The case of Mozambique
By Kirsten Havemann, Alice Agnete Zalaf Bjørnlund- Larsen and Kristine Dandanell Garn
Chronic malnutrition, measured by low height for age in children younger than five years, is caused by a mix of factors. Only one of these factors is the access to and consumption of nutritious food. Other factors include health, hygiene, education, and social/cultural practices. These factors can be classified into three areas: Food, Care and Access to Services.
During recent years Mozambique has experienced great economic growth with an average annual growth rate of 2% since 2000. Despite this apparent economic boom, the level of chronic undernutrition in children under five has remained alarmingly high during the last decade.
During the period from conception to a child’s second birthday (the crucial 1000 days), chronic malnutrition has a negative impact on physical, mental and cognitive development. This irreversibly affects the child’s ability to develop to his or her full potential. In addition, chronic malnutrition increases the risk of disease, both communicable and non-communicable.
A combination of measures is required to break the vicious circle of malnutrition. On the one hand, ensuring that infants and children receive appropriate food, services and care and on the other hand, ensuring that girls and women of reproductive age are well nourished.
What does chronic malnutrition mean for Mozambique? Malnourished children perform worse in school compared to other children. This leads to loss of job opportunities and lower incomes in adulthood. For every 10% increase in chronic malnutrition there is a 7.9% drop in the proportion of children completing primary school. Furthermore, chronic malnutrition is estimated to reduce an individual’s lifetime earnings by around 10%. In Mozambique this is estimated to result in a reduction of the Gross Domestic Product (GDP) of 2-3%.
What is being done and what are the challenges ahead?
A multifaceted problem requires a multifaceted response. Mozambique has responded by developing a strategic plan for the reduction of chronic malnutrition that includes stakeholders from government, civil society and private sector. The plan has seven objectives that foresee measures in all relevant sectors. The strategic plan has been praised for its ‘lifetime approach’ with activities addressing malnutrition from conception, through early childhood, on to adolescence and the reproductive years. Mozambique is also one of the 20 ‘early riser’ countries in the UN’s ‘Scaling Up Nutrition’ (SUN) initiative.
Even though nutrition has received more attention and improvements have been made in recent years, there are still many challenges. One of these challenges is achieving recognition that malnutrition has multiple causes and is not just the result of food insecurity. Although food insecurity does impact malnutrition, evidence shows that in Mozambique chronic malnutrition is worst in areas with the highest food production.
Sadly, it too often appears that decision-makers’ priority is increasing the production of food and not addressing the underlying causes of malnutrition. Recognizing the complexity of the causes of malnutrition, and then ensuring that the problem is addressed through a coordinated effort across traditional vertical programmes is essential for the reduction of malnutrition. This includes the development of funding mechanisms that address such challenges.
Transforming national strategies and plans into action on the ground is, however, not easy. We know what measures work and why. Yet the cruel reality reflected in chronic malnutrition figures shows that solving the problem of malnutrition is not just a question of implementing these measures. Our struggle is rather to ensure that the different ministries involved learn to work together, in coordination. Unless activities to address all three areas of Food, Care and Access to Services are implemented simultaneously, we are unlikely to see a decrease in the number of stunted children. To have access to quality health care while not having access to education or clean water is a lost opportunity for the future of the Mozambican people.
Why is it important to help reduce chronic malnutrition now?
Direct investment in the reduction of chronic malnutrition is the key that will allow generations of Mozambicans, including the most vulnerable, to benefit from Mozambique’s economic growth. Indeed, the Copenhagen Consensus 2012 rates ‘Bundled interventions to Reduce Undernutrition in Pre-Schoolers’ as the number one global priority to advance global welfare .
Nutrition is a long-term development goal and thus not a priority for politicians’ short-term goals of winning voter confidence. Long-term, however, economic growth requires a healthy, well-nourished and educated population for a qualified workforce. Health and nutrition are therefore central to inclusive, sustainable development.
In Mozambique, as in other developing countries that suffer high levels of chronic malnutrition, the time to act is now. If not, the world will see yet another generation limited from birth by the grim effects of chronic malnutrition.
The opinions expressed above are made on the authors’ own accounts and not on behalf of the organizations with which the authors are affiliated.
Guest Bloggers: Kirsten Havemann (Danish Embassy, Mozambique), Alice Agnete Zalaf Bjørnlund- Larsen (Danish Embassy, Mozambique) and Kristine Dandanell Garn (UNICEF, Mozambique)