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José Manuel Cuevas Borda, Assistant at research of the Navarra Center for International Development (ICS-University of Navarra)
Chronic malnutrition kills. Lack of political will, too
This subtype of malnutrition affects more than one million children in Guatemala for life, if it does not cause their death in their early years. Given the lack of success in policies, the successful case of Peru may provide clues to begin to solve a status that has the country with the worst rates in Latin America.
In pre-election times, it does not seem to outrage as much as corruption. But it is also a burden. It is not as noisy as the current institutional turbulence, but it also touches a large part of society. It is not violent like organized crime, but it also affects the youngest: chronic malnutrition, which is the progressive loss of organic reserves due to lack of protein and calories, affected between 2014 and 2015 1,200,000 Guatemalan girls and boys under five years of age, according to the survey National Maternal and Child Health (ENSMI).
At the time, this figure represented 46.5% of children of that age in the country, of which 16.5% suffered from severe chronic malnutrition. Also according to the ENSMI, the situation is worse in rural areas and among the indigenous population, where 53% and 58%, respectively, are affected.
Chronic malnutrition delays the growth of fetuses, infants, children and adolescents, affecting their height, energy and weight, and is an irreversible problem for their cognitive development development . It marks them for life when it comes to studying and working. In relation to the latter, according to programs of study cited by USAID's project Food and Nutrition Technical Assistance, these minors will eventually have less income than those who grew up well nourished, which reproduces their status of poverty and affects the country's general production and development .
Over time, malnutrition can also lead to anemia and iodine deficiencies. As well as death from diarrhea or pneumonia, as UNICEF warns. Many, however, do not even manage to live through all this, as chronic malnutrition is the cause of 45% of infant mortality in Guatemala, which tops the list in the continent, according to the Pan American Health Organization ( agreement ).
Faced with this panorama, the government has acted in recent years - mainly thanks to cooperation and loans from international organizations, and through the Ministry of Health - with policies of prevention and direct attention. And the Ministry of Agriculture, Livestock and Food, with a food security plan, agricultural extension, irrigation and product chaining.
In that framework there are relatively successful projects, such as those focused on combating maternal mortality, as well as the so-called Thousand Days Window, launched in 2013, which consists of prevention policies focused on the months of gestation and the first two years of the baby. Although chronic malnutrition has remained in proportion, a study by the Foundation for the development of Guatemala sample shows that under-five mortality in the country dropped from 80 to 32 per thousand between 1990 and 2012.
However, these projects, which are usually medium and long term deadline, have been hindered or slowed down at different times. project For example, at the beginning of December last year, a bill to combat malnutrition stalled at congress due to a lack of attendance by the deputies. The initiative seeks (or sought) approve a loan from the World Bank for the Crecer Sano program, which is part of the National Strategy for the Prevention of Chronic Malnutrition 2016-2022.
This lack of political will, which closely follows the lack of national consensus, is perhaps one of the main differences with the case of Peru, which has reduced chronic child malnutrition in its territory, from 28% in 2008 to 13% in 2016. The legislators of the South American country took action, precisely, hand in hand with the social pressure that was behind, and in the last decade have acted on this front beyond the government of the day.
In line with the political agreement , the implementation of measures to combat this problem in Peru has had as fundamental components the institutional dimension, assuming the complex and transcendental nature of topic, and the empowerment of parents, which in Guatemala has not enjoyed the prominence of the provision of supplies.
In the Peruvian example, this support to parents through territorial institutions and NGOs has been translated into awareness-raising so that they see that their children are not growing enough (especially with the indigenous poor), logistical support so that they themselves and the doctors can follow up, improvements in the availability of health services, monetary incentives, among other measures that can be found in a report of the World Bank.
Finally, the implementation of these policies in Peru has been achieved under an institutional coordination that, together with the distribution of resources based on results, has given it an effectiveness that Guatemala can pursue by studying the case and adapting the policies to the national context.