Anemia among young children has been a public health problem for a long time in Nepal. While the government is trying the best it can to reduce it, the prevalence of anemia has remained high. Stakeholders who support the government are puzzled as to what causes anemia in children and how public health burden can be reduced. Some of these stakeholders include international organizations that cleverly posit themselves as enlightened elites who know the fool-proof answer. These organizations have convinced the government’s child nutrition agency, using a variety of attractive techniques well known to the actors in Nepal’s development industry, to distribute micronutrient powders (MNP) to children two to six years of age.
This distribution of MNPs, supposed to be sprinkled over food, has encountered more than a few problems at the implementation level. Children have refused to take any food sprinkled with MNPs. However, those who funded this government program claim that the powders do not change the color or taste of food. Since we have heard both sides of the story, I leave it to the readers to decide who we should believe–the mothers of children who have refused to eat food adulterated with MNPs, or the so-called experts of international organizations whose children do not seem to need such powders?
ARUNA UPRETY
These organizations have been distributing MNPs in many countries, spending a large amount of energy and resources in this exercise. So large that if the same amount of money and energy was used to implement sustainable nutrition programs, the very existence of these MNP-toting organizations in developing countries would have been at stake long ago.
Despite large scale implementation in multiple locations across the developing world, there is no sound evidence that MNPs have helped reduce anemia among children. These organizations do cite some articles that claim to have such evidence. However, scientists working in technical capacities within universities, research organizations and technically mandated UN specialized agencies have on several occasions mentioned that this claim is baseless, since the quality of such evidence is scientifically poor. Further, a joint statement by WHO and UNICEF on combating childhood anemia published in 2004 recommends that children’s anemia can be controlled by using sustainable multi-faceted, multisectoral approaches that are specifically tailored to local conditions. Sadly, the MNPs distributed in over a dozen of Nepal’s most impoverished districts do not take local realities into account. International organizations bought the concept wholesale, like the bulk purchase of MNPs, from some extreme conditions existing elsewhere in the world.
It is claimed that the MNPs contain 15 vitamins and minerals, including iron. When asked why they needed to put 15 minerals in the powders to control anemia, which is basically iron deficiency, these international organizations sheepishly answer that the vitamins and minerals don’t cost much, since more than 75 percent of the cost is incurred in the packaging of the MNPs.
It is a known fact that given their vested interest—agreements with the for-profit industries that have patented MNPs—international organizations that force governments to implement MNPs are adamant. They are not willing to admit that MNPs are not effective, or even to step down silently. Usually, they woo the governments of developing countries by offering frequent international travels and other lucrative opportunities. Their interests are vested in personal egos, and also mutual benefits connected with companies that market medical and nutritional products in developing countries (only developing countries, since developed countries do not tolerate such marketing tricks).
MNPs will cause dependency, as the community will stop giving homemade food like rice, lentils, vegetables, etc to children.
The distribution of imported nutritional products such as MNPs will cause (and has already caused in many cases) dependency, as the community will stop providing homemade food like chapatti, potato, rice, lentils, vegetables, beaten rice, etc to children.
On one hand, the National Planning Commission has acknowledged that nutrition is a multi-sectoral issue that requires coordinated actions. On the other, the government has already accepted donors’ prescriptions of MNPs. This is contradictory, because highly placed government officials at the Ministry of Health have stated that such products have no meaning in families suffering from hunger or food scarcity.
One of the brochures of MNP claims that MNPs will “make your child happy, healthy, and strong.” If that is the case, then do the people who give MNP trainings to villages administer MNPs to their own children?
When I repeatedly write that we have to support sustainable solutions, international donors raise their brows. Perhaps I should request the readers to suggest a solution. Which approach should we choose—a home-grown, empowering and sustainable one, or an externally prescribed administration of a controversial product?
The author is a doctor focusing on public health
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