Purpose <p>The study examines the challenges of implementing nutritional programs to address severe acute malnutrition in children under five, a major cause of illness and death in Ethiopia. This paper examines why nutritional programs are ineffective in Eastern Ethiopia.</p> Methods <p>The research, conducted from April to June 2023 and from February to March 2024, included in-depth interviews, focus groups, and participant observations with mothers, healthcare workers, and traditional birth attendants. Thematic analysis was employed to identify key themes within the transcribed and coded data.</p> Results <p>Five themes representing challenges in implementing nutritional feeding programs to address severe acute malnutrition among children under five were identified in the interviews, focus group discussions and observations. These themes are: management steps for severe acute malnutrition; the role of grandmothers in severe acute malnutrition treatment; the 1000-day approach to tackle malnutrition at early stages; behavioural and knowledge-building focused intervention; and factors influencing the management of SAM among health workers. The feeding program is hindered by too high workloads of the healthcare workers, limited access to healthcare facilities, inconsistent availability of nutritional supplements, and inadequate support for malnutrition. Delayed health-seeking behaviours pose behavioural challenges.</p> Conclusions <p>The feeding program encounters challenges due to limited access to healthcare, inconsistent availability of nutritional supplements, inadequate support for malnutrition, and delayed health-seeking behaviour. Addressing malnutrition begins before a child’s birth and requires a comprehensive and long-term strategy. Intergenerational caregiving and effective collaboration between communities and healthcare workers can offer valuable insights.</p>