationwide, with the goal of driving lasting improvements in child health and nutrition.