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When small’s not necessarily beautiful

Publication Date : 19-06-2012


Bhutan would have taller, smarter, healthier and stronger children after two generations if it feeds its children better today.

That would, however, be possible only if Bhutan and its neighbouring countries spent a dollar today to improve the nutritional status of its children and get an “economic return” of US$16 over a period of time, World Bank studies have found.

Senior nutrition specialist with World Bank, Luc Laviolette explained that this economic return is based on a combination of the cost of putting a value to reduction in mortality and to morbidity. “What does that cost in terms of economic returns to society when someone is unable to work productively,” he said.

While Bhutan may have done economically well to give reasons for donors to withdraw its assistance, its performance in nutrition for the kind of money it spends on healthcare is “way below average,” pointed out experts.

“Bhutan may be spending 3.7 percent of its GDP on healthcare but its spending on nutrition is very less,” a nutritionist pointed out.

Which could be the reason why about 13 percent of its children are underweight; about 34 percent are stunted (short for age) and about six percent are wasted (thin for weight), according to findings of Bhutan Multiple Indictor Survey, 2010.

For Bhutan to improve its children’s nutritional status as well as these figures, it has only 1,000 days  (0-2 years) in a child’s life as the “window or opportunity,” to make a difference.  If this opportunity is missed, the nutritional status is irreversible, World Bank’s senior nutrition specialist Nkosinathi Mbuya said.

So why are Bhutan’s children malnourished?

While there are several reasons cited, no study has been done to really find out if its because of “breastfeeding practices or complimentary food or infection,” said nutrition officials in Bhutan.

“There is no data or study done to find out why Bhutan’s nutritional status is poor,” an official said. “The studies we have done tell us how many are malnourished not why they are malnourished.”

Which is why health officials feel it is time Bhutan’s 27-year-old nutrition program needs a “serious revamping.”

The program that eliminated iodine deficiency disorders, cretins and improved immunisation in the country, is today manned by only one person and not “really an area” that donors are interested in, said public health officials.

Save for ideas and hopes to improve the nutritional status, the nutrition program is today suffering from a deficiency of manpower, with just one person manning it; budget, studies and an absence of non-government organisations to support their program.

That perhaps explains why there were no “community experiences” to share from Bhutan at the recent South Asia knowledge forum in Kathmandu where more than 200 representatives from NGOs shared their stories of improving infant and young child nutrition in their countries.

These stories were shared at a time when Bhutan’s adolescents were diagnosed with nutritional deficiency, died from nutrition deficiency and when it has started working towards vegetable and food sufficiency.

Department of public health’s director general, Dr Dorji Wangchuk said it’s because of the nutrition program that Bhutan today doesn’t have night blindness or hookworms or people with goiter.

“We regularly monitor a child’s growth through the mother and child health handbook,” he said. “If they are not growing well, we immediately intervene; the prime minister also said we can’t tolerate stunting.”

Monitoring the health of a child starts from the first antenatal visit, Dorji said and goes on until the child is a year old, during the immunisation period.

“We are now working on a new health book that would monitor a child’s health for five years,” he said. “We are not just basking under the achievement of eliminating iodine deficiency disorder but also planning on fortification of iron, iodine and salt to make sure our women get their share of vitamins.”

The health ministry is working with the World Bank on a nutrition study and another study on nutritional neuropathy, following recent outbreaks in schools and institutions, he said.

Most women in Bhutan are anaemic when they enter pregnancy, he said. “But the nutrition program can only tell people what to eat, not feed,” he said. “What can the nutrition program do if food is not available?

The World Bank has very little financial support with Bhutan, the bank’s sector manager for health, nutrition and population in South Asia Julie McLauchlin said.

“We have been working with the health and finance ministry to do some analysis of the nutrition situation of Bhutan,” she said. “Bhutan, Maldives and Sri Lanka have all gotten wealthier and become more educated, but you all still have quite wide spread malnutrition.”


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