GABORONE, Botswana – Five-year-old Calvin Puleng has been battling undernutrition for more than three years.
“We found out that Calvin had malnutrition when he was 20 months old,” his mother, Gafaone Puleng, told News Deeply. “Following that he was in and out of the hospital for checkups.”
Now the boy weighs only 27lb (12kg). His father, a self-employed vendor, tries to find work so he can afford to consistently feed his son. And Gafaone Puleng, who is currently unemployed, is desperately looking for a job so she can supplement his diet. But most days, she said, their only choice is to turn to outside help.
“My son has only been getting peanut butter sachets from the clinic,” she said. “When Calvin eats he gains weight, but then he loses the weight when there is nothing to eat.” And because the clinic frequently runs out of the food supplements there is often nothing for Calvin to eat, leaving him at risk of stunting or worse.
The shortages reflect a deeper problem. In a country where nearly one-third of all children under 5 years of age suffer from stunting, according to statistics from the World Health Organization, Botswana is scrambling to address undernutrition among the country’s children. But it lacks the systems to accurately and consistently track data on how the situation is changing. That means the distribution of services and treatment, like the food supplements Calvin relies on, frequently do not meet the needs on the ground.
Filling the Gaps
Botswana’s persistent undernutrition stems both from poverty and the difficulty of delivering services to the country’s rural communities, said Boitumelo Leburu, the coordinator of Gabane Home Based Care, a local nonprofit that is working with the government to address malnutrition.
Botswana’s health officials are trying to put systems in place to consistently provide nutrition services for any child who needs them.
With support from the United Nations Children’s Fund (UNICEF), one of the government’s first steps has been regular distribution of vitamin A capsules. Deficiencies in the vitamin can increase a child’s risk of suffering from illnesses such as diarrhea and measles, which can then exacerbate undernutrition. Supplementation now reaches 86 percent of the country, according to government officials.
Health officials have also been experimenting with subsidizing feeding programs run by nonprofits, such as Gabane Home Based Care. Malnourished children are referred to the program by local healthcare and social workers. Once they are enrolled, the children get access to at least two meals each day.
“We give them food with vitamins, supplementing rations they get from government clinics,” Leburu said.
Those rations, though, distributed through government hospitals, health centers and clinics, remain the primary tool for trying to reverse undernutrition – especially in places that are simply too far afield for a program like Leburu’s to operate. The ongoing efforts to improve the system underscore its importance.
“Government is working on improving the supply chain management to address problems related to shortage of [supplemental foods] at health facilities,” Kenanao Motlhoiwa, a health and nutrition specialist with UNICEF, told News Deeply.
Shortages remain, though, especially in rural areas and communities outside of major cities and towns, in large part because of the lack of up-to-date data reflecting the evolving needs within communities. Shortages that become apparent only when people like Gafaone Puleng come to pick up their supplements.
Room for Improvement
Though Botswana has been ambitious in trying to tackle its undernutrition problem, Abia Sebaka, the chief health officer in the ministry of health and wellness, acknowledged, “There is still room for improvement.” And it begins with data collection.
Information about malnutrition in Botswana is coming from administrative records that are collected by health institutions in the course of their day-to-day work, but that information is gathered infrequently and plagued by gaps, officials said.
Instead, the bulk of data is coming from surveys run by Statistics Botswana, which is charged with collecting and disseminating data for the government.
The problem Motlhoiwa and others have is that the data is not collected frequently or in a form that is easily useable, which creates difficulty mounting both emergency responses and structuring long-term programs.
There can be years between the surveys run by Statistics Botswana, which makes it difficult to estimate deliveries of anything from vitamin A capsules to food supplements. It also means the government may have no way of immediately quantifying the full impact of a bad harvest or a catastrophic weather event, for example, on the nutrition of a community.
Meanwhile, the information the surveys ultimately present does not break down by sociodemographic factors or geographic areas. That leaves nutrition experts in the government the task of reanalyzing the data to look for more granular information on undernutrition that could help them structure and guide long-term programs.
Statistics Botswana is aware of the problem, but Lillian Setimela, the communications manager, said they are constrained by the resources they have. Ideally, she said, they would receive enough funding to fully automate the process of collecting nutrition data and then provide the kind of real-time information that hospitals and health centers are not currently able to.
“Such assistance would enable the organization to undertake automation, and overcome some of the challenges incurred in data collection, processing and analysis,” she told News Deeply.
Until that happens, nutrition officials said, they will have to continue to run nutrition programs based on estimates and hope there is enough for everyone.