The Ethiopian Context

Ethiopia has made significant progress in reducing the rates of malnutrition over the past two decades (see graph below), although high levels of child stunting, wasting, underweight and micronutrient deficiencies persist. By 2023, levels of child stunting and wasting remained high at 39 per cent and 11 per cent respectively, indicating the additional efforts needed to maintain the gains and the marked improvements attained in previous years.

The GoE’s flagship SD programme has shown very promising results in terms of stunting reduction (an annual reduction rate of 3 per cent) and the prevention of related deaths. Key success factors for the SD are the high-level leadership commitment, implementation of innovations, female empowerment approach, use of data for informed decision-making and sustained government and development partners’ financial commitments.

Other important policies and programmes in Ethiopia include the National Food and Nutrition Security Strategy, the Nutrition Sensitive Agriculture Strategy and the PSNP. All these efforts provide multisectoral nutrition guidance to improve the food and nutrition security of the Ethiopian population, as part of the national development agenda.

Support for scale-up of a national multisectoral nutrition programme 

N4D’s Directors have a long-standing engagement with different initiatives in Ethiopia spanning many decades and over numerous country visits. In 2023, N4D looked at the potential for greater nutrition sensitivity of the national PSNP, followed by a detailed evaluation of the Ethiopia National Information Platform for Food and Nutrition (NIPFN) in 2024.

In 2023, the Federal Ministry of Health nutrition coordination office asked N4D to support the development of its national Nutrition Centric HDP Triple Nexus (NC-HDPTN) Operational Guide and Implementation Roadmap.

Many of the documents outlined in these pages are available via Ethiopia’s Ministry of Health portal.

N4D support in 2024

Though the concept of a nexus approach has been around in various guises since 2016, from a nutrition perspective, there wasn’t much in the way of existing frameworks, tools etc. to guide the NC-HDPTN approach in Ethiopia. N4D was able to share evolving Nexus learning from Niger and Yemen and generic principles from the global level.

Under the leadership of the MoH, Ethiopia’s SUN movement stakeholders made the NC-HDPTN a priority following the 2023 SUN Joint Annual Assessment. The GoE’s desire for this was to overcome the limitations of cyclical emergency nutrition response and to harness collective HDP resources and approaches. This in turn supports communities and families to be more resilient to shocks and to focus on the prevention of malnutrition, whilst maintaining treatment capabilities, and to visualise the route towards achieving a common goal around these priorities.

To kick-start the process, MoH presented the approach to Action Against Hunger (ACF) during a high-level engagement meeting in March 2023. ACF helped mobilise financial support and technical assistance to support the development of the Operational Guidance (OG) and Implementation Roadmap (IR), and this process was completed in over one year through a vibrant partnership between GoE and its partners.

Facilitation of technical coordination was through the newly-established Technical Working Group (TWG – see members’ list below) comprising stakeholders in government, UN and civil society organisations, academia and donors. N4D engaged with the TWG, providing technical and strategic assistance as required for the six phases of the NC-HDPTN (see diagram below).

The first three phases were completed one year later in July 2024.

Phase 1: As part of the first phase of implementation a situation analysis was conducted to explore the existing lessons, identify potential actors and stakeholders and identify essential ideas for the development of the NC-HDPTN OG and IR for Ethiopia.

Phases 2-3: During the second and third phase of the road map, the MoH in collaboration with its partners, finalised and officially approved the IR and OG.

Phase 4: The implementation phase is currently being initiated and this will involve the development of the Advocacy and Communication guide and M&E framework.

N4D were also able to support the development of the NC-HDPTN Theory of Change (ToC) (see below, click image to enlarge) by drawing on learning from other ToC-related processes that we had supported.

In April 2024, N4D visited Ethiopia to support the process of scoping donor and other stakeholder views on the NC-HDPTN. This also enabled a better understanding of the nutrition ecosystem, financing arrangements and the need to begin to understand how the NC-HDPTN and the SD could be linked operationally. Following the country visit, N4D co-developed with MoH colleagues a summary document of the OG and the IR for advocacy purposes and a generic concept note to support efforts to mobilise funding for the operationalisation of the approach through pilots in a small number of SD woredas.

N4D also co-authored with MoH and other colleagues a peer review published paper (see below) capturing the process.

N4D support in 2025

2025 has been a year focused on moving on from the theory (as set out in the OG/IR) to begin operationalising the NC-HDPTN approach in SD woredas that are exposed to different forms of fragility, and working with the MoH on donor resource mapping for the SD. This required technical work on some of the key tools for application at the sub-national level. Key among these were the Context Assessment and Needs Analysis Tools (available soon), which went through a detailed process for development by members of the TWG with N4D support.

Taking the NC-HDPTN OG/IR framework as their guide, two government partners secured financing from a variety of donors to begin piloting the NC-HDPTN approach and testing the tools. This work began in mid-2025 and MoH, as convenors of the NC-HDPTN, are supporting the pilots through engaging regional heads, sensitising key actors and supervising on-the-ground operationalization.

Piloting NC-HDPTN approach in vulnerable woredas

The early intention was to have four pilot regions running in parallel in 2025; however, resource constraints and other obstacles have meant that by the last quarter of 2025, two pilots were well underway in Oromia Region-Moyale woreda and Central Ethiopia-Abeshge woreda. Currently the Moyale woreda piloting is at project launching status and Abeshge woreda is at the stage where joint analysis of field data has been collected. These regions experience different types of vulnerabilities and crisis, and they have high levels of malnutrition. All are actively engaged in the SD programme through woreda-based costed annual plans for implementation into which the NC-HDPTN is integrated.

In October 2025, N4D attended (and financially supported) an MoH convened national TWG workshop to take stock of learning from the piloting and to review the gaps needed to be filled in order to finalise the tools as a nationally endorsed resource. This well-attended workshop involved the convening of four groups that each provided technical comments for finalizing the tools. The MoH team will utilize the lessons from two pilot woreda field assessments and oversee finalization and the TWG is expected to endorse the national tools in December 2025 (to follow). At this workshop, it was agreed that work should start on developing the communication and advocacy and monitoring and evaluation tools.

N4D, working alongside MoH colleagues, carried out a ‘light-touch’ mapping of donor resources for the SD and the NC-HDPTN in October 2025. This involved consultation with over 17 donors, private sector and foundation representatives to better understand the opportunities and constraints to more and better financing for nutrition in Ethiopia and to discuss progress with the SD, the financing needs to expand and achieve scale up by 2030 and to discuss the nexus approach.

Engaging with donors

A donor engagement report co-produced by MoH and N4D sets out the key findings and the short- and medium-term activities needed to drive up SD investment. The report will form the basis of a roundtable meeting to continue engaging with current and prospective donors.

The light-touch donor mapping is part of a larger analysis of the donor landscape being carried out in Niger and Yemen. Together, these country insights will inform the development of an advocacy paper in 2026, which will provide recommendations to donors investing resources in fragile and conflict-affected states (FCAS) contexts.

As well as the NC-HDPTN, there is a broader nexus approach being developed and piloted in Somali Region. This initiative is being supported by Team EU with UN being capacitated to lead the nexus approach and GIZ providing technical support. It aims to increase coherence across EU-financed programmes in fragile settings, including supporting populations who are displaced.

What has been achieved?

A great deal has been achieved in 2025 to better understand the financing landscape and to map out the strategic activities that will increase traditional and innovative resourcing for the SD Scale Up Phase. Added to this, the GoE has managed to galvanize partners to operationalise the NC-HDPTN approach in selected woredas, affording a unique opportunity to generate future evidence and learning.

In 2026, considerable effort will be placed on continuing to advance these important areas of work to help accelerate reductions in the levels of malnutrition in Ethiopia.

Lessons learned

Operationalising the NC-HDPTN is a learning journey

Being open about the wins and the obstacles inherent in operationalisation requires an active culture of learning, coupled with strong government coordination of the nexus-related initiatives in Ethiopia to actively share intelligence, resources and expertise. The TWG has proved to be such a forum and has experienced the following constraints:

• Limited engagement of peace pillar stakeholders
  Little global, regional and national experience to draw on for the implementation of the nexus approach
• Limited knowledge and capacity at sub-national level on integrating nexus programming into the existing SD coordination platforms
• Very varied levels of stakeholder understanding on nexus implementation can limit engagement

Whilst the nexus approach is not a separate project but a part of the SD, the development of new guidance, tools, sensitization and training to expand the pilots require relatively small amounts of financing. These can be hard to secure but are essential in building and sustaining momentum and for capturing learning on operationalisation.