Malnutrition among children and weakening food insecurity remain an unfinished agenda in the country, even as Government findings showcase worsening statistics over the years.
The issue has resurfaced with the recent release of the report of the Sectoral Oversight Committee of Parliament to look into whether the child malnutrition issue in Sri Lanka is aggravating and to identify short-, medium-, and long-term measures to be taken in that regard, as well as to oversee the speedy implementation of the identified measures.
Notably, in unveiling the report, Committee Chair Vadivel Suresh said: “I do expect that the authorities responsible will take action to implement measures and recommendations outlined in this report without delay.”
Nevertheless, especially since the advent of the economic crisis, Sri Lanka has witnessed a steady erosion of childhood health and food security. Speaking to The Sunday Morning, Samagi Jana Balawegaya (SJB) MP Rohini Wijeratne Kavirathna, who was part of the committee, highlighted the severity of the situation.
“Food insecurity implies that people have no means of accessing nutritious food. One reason for this could be economic collapse, wherein parents have no economic capability of providing nutritious meals to their children. The other is ignorance of what constitutes nutritious food. For instance, advertisements do not depict food that is nutritious for children,” she explained.
She therefore stressed that solutions needed to be sought to emerge from this situation. “We need short-, medium-, and long-term solutions for this and regardless of the solution, it must ensure nutritious meals. In the short term, we can create awareness, such as on the value of home-grown food and what constitutes nutritious food. In the long-term, we need to strengthen the household economy.”
Moving beyond these basics, she noted that there were other steps that needed to be taken as mentioned in the committee report, such as addressing micronutrient deficiencies among children through Health Ministry intervention.
“Government intervention is crucial for this. The report clearly states that this situation can contribute to increased mortality among children; therefore, the Government must intervene. Otherwise, we cannot have hopes of a healthy future generation. This needs to be a priority at this moment. The Government should increase the budget allocated to the Health Ministry for children and the Education Ministry must also increase provisions in this regard.”
She pointed out that certain measures implemented thus far were inadequate, such as the mid-day meal programme, which did not cover all those who required attention in terms of preventing malnutrition. She stressed that alternative methods were required to address this, for instance with the Government regularising community service programmes carried out by companies.
“The lack of regulation in addressing these problems has allowed the situation to unravel to this extent,” she claimed.
Statistics
The report points out that food insecurity at household level has increased after the economic crisis, with approximately one-fourth of households moderately food insecure and having an inadequate diet. Moreover, while the average household spent only 35% of the household income on food pre-Covid-19, the proportion of expenditure on food dropped to 29% from total household income due to the economic crisis in 2022.
During the economic downturn in 2022, 64% of Sri Lankans faced reduction of their income, especially 82% of daily wage earners and 78% of farmers, while 98% of the population was affected by high food prices. In the last six months of 2022, 74% of the households were unable to afford food or daily essentials.
During the third quarter in 2023, 24% of the households were food insecure compared to 17% in March 2023, with the highest food insecurity (51%) observed in the estate sector followed by the rural (26%) and urban (15%) sectors.
Moreover, the report notes that the low birth weight rate in Sri Lanka in 2022 was 15.1%, with the highest low birth weight rate of 23.7% reported from Nuwara Eliya. Following the nutrition month assessment in June 2023, it was observed that among infants and children up to two years, underweight and stunting had increased compared to 2022 data.
As per the Nutrition Month 2023 report, compared to 2022, the proportion of underweight had increased in almost all districts in 2023; the highest underweight rate was reported in Nuwara Eliya (24.6%) with almost every fourth child being moderately or severely underweight, followed by the Badulla, Ampara, and Polonnaruwa Districts where every fifth child was moderately or severely underweight.
The report pointed out that other conditions were at concerning levels, with 2022 data revealing that one-third of children of 5-18 years were either stunted, wasted, overweight, obese, or having more than one poor nutrition condition.
Interventions
Ministry of Women, Child Affairs, and Social Empowerment Director – Planning and Monitoring Division Varuni Rasadari, who was among the officials present at committee meetings, noted that they were working on programmes that had provisions allocated, for instance the programme for pregnant mothers and the morning meal for preschool students. She noted that when it came to preschool meals, they had to prioritise schools with more underweight children within a quota of 155,000 children.
Addressing the recommendations in the report, she said: “We cannot take decisions on the recommendations as a singular ministry, since this is a programme that has to work within budgetary allocations. Therefore, if there are any plans within the Health Ministry, we will lend our support.”
According to the report, thus far, the Government, with relevant ministries (Health, Agriculture, Education, Women and Child Affairs, Finance, and others), has implemented programmes to improve nutrition among children while national and sub-national level governance structures have been established for effective coordination of multisectoral direct and indirect nutrition actions.
The National Food Security and Nutrition Council (NFSNC) is a higher-level authority functioning at the Presidential Secretariat, established in 2022. The National Combined Mechanism on Food Security and Nutrition as an implementation arm of the NFSNC at national and sub-national levels coordinates the direct and indirect nutrition interventions at different levels.
The Maternal and Child Nutrition (MCN) subcommittee (a subcommittee of the Nutrition Steering Committee) provides technical expertise to the nutrition issues among mothers and children.
Sri Lanka has reportedly adopted all relevant nutrition actions mentioned in the 2019 World Health Organization (WHO) overview of essential nutrition actions to address malnutrition in all its forms in order to prevent and control malnutrition among children, and implemented these at scale islandwide.
The report further notes that in 2018, the Government disbursed Rs. 6,441 per person as nutrition expenditure. This is only 1% of the Gross Domestic Product (GDP), while it was only 5.2% of the Total Public Expenditure (TPE) for that year. This is a reduction from 2015, when the nutrition expenditure was Rs. 188 billion to Rs. 140 billion in 2018.
Recommendations
Identifying solutions for the situation, the report calls for short-term measures such as provision of nutrition supplements to pregnant mothers and undernourished children, expanding the preschool and school meal programme to cover all vulnerable preschools and schools, and adequate budgetary allocation for preschool and school mid-day meal programmes.
Further measures include price control of selected essential food items to make those available at affordable prices; enhancing nutrition communication to scale up messages on healthy eating and cash management; taxation of foods high in sugar, salt, and fats to prevent obesity; and immediate implementation and enforcement of protective food legislation which prohibit food advertisements to children.
For the medium term, the report recommends implementing nutrition-sensitive agriculture to make healthy food available at affordable prices and establishing surveillance programmes such as dietary behaviour surveillance, nutrition surveillance of reproductive age women, and a surveillance mechanism for unethical marketing of food.
Further, it recommends revisiting nutrition financing, with a separate nutrition budget for relevant sectors to improve accountability, increased funds for direct nutrition interventions, and provision of funds to improve resources for existing interventions with proven efficacy.
Among the long-term measures are to ensure accountability of nutrition actions of all relevant partners through monitoring to guarantee value for money and ensure food security, coordinated multi-sector collaboration for effective nutrition actions, streamlining food legislation systems throughout the food supply chain for safe and quality food, and strengthening analytical capacity for assessment of food for safety and quality.