A 2016 essay, titled Nutrition and Equality: Brazil’s success in reducing stunting among the poorest, written by Meagan Keefe, attributes the massive advances in the status of child health and nutrition to the rapid progress in health care and economic development in Brazil. This extended to the reduction in poverty, improving nutrition and food security and reducing socio-economic inequalities in malnutrition via a multi-sectoral approach that included targeted income redistribution as well as social protection in the form of universal access to health, education and sanitation services.
Brazil’s programs and policies led to dramatic reductions in child stunting levels by about 80% and related socio-economic and geographical inequalities across the country. Other domains of intervention included: family purchasing power, water supply and sanitation, maternal schooling and maternal/child health. The single most crucial factor that led to a decline in child undernutrition was the transformation in women’s education between 1996 and 2007.
Brazil initiated its national food security policy framework (Fome Zero or Zero Hunger) in 2003 that integrated socio-economic policies to combat poverty and hunger. In 2004, the consolidation of the largest cash transfer program for nutrition and health in the world led to the creation of a broad social protection program called BolsaFamilia, encompassing 54 different initiatives and programmes within the country’s strategy for food security.
Through the National School Feeding Program and the Food Acquisition Program, Brazil successfully linked the supply from the small-holder farmers to the demand from food-based social protection programs. This led to an increase in their minimum wages, purchasing power, food and nutritional security as well as expansion in agricultural production, rural incomes, farmer credit and agricultural input procurement programs.
In 2009, the government integrated investments in school meals with smallholder agricultural policies to strengthen those and improve the attendance and performance in schools.The redefinition of its National Program for the Strengthening of Family Farms (PRONAF) led to an improvement in production through technical assistance, increased credit access, marketing support and infrastructure to boost the quantity and quality of food produced.
The National Program for the Promotion of Breastfeeding was established in 1981 to sensitize decision makers and the general public via advocacy campaigns, about the relationship between optimal breastfeeding and maternal and child health, while also training health workers about lactation and engagement of civil society organizations, such as the International Baby Food Action Network to increase community awareness.
A universal tax-funded national health service was established in 1988 as a result of a civil society campaign that demanded health reforms in the 1980s. This led to a radical decentralization process that allowed for greater participation of relevant stakeholders in the decision-making processes. Each level of the government extended support for the implementation of the national health policy. This led to a significant increase in the coverage of prenatal and vaccination care as well as investments in human resources and technology across the country.
Brazil’s food security framework was transformed between 1996 and 2006 with institutional structures designed to facilitate the realization of the human right to adequate food. In the 1990s, the country’s civil society proactively brought food and nutrition security to the national agenda as well as the design and implementation of the national nutrition policies. The Food Security and Nutrition Law strengthened Brazil’s legal framework for food security and nutrition, institutionalized this cooperation in 2010 by establishing institutions to facilitate collaboration among ministries and within the different levels of government. The programs were funded in such a manner that it facilitated inter-sectoral cooperation at the local level.
The membership of the highly institutionalized National Food and Nutrition Security Council (CONSEA) consisted of the civil society and the government. With its own formal structure, legal standing and budget allocation, it provided a mechanism for the involvement of the civil society in policy processes, especially vis-à-vis the implementation of an information system (including 50 indicators across 6 food security dimensions i.e. food availability, income and living conditions, food production, health, education, nutrition, access to adequate food and water as well as related services) that monitors food security and nutrition, guides policy decisions and documents progress.
Brazil’s approach to malnutrition by framing nutritional challenges within a national poverty reduction agenda is a cogent example of how pro-poor policies like investments in human and social capital through health and nutrition programs as well as conditional cash transfers can aid strong political will to combat malnutrition. The sustenance of nutrition security gains depends upon the maintenance of economic growth and policies of income redistribution. This must be supported by the universalization of elementary and secondary education while addressing challenges related to the adequate availability of health care and sanitation services.
India Outbound
November 19, 2018
source https://indiaoutbound.org/brazil-a-model-for-curbing-malnutrition/
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