Phub Dem

Despite significant progress in health outcomes in recent decades, malnutrition remains a concern with relatively high rates of stunting, anemia, growing challenges related to over-nutrition and non-communicable diseases.

Assessing public financing for improved nutrition and human capital report states that regular financing data, which is essential for informing policy makers to address malnutrition, is absent in the country. Data is considered important to increase accountability and to enable adjustments so that funds can be prioritised and allocated efficiently and equitably.

Estimating public financing specifically for malnutrition is noted as a challenge for Bhutan.

The report states that the previous methods based on National Health Accounts (NHAs) have “grossly underestimated” nutrition-related financing by focusing solely on expenditures that flow through the health sector.

The report also states that the estimation of public financing for nutrition is faced with numerous challenges such as lack of budgetary estimates in the national nutrition action plan, insufficient budgetary details for relevant activities and bundling of nutrition interventions with other interventions, among others.

Despite the increased level of spending from Nu 1,744 in the fiscal year 2013-14, the report states that there does not appear to be any increased priority to nutrition over the course of the 11th FYP. “The increases in the levels of expenditure for nutrition have resulted from the growth of the economy and not because of a higher budget allocation to address nutrition concerns.”

The largest nutrition-specific expenditures were those related to the national school-feeding programme, and the largest nutrition-sensitive expenditures were those related to water, sanitation, and hygiene (WASH) programmes.

However, the report points out that neither of the programmes is effective or cost-effective for addressing stunting among those under five. While feeding children in school is important to increase attendance and provide basic nutrition, it does little to prevent or reverse stunting. It also misses the critical years when anemia sets in at about six months of age, affecting cognitive development.

Recent studies indicate that one-fifth of children under five are stunted. And there is a high prevalence of anemia among children, adolescent girls, and women of reproductive age; and the country is facing a growing disease burden from over-nutrition.

According to the report, lack of dietary diversity and low levels of nutrient-rich food intake have contributed to the high rates of anemia and other micronutrient deficiencies among children under five, children of school age, adolescent girls, and women.

It also states that delays in seeking antenatal care (ANC) and low rates of pregnant women completing the recommended minimum of eight ANC visits also contributed to the problem. Lack of adequate sanitation facilities in rural areas as well as poor water and sanitation in health facilities are additional barriers to achieving good nutrition outcomes in the country.

The country is currently tracking the implementation of a multi-sectoral nutrition action plan that includes several activities that contributes in improving nutrition outcomes. These activities include revitalising the baby-friendly hospital initiative for early initiation of breastfeeding and monitoring exclusive breastfeeding, providing micronutrient supplementation, and strengthening Infant and Young Child Feeding (IYCF) counseling.

Others include promoting locally available foods and recipes, improving the quality of complementary feeding for children age six to 59 months, providing midday meals in schools, ensuring food fortification, ensuring availability of subsidised seeds and tools to improve kitchen and community gardens and investing in water and sanitation, among others.

The report recommended institutionalising access to public financing for nutrition.  It states that having action plans and strategies is not very meaningful if financing is not monitored and assessed.

Since the investment in school-feeding programmes and for WASH-related interventions were found ineffective, the report recommended to re-evaluate its impact to better inform policy.

Furthermore, the nutrition action plan should consider prioritising over-nutrition and creating awareness on nutrition in the country.