In January 2013 Dr Paul Amuna from the University of Greenwich, delivered a fantastic Sussex Development Lecture on scaling up nutrition and building capacity in the health workforce. He argued that before even considering up-skilling the health workers, a broad understanding of the context and culture of the country and region in question is required. Generally speaking, interventions are not implemented in a vacuum and context can be important to consider. I applied his logic to Mozambique, a country where I spent a few years working for the Mozambique Eyecare Project. The recent headlines for this south-eastern African country have been dominated by two stories, both which had the potential to disrupt plans of improving nutrition.
The first was the story of the Mozambican Medical Association’s (AMM) strike that saw doctors stand down from work for nine days, demanding higher wages and better conditions. Although the doctors did not achieve any specific changes (other than a pay increase due in April that the Ministry of Health argue was arranged before the strike), Mozambican nurses are now also pondering strike action. The Mozambican Health Minister Alexandre Manguele has urged the country’s nurses not to follow the example given by the doctors, by saying “Do not let people suffer or die because your wages are low”. Health workers are key players in the battle against malnutrition and their absence through industrial action will unquestionably impact on the health and nutritional status of members of the public. Whether this is in the form of someone who is malnourished being diagnosed and appropriately treated, or whether it is simply good nutritional advice given to a patient who has presented themselves with a non-nutrition related ailment. This point is not intended to take a position on the dispute between the government and the AMM, rather to make clear that for every patient not seen by a doctor, an opportunity has been missed to improve the nutrition of the population.
The second headline was the severe flooding that has reportedly displaced 150,000 people. Not only do the floods increase the risk of drowning, they also bring with them waterborne diseases, damage shelter and destroy livelihoods – in particular, farmland. The World Food Programme has sprung into action, mobilising to help the large numbers of people affected. They have already implemented emergency distributions of high-energy biscuits for some 25,000 people followed by supplying seven-day rations of maize and beans for as many as 60,000 flood-affected people. The needs are huge and with more poor weather on its way, the struggle is far from over.
Famine and malnutrition tend to only make the news in times of crisis with reports focusing on short term gains. The reality is that in developing countries like Mozambique, malnutrition presents a daily challenge to a large number of people. According to Helen Keller International, in Mozambique 19% of rural children under five and 13% of urban children under five are underweight. As many as 69% of children under five suffer from vitamin A deficiency, 75% are anemic and 36% are iron deficient due to a lack of dietary diversity. High-energy biscuits may win the battle but how can we win the war?
It is not all doom and gloom. The SUN movement progress report 2011/12 praised Mozambique’s significant scaling up of the treatment of severe acute malnutrition and for their development of food and nutrition policies. Perhaps the fact that the President of Mozambique, H.E. Mr. Armando Emilio Guebuza, sits on the SUN lead group is testament to the national determination to beat malnutrition. The report also hails frontline health workers as the key to addressing malnutrition and other health issues. If health workers are the key to the problem, why is so little invested in their training and capacity building? This problem is not unique to Mozambique. In the 2012 Action Against Hunger: Aid for Nutrition report indicates how little aid funds are invested in nutrition and even more worryingly, investment in training and capacity building for the health workforce seems non-existent.
You do not have to be a nutritionist to include nutrition in your work, but I would argue that you do need proper training to ensure the interventions and advice you give are based on good practice and scientific evidence. The health workforce in Africa is rapidly developing yet training in nutrition is lagging behind. At the moment nutrition information and communications are not high on the agenda. We must realise the potential gains of investing in human resources. Building capacity within the health workforce through improved training will propel us in the right direction and move us closer to winning the war against malnutrition.
Blog by Stephen Thompson, Research Officer with the Health & Education Advice & Resources Team (HEART)