Photo courtesy of International Dairy Federation
Malnutrition is a complex issue that many nations in the world face at different levels. To successfully eliminate and prevent malnutrition a nation needs a multifactorial, multisectoral and multistakeholder response.
The definition of a multisector approach is a deliberate collaboration among various sectors such as health, agriculture, trade, economy and education to jointly achieve a policy on improved nutrition.
The government, UN organizations, civil society and private sector are various multistakeholders who are expected to engage in addressing food nutrition and take forward policy action. Therefore, the multistakeholder approach is important to combat the food and nutrition issues currently faced by the country.
Nutrition is a link between food and good health. Sustaining nutrition and non-nutrition from food is what keeps humans alive. Due to the current economic crisis situation agriculture, transportation, food supply and other food-related services are disrupted. In fact, the country is facing a food crisis situation right now. Food is in short supply and this will affect the nutrition status of people before long, adversely impacting their health. In this instance, protection and prevention treatments are challenging.
There are many forms of malnutrition that people face in their life cycle. These include undernutrition resulting in stunting, wasting and underweight in children and low Body Mass Index (BMI) in adults; micronutrient deficiency disorders; and anemia, Vitamin A deficiency and calcium deficiency.
On the other hand, due to unhealthy lifestyles and eating habits, there is a certain sector of the population suffering from nutrition issues. This condition leads to non-communicable diseases (NCDs). Overweight and obesity, hypertension, diabetes and high blood cholesterol are some of the non-communicable diseases today’s health sector is burdened with.
Sri Lanka was grappling with a triple burden of malnutrition even before the economic crisis and it is only expected to get worse with the cost of living increasing by as high as 57%. The stagnant status of undernutrition among the under five child population, micronutrient diseases and non-communicable diseases are some of the prevailing problems.
Children are more vulnerable to nutrient deficiencies when there are gaps in the diet. In a study done by the Medical Research Institute of the pre-economic crisis of urban poor in 2020 it was found that stunting was 17.3%, wasting was 11% and underweight was 19.9%. It is certain that the numbers will increase alarmingly with the current situation of an economic crisis and food shortage.
The prevalence of food insecurity is mostly seen in the estate sector where 12.2 % of the population is without a steady food intake.
There are multiple factors impacting nutrition status such as individuals, households and society at large. Conducting a needs assessments will help look beyond just the food needs of a population. The immediate causes of malnutrition are inadequate dietary intake and diseases, which need to be urgently addressed and followed by action. The underlying effect of this is inadequate care on food practices due to the shortage of nutritious food; poor and irregular eating habits end in diseases. The basic cause is inadequate financial capital that confines people to a certain social and political context. These conditions have a direct bearing on maternal and child undernutrition. Short term consequences are mortality, morbidity and disability and some of the long term consequences are adult height, cognitive ability, reproductive performance and economic productivity. This cycle could keep going on and turn out as an intergeneration consequence.
During an emergency or crisis situation, it is important to identify and prioritize the short and long term needs and gaps in services provided for people, particularly the identified vulnerable groups.
There are two complementary approaches to improving nutrition, namely, nutrition-specific interventions and nutrition-sensitive interventions.
Nutrition-specific interventions or programs address the immediate determinants of malnutrition. Adequate food and nutrient intake, feeding, caregiving and parenting practices and low burden of infectious diseases are areas to look into as an immediate measure. Examples for nutrition-specific interventions are maternal dietary and micronutrient supplementation, Complementary feeding and micronutrient supplementation for children, treatment of severe acute malnutrition in children, disease prevention and management of nutrition in emergencies.
Currently, Sri Lanka is facing a challenge in the provision of Threeposha, the supplement food provided by the government free of charge to mothers and children.
Nutrition-sensitive interventions or programs address the underlying determinants such as food security, access to health care services and resources in individual homes or community level and supplying direct nutrients in case of fatal or severe cases of malnourishment. Nutrition-sensitive approaches serve as the delivery platform for nutrition-specific interventions potentially increasing their scale coverage and effectiveness. Agriculture and food safety, water sanitation and hygiene, social safety nets maternal mental health, child protection, early childhood development, schooling, health and family planning services and women empowerment are identified areas through which a nutrition-sensitive approach can be demonstrated.
The history of the multisector approach goes back to 1970s. In the 1980s the first food and nutrition policy was formulated under the Ministry of Plan Implementation. It was revised in 2004. Thereafter in 2010, a national nutrition policy was developed. In 2012 the National Nutrition Council (NNC) was established with the National Nutrition Secretariat of Sri Lanka functioning under the Presidential Secretariat until 2019. The NNC joined hands with the Scaling UP global nutrition movement in 2012 and in 2013. Sri Lanka developed the first Multisector Action Plan for Nutrition (MSAPN) integrating 17 ministerial actions. The multisector action plan was revised and a new action plan for the period 2019-2025 was prepared. It was approved by the cabinet. However after November of 2019, neither the NNC nor the MSAPN or any systematic multistakeholder coordination functioned in Sri Lanka.
The need for a multisector action plan is to ensure optimum nutrition throughout the life cycle of communities. It enhances effective and appropriate nutrition interventions. It helps to properly manage adequate nutrition for vulnerable communities and ensures nutrition security for all citizens of Sri Lanka. It will help in advocacy partnership and networking and strengthen research monitoring and evaluation as well.
Sri Lanka is facing a triple burden of malnutrition and the current food and nutrition insecurity is turning on a red alert. A multisectoral and multistakeholder engagement needs to address this issue as a first priority emergency.