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	Breaking down the barriers to treating malnutrition by Casie Tesfai, Jeanette Bailey International Rescue Committee, agencies   In South Sudan, an acutely malnourished child may have to travel up to eight hours along unpaved roads, through swamps and mud, under threat of violence, to reach a medical clinic where treatment can be administered. To complete a full course of treatment, this journey must be repeated once a week for three months or longer.   The result, not surprisingly, is that the majority of malnourished children in South Sudan and many other countries are not getting the urgent treatment they need. Globally, malnutrition accounts for roughly half of all deaths of children under the age of five, yet only one in 10 severely malnourished children get treatment. That amounts to approximately three million children each year whose deaths are entirely preventable.   The biggest obstacle to treatment is the inability of families to travel long journeys to health facilities, or to bear the costs of taking time away from home or work.   But the barriers to treatment go beyond poverty or weak governments and infrastructure. They are also the result of global decisions. Acute malnutrition is a continuum condition, but severe and moderate acute malnutrition are treated separately in different programmes, with different protocols and therapeutic products managed by separate UN agencies.   Funding shortages and the logistical difficulties of coordinating two programmes mean that treatment is often only available for severe malnutrition. The result of this system is that children often must deteriorate into the life-threatening stages of severe malnutrition before they are eligible for treatment.   The global community can do better, but only by fundamentally challenging how we think about delivering nutrition services for those who need it most.   Bringing treatment home   Across the world, three leading causes of child death - diarrhoea, malaria, and pneumonia can be treated by local health workers right in children's homes.   In many African countries, these workers often have little to no formal education, but they are given rudimentary training and equipped with simple-to-use tools that allow them to diagnose and begin treatment of all three conditions.   In South Sudan, this approach has increased treatment for diarrhoea, malaria and pneumonia tenfold over what could have been achieved if children were required to visit distant health facilities.   Unfortunately, the treatment of malnutrition, beyond identification and referral is not currently part of this community-based model. In South Sudan, and most countries where the burden of acute malnutrition is highest, treatment is limited to health facilities because it has been assumed that only a literate health worker can provide treatment.   But the effect of this policy, in poor countries where literacy is very low, is to condemn thousands of children to preventable deaths.   Since 2015, the International Rescue Committee has been developing and field-testing tools that enable people with low-literacy levels to treat malnutrition. We've simplified treatment diagnostics and dosages, how to monitor progress over the course of treatment, and how to match patient records with individual children so they can all be done by someone who doesn't know how to read or write.   We've learnt that it is possible for people with little to no education to provide effective treatment for malnutrition if they are given the appropriate tools and training. In the future, it may be possible to eliminate the necessity for many malnourished children to make gruelling journeys to health centres.   Creating a unified treatment protocol   No one deliberately set out to make the treatment of malnutrition needlessly complex, but decisions made over the years have evolved into standardised practices that are hard to change. In 2016, the IRC and its partners Action Against Hunger and the London School of Hygiene and Tropical Medicine completed the first phase of a global research initiative that challenges some of the assumptions preventing progress in treating malnutrition.   Together, the consortium developed a protocol that eliminates the binary distinction between severe and moderate acute malnutrition, and instead offers a unified and simplified protocol for treating both.   Having one protocol for the two conditions lowers costs, thereby improving the availability of treatment and reaching more children who are considered moderately malnourished before they deteriorate into the potentially irreversible consequences of severe malnutrition.   The simplified protocol also supports efforts to enable low-literacy local health workers to treat malnutrition in their communities. We look forward to seeing the impact health workers in Kenya and South Sudan will have as they pilot this approach in 2017.   The way forward   We now know that treatment need not be restricted to the confines of clinics and to children who are severely malnourished, but can be made available to even moderately malnourished children in every corner of a country.   Changing the way we deliver international aid can feel like a daunting task. But it is far easier than the perilous journeys thousands of families in South Sudan make every day to access life-saving treatment for their acutely malnourished children. We should be willing to take every step necessary to shorten those journeys. Visit the related web page
	Hunger is a silent, invisible symptom of poverty by Mercy Corps, The Hunger Project, agencies   One in every eight people goes to bed hungry each night. (Mercy Corps)   Hunger is more than missing a meal. It's a debilitating crisis that has almost one billion people in its grip.   Families struggling with chronic food insecurity, hunger and malnutrition don't consistently have the food their minds and bodies need to function, which then prevents them from having the resources to improve their lives. It's a perilous cycle that can pass hunger from one generation to the next.   Mercy Corps believes that breaking the cycle of poverty and building strong communities requires that every person has enough nutritious food to live a healthy and productive life. It is key to our work in more than 40 countries around the world.   One in every eight people goes to bed hungry each night. Around the world, 842 million people do not have enough of the food they need to live a healthy life.   People suffering from chronic hunger are plagued with recurring illness, developmental disabilities and low productivity. They are often forced to use all their limited physical and financial resources just to put food on the table.   The highest number of malnourished people, 553 million, live in Asia and the Pacific, in countries like India, Indonesia and the Philippines. In sub-Saharan Africa, 227 million people face hunger in arid countries like Ethiopia, Niger and Mali.   And 47 million people in Latin America and the Caribbean, in places like Guatemala and Haiti, are struggling to find enough to eat.   The majority of these hungry families live in rural areas where they widely depend on agriculture to survive. Some 60 percent of the world's hungry are women.   Male-dominated social structures in many places limit the resources women have - job opportunities, financial services, education making them more vulnerable to poverty and hunger.   This, in turn, impacts their children. A mother who suffers from hunger and malnourishment has an increased risk of suffering complications during childbirth or giving birth to an underweight baby, which can mean irreversible physical and mental stunting right from childbirth.   Many hungry people live in countries with food surpluses, not food shortages. The issue, largely, is that the people who need food the most simply don't have steady access to it.   In the hungriest countries, families struggle to get the food they need because of several endemic issues: lack of infrastructure like roads and storage facilities; frequent war and displacement; dependence on livelihoods like farming that are disrupted by natural disaster or climate change; and chronic poverty.   Many poverty-stricken families depend on their land and livestock for both food and income, leaving them vulnerable to natural disasters that can quickly strip them of their livelihoods.   Drought the result of climate change and increasingly unpredictable rainfall has become one of the most common causes of food shortages in the world. It consistently causes crop failures, kills entire herds of livestock and dries up farmland in poor communities that have no other means to survive.   People living in poverty on less than $1.25 a day struggle to afford safe, nutritious food to feed themselves and their families. As they grow hungrier they become weak, prone to illness and less productive, making it difficult to work.   If they're farmers, they can't afford the tools, seeds and fertilizer they need to increase their production.   The limited income also means they often can't afford to send their children to school or they pull them out to work to help support the family. Even if children are lucky enough to go to class, often their malnourishment prevents them from learning to their fullest. Lack of education can prevent better job opportunities in the future.   Over 300 million children go hungry every day. And most of them are suffering from long-term malnourishment that has serious health implications and will keep them from reaching their full potential.   Malnutrition causes stunting, when the body fails to fully develop physically and mentally and increases a child's risk of death and lifelong illness. A child who is chronically hungry cannot grow or learn to their full ability. In short, it steals away their future.   Around 9 million people die of hunger and hunger-related diseases every year, more than double the lives taken by AIDS, malaria and tuberculosis in 2012. Every 10 seconds, a child dies from hunger.   Poor nutrition is responsible for nearly half of all deaths in children under the age of five - 3.1 million children die each year because their bodies don't have enough of the basic nutrients they need to function and grow.   The world produces more than enough food for everyone to live a healthy, productive life. If all the world's food were evenly distributed, there would be enough for everyone to get 2,700 calories per day, even more than the minimum 2,100 requirement for proper health.   Empowering women is essential to global food security. Almost half of the world's farmers are women, but they lack the same tools, land rights, financing, training that their male counterparts have, and their farms are less productive as a result.   If women and men had equal agricultural resources, female farmers could lift as many as 150 million people out of hunger.   http://www.mercycorps.org/blog/climate-change-poverty http://www.mercycorps.org/blog/quick-facts-global-hunger   Hunger is a silent, invisible symptom of poverty. (The Hunger Project)   Worldwide over 800 million people are chronically hungry. Hunger is a silent, invisible symptom of poverty, and is exacerbated by a host of socioeconomic causes, including climate change, lack of women's empowerment, child marriage, lack of access to clean water and sanitation facilities, and lack of education and literacy.   Over 800 million people were chronically undernourished last year, with 98% of the world's chronically hungry living in the developing world.   Malnourished mothers are more likely to give birth to underweight babies, and underweight babies are 20% more likely to die before the age of five. Half of all deaths of children under the age of five are attributable to undernutrition.   In every region, the poor are the most at risk of child marriage. Globally, 1 in 4 women alive were married in childhood. Ending child marriage can help to break the cycle of intergenerational poverty that often results in hunger.   Climate change is projected to cause at least additional 250,000 deaths annually among children due to malnutrition, diarrhea and heat stress. In low and middle-income countries, lack of access to clean drinking water and sanitation facilities result in 1,000 deaths of children under five every day.   When mothers are educated, they are better able to provide better nutrition and secure access to better healthcare for their children. If all mothers achieved secondary education, there could be 2.8 million fewer deaths of children under the age of five in Sub-Saharan Africa and Southeast Asia.   The old saying that 'All politics is local' is especially true when it comes to overcoming poverty and hunger.   Issues of nutrition, primary education, primary health care, water and sanitation, preserving the environment and ensuring public safety are all local issues. Actually getting basic public services to work requires good local government.   Local control of local programs can be more economical, more flexible in meeting local conditions, more responsive in meeting local needs, and better able to mobilize public support.   However, decentralization is often not easy. Bureaucrats do not easily relinquish power. The most important feature of good local governance is participation. People not only vote every few years; they can have a direct voice in decision-making and governance through public forums, citizen committees and voluntary action campaigns. Participatory Local Democracy.   Our experience has taught us when poor people have the opportunity to take charge of their own lives and destiny, and exert control over a fair share of public resources, they can more effectively improve their lives.   http://www.thp.org/issues/local-democracy/ http://thp.org/the-latest/newsroom/ http://mcld.org/   * Below is a link to InterAction, the largest U.S.-based coalition of international NGOs: http://www.interaction.org/   Give Us a Voice over New Development Goals, say People Living in Poverty.   Decisions on a new global plan for ending poverty and protecting the environment must be informed by the voices of poor people, says a new Christian Aid report.   'Do we actively want widening gaps between rich and poor, with all the instability that entails, all the global insecurity, displacement, violence and misery it means ultimately, for everyone on the planet?   The new report, The World We Want To See: Perspectives On Post-2015, carries commentaries by 17 Christian Aid partner organisations from Africa, Asia, the Middle East and Latin America, about the future world they want.   Issues that must be tackled, they stress, include climate change, women's rights and the importance of powerless people having a greater say in decisions which profoundly affect their lives.   http://reliefweb.int/report/world/world-we-want-see-perspectives-post-2015 http://www.undp.org/publications/million-voices-world-we-want Visit the related web page
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