The Missed Opportunity: Addressing The Nutrition Question After MDGs

It is exciting that the preparations for review of the implementation of the Millennium Development Goals (MDGs) are in high gear through the Breaking Point project. Consensus has been building among a core group of countries to shift the agenda from poverty to sustainable development. Core concerns of the MDGs have however been on nutrition, health and education and this are likely to remain valid after 2015. None the less, issues of sustainability, resilience and climate change are also likely to dominate discussions on the post-2015 agenda according to Seth Lartey from the Commonwealth Foundation.

Although majority of people recognize that nutrition is central to Uganda’s larger development agenda and a prerequisite for achievement of the hunger and health MDGs, my concern is on the urgency for Uganda (one of the 20 countries the MDGs will be reviewed) to take on this opportunity to examine, refocus and address nutrition as one of its key strategies to achieving sustainable development. I have all the reason to enunciate that the failure to address nutrition comprehensively in the last thirteen years of the MDG implementation is a missed opportunity in our country’s development efforts.

Generally speaking, under nutrition is a state of health that results from inadequate nutrition due to insufficient intake of energy, vitamins, or minerals and poor health. Much of the disease burden is directly related to malnutrition especially among children and women. Recent statistics reveals that minimal progress has been made in reducing the prevalence of malnutrition among children in Sub Saharan Africa in the last 25 years; malnutrition is increasing as an indirect result of armed conflict, deteriorating health systems, shrinking economies and HIV/AIDS.

In fact the achievements of our human development goals and socioeconomic well-being of the people hinges upon elimination of under nutrition as it impacts on health, productivity and educational achievement. The very reason for Uganda’s commitment and effort towards meeting the Millennium Development Goal-one to eradicate extreme poverty and hunger by 2015. However, with the target date set for achieving the MDGs due to expire in just two years, the indicators on nutrition are still unpleasant.

The fact is that Uganda has some of the worst nutrition indicators in the region and yet, critical examination on the policies in regard to nutrition reveals that they exist but how adequate and coordinated are they when it comes to implementation is the issue? How strong and coordinated are the institutional frameworks? There is a missing link that has hindered their implementation for positive results.

Currently, the rate of under nutrition among children in Uganda is above 2.3 percent of (UDHS 2011) although there is variation by region. Furthermore, the proportion of children who are stunted or too short for their age has persistently remained high at 33 percent and Karamoja region has the highest stunting rate of 45 percent, while those severely wasted are14 percent in Uganda. However, the MDG target on prevalence of underweight children (weight-for-age) under five years in Uganda has slightly improved from 26 percent in 1995 to 10 percent in 2010. The average caloric intake per person/day of 1971 is below the WHO recommended level of 2300 and this means vulnerability to ill health and low productivity.

Whereas Uganda prioritizes repositioning nutrition in its development agenda, it should be noted that, Uganda currently produces sufficient food to meet the needs of its rapidly growing population, the proportion of Ugandans unable to access adequate calories has increased from 59 percent in 1999 to 69 percent in 2006. Documented research findings show that, addressing nutrition in pregnant women alone can lead to an increase of up to 10 percent in an individual’s life time earnings. But failure to address under nutrition is likely to lower a country’s GDP by as much as 2 percent (MoFPED, 2010.

Research shows that various factors in different settings explain the magnitude of malnutrition in Uganda. It is therefore not surprising today to find homesteads where feeding practices of children is discriminatory on the basis of their sex and age. But it good to know that the type and number of meals taken on a daily basis determines the amount of calories consumed. If the calories are adequate, it is likely to affect body metabolism and the tissue may break itself to meet its own needs. Therefore, it results into poor health and retarded growth manifested in underweight wasting and stunting.

The obsession to look for money by households has greatly altered the nutrition preferences of families today. I was told by a community of women in Kabale that they would rather feed their children on a pan cake of 100/= after selling the millet at 25000/= harvested from their gardens just to be able to meet the needs of the family. The Ministry of Health argues that the immediate causes of malnutrition for children in Uganda continue to be the high disease burden resulting from malaria, diarrhoeal disease and acute respiratory infections, as well as inadequate dietary intake. Sanitation and hygiene have worsened in marginalized areas. While the underlying causes of malnutrition in Uganda are inadequate water and sanitation safety and access, inadequate health infrastructure and access to health care, and food insecurity. Access to health services has improved in the past decade, however, the quality of those services has remained questionable.

As noted above, under nutrition has a serious and economic consequence and leads to poor health status that reduces the earning capacity of the affected households. Breaking this further, it means that each percentage reduction in adult height there is a 1.38 percent reduction in wages and a child who suffers from moderate or severe stunting observes 4.38 percent and 6.2 percent reduction in adult height respectively.

Various stakeholders in Uganda have called for a comprehensive school feeding programme with concern over the effect of nutrition on educational attendance and performance. It is well documented in research that under nutrition also lowers the levels of cognitive development that manifests into poor education attainment. The accumulated effect of under nutrition over the years may also lead to a reduction in productivity and increased absenteeism in the work place, both of which may reduce individual and national lifetime earnings potential. This in turn puts a burden on national budget and impacts negatively national growth. Owing to the fact that one third of children in Uganda are chronically undernourished, and with many more deficient in several micro nutrients, this appalling situation should be eradicated.
Overall, improved nutrition underpins progress towards each of the 6 MDGS. On the other hand good nutrition status reduces poverty by boosting productivity throughout the lifecycle and across generations, which leads to improved educational outcomes and dealing with malnutrition typically empowers women. Be that as it may, malnutrition is associated with over 50 percent of all child mortality and is also a direct contributor to poor maternal health, while good nutrition status slows the onset of AIDS in and HIV+ individual. Good nutrition also increases malarial survival rates and lowers the risk of diet related chronic diseases.

It is therefore critical that Uganda focuses on addressing the nutrition question in its development agenda if it has to realize the national vision. The review of the MDGs is a great opportunity that should not be missed.