Nutrition and industrial action – thoughts on the current situation in Mozambique

Since my first blog on nutrition and Mozambique back in February 2013, parts of the contextual landscape look different while other parts look worryingly familiar. While the floods that devastated the country earlier this year have receded, the Mozambican Medical Association (AMM) has declared a fresh strike, which at the time of writing is entering its 22nd day.

Some of Mozambique’s most prominent doctors, including three former ministers of health, have urged President Armando Guebuza to get involved to resolve the dispute, which is mainly focused on the demands by health workers for improved working and living conditions. With the entire public health service on the verge of collapse without health workers, AMM have urged President Guebuza to intervene in order to establish an immediate, genuine and fruitful dialogue. Until the dispute is resolved, the nutritional status of the Mozambican people may well suffer.

Nutrition is a vital part of public health. In most cases, doctors and nurses can provide essential advice regarding nutrition and other public health concerns to any patient that comes through their doors. With the health workforce absent, each unseen patient represents a missed opportunity to improve nutrition. However, it should also be noted that part of the dispute relates to shortages of basic medicines and equipment in the health units, which may also be leading to a negative impact on nutrition.  These problems must be resolved if impact on nutrition is to be kept to a minimum. With the recent launch of The Lancet Series on Maternal and Child Nutrition, never before has nutrition been so relevant to public health.

Key messages from The Lancet Series include:

  • New findings reinforce the importance of nutrition in the first 1,000 days of a child’s life, a critical window of opportunity to shape healthy lives and a prosperous future.
  • By scaling up ten proven nutrition interventions, nearly 1 million children’s lives can be saved 33 million more can be protected from stunted growth and development.
  • One in four newborns – more than 800,000 babies each year – die because they are born too small or too soon, as a result of poor maternal nutrition.
  • Countries will not break out of poverty unless malnutrition becomes a global priority.
  • 165 million children still suffer from stunted growth and development representing a massive unfinished agenda.
  • Countries will not be able to break out of poverty or sustain economic advances when so much of their population is unable to achieve the nutritional security that is needed for a healthy and productive life.
  • Poor nutrition causes nearly half (45%) of deaths in children under five – 3.1 million children each year. These deaths are preventable.

While the growing problem of obesity for women and children is addressed by the Series, much of the work focuses on the consequences of undernutrition.  Undernutrition is defined as the outcome of insufficient food intake (hunger) and repeated infectious diseases. It is one of the world’s most serious but least addressed health problems. The HEART Topic Guide on Nutrition provides a useful resource to better understand undernutrition. The Topic Guide will be updated soon to incorporate the new data presented in the 2013 Lancet Series.

Another useful resource is the video summary provided by Dr. Gillespie, the lead author of one of the papers that make up the Lancet Series, titled, ‘The politics of reducing malnutrition: building commitment and accelerating progress’. As a Senior Research Fellow for the International Food Policy Research Institute (IFPRI), a visiting Fellow at the Institute of Development Studies and the CEO of the Transform Nutrition Research Program Consortium, Dr. Gillespie gives his views on nutrition and the enabling environment. He explains that the political economy of reducing malnutrition has been largely neglected up to now. To make progress, an enabling environment is needed to provide support for nutrition-relevant policies and programmes, and that political momentum for nutrition must be created and sustained. Knowledge, evidence, politics, governance, capacity and resources are all pivotal to create and sustain political momentum, and to translate momentum into results in high-burden countries like Mozambique.

A vital part of the enabling environment is the political commitment to reduce hunger and address undernutrition. In a recent body of work called the Hunger and Nutrition Commitment Index (HANCI), Mozambique was found to be a top performer with regards to government commitment to nutrition. A brief introduction to HANCI, including a short video, can be found here. These findings are encouraging and, when combined with the information presented in the paper on the enabling environment in The Lancet Series, it is clear that political commitment is a key aspect to reducing undernutrition and hunger. However, political commitment is meaningless if the health workers are not at work. I sympathise with the health workers in Mozambique regarding their working and living conditions, but I also sympathise with the Mozambican people whose nutritional status may be negatively affected by the disruptions to the health service. I can only hope that the dispute is resolved soon, with the health workers returning to their posts with a renewed devotion to reducing hunger and undernutrition, backed by the government building on its current good performance regarding political commitment.

Blog by Stephen Thompson, Research Officer with the Health & Education Advice & Resources Team (HEART)

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