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The multi-stakeholder approach to address malnutrition in SL

25 Sep 2021

By Sheron Hewawaduge   According to the World Health Organisation (WHO), “malnutrition” refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. One form of malnutrition is undernutrition, which includes stunting (low height for age), wasting (low weight for height), being underweight (low weight for age), and micronutrient deficiencies, such as anaemia, etc. The other form is overnutrition, which causes one to become overweight, obese, and includes diet-related noncommunicable diseases such as heart disease, diabetes, cancer, etc. The need to overcome malnutrition has been recognised in the 2030 Sustainable Development Agenda of the United Nations (UN). Sustainable Development Goal (SDG) 2 aims to “end hunger, achieve food security and improved nutrition, and promote sustainable agriculture” and SDG Target 2.2 aims to end all forms of malnutrition and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons by 2030. Despite the various programmes initiated by the Government, such as school nutrition programmes, provision of Thriposha for pregnant and breastfeeding mothers, and issuance of food-based dietary guidelines, etc., malnutrition remains a major nutritional problem in Sri Lanka. According to the Department of Census and Statistics, the prevalence of malnutrition among children under five years of age was 17.1% in 2016. According to the Global Sustainable Development Report 2021, addressing malnutrition, particularly stunting and wasting, requires urgent attention of all stakeholders.  Sri Lanka’s performance under the following indicators has been rated as follows: Source: Jeffrey Sachs, Christian Kroll, Guillaume Lafortune, Grayson Fuller, and Finn Woelm (2021). Sustainable Development Report 2021, Sustainable Development Solutions Network (SDSN), the Bertelsmann Stiftung and the Cambridge University Press Increased vulnerability to illness due to weakening of the immune system, growth failure and stunting, delayed sexual development, reduced muscle mass and strength, and impaired intellectual development are consequences of malnutrition or undernutrition. In very extreme cases, malnutrition may even lead to death. The Covid-19 pandemic has brought unprecedented challenges to public health. Experts recommend maintaining a healthy diet as being essential to strengthening the immune system against the virus. Nutrition education is vital to address the problem of malnutrition in Sri Lanka. Studies have found that women in the reproductive age category have a low level of nutritional knowledge in marginalised areas in Sri Lanka (Weerasekara, P.C., Withanachchi, C.R., Ginigaddara, G., and Ploeger, A. [2020]. Food and Nutrition-Related Knowledge, Attitudes, and Practices among Reproductive-Age Women in Marginalised Areas in Sri Lanka. International Journal of Environmental Research and Public Health, 17[11], 3985). The Nutrition Division of the Ministry of Health has published “Food-Based Dietary Guidelines” for Sri Lankans, which provides very comprehensive guidance to maintain a healthy diet.  Sri Lankan food pyramid Source: Food and Agriculture Organisation of the UN The Sri Lankan food pyramid, which was developed by the Ministry of Health, comprises of six levels: rice, breads, cereals, and yams are at the base level; vegetables and fruits are on the second level, while fish, pulses, meat, and eggs are on the third level, followed by dairy products, nuts, and oils. It recommends the sparing use of fat and sugar in the diet. The pyramid shows different serving ranges for each level. The exact number of servings a person should eat depends on the calorie requirement, which may vary with the age, sex, height, weight, physical activity level, and overall general health. The servings listed can only be used as a general guide. Proper nutritional planning, nutrition education, early detection and response to malnutrition, and nutrition supplementation for target groups such as infants and children, adolescents, pre- pregnant and lactating women are vital steps to address the problem of malnutrition. Indeed, the progress so far made in addressing this problem has been severely challenged by the consequences of the Covid-19 pandemic. This makes urgent attention even more pronounced to achieve the policy targets by 2030. The National Policy Framework of “Vistas of Prosperity and Splendour” contains several policy commitments such as implementing a “New Nutrition Aid Programme” to provide for proper nutrition for pregnant women and infants, particularly in the estate sector, implementation of economic policies viz a viz tax reduction to reduce the cost of living, expand livelihoods activities in rural and urban areas, improve children’s nutrition, etc. With the adoption of the 2030 Agenda for Sustainable Development, the National Nutrition Policy 2020-2030 has been formulated. It aims to address the nutritional needs of all Sri Lankans through evidence-informed, nutrition-specific and sensitive actions with the objective of ending all forms of malnutrition by 2030. Several government and non-government organisations are working in the nutrition sector. State institutions such as the Nutrition Division of the Ministry of Health, State Ministry of Women and Child Development, Ministry of Agriculture, Nutrition Society, etc. are some such government organisations mandated to work in the sector. In addition, several non-government organisations are implementing programmes of different scale and type across the country.  Streamlining and better synchronisation of the nutrition-related mandates, functions, and interventions of government as well as non-governmental organisations are important for catalysing action towards ending malnutrition by 2030.  According to the Committee on World Food Security, countries like Thailand, Bangladesh, etc. have implemented national multi-stakeholder responses to improve nutrition levels. The Thai Cabinet established the National Food Committee in 2010 and formed several subcommittees, task forces and working groups on linking food, nutrition, and health. Bangladesh has put in place a three-layer multi-stakeholder governance mechanism, including 13 ministries, civil society, development partners, and the academia to govern the National Food Policy and the Country Investment Plan for agriculture, food security, and nutrition. These examples from the region show that a multi-stakeholder approach is an effective mechanism to address the problem of malnutrition by achieving synergy of action and avoiding duplication of efforts. (The writer is an Assistant Director of the Sustainable Development Council of Sri Lanka)


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