Silver Karumba is the Country Representative for GAIN in Rwanda. In an exclusive interview with The New Times, he discussed GAIN's role working closely with the government and contributing to the fight against malnutrition in the country. Excerpts: Tell us about GAIN? The Global Alliance for Improved Nutrition (GAIN) is a Swiss-based foundation launched at the United Nations in 2002 to tackle the human suffering caused by malnutrition. Working with governments, businesses and civil society, we aim to transform food systems so that they deliver healthier diets for all people, especially the most vulnerable. Headquartered in Geneva, Switzerland, GAIN has offices and programs in countries with high levels of malnutrition: Bangladesh, Benin, Ethiopia, India, Indonesia, Kenya, Mozambique, Nigeria, Pakistan, Rwanda, Tanzania and Uganda. Specifically, this year in Rwanda, we are working with the Ministry of Agriculture and Animal Resources (MINAGRI), the National Child Development Agency (NCDA), other Social Cluster Ministries, and the Private Sector to ensure national strategies and policies are nutrition sensitive and food systems transformation frameworks are strengthened. What is malnutrition and what are its different forms? Malnutrition is a condition that occurs when a person’s diet lacks the proper nutrients, either because they are not consuming enough food (undernutrition) or are eating too much of the wrong kinds of food (overnutrition). It includes deficiencies, excesses, or imbalances in a person’s intake of energy and nutrients. The condition can lead to various health problems, affecting growth, development, and overall body function. Malnutrition can be categorised into: · Undernutrition: Includes wasting (low weight-for-height), stunting (low height-for-age), and underweight (low weight-for-age). · Overnutrition: Refers to the consumption of excessive nutrients and energy, leading to overweight, obesity, and associated diseases. · Micronutrient deficiencies: Occur when individuals lack essential vitamins and minerals like iron, vitamin A, Vitamin C, iodine, etc. For the case of Rwanda, we normally have an issue with undernutrition (child stunting), but over the last decade, overweight and obesity is on the increase especially in Rwanda’s urban cities. What do you consider as nutritious food? Nutritious food refers to foods that provide essential nutrients the body needs to maintain health, support growth, and prevent diseases. A nutritious diet is typically balanced, diverse, and rich in vitamins, minerals, fibre, protein, healthy fats, and carbohydrates. A better approach to eating healthy is to ensure your plate is colorful (has different colours in case of fruits and vegetables), as different fruits provide various nutrients and complement one another. Protein is crucial too, available from both animal and plant sources. Vegetables are often neglected but are nutrient rich. For children, good nutrition begins at conception and continues through the first 1,000 days of life, a critical period for brain development and health of the mother and the baby. That’s why good nutrition is essential for adolescent girls and young women too to prevent malnutrition cycle. Mothers expecting to have a baby should prioritise a nutritious diet before, during and after pregnancy, to support their children's optimal growth, and prevent low birth weight and malnutrition especially stunting. What are the current statistics regarding the state of nutrition in Rwanda? The official figures about maternal and child nutritional status is captured in Rwanda’s Demographic Health Survey which is conducted every five years. The last survey was conducted in 2019/2020. Stunting (measured by height for age) among children under five years of age was 33% down from 38% in 2015. The reduction trend is positive but perhaps not at the pace the government wants. Wasting (measured by low weight-for-height) was recorded at 1.5 per cent, which is considered an achievement for Rwanda, as this rate meets the World Health Organization’s (WHO) thresholds to classify the severity. This status meets health targets. However, anaemia, a micronutrient deficiency, remains a concern that needs attention. Among children under five years of age, 37% are anemic, while among women of reproductive age, 13 per cent have anaemia. Additionally, there is a growing problem of obesity and overweight, especially among women which is driving the increase of non-communicable diseases (NCDs) in Rwanda. For example, women who are overweight or obese have steadily been increasing in Rwanda over the last 20 years of DHS surveys. In 2005, overweight or obese among women was 12%, in 2010, it was 16%, in 2015, it was 21%, and by 2020, it reached 26%. This is a concern. What are the causes of malnutrition in the country? One key cause is insufficient food intake with poor nutrient quality, which particularly affects children. In Rwanda, stunting is more common in rural areas than in urban areas. A closer look at the data reveals that children born to women with no education experience the highest levels of stunting (36%), whereas children born to educated women, higher than secondary school, face the lowest stunting rates (6%). This is due to both the ability to afford nutritious food and the knowledge of what to feed their children. Mindset and cultural influence are another factor contributing to malnutrition. Certain culturally preferred foods, such as potatoes, tubers and flours, are popular but lack essential nutrients to foster optimal child growth. Other factors include food insecurity, especially during lean seasons. Post-harvest loss is also high for certain nutritious foods in the country, for example fruits and vegetables. This impacts nutrient intake. As you said, vulnerable populations are often found in rural areas. Are there statistics indicating that vulnerability is lower in urban areas? Yes, this is what we notice in the national DHS. Let’s look at the districts of Nyabihu and Musanze which are often referred to as the food baskets for the country. Musanze, the stunting rate is 45 per cent, and in Nyabihu District, it’s around 47 per cent. However, if we compare it to Kigali, Kicukiro District, the stunting is as low as 17 per cent. In Gasabo District, the stunting rate is 23 per cent, while in Nyarugenge, it’s 27.9 per cent. Still, these urban districts have stunting rates below 30 per cent. What challenges does the country face regarding stunting and malnutrition in general? What are the underlying reasons for these issues, and how does GAIN try to contribute? Fighting malnutrition, especially child stunting, requires multi-sectoral approaches and multi-sectoral investments. There is no single intervention that can reduce malnutrition. Stunting is both an impact and development indicator. You cannot eliminate stunting in one year, two, three years like it is the case for acute malnutrition. No. The government of Rwanda has done a commendable job by investing heavily in promoting projects that address malnutrition, like community-based nutrition promotion programmes, setting up early childhood development centres, Girinka programme, promoting maternal and child health, investing in sustainable agriculture and food security programmes, and economic transformation investments to fight poverty. The government and partners should ensure investing in projects and programmes that increase the productivity of nutritious foods, and reductions in their post-harvest loss which in the end generates good returns for farmers while being affordable for domestic consumers. This requires demand generation for nutritious foods, reducing transactions costs of linking farmers and markets and introducing supportive policy incentives, especially for nutritious foods like fruits, vegetables, eggs, fish, milk, etc. As GAIN, we have taken steps to play our role and contribute to addressing these issues that I have discussed above. This year, we've been working closely with the government, particularly with the Ministry of Agriculture and Animal Resources (MINAGRI) and the National Child Development Agency (NCDA) under the Ministry of Gender and Family Promotion. Our role of working with our government counterparts has been to ensure that the new policies and strategies are nutrition-sensitive. As we discuss now, MINAGRI has embraced a food systems transformation approach to address food security and nutrition holistically through the new PSTA5 that we worked together to formulate with other partners. The ministry will ensure both production and investing in nutritious foods is prioritised. With NCDA, we worked to ensure nutrition is a priority in the new National Strategy for Transformation (NST2), and one of the key goals highlighted by the government is fighting malnutrition. GAIN in partnership with our line ministries, and our development partners, we are still working out modalities to invest in high-value chains programs that promote the consumption of nutritious and healthier foods, such as eggs, fish, and fruits, and food fortification especially the commonly consumed flours to ensure nutrients additions. This is our goal for the next five years to ensure GAIN contributes to the implementation of the new strategies (NST2 and PSTA5). Regarding NST2 and its targets, along with your interventions as GAIN and other partners, do you think the government will be able to achieve these targets? Through NST2, the government has set a target to reduce child stunting from the current 33 per cent to 15 per cent in the next five years. Reaching 15% is achievable but it is not an easy task. This requires everyone to work hard to achieve it. This is where we come in as partners to support these initiatives and invest in projects that are addressing the core issues. This is where GAIN comes in to propose solutions for accelerating this reduction. The two new strategies; the NST2 and PSTA5 will create an enabling environment and guiding principles to invest in programs that address these central issues. Rwanda’s intentions are very clear. This will require a strong multi-sector approach where each line ministry, development partners, UN agencies, the civil society organisations and the private sector are working together to support the government to achieve the set target. The President has encouraged us in the country to work together, foster cross ministry collaboration and bring partners on board to work as team in a coordinated way. This is the best way to address an issue like child stunting that requires a functional multisector approach at all levels. What role do communities play in your project’s intervention? Good question. When designing programmes, it's important to involve the community from the start. Take time to analyse and listen to their challenges and gather their inputs. This is very imperative especially when you are designing new projects. Let them be part of the process. When you invest in projects that empower them and increase their income, their purchasing power will increase, and they will have a choice to buy nutritious foods for their children and their families in general. But ensure a strong behavior change program to change people’s mindset is integrated. We have seen today, when people’s income increases, they tend to buy heavily processed or junk foods, thinking that it is cool and modern.
