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The Nutrition Landscape in Malawi. Public Discussion. Zione Kalumikiza. Lilongwe, April 30, 2019
- 1. THE NUTRITION LANDSCAPE IN MALAWI Past, Present, and Future Presented by Zione Kalumikiza Public Discussion on Political Party Manifestos 30th April 2019, Capital Hotel, Lilongwe
- 2. We share a common vision……. whose success depends on a well nourished population
- 3. Nutrition is at the heart of the SDGs
- 5. Understanding (mal) nutrition: the past
- 6. Understanding (mal) nutrition: the past
- 7. Malnutrition today • Undernutrition • Micronutrient deficiencies (Hidden Hunger) • Overnutrition and related problems
- 8. The state of nutrition in Malawi
- 9. 55 53 47 37 7 6 4 3 20 17 13 12 2000 DHS 2004 DHS 2010 DHS 2015-16 DHS Stunted Wasted Underweight Trends: Under-five nutritional status Percent of children under 5
- 10. Trends: Hidden hunger 80 62 59 59 47 55 51 31 22 83 28 22 9 4 Anaemia Iron deficiency Iron deficiency anaemia Vitamin A deficiency Salt with >15 ppm I Percent 2001 2009 2015/16 Sources: GoM (2003), NSO (2011, 2017)
- 11. Trends in Childhood Mortality 135 104 76 66 42 234 189 133 112 64 1992 DHS 2000 DHS 2004 DHS 2010 DHS 2015-16 DHS Infant mortality Under-5 mortality Deaths per 1,000 live births for the five-year period before the survey
- 12. Success stories: chronic malnutrition 55 52 52 47 42 37 1992 2000 2004 2010 2014 2015/16 %StuntedChildrenU-5s Burden of stunting in Malawi
- 13. Success stories: Vitamin A deficiency 59.2 38.3 57.4 36.9 22.0 8.5 1.6 0.2 3.6 0.9 0.3 0.1 Preschoolers (6-59 mo) School-aged (5-15 y) Women (15-49 y) Men (20-55 y) Source: NSO (2003, 2011, 2017)
- 16. Feeding practices- frequent but poor, with declining EBF rates 31 24 9 19 30 4 29 25 8 Minimum Meal Frequency Minimum Dietary Diversity Minimum Acceptable Diet Percent Breastfed Non-breastfed All children 6-23 months Sources: NSO (2017)
- 17. Over-nutrition on the rise, increasing risk for NCDs Datasourcedfrom2000,2004,2010&2015-16MDHS reports
- 18. NCDs no longer a problem of the affluent “The notion that NCDs and their risk factors are problems of urban people is a misconception” (Msaymboza et. al, 2011) “Our findings show that hypertension, diabetes, and overweight and obesity are all highly prevalent in urban and rural Malawian adults from a young age, despite it being a very low-income country affected by under-nutrition and food insecurity” (Price et. al, 2018)
- 19. 6 in 10 are Zinc Deficient 60% 60% 63% 66% Preschoolers (6-59 mo) School-aged (5-15 y) Women (15-49 y) Men (20-55 y) Source: NSO (2017)
- 20. Climate change taking its toll….posing a threat to food security & available investments
- 22. Underweight, overweight & mortality The cost of malnutrition (1/3) – Poor immunity to infections – Elevated disease risk
- 23. The cost of malnutrition (2/3) Stagnant national development • Poor nutrition in early life results in: – Low cognitive ability – Low education attainment – Increased health care costs – Low productivity – High dependency on public resources
- 24. The cost of malnutrition (3/3) • In 2012 alone, USD 597 million was lost due to health, education, productivity losses • Equivalent to 10.3% of GDP
- 25. ADVANCING NUTRITION PAST AND FUTURE ACTIONS
- 26. Best Practices to date…… • Coordination & collaborations – DNHA – Other support platforms • Focus on high impact interventions – Scaling Up Nutrition • Policy environment – NMSNP, MGDS III, Ag-Nut Strategy • Investments
- 27. Critical issues - coordination
- 28. Critical issues - Investment • Some improvements but still huge financing gaps • The majority of interventions (over 80%) of those indicated in MGDS III were not been included in the 2018/19 budget – For the few interventions included, the resource allocation was insufficient and much lower than the earmarked spending target for the 2018/19 FY as per MGDS III.
- 29. COHA study recommendations • Set ambitious targets to reduce under-nutrition • Scale up high impact nutrition interventions • Communication and advocacy • Monitoring and Evaluation • Coordination
- 30. Other key issues……thinking UNUSUAL Think beyond: • Food – rights & accountability • Plate – farm to plate • Short term – long term, sustainable, lifecycle • One sector – leave no one behind • Communities – systems (education, work places) • Usual ways – ICT, Indigenous knowledge
Editor's Notes
- Notable progress has been made
- DNHA created in 2004 Wasting is at 3% Underweight at 12% against MDG target of 8%
- Spending on agriculture (17.6% of public spending in 2016) meets government commitments set out in the African Union’s Maputo Declaration (10% of public spending). Relative to other HANCI countries, Malawi’s medium/long term national development policy (Malawi Growth and Development Strategy III) assigns strong importance to nutrition. Malawi instituted a separate budget line for nutrition, enabling transparency and accountability for spending. The National Nutrition Policy/Strategy identifies time bound nutrition targets and a multisectoral and multistakeholder policy coordination mechanism has been set up. Policymakers in Malawi benefit from regular nutrition surveys that are statistically representative at national level. The last survey was published in 2015-2016. The Government of Malawi promotes complementary feeding practices. In Malawi 96.1% of women aged 15-49 were visited at least once during pregnancy by skilled health personnel in 2013-2014. In Malawi, constitutional protection of the right to food and the right to social security is strong.
- IYCF indicators remain poor including a decline in EBF rates from 71% in 2010 to 61% in 2015/16 Zinc deficiency alarmingly high across all population groups Overweight and obesity on the rise The prevalence of undernutrition is high among adolescent girls (15.6 percent)
- Overweight and obesity, hypertension, and diabetes were highly prevalent, more so in urban residents, the less poor, and better educated than in rural, the poorest, and least educated participants. 18% of urban men (961 of 5211 participants) and 44% (4115 of 9282) of urban women, and 9% (521 of 5834) of rural men and 27% (2038 of 7497) of rural women were overweight or obese; 16% (859 of 5212), 14% (1349 of 9793), 13% (787 of 5847), and 14% (1101 of 8025) had hypertension; and 3% (133 of 3928), 3% (225 of 7867), 2% (84 of 5004), and 2% (124 of 7116) had diabetes, respectively.
- Hidden hunger can lead to illness, blindness, premature death, reduced productivity, and impaired mental development, particularly among women and children in developing countries
- Equivalent to MK 430 billion
- Some remarkable increase in allocations to nutrition over the past three years, with the 2018/19 provision more than doubling the previous two years. The aggregate PBB nutrition budget is substantially lower (32% of the recommended MK 34 billion) for the 2018/19 budget as per MGDS III costing, implying a financing gap of 62%. Ministry of Health (through DNHA) has only 4 results out of the 12 MGDS III. Ministry of Agriculture (3 out of 12) have been planned for implementation, with a resource provision of MK 6 billion (22%). Ministry of Gender shows that the vote has MK 680 million, about 30% of the planned provision. Only 1 of the 4 key outcomes have been included. Ministry of industry has not allocated any resources to the interventions that it was mandated to implement. Ministry of Civic Education has allocated less than 5% of the targeted MK 1billion for its targeted activities
- We seem t know what must be done