Gains in war on malnutrition

Malnutrition is a global issue but it has been tackled successfully in certain parts of the world

Malnutrition is a global issue but there is evidence that it has been tackled successfully in certain parts of the world. Governments and civil society in Brazil, Ghana and the Indian state of Maharashtra have followed determined and sustained efforts to improve nutrition outcomes by making political choices to assign limited resources to nutrition. How can Pakistan learn from these examples? And what can be done to counter the threat of malnutrition?

Maharashtra has been mentioned as a ‘success story’ for its fast and noteworthy decline in malnutrition amongst children. Between 2006 and 2012, childhood stunting dropped dramatically from 39% to 24%. In September 2001, 14 children died of causes related to malnutrition in Aurangabad division of Maharashtra. The local media took note and published articles asking, “What is the government doing?” Politicians and the Unicef representative descended on Aurangabad. On investigation of health centre data, it was found that none of the children who died had ever been weighed or measured.

In 2002, a pilot programme known as ‘Malnutrition Removal Campaign’ was launched with technical and financial support from Unicef. The programme was aimed at (1) surveying, registering, and weighing 100% of children under age six in Aurangabad division, (2) classifying them into one of five categories based on their nutritional status (3) referring acutely malnourished children to medical facilities, and (4) counselling mothers on feeding and care practices. The designated team organised workshops with health workers and supervisors from the health ministry and the ministry of women and child development and reinforced skills such as proper weighing and the maintenance of child-growth charts.

By December 2004, 1.7 million under-six children had been registered and 91% were being weighed monthly. Over 22,000 anganwadi workers were trained. The increased screening led to a 50% increase in malnourished children detected.

In March 2005, the government of Maharashtra approved the Mother-Child Health and Nutrition Mission “to reduce the incidence of malnutrition in children under-six in rural and urban areas” for five years. The mission involved all stakeholders. It identified rural districts with the highest incidence of malnutrition and endorsed accurate local data collection to understand the full picture by training health workers at the district, block and village levels. Communities were also involved in the weighing of children and measuring activities.

In 2007, the mission developed protocols to manage severely malnourished children. With guidance from Unicef, it asked the health department to fund child development centres. These centres had medical facilities that hosted severely malnourished under-six children and their mothers for 21 days of treatment and monitoring as well as health education for mothers. By 2008, the mission was training health workers across all 33 districts in the state in how to effectively implement and manage child development centres.

By 2010, it was clear the mission had made inroads into strengthening community responsiveness and political action around malnutrition. In November 2010, the government renewed the mission but shifted its focus to preventing undernutrition during the ‘first 1,000 days’ of a child’s development. For this purpose workshops were arranged to train anganwadi workers and mothers about feeding practices and nutrients from local foods.

In 2012, an independent survey was conducted by the government which showed that stunting in under-two had decreased from 39% in 2005–2006 to 23% in 2012. Wasting had decreased from 19.9% to 15.5%, and underweight decreased from 29.6% to 21.8%.

The above example clearly demonstrates how the government sensitised different stakeholders to various issues in child malnutrition and generated confidence that the problem could be tackled in a systematic, time-barred manner. However, while it may be difficult to duplicate individual successes, it may be easier to reproduce principles and processes. A major long-term investment is needed in countries like Pakistan, in strengthening capacity for nutrition.

Published in The Express Tribune, June 9^th, 2018.

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