CLAUDIO SCHUFTAN
schuftan@gmail.com
This ACC/SCN synthesis of findings from the review of nutrition-relevant actions in ten countries recently carried out was reviewed in Adelaide in late September 1993.
The key findings ware summarized by Stuart Gillespie at that time and, in what is relevant for this review, one could highlight the following:
Economic development is positively related to nutritional improvement via its impact on poverty, equity, household food security and social expenditures.
An equitable growth strategy is a more efficient long-term means of alleviating poverty and indirectly improving nutrition than are compensatory poverty alleviation programs.
Quantity, quality and distribution of social expenditures are important; a threshold exists at about $500 GNP per capita; above it, social expenditures rise exponentially with rising income.
Mutually reinforcing long-term effects on nutrition may be had by investing in health education and women’s issues.
Social discrimination against women is common in countries where nutrition has not improved as much as would be predicted by economic growth.
Nutrition programs give constituency to nutrition; they may even promote broader awareness; process is as important as the actions per-se.
A mix of top-down and bottom-up interventions is pragmatic and effective, often synergistic. Most successful and sustainable nutrition programs have strong community ownership; decentralized decision-making power is crucial. Nutrition considerations have influenced broader development policies; relevant information, democracy and a free press have catalyzed such an awareness.
Nutrition policy development is important as an outcome in mobilizing sectoral awareness and support.
This synthesis of the recent lessons learned (pertaining reasons behind real nutritional improvements observed in those 10 countries) still leaves us with some apprehensions, because, when malnutrition (an outcome indicator) improves, it leaves no explicit track or trail of why it did so. It basically is still left to us to sort out the (sometimes contradictory) reasons. And this depends on the ‘glasses’ we wear to look at the ‘reality’ in front of us.
The detective work done by the respective researchers engaged highlights, how we, more than anything, need to sharpen our political acumen and instincts and our analytical capacity to put all elements of the observed (sometimes puzzling) ‘reality’ together coherently.
It is more, now we are left with the need to apply the lessons learned so we can more decisively throw our support on any of the nutrition-relevant actions suggested by the analysis and voice our vocal opposition (to the point of open confrontation) to the nutrition-irrelevant or anti-nutrition actions we observe in a given national or sub-national context.
What has come out, loud and clear from the analysis presented, I think is that people will feed themselves given an ‘enabling’ environment’. What the latter means varies from place to place, of course, and is true ‘despite’ of what we, as technicians or institutions, do. And that is where our political interpretative acumen comes in.
Let’s face it: Governments and agencies (including NGOs) do not always foster such enabling environments -either being part of the problem or being neutral towards the main obstacles in the way of achieving such an environment.
Sharing a common conceptual framework has proven to be crucial to understand the causality of malnutrition and to develop at least the buddings of a shared political view.
But this is only the first step. Creating political awareness of the problems of malnutrition is not enough anymore. Our goal has to be to mobilize resources for action for nutrition-relevant-actions (many of the identified in the synthesis document).
A correct causal analysis should thus lead to embarking in the right combination of interventions simultaneously in the areas of service delivery, capacity building and empowerment.
Since sustainability starts with local control of interventions, engaging communities actively in service delivery, in capacity building and in their own empowerment becomes central. Local enabling environments are perhaps more important to be created first (but not only) than national or global environments; not that the latter are less important, but they are just more ‘remote’.
Fostering effective local democracy may have to be a stepping stone not only to tackle the ominous health/nutrition consequences of a non-enabling environment, but also to enter the wider political arena.
Outside agencies and agents can play a role in supporting effective local democracy. First, governments (as well as other organizations) that only passively respect or actively claim to protect the poor’s entitlement to food, care and health, but do not proactively fulfill their state obligations in this respect should be openly confronted. Missing actions in the areas of ensuring household food security, the care of women and children and the provision of basic health services and environmental sanitation need to be identified with communities and, jointly with them, governments need to be taken to task to embark on needed interventions if they are to get additional outside support.
Second, work with communities should lead to them taking responsibility for their own proactive role by, on the one hand, engaging the resources they control in making the same entitlements more attainable and, on the other, by launching a general mobilization to fight for those resources that they do not control (assuming there is no government repression for engaging in such actions).
At the center of what we are here considering is the twin issue of community mobilization and empowerment – “the empowerment factor” – to create an enabling environment; and the latter cannot be separated from the underlying socioeconomic issues at the base of ill-health and malnutrition.
As “How Nutrition Improves” prominently showed, economic development is positively related to nutritional improvement, National economic growth -when and if it trickles down – is known to help reverting ill-health and malnutrition in the Third World. But the effects of such aggregate economic growth are not immediate (nor automatic) on poor households’ disposable income. So why waiting for a promised (but seldom realized) trickle down?
The empowerment measure most at hand I can think of for now is a wide movement to promote income generation activities for women (IGAs).
IGAs for women have the attractive feature that they can potentially short-cut this ‘Waiting-for-Trickle-Down Syndrome’ emptily promissed by Structural Adjustment; IGAs can generate more immediate needed additional modest household income -a true bottom-up solution.
Women’s IGAs can. In the poorest households, result in sometimes quite significant increases in disposable household income (even if the total income from the IGA is low).
As an intervention, IGAs for women attempt to blend the technical with the political in our battle against malnutrition by more directly dealing with the basic causes underlying the ill-health and malnutrition that characterize poverty worldwide.
[Note that interventions tackling underlying causes are as important, but as a rule are more capacity-building than empowering].
Income earned by women is, to a much higher degree than men’s, used for family wellbeing expenditures -nutrition expenditures included; women’s modest, frequent income simply affects income elasticities of demand for family consumables more directly (including basic services).
Let us be clear. IGAs for women do not correct the roots of the immiserizing process of an unfair political and economic system.
But IGAs for women:
a) can be applied as a technical intervention targeting the key determinant(s) of ill-health and malnutrition, and, more importantly
b) can ultimately organize and empower women in a way that prepares them for taking more active roles in participating in food/nutrition and other important decisions and actions In their families and in their communities,
Efforts to revert malnutrition in the world should start with a universal declaration that effective democracy should underpin any proactive efforts to do so. But we always append this requirement at the tail and never focus on it as a prerequisite. I have here advanced some ideas that might provoke you to contribute to this debate of how we can get closer to the day when effective democracy is no longer a total utopia.
Claudio Schuftan
Saigon, Vietnam.