Why the government needs to intensify efforts to prevent and treat Severe Acute Malnourished children in the country
By Muritala Muhammed
As the world grapples with the health challenges posed by COVID-19 pandemic, more families and household are being exposed to poor nutrition intake due to loss of livelihood as a fallout of the economic cost of the pandemic. The most buoyant economies of the world has since plunged into recession with huge number of job losses recorded resulting in large chunk of their citizenry filing for unemployment and depending on food banks for free meals to feed their families. This comes with a huge implication on the global effort to fight malnutrition, which was hitherto a threat to the health and economic existent of the vulnerable population around the world. The situation is more glaring in developing nations like Nigeria that was among the 20 countries of the world contributing to more than 80% of the global malnutrition burden. Records available show that the situation of malnutrition is getting worse by the day as more children and women are driven into severe acute malnourishment, especially in the northern part of the country.
Stakeholders are deeply concerned by the decision of the federal government to allocate Zero Naira (N0) for the procurement of Ready-to-use Therapeutic Food (RUTF) in the reviewed 2020 Appropriation Act. The 2020 budget that was approved initially had N800 million for the procurement of RUTF but it is strange that despite the overwhelming evidence on the dangers of severe acute malnutrition in the country, both health and economic-wise, the government still did not deem it fit to prioritize prevention and treatment of SAM to the extent that the amount initially allocated for it can be entirely removed from the budget. This will not only set the nation back on the national nutrition intervention trajectory, but will also mean that more lives will be lost across the country due to lack of funds for the prevention and treatment of SAM in 2020.
The malnutrition situation in Nigeria before the pandemic was alarming despite stakeholders’ various interventions aimed at upturning the worrying indices without much success as mobilization of local resources had been grossly inadequate in addition to the none prioritization of nutrition funding by government especially at the state level. With the current pandemic, where all the underlying causes of malnutrition are on the rise, more children are pushed into severe malnutrition daily. Huge resources are required to prevent and treat Severe Acute Malnutrition among under five children in the country and there is growing indication that state governments are not prioritizing this intervention to stem the tide. The benefit of preventing and treating these children far outweighs the cost of treatment in many folds. In fact, the benefits are inter-generational in nature as the economic productivity increases in both medium and long term when these children are treated and saved. Studies have shown a strong correlation between a well-nourished population in a society and a prosperous society. To revise our current economic woes, perhaps, the government should rethink the priority they give to the nutrition situation as well as the health care system of the country.
In the quest to address the malnutrition burden of the country, the federal government has been very willing in budgeting and releasing of funds for the procurement of RUTF over the years. But the biggest culprits are the state governments that are always unwilling to release funds for the procurement of RUTF for the treatment of children with SAM. This has created negative outcomes in the states resulting in perennial stock out of RUTF; and oftentimes rely majorly on the RUTF intervention of the federal government and other donor partners which is not sustainable and does not last all year long. Except for the RUTF being sent to the states since the pandemic began, most states would have been out of stock as most of them are yet to release a dime of the procurement of RUTF in the 2020 budget, despite the fact that the year is half way gone. The consequence of this irresponsible behaviour from state governments is that more children will die from treatable SAM complications.
We agree that the current system of treating SAM children in the country is not sustainable where the RUTF is still being imported. This is why our effort in advocating for SAM prevention and treatment has been expanded to include the advocacy for in-country production of RUTF. To achieve this, there is need for concerted effort for the creation of demand for RUTF in order to bring down the price of the product by increasing the scale of production as the price elsewhere is currently lower than the locally produced RUTF. Aside the scale of production, which is a major determinant in the current high cost of production in the country, we have other administrative bottlenecks militating the smooth production of RUTF in the country such as the current ban on the importation of skimmed milk, except for some few selected companies that have the approval of the Central bank of Nigeria (CBN). Unfortunately, none of the interested RUTF candidates in the country is among the company with the approval for the importation of skimmed milk into the country. What this means is that these companies will have to buy the skimmed milk from the company with approval at a price that will make them not competitive with other companies elsewhere. In the short run, there is the need for the Federal Ministry of Health (FMoH) to interface with the CBN to give these companies approval to import the milk in order to help reduce the cost of their production. As a long term strategy, FMoH should work with various research institutes in the country to produce internationally approved standard skimmed milk and peanut in the country for smooth uptake of the RUTF production in the country in a price competitive manner. This can be done through collaboration between the FMoH, Federal Ministry of Agriculture and Rural Development and other relevant MDAs in the country.
In order to increase the access to treatment by children suffering from SAM, there is need for the federal government to collaborate with the state governments to scale up the Community-based Management of Acute Malnutrition (CMAM) programme in ensuring that all Local Government Areas with high incidence of malnutrition burden in the country have at least a centre for the treatment of children with SAM. This requires huge resources which is why there is need for the synergy between the federal government and the state governments.