The general issues
North-South conflict
The response of the rich
Aid and funding agencies
The international bureaucracy
The basic questions
The planners and the people
Research
A third world perspective
Food Policy, Vol.3, No.1, Feb1978.
CLAUDIO SCHUFTAN
schuftan@gmail.com
Modern societies are interventionist. They do not have a “laissez faire” attitude. People are, therefore, ‘pushed around’. Sometimes in the name or a policy, often without one.
The new food and nutrition planning approach, that attempts to tackle the world’s future feeding problems in a comprehensive multi-sectoral way, has raised high hopes in the international community concerned with such problems. However, after considerable reflection on this approach I am left with main doubts about its potentialities, if it is used as a mere technical tool.
Here I wish to raise a number of questions that have come to my mind in the years since I became a nutrition planner. I have tried to answer them as best as I can. The set of questions does not pretend to be all inclusive. I am sure other questions might have come to the reader’s mind as well and I would encourage readers to put those doubts in writing and share them with all of us concerned with nutrition planning and food policy. Such contributions would expand the dialogue that I consider to be vital if nutrition planning is to be used as the major tool to combat malnutrition in the world in the coming years. The dialogue could save the world money and vital time, as well as avoid frustrations for planners, those implementing the plans and the potential beneficiaries.
The general issues
· What are the world’s major food and nutrition problems?
· What is the problem’s magnitude?
· What are the hardest hit areas or regions?
· What about the ‘population-explosion’ and hunger?
· Is the nutrition problem an isolated and technical problem?
· What are the alternatives?
· What has been tried so far?
· What has worked?
The number one problem is a problem of shortage of food. That means, first a big caloric gap and only secondly a protein gap. As long as an appalling number of people go to bed hungry every night, the first priority for the planner, from an ethical point of view, is to put all of his efforts to make available more food for those who suffer from hunger. What kind of food doesn’t matter, as long as it is acceptable to the different affected groups – hopefully more of their local staple. First quantity then quality. There is no way to achieve the latter in a sensible lime span without an explicit, aggressive policy of redistribution, both at the national and international levels: ie. an overall economic redistribution of wealth and redistribution of food resources: the redistribution of food itself and of food production inputs.1
1 There is perhaps one exception to this ‘quantity first’ approach. That is the special case of providing the kwashiorkor stricken areas with protein rich weaning foods (or food mixtures).
Statistics on the magnitude of the world’s food shortages vary a lot according to the sources. All of them are estimates and lend to separate the third degree malnutrition problem in children from the almost quarter (or more?) of the world’s population that are undernourished.
The magnitude of the problem is tremendous. It is almost beyond our mental capabilities to imagine so many people at those levels of malnutrition. My outlook for the immediate future is pessimistic. But the urgent need for significant interventions to halt the trend is ethically inescapable.
It is no coincidence that the vast majority of the areas hardest hit by malnutrition are in the Tropical Belt across several continents. The myth that nature provides abundant food in tropical climates has long been exposed.
The level of malnutrition in these areas is due to a wide variety of problems. These range from an irresponsible world neglect of adaptative agricultural research for tropical climates to the still unconquered epidemiological problems ie. infections and infestation.
Population
A further complication is the continued population growth. Many concerned individuals or institutions are trying to tackle this problem. But a good proportion of them have found or find themselves pushing very narrow minded birth control policies and strategies. It is the poor people, mostly in the poor countries, who have more children. Why? Have we fully analyzed this question, always in an unbiased and scientific way, in the light of the many failures of conventional family planning approaches? Family size and child spacing are the final result of a complex chain of decisions made by even the poorest of poorest couples. The link between this specific decision in many areas where family planning services are available hut unsuccessful is infant mortality. Infant mortality, as we know, is directly related to early malnutrition and hunger. (Mortality after the age of one year is, of course, also significant in this decision.) The old question of hands to cultivate the land and of offspring as social security for old age in the rural areas – where most of the world’s poor live – is simply too undeniable to continue to be overlooked. These are the rent issues of motivation for most rural poor couples.
”Saturation” with birth control devices as a technique is doomed to fail. What is needed is a comprehensive package of improvements in the socio-economic conditions and a family medicine (not family planning) approach. As Dr Cicely Williams put it: ‘If we look after the quality of life, quantity will take care of itself.’
Neither the population nor malnutrition are isolated technical problems. They are the masks of a much more universal problem, poverty. Malnutrition and high fertility rates are the biological translation of a social disease, and social diseases can not be cured through medical interventions, (not even in a wide comprehensive package) nor can they be cured through the latter plus a package of agricultural interventions. This is why nutrition planning with its multisectoral approach appears so attractive, at least initially.
Table 1. Theories of underdevelopment and related aid programmes
Perceived cause of underdevelopment: Lack of entrepreneurship. Consequent aid programmes:Training of intermediate and high level private entrepreneurs and government officials, mostly in the USA.
Perceived cause of underdevelopment:Lack of technology.Consequent aid programmes: Technical assistance in various areas.
Perceived cause of underdevelopment: Capital shortages and lack of saving. Consequent aid programmes: Export of first world capital to underdeveloped countries mostly through multinational corporations.
Perceived cause of underdevelopment: Lack of planning, Consequent aid programmes: Training of planners in western planning techniques with heavy emphasis on cost effectiveness and cost benefit studies to help decision making.
Perceived cause of underdevelopment: Lack of education. Consequent aid programmes: Loans for education in all areas.
Perceived cause of underdevelopment: Too much international dependency. Consequent aid programmes: Substitution of imports and industrialization policies
Perceived cause of underdevelopment: High unemployment and weak infrastructure. Consequent aid programmes: Public works project (roads, hospitals and housing mainly): restructuring areas of the local bureaucracies.
Perceived cause of underdevelopment: (Growing) income maldistribution (nationally and internationally)aid programmes: . Consequent Surprisingly (or not?…) very little has been done on this front.
Two alternatives
Nutrition planning gravitates towards two alternative policy pathways. We planners can continue to attack the problem in isolation through interventions that attack the symptoms and signs of the problem (masks) rather than the root causes, or we can articulate our policies in such a way that all problems of poverty, malnutrition included, are tackled vigorously at the same time. Certainly, the latter cause is neither the easy nor the short way, but for me, it is the only way to real, significant improvements in the long term. This is why some of my doubts about nutrition planning’s potentialities have arisen.
The traditional approaches of nutritionists – nutrition education, food distribution, food fortification, etc -have served more, in the past, to self justify their doing ‘something’ about the problem rather than really significantly helping the poor who suffer from malnutrition. Many single-shot interventions have been tried in the past, each depending upon the prevailing theory of underdevelopment that the international scientific community shared at a specific time. Aid programmes have followed most of these theories in the past decades. (Sec Table 1.)
In nutrition a number of single shot interventions were and are being tried, with varying degrees of success. Apart from pilot projects, where special conditions make most of them successful, but non reproduceable, the success rate of nutrition projects, on average, has been low. Most interventions have not worked.
Are underdeveloped countries less underdeveloped today than they were 10 or 20 years ago? It seems to me, the answer is again no. Despite changes in that time the gap has grown and malnutrition is still rampant. So, what is wrong with all that has been tried? Would the underdeveloped countries be worse off today if the said interventions had not been pushed and implemented? I doubt it. On the other hand, in these same 10 or 20 years, a few countries have improved the nutritional status of their populations dramatically and some of them, astonishingly enough, without any explicit nutrition policy. This brings our attention back to maldistribution. How genuine can international aid to underdeveloped countries be if the maldistribution factor is ignored as a major factor to be attacked?
North-South conflict
· What is the role of the rich and poor countries?
· What has the role of the multinational corporations been in the whole picture of the rich-poor relations?
If we look at the international rich poor relationships and often the national rich poor relationships as well, it should be no surprise to us that the gap is growing. The poor nations balances of payment are constantly deteriorating, in part because of the higher oil prices. As president Nyerere put it: ‘In 1965, Tanzania could buy a tractor by selling 175 tons of sisal. In 1972 the cost of the same model needed 42 tons of sisal. In 1974, 57% more sisal was needed to get the same tractor. The poor buy and sell at whatever price suits the wealthy. They are price takers, not price-makers’.2 The situation in the world tends to be what game theorists call a zero-sum game in which there can only be winners to the extent there are offsetting losers.
2 ‘The economic challenge: dialogue or confrontation?’ Julius K. Nyerere, Bread for the World Newsletter, August, 1976.
The deteriorating situation in the underdeveloped countries is caused by the international market keeping raw materials at low prices and inflating the prices of manufactured goods, only in part because of oil price rises. High oil prices have had a direct impact on food production as the cost of fertilizers has risen to the point of making them increasingly unavailable to the third world.
This can not continue, and the poor realize it. They are now organized, in ‘The Group of 77’. What they fight for now, is a ‘new economic order’, for ‘price indexation’ in foreign trade and for fair import tariffs and quotas of their manufactured goods to the rich countries. This would give them a chance to sell their products at an equitable and proportionately more stable price that would allow them to import the goods they do not have, at a more equitable rate of exchange. They are also asking for a more just international allocation system, especially for agricultural inputs (mostly fertilizer), proportional to the populations they have to feed, and for oil, the vital energy source to all economies.
As Nyerere said. ‘The transfer of wealth from the rich to the poor is a matter of right; it is not an appropriate matter for charity’.
I am afraid we are still far, in international relationships, from a point where these basic facts are universally accepted. The longer it lakes, the more emotional the issues will become in the international arena. It is ultimately a matter of survival. Josué de Castro once wrote… ‘the world can be divided into two groups: Those who cannot eat and those who cannot sleep; the former do not have the means to feed themselves and their families and the latter don’t sleep because they fear the violent rebellion of the hungry’.
The response of the rich
What makes the rich governments so ‘insensitive’ to the third world claims? Bluntly speaking it is economic interests. What and whose economic interests? Mostly those of big private capital, primarily of multinational corporations. Is this an oversimplification? I do not think so. First-world governments are under (he continuous pressure of capitalist economic expansionism, which in everyday language means that they often give in to big corporation’s lobbying. This is no secret anymore. The logic is that if the ventures of the multinationals overseas are not profitable, its host country loses revenues and power. The cheap labour and cheap raw materials of the underdeveloped countries are still instrumental for the ongoing capitalist concentration of wealth through higher profit margins in overseas and domestic operations.
Nothing is accidental or self-correcting in this situation. The increasing concentration of wealth in the western world in the hands of huge economic conglomerates (oligopolies) is a historic phenomenon which has progressed quickly since World War II. The concentration of wealth also leads to an increasing concentration of power in the making of decisions that affect world trade and therefore the third world.
The underdeveloped countries have passed in the last 100-150 years, from outright colonialist exploitation to neocolonialism in which the exploitation might be more subtle, but still dominates their fate. The classical example for this, related to nutrition, is the competition for farmland by cash crops versus food crops. The underdeveloped countries have become so endebted because of deteriorating trends in international trade that the balancing of their balances of payment has become a key issue in their economic policies (often pushed by the International Monetary Fund), and when the country is basically a cash-crop exporter this is achieved at the cost of a lower food production and the hunger of the poor. Examples of the latter are numerous and seen in at least three continents.
An interesting recent report that I read showed that the cost of food as a percentage of family income was highly correlated, in the four countries studied, with the percentage of total agricultural resources dedicated to the production of export commodities.3 Here again the multinational corporations are frequently involved in cash-crop production and trade in third world countries.
3 Letter from George Poynor to me (from Poynor International, Inc, Silver Springs, Maryland).
Are underdeveloped countries governments also responsible for this cash versus food-crop issue? I certainly think so. In part it is because they have often followed colonial patterns of land allocation and usage and in part it is because, not infrequently, the local economic and financial interests that support the local governments are partners in the export business.
The paradox is that more often than not, these cash crop exporting countries end up importing high cost foods from the international market, again, in a vicious circle, upsetting their balance of payments.
Aid and funding agencies
· What role has international aid played in the level of agricultural self sufficiency of the underdeveloped countries, in the training of manpower and in the transfer and adaptation of technology?
· What has the role of international technical assistance been?
International food aid expanded greatly after the 1950s. Food distribution and subsidization programmes became one fashionable way of intervening to attempt to alleviate malnutrition. For years these programmes were coupled with US grain surpluses. The food grain imports, mostly PL 480 Title II aid, had a negative impact on local grain prices and diminished the economic incentives for local farmers to grow the same grains. As a result they ended up shifting to other more profitable, often non edible, crops.
It is difficult to assess how much food dependency this has created. But what is clear, is that now, when world food surpluses are erratic, poor countries are often forced, in times of scarcity, to compete with the affluent nations in the world market for badly needed grain to feed their people. Third world countries are slowly beginning to realize that it is economically sound to become self-sufficient in food and some internal investment is being redirected to agriculture and food production. Fortunately this approach is also becoming popular with the donor agencies.
Services through technical assistance have also been provided by international agencies dealing with food and nutrition. Have these efforts had any significant impact? I doubt it. Most of the technical assistance available has been connected with single shot interventions in nutrition mentioned above. Too often have technical assistance missions been short term and with little real involvement in the problems by the consultants. More often have the goals of the agency been fulfilled rather than the needs of the recipients.
Technical assistance has been significant mainly in the training of manpower and in the transfer of technology. In training, the emphasis in the past has clearly been biased towards the higher national echelons with little attention to intermediate level cadres and an almost total neglect of low level executors. Training has usually been short term, ideologically biased, too general, theoretical and unrealistic given the local physical and political conditions. The participants in such courses have rarely been given the change to or been able to, implement what they learned. The dark age of attempting direct transfers of technology is passing. Failures have been reported by the dozens. Fortunately, some lessons have been learned from this naive approach and more efforts are now being directed, both in research and implementation, towards the local adaptation of technologies particularly in agriculture and in rood preservation and food processing.
The single shot intervention approach is also slowly being replaced by concepts, such as comprehensive rural development, multisectoral nutrition planning and others, which in general try to understand the deeper nature of the problems of the poor, especially the rural poor. Gross misconceptions about these sectors have often explained the failure of well intended programmes.
The best example or this is perhaps the new understanding that is emerging about the subsistence former sector which accounts for a large proportion of the world’s malnourished. It is becoming understood that subsistence farmers already maximize their output in terms of their expectations and needs. They cannot afford to introduce new technology to increase output, and even if they could, they would not be motivated to increase production. We should, therefore, study their maximization mentality in each locale. (“Why don’t you produce more?”), to determine the constraints that should be tackled in order la have them increase output with their particular level of technology.
The World Bank, at least, is one major international agency that is moving along these lines in its explicit policies which are oriented toward helping the small farmers of the third world.
The international bureaucracy
· What is or should be the role of the UN agencies in the battle against malnutrition?
· What role did the Rome conference play? What has been achieved since?
The UN agencies involved in food and nutrition have not escaped the fashions in foreign aid discussed above. The agencies ‘neutrality’ has been both an asset and a burden. It has enabled them to achieve a worldwide presence and prestige and in some cases, enabled them to bring governments attention to nutrition problems. The burdens, on the other hand are their inherent advisory role with no power whatsoever to implement programmes along the lines of their perceived priorities. These agencies have become an excellent source of collected data and statistics, but they can do very little to change some of the observed trends without the cooperation of each government.
I think we need a UN with more command over the directions our world is taking. Unfortunately, I doubt whether I shall see this change in my lifetime. I am afraid the ‘haves’ will struggle to the last to maintain their privileges. They often do this by exercising their veto powers, at least in the UN Security Council. Only if real decisions would be taken on a ‘one country one vole’ basis, with a system that abolishes or diminishes substantially the first and second world veto powers or gives the third world as a block the same powers, would we be in a situation, as humanists, to solve world problems in a rational manner.
The Rome Conference was a typical example of a world forum called and convened in limes of distress that ended up bureaucratizing and diluting the big issues at stake with no substantial agreements reached. As far as I am aware the follow-up groups have not been able to produce any dramatic breakthroughs either, most probably because the overall emergency has passed for the time being. A typical case of management (or non management?) by crisis.
The basic questions
· Is nutrition planning a technique by or in itself?
· How closely is it related to contingent politics?
· What is ‘new’ about nutrition planning that has not been tried before as a development strategy?
· What can nutrition planning? really offer?
· Western planning: is it pro status-quo?
Nutrition planning is the latest, western approach to solving the problems of malnutrition. It is a technique, borrowed from systems analysis, mostly of analysis and diagnosis, applied to the nutrition system or food chain, and coupled with a number of procedures helpful in decision making and in the implementation of programmes.
Nutrition planning is a more comprehensive and multisectoral approach to solving malnutrition than any strategy used before. Because of its broadly-based approach it is much closer to a political approach (in the classical sense of the term) to the problems behind malnutrition. Therefore, I see nutrition planning having additional potentialities for change over any of the approaches used before. On the other hand, nutrition planning – as does any form of economic planning – necessarily reflects primarily the objectives of the group in power.
Nutrition planning can be seen as the fusion of at least four activities: analysis, diagnosis, decision making and implementation. The first two activities are the more technical and objective ones, even the tools used in analysis and diagnosis are not value-free. The third and fourth activities are clearly primarily ideological and only secondarily technical. Therefore, nutrition planning is a technique with inescapable political implications, especially when it comes to choosing alternative strategies.
The comprehensive analysis that this type of nutrition planning requires should put into perspective the under lying determinants of the problem. The planner is then confronted with evidence that suggests more radical interventions (meaning going to the roots of the problem and not necessarily in the pejorative sense of the word radical used in everyday politics). If planners chose not to go that route hey are deliberately skipping the issue, not at a subconscious, but at a conscious level, which tends to make their contradictions more visible, less sustainable and less bearable. This is the major new dimension that nutrition planning offers.
Nevertheless, man is a political animal, and so are planners, whether they accept it or not. Therefore, critically speaking, nutrition planning will continue to offer us only a good diagnostic tool, a good framework to consider alternative intervention strategies and a basis to validate ideologically stained policy decisions. It will also provide a good set of programme implementation and evaluation techniques. It should be clear that we cannot agree on the content of nutrition planning if we do not share the same explanations of why people are poor and malnourished. Different socio-economic contexts call for different nutrition planning approaches. These should be designed according to how far governments represent the underprivileged and how deeply they are committed to social equality. Only in countries with governments committed la quite radical social change can nutrition planners concentrate primarily on the more technical aspects of nutrition planning. Otherwise, community (grassroot) level organization, around food and nutrition issues in our care, is the only viable answer in the long term.
If others disagree with this view. I think they owe the rest of us an explanation. The challenge for the planner is to determine, in each national context, how much and what kind of macro changes are necessary, if the micro changes are to have improved prospects for success.
Does, then, western planning promote the status-quo or promote significant changes. Frequently western planning has left things basically as they are. There are many examples in the world in which sophisticated planning techniques have been, and are used, without having any really significant impact on development and on the nutritional status of the vulnerable groups. All too frequently this planning has lead to a worsening of the standards of living of considerable sectors of the population. This can be attributed to at least two major factors. The first is related to the choice of overall development strategy, ie. an emphasis on industrialization schemes to the detriment of agriculture, or an emphasis on increasing GNP as opposed to investment in human capital as a means of long term development. The second has to do with the dichotomy observed between suprastructural planning and the local realities of the infrastructure.
Western planning has tended to disregard the overall revolution of expectations, especially for the rural population, that modernization brings with it. I think we should ask the following type of questions at (he grassroots level: What are you and your family’s expectations? How do you see them materializing? Does the system, with its rules of the game, allow for your expectations to become true? If the system would not put a limit on your expectations what would your expectations be then? What would your priorities be then? Winch of your expectations would you like to fulfil first, and how? What in the present system does not allow for your expectations to become true? What can be done about the latter?
Planners keep planning for the poor without incorporating them into the process.
The planners and the people
· How much popular participation does a nutrition planning programme need to be successful?
· What is the role of the nutrition planner?
· How much of a change agent should the nutrition planner be?
· Should we centre our nutrition planning efforts around the planner?
· Are more nutrition planning units needed in central governments?
· What should the role of the nutrition planner as an international consultant be?
Popular participation is absolutely basic for success in nutrition planning and planners have disregarded this central issue persistently. The process has to be decentralized from the ministerial levels. This is the main reason why we at Meharry Medical College, who have been involved in the training of African nutrition planners, have moved towards the concept of community level nutrition planning, developing a special three week curriculum together with an ad-hoc training manual. There are many inter locking local interventions that can be implemented, some of them even through self help, that will ultimately have a positive impact on some aspects of the local malnutrition problem. The participation of the affected population begins with creating awareness that they have a problem, to be followed by ample discussion about what can be done about it. The types of possible solutions will always be twofold. One set of problems can be dealt with by the organized community itself; the other set requires government intervention. It should be the organized people themselves, with the help of the planner, that look for the appropriate channels to obtain the needed government help. Ideally, at the same time, the government should provide information on its channels and leave them open and flexible.
In a way this is a completely new approach to nutrition planning, opposed to the classical top to bottom management of programmes. This is effort and action from the bottom or base. Only this type of effort will last and hear fruits in the medium and long term, because the planner will not always be around and when people take their fates in their own hands, grassroot planning for community development tends to become a longer-lasting effort.
Nutrition planners have too often been operating from their desks, submerged in complicated schemes and organizational charts. They tend to produce long documents for programmes to be carried out by others and eventually get involved again with the reality only to evaluate outputs which are, not surprisingly, often poor.
A new type of nutrition planner is needed: one that plans for people to get organized to work with him in solving the problems. Training more nutrition planners as we have traditionally done will not solve the problems in their countries of origin. The fact that more and more countries are setting up nutrition planning units or cells at the ministerial levels is not a guarantee by itself either.
Emphasis on the technical approach to nutrition planning also has justified in the past the need for western trained experts.
The nutrition planner must be aware of his political role. He must be very well politically oriented because nutrition planning is never politically neutral. Although most nutrition planners have generous and humanitarian objectives, they are in fact, reinforcing the existing centralized structure.
We need to move in the direction of training nutrition planners as trainers of others. Programmes need to be funded in a way that the graduates of these workshops can count on funds to reproduce their own experiences at multiple lower levels in their countries, given the limited geographical coverage per planner that this approach from the bottom inherently has.
Our future graduates will have to be change-agents, and generalists, not only nutrition planners. Health, ecology, sanitation, agriculture, management, nutrition, food technology, family planning and other domains have to be among their general concerns, in order to analyze with the people their local nutrition system and arrive with them at an overall community diagnosis.
Funding should also be foreseen for continuing education in additionally needed special skills for the planners.
This might sound utopian, but it is not necessarily so. It just requires a change in our focus. The major problem with this approach is that it might look too politically radical to some governments. If this is the case, then the particular governments are not genuinely interested in solving their problems. Would they then deserve international aid? This issue of putting preconditions to aid is a thorny problem. To continue pushing suprastructural measures is to perpetuate the problems. It will mean a waste of scarce resources and precious time in the vast majority of cases.
This does not necessarily mean that central nutrition units in ministries are obsolete. They would only have to reorient their overall working approach and coordinate and push grassroots activities from, their position at the top by decentralizing into regional and/or provincial sub units.
As an international consultant, in this context, the role of the nutrition planner is beyond doubt a delicate one. As an outside observer he should help the local people and local officials sec things from another angle – help them to explore their contradictions, perhaps being softly critical, and have them come to their own new conclusions, hopefully without creating false expectations. Sensitization and advocacy skills are perhaps more important to his success than technical know how. Paternalism, often a subconscious altitude in consultants, should be actively combated.
Research
· How much more is needed?
· Basic or applied research?
· What kind?
These questions are difficult to answer without a personal bias. From what we know so far through previous research, there it more than enough knowledge to begin implementing sound strategies to combat malnutrition. Generally, what is needed to achieve good nutrition is an individual or in a community is known. The question is how?
I have no objections to basic research, per se. Only I see it as competing for scarce resources on a world perspective and on that basis I would give it a tertiary priority in nutrition. In applied research. I see the highest priority being for the kind of research built into alternative significant interventions. This would include the collection and analysis of base line data in all the areas of the food chain needed for intelligent decision making, as well as the evaluation of alternative interventions that will help the decision makers to adjust programme goals and maximize outputs. Comparative studies of the different results will help us in the future to make the most appropriate choices when delineating policies.
A third world perspective
· Is nutrition planning in the context of the underdeveloped countries a utopia, a possibility, or a reality?
Two factors are important in trying to answer these questions. The first is the degree of commitment of a given third world government to finding a solution to the problems of malnutrition in its country. This may be difficult to determine, given the frequency with which governments pay lip service to their commitment which in the end turns out not to be genuine. The implementation of agreed strategies too often becomes tangled up due to rigidities in the bureaucratic structure which the governments are not willing to bypass through new regulations.
Evaluation of the programmes funded by international donor agencies should be built-in to grants with a clear bilateral understanding that a lack of progress in programme implementation and achievement of previously agreed intermediate goals would necessitate a closure of the programme. This may sound dictatorial and unfeasible, but, again, time and money are too precious to continue playing nutrition or development games that lead nowhere in terms of real improvements for the target population, because of a lack of a true commitment.
The second aspect has to do with how the underdeveloped countries perceive nutrition planning. Do they really see nutrition planning as a comprehensive package that will provide alternative answers to a number of problems often not directly related to the nutrition issue, but certainly affecting it indirectly? Do the international agencies see it this way themselves? If so, there is a vast field here for advocacy by the international donor agencies.
Linking both the above aspects is the problem of what the countries do with the people they have sent for special training in nutrition planning. We should explore this issue more closely each time we accept a candidate for training and, as I said before, give support to our graduates when they return home, to make sure they can apply their newly acquired knowledge in a productive way. Too many of our graduates lie fallow back in their countries, and its partly our fault. Finally, do we need a threshold number of trained nutrition planners coming from the various different professional backgrounds in order to begin some national activities in nutrition planning? This question has been raised before. Do we need a minimum number of trained personnel to make a real impact? If we think the answer is yes then we should move away from international nutrition planning workshops and concentrate exclusively in in-country training.
· Is nutrition planning going to solve the world’s malnutrition problems?
I am the first to accept that my views in this article are extremely polemic and often only sketchy. My personal opinion, after having ruminated over these problems, is that we have enough evidence and experience, so far, to be able to predict that if we ritualize nutrition planning as a technique only, we have a good chance not to solve the problems implicit in the question above, with all the ramifications that this may bring, including for world peace.
Since the final consideration will continue to be a question of Weltanschaung, of ideology, in terms of equal rights and opportunities for people in the world, it will partly depend on what position we, who are involved in the matter, will lake in the near future. If we do not move towards genuine changes, changes are going to come in spite of us, the question is how and when. History may give us the answer.
Claudio Schuftan
Saigon, VIETNAM
Acknowledgements:
I would like to thank the many friends with whom I have discussed these ideas, especially during the US AID sponsored Berkeley Food and Nutrition Planning Symposium in late March 1977. Their criticism and some of their ideas were incorporated into the final version of this article.