‘s battle against malnutrition amidst COVID
Priyanka Jayawardena
Although, Sri Lanka performs well in
most health indicators, child nutrition remains a major issue.
According
to the Demographic and Health Survey (DHS)
2016, in Sri Lanka, more than 20% of children under five years
are underweight. Unsurprisingly, malnutrition is especially prevalent among
poor households. Successive governments have implemented several programmes to
improve child nutrition in Sri Lanka. Of these, school and preschool meal programmes are key to fighting
malnutrition among young children. Free meals distributed in schools fulfil up to one third of
children’s daily nutritional needs. Some parents send their child to school with the
promise of a meal.
Unfortunately, due to the COVID-19
pandemic, schools
and preschools have been closed for nearly three months and until further
notice. To make matters worse, breadwinners in many
poor households have already lost
their jobs or sources of income, due the economic disruption caused by the COVID-19 crisis. As such, missing
out on school meals may lead to nutritional deficits of thousands of poor
children in Sri Lanka. This is a grave situation, as nutritional shocks during childhood can result long-term effects on
health and education outcomes. Given this context, the blog will discuss some
steps that can be taken to mitigate nutritional fallouts among vulnerable
children.
Causes of Child
Malnutrition
Statistics show that children from
low-income households are more likely to be undernourished than children from
high-income households. In fact, the
number of underweight children among low-income households is almost double, compared to high-income
households. IPS research on combatting malnutrition in
Sri Lanka reveals that one of the main reasons
for child malnutrition among poor households is the lack of protein-rich food
in daily diets. Further, it reveals that growth deficiencies significantly
increase with the child’s age, especially after the first two years. For instance, of the 24-59 month old children in Sri
Lanka, 22% are underweight. Child growth retardation indicates inappropriate food intake, in
terms of quantity or quality.
Additionally, nutritional deficits in
childhood can result in irrecoverable growth deficiencies. Research
has shown that inadequate intake of
specific micronutrients, such as iron, folic acid, and iodine stunts the
development of the brain and nervous system. Against this background,
school and pre-school meal programmes are key to address the nutrition gaps of
poor children.
Source: Jayawardena P (forthcoming) A
Proactive Path to Combat Malnutrition in Sri Lanka, Institute of Policy Studies
of Sri Lanka.
Prevalence of Underweight Children by
Age
Source: Author’s calculations based on DHS micro data
Children Missing Out
on School Meals
The daily school meal
programme delivers vital nutrition to nearly one million children in grades 1-5 and covers 80% of
government schools, costing around
Rs. six billion
annually. Similarly, the preschool nutrition programme aims to improve the
nutritional status of young children in vulnerable areas. In these programmes, schools follow approved guidelines to fulfil children’s daily nutritional needs and these meals
are healthier than food brought from home. For most poor children in Sri Lanka,
this is usually the only nutritious meal for the day.
When schools are closed, children miss out on food
services worth at least Rs. 650 per month, while
preschool children miss around Rs. 370 worth of food supplements per month. For
parents, it is costlier to feed children, because retail food prices are higher
than schools’ bulk-purchasing rates. Thus,
losing school meals during the pandemic will escalate food-related financial
burdens of poor families.
Aiming
to ensure food security in households during the COVID-19 crisis in Sri Lanka,
the government has introduced several relief measures, including price controls
for rice and vegetables, the distribution of vegetables and fruits by the
government, and home gardening. Further, a consumption
support of Rs. 5,000 per month
was given to Samurdhi recipients and other vulnerable groups, including some informal
workers, during the lockdown period. However, as discussed in a recent IPS blog,
these measures are not sufficient to battle hunger and nutritional deficiencies,
primarily due to poor targeting and administration issues.
Way Forward
Considering
the fiscal burden imposed on poor families during the crisis, the government
should consider redirecting funds and resources to expand emergency nutrition
services for targeted groups – infants, school children, pregnant mothers, etc.
Some possible options are discussed below.
The current crisis is unprecedented, and it is unclear how
long school closures will last; primary grades, especially, will not be opened at
least until September 2020. Due to the precautionary health measures in place,
it is difficult for schools to offer food services while the threat of COVID-19
is present. Instead, the government can take alternative measures, with the
involvement of school authorities — school principals and teachers — to
ensure that the needs of low-income children are met during these extended
school closures. Some of the
recommended measures include delivering rations and scaling up cash and voucher
programmes. In Argentina, for instance, there is already a programme in place
to support mothers with children under five years of age by providing cash
benefits; the benefit is now increased
to include the cost of missed school meals.
In Sri Lanka too, the
government should consider converting allocations for the school meals
programme to cash vouchers or food packs, to support families with children
under 10 years old. After
the crisis, the government should introduce a special nutritional meal
programme for school children that includes fortified rice to make up for the
growth failures during the crisis period.
Further,
the UNICEF recommends the rapid expansion of basic nutrition and health
services in the aftermath of an emergency; this can dramatically improve the
nutritional status of children. For instance, a few months after the earthquake in
Haiti, nutritious food, including ready-to-use therapeutic food (RUTF),
was distributed to about four million Haitians. The Sri Lankan government should also
consider implementing
special nutrition interventions, including the use of RUTF to treat malnourished
children as a part of primary health care services.
Unless the government acts immediately, by meeting
the nutritional needs of vulnerable children, the disparities in health and
educational outcomes caused by the COVID-19 crisis will be felt for years.