The child malnutrition problem
Benedikt Freude | Monday January 23, 2023 06:00
Now that that’s out of the way, here’s my topic statement: Botswana has an under nutrition problem, specifically among children.
Don’t get me wrong, though; all forms of malnutrition exist in Botswana, as they do in many other countries, but under nutrition is at an alarmingly much greater rate.
According to the World Food Programme, using data from 2017-2019, 15-25% of Botswana’s population is undernourished. Put simply, one in every four people in the country are not consuming enough of the nutrients they need to maintain their health.
Children are especially vulnerable to malnutrition, given that it can severely and permanently hamper their physical and mental development. Per the Global Nutrition Report, nearly a third of children under the age of five in the country are stunted, which means they are too short for their age due to poor nutrition, while underweight and wasting levels stand at 11% and seven percent, respectively.
How did we get here? Research shows that malnutrition among children is related to and caused by several household and individual-level factors, including low family socio-economic resources, poor household food security, and poor access to health services. Some families can’t afford or don’t have access to fruits and vegetables, of which five daily servings are recommended.
In many cases, the nutritional status of a child is determined before birth; what a pregnant woman eats and drinks during pregnancy affects the birth weight and nutritional status of the child, which are, in turn, also affected by the mother’s income level, and access to healthy foods and health services. Botswana has struggled with these trends since its existence, facing seasonal drought, high unemployment levels, and income inequality, the effects of which are likely to be exacerbated by the recent COVID pandemic and fruit/vegetable shortage.
One of the most direct measures undertaken by the government to combat child malnutrition is the rationing of food in conjunction with the monitoring of children’s growth and provision of micro-nutrient supplements at public healthcare facilities.
These programmes are mainly tailored for children from birth to five years before they transition to public school, where they are then provided with school meals. Granted, we have made tremendous gains in the past few decades, and we shouldn’t treat government intervention via public education and feeding programmes as a single band-aid solution.
However, that progress has recently slowed despite greater investments in health and infrastructure. Our public spending on early childhood development (ECD, which includes education, health, and social support services) alone was estimated to be P10.6 billion in 2016-2017, but does that money actually reflect the outcomes? Not really.
According to UNICEF, our spending eclipses that of other countries in the region, namely Lesotho and Zimbabwe, yet our under nutrition rates are worse. In the government’s 2019 evaluation of ECD programmes across various ministries, they write “funds allocated may not actually be used to benefit the intended beneficiaries, that donors may “double fund” certain budget lines in the government” and cite the lack of a joint and coordinated framework as a barrier to effectively address malnutrition, among other children’s needs.
We also don’t have the data to determine the degree of this problem; how a drought or economic recession, for example, impacts our eating habits in real time can be a useful insight for developing or adjusting policies that immediately respond to our needs as a nation. Statistics Botswana takes several years to conduct and publish the results of even small-scale rapid surveys, a practice which they attribute to being “constrained by the resources they have”. The ECD evaluation goes on to say that the Ministry of Health dedicates up to 80% of its budget to “procurement and salaries”, while the services meant to directly improve children’s health “are left with a much lower allocation of funds”. In fact, put aside spending for a moment––since we clearly spend a lot––and consider service delivery, the one thing that all that money spent should at least guarantee, regardless of the outcomes.
It turns out that families are turned away as public clinics reportedly face shortages of mealie-meal and other vital food supplements. These issues are known by our government. In fact, they have written extensively about plans to continuously monitor and evaluate the impacts of their programmes. There’s the “National Performance Monitoring and Evaluation Policy” draft of 2017, the Vision 2036 framework, and the document I refer to throughout this article, aptly titled, “Investing in Early Childhood Development is the Foundation for Human Capital”. Drafting lofty, wide-encompassing, bi-partisan plans to overcome the challenges we face as a nation is commendable.
But then come the questions around implementation. What have we done to meet these goals? Have we progressed or backslid? Are the systems we have in place being improved upon or at least maintained? These questions may sound simple, but there are no easy answers. Good governance is hard. But that doesn’t mean it’s not worth doing.