Five months after malnutrition took centre stage in President Paul Kagame’s keynote address at the National Leadership Retreat in Gabiro, the issue returned to parliament last week, prompting members to ask the government to find a sustainable long-term solution.
An estimated 38 per cent of Rwandan children below five are stunted, according to official statistics.
Addressing both chambers of parliament, Prime Minister Edouard Ngirente said that 13 districts were dealing with high stunting numbers with others like Nyabihu and Ngororero going as high as 59 and 56 per cent, respectively.
He blamed the issue on several factors including poverty, lack of proper hygiene, lack of access to enough water and domestic conflicts as some other reasons that continue to affect child growth.
For a country that is already promoting proper hygiene and sanitation through the construction of latrines, promoting kitchen gardens, promoting exclusive breastfeeding, monitoring growth and providing education on good nutrition practices, what really could be the problem? What is the long-term solutions to fix it for good?
The New Times sought out several nutrition experts who weighed in on the issue and provided solutions.
Poverty reduction
Senator Jean Damascène Ntawukuriryayo served as the Minister of Health for four years before he joined parliament.
He said in a recent interview that there are three things that can fix the problem of malnutrition. The first one, he says, is reducing the number of people who are living in poverty.
"38 per cent of the country’s population is living below the poverty line. If you calculate it, that’s about four million people. When we talk about food security, we mean at least three meals a day. Do these people have enough food? Poverty reduction should be prioritised if you want to see any improvements,” he said.
Family planning
The second area that should be looked into is family planning. Ntawukuriryayo says that government needs to intensify family planning sensitisation programmes, specifically targeting young people.
"What needs to be done right now is change focus and concentrate on the young because what we are trying to achieve is for those that are young to be equipped with the right tools to make the right choices when the time comes,” he said.
Promotion of internal trade
He also challenged the concerned Ministry to work hard to promote internal trade so that those who harvest more can circulate food within the country to those that are not food secure.
"Rwanda is not a food insecure country. What we need is a policy that promotes internal trade so that food can move around from the country and circulate to those who don’t have enough,” he said.
Sensitisation
According to Ntawukuriryayo, in countries where the literacy levels are still low, it is important to keep the sensitisation programmes on nutrition constant and consistent.
"The education should be taken to the grassroots levels but most importantly should target the younger generation who can be the ambassadors of behaviour change.”
Programme synergy
Youssouf Koita, the United Nations Children’s Fund (UNICEF)’s Nutrition Programme Manager, said that each country may have its malnutrition issues, but, for Rwanda, the main one is stunting.
He points out that the push for a drastic reduction in the number of children who are malnourished in a very short period of time is possible but not easy.
"For that kind of reduction to happen, you have to ensure that we can build on some synergic effect on all the interventions that are being implemented. If you promote breastfeeding, you reduce by 1.1 year, if you apply vitamin supplements, you reduce by another point the next year but if you do both at the same time, then you reduce the issue by two points in one year. It’s possible and it has worked elsewhere,” he said.
To achieve this, Koita says, the best way forward would be to bring all the actors in this area together where they can come up with a joint plan, joint implementation strategy, and most importantly, ensuring that a whole package is being delivered at the same time to the same beneficiaries.
Koita says that one of the best results in reducing chronic malnutrition has been realised in Rwanda, something that he attributes to the introduction of several interventions.
"We are promoting breastfeeding, home-based fortification, we are doing regular vitamin supplementation for children and this is why we have seen a reduction over the years in terms of the number of children who have stunted,” he says.
Case of poverty or food security?
"It’s both. One doesn’t exclude the other. In some areas, it’s the issue of food security, and in another, behaviour or poor feeding practices or even a combination of both. A reduction of six per cent per year requires 21 interventions together to ensure that the entire package is being delivered,” he said.
In an interview with The New Times, the Chairperson of the Rwanda Civil Society Platform, Jean Léonard Sekanyange, blamed the issue on mindset and teenage pregnancies.
"It’s not necessarily an issue of poverty but more of an issue of failure to know or even practice good feeding habits. Also, there is need to look into these teenage pregnancies since these are children raising other children and have no grasp of how to do it properly,” he said.
Imelda Muhuza is a Behaviour Change Communication Expert at the Society for Family Health (SFH). She told this reporter in an interview that despite the impressive progress in reducing stunting in Rwanda, some challenges still hamper the process.
"The fact that nutrition is a multi-sectoral issue, there was a need of increasing efforts in the coordination of multiple strategies put in place. It takes time to address cultural norms, attitudes, beliefs and practices,” she said.
Muhuza also said that there was a need of integration or connection between nutrition and hygiene and sanitation.
She said that the government is currently putting more efforts to maintain focus on behaviour change communication, increasing access to, availability of, and utilisation of nutritious foods, and flexibility in implementation approaches.
"Though the National Early Childhood Development Program (NECDP), effective coordination mechanism has been put in place and hopefully this will be at both at central and decentralised levels. This should be done from social cluster ministries, district and grassroots levels and hopefully this will have a positive impact,” she said.
How Cuba did it
According to UNICEF, none of the 146 million children under five living below weight in the world today is Cuban. So how did a country that was facing sanctions from the US for decades achieve this?
First, the Cuban state guarantees a basic basket that allows the feeding of its population, at least at the basic levels, through a network of distribution of regulated products.
Similarly, economic adjustments are made in other markets and local services to improve the nutrition of the Cuban people and alleviate food shortages. An especially constant vigilance remains on the lives of children and adolescents. Thus, attention to nutrition starts with the promotion of a better and natural nutrition of the human species.
UNICEF also says that Cuba has 99 per cent of newborns discharged from hospitals, with exclusive motherly breastfeeding, higher than the target of 95 per cent.
Despite difficult economic conditions experienced by the island, it provides guaranteed food and nutrition for children through the daily delivery of a litre of milk to all children from zero up to seven years old.
Children incorporated into Circles (nurseries) and primary schools also benefit from the continuing effort to improve their diets in terms of dietary components of milk and protein.
Adding to that is the delivery of other foods such as jams, juices and meats, which, depending on economic availability for the country, are equitably distributed to children at a younger age.
Until the age of 13, the priority is the distribution of subsidised complementary products such as soy yogurt, and during natural disasters, children are protected by the free distribution of basic foods.
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