Designing Proactive Policies to Combat Child Malnutrition in Sri Lanka

A research conducted by the Institute of Policy Studies of Sri Lanka (IPS) identifies the “life cycle effect” as a major contributor to the prevalence of child malnutrition, especially among the country’s poor.  A mother’s poor nutritional status during pregnancy can lead to underweight births. Being born underweight can lead to growth retardation causing nutrition issues in adulthood and thus continuing the malnutrition cycle.

Dietary issues, like not consuming enough animal protein, also significantly increase the prevalence of child malnutrition.  These are often caused by food insecurity, socio-cultural practices, and lack of awareness about proper nutrition, especially among the poor. A mother’s lack of education is also a contributing factor.

Sri Lanka currently practices most of the World Health Organization’s (WHO) recommendations, including life course interventions under the maternal and child health programs of the Family Health Bureau. However, only 5% of the total nutrition-specific spending is allocated for medical and supplements supply. There are also gaps in the interventions for pre-pregnant women (22% of those 15–24 years old were underweight) in terms of quality and coverage.

Promoting a healthy diet and effective feeding practices can help address existing dietary issues. Yet, awareness and communication programs aimed at changing behaviors get only 0.2% of the nutrition-specific budget.

Timely access to quality health services is a key factor in the successful management and treatment of severe acute malnutrition (SAM). However, there is low demand for this treatment, efforts to identify active cases are lacking, and some provinces have limited access to services and facilities. There is also no data available on the performance of existing interventions, making it difficult to assess their success.

The country’s annual public investment on key nutrition-specific interventions is approximately around 15 billion rupees ($75 million), which is allocated for the school meal program (40%), pregnant mothers’ food allowance program (37%), and the national supplementary food program Thriposha (16%). However, there are concerns about the effectiveness of these nutrition interventions, particularly the last two, which take nearly half of the government’s total budget for nutrition.

Moreover, a blanket provision for some nutrition programs was costly. For instance, the expansion of the food allowance program for pregnant women to a universal program in 2015 was a substantial expense. The government’s annual expenditure for this has increased by more than Rs. five billion ($25 million).

The government should improve the quality of maternal and child health supplementation efforts as these cover the entire life course interventions recommended by the WHO.

Due attention should be given especially to the first 1,000 days, which cover the period of pregnancy and the first 2 years of a child’s life, as this is the most crucial time to meet a child’s nutritional requirements.

To improve the coverage of preconception health, separate services for adolescents must be provided as an option.  Adolescent girls may prefer to use facilities especially designed for them instead of general maternal and child health services. Nutrition intervention programs, regular screening tests at workplaces, and community-based organizations that provide services to adolescents and youth must also be implemented.

Allocate resources to more targeted interventions to optimize project efficiency.  For example, food fortification, or adding vitamins and minerals to staple foods, can help reduce micronutrient deficiency. There could be more fiscal space if the supplementary feeding program (Thriposha) focuses only on pregnant women who are at risk rather than covering all those who are pregnant and lactating. The food allowance for pregnant women should be deployed in more deprived regions.

Raising awareness on healthy behaviors is vital. Effective communication, awareness efforts, and educational programs deserve more funds and resources to proactively combat malnutrition. Nutrition education programs should be strengthened to inculcate better consumption habits—what foods to select, how to prepare food and feed children, and the hygienic and nutritional value of food.

School- and community-based management are globally recommended interventions in treating children with severe acute malnutrition. Community support can include providing services, such as counseling, support and communication on infant and young child feeding, screening for acute malnutrition and follow-ups, deworming, and micronutrient supplements.

Lastly, building a strong monitoring and evaluation framework is essential. A rigorous prioritization exercise is recommended to investigate and analyze the effectiveness (cost and others) of practices and interventions.

P. Jayawardena. 2020. A Proactive Path to Combat Malnutrition in Sri Lanka. Colombo: Institute of Policy Studies.