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WSSCC’s National Coordinator for Cambodia, Dr Chea Samnang discusses the importance of nutrition for his country’s development
Thirty two percent of children in Cambodia are affected by stunting, according to the 2014 Cambodian Democratic Health Survey, (down 39 percent compared to the 2010 survey). How can Cambodia further reduce the rate of stunting among its children?
In March 2015, the government held a two-day National Conference on Nutrition with line ministries and international and national experts on nutrition to consider how to reduce the rate of stunting as much as possible.
The government recognises that stunting in children is very much a threat, not only to individual families, but also to the national economy. So government is trying to bring everybody together to help increase nutrition in the rural community.
Research shows that just 30 percent of 6 to 23-month-old children in Cambodia receive what is known as a ‘minimum acceptable diet’. Why is this the case?
About 85 per cent of people in Cambodia live in rural areas. Many worry that without money they cannot buy good food for their children. But there are nutritious foods they can grow at home, so we need to build capacity and provide interventions within communities. We are running a school feeding programme that provides food for poor students and families, which they can access at school through the World Food Programme. But food is just one factor.
The multi-dimensions of malnutrition mean that we cannot rely on food accessibility or food ability alone. We have to think about behaviour change; water, sanitation and hygiene (WASH) programmes.
Stunting is often associated with poverty, so why do studies in Cambodia suggest it affects children right across the socio-economic spectrum?
We have found that poverty alone is not the only major cause of stunting of children. We are also looking at the behaviour of parents or care takers within the family; poor food preparation and why families are not making improvements in this area; and healthcare coverage; and the effect of diarrhoea from poor water supply and poor sanitation.
These are some of the multiple dimensions that impact malnutrition in Cambodia. In the policy adopted by the government we would like to have a multi-sector intervention to support nutrition in the country. We’re working with WSSCC and the Global Sanitation Fund, to bring nutrition improvement through access to toilets and hand-washing in the community.
What steps can be taken to ensure better understanding of malnutrition?
Firstly, coordination is important. We have to be well-coordinated at the national, sub-national and community levels, so we know who is doing what and how we can all work together to have the same voice and reach the same goal.
Secondly, capacity building: most people think that nutrition only comes from food. Maybe, if you don’t have enough food, you may experience malnutrition. But there’s more to it than that. We have to explain that malnutrition is complex, with different factors. For example, children with diarrhoea may have good food to eat at home, but if they have poor sanitation or poor drinking water and it is untreated, this leads to malnutrition. Again, we need to educate people that nutrition is a key input to improve children’s physical and mental ability, and their educational achievement.
We need to build networks and share knowledge and experience among politicians, civil society, government agencies, and development partners. Financing plays a crucial role. If we don’t have the budgets we cannot do the work to improve nutrition. So budgets must come from communities themselves, from national budgets, sub-national budget, private sector and donors.
We also have to look at the potential role of local authorities, including commune and village chiefs to support Nutrition improvement. Communities have to work together to improve their nutrition. Lastly, I think interventions from the different sectors should inspire people to work together, for example through total sanitation programmes or hand-washing campaigns.
What is the Cambodian government’s response to high levels of child stunting?
Improving nutrition has become an increasingly important issue on the government’s agenda. Nutrition improvement through multi-sector integration is important. Government has stated in the National Strategy for Food Security and Nutrition 2014-2018 that we need technical inputs, not just from the Health and Agriculture sector, but other line ministries as well.
The Ministry of Rural Development and The Council for Agricultural and Rural Development (CARD - a coordination body and policy developer) have been working with the WASH sector to integrate water, sanitation and hygiene into improved nutrition. We’re working on total sanitation programmes, where everybody can access to a toilet, and practice hand-washing with soap at critical times.
Last year the government founded a National Nutrition Day, on 6 November. With this national day we want to advocate to policy makers, academics, technical experts and so on, that all people in Cambodia understand the importance of nutrition, because it improves your family and the country. And finally it will improve economic development.
How difficult is it to highlight the importance of sanitation as a means of fighting against malnutrition in Cambodia?
We don’t have any evidence yet for Cambodia, but we are learning from other countries – such as India or some countries in Africa – where we’ve seen research and studies showing that sanitation improvement do much to improve nutrition. Right now we are working on how to integrate WASH into nutritional improvement.
The Global Sanitation Fund started supporting Cambodia about six years ago and has helped us to carry out a study on these issues, so we’ll be discussing the findings at the forthcoming WASH and Nutrition conference.
Dr Chea Samnang is WSSCC's National Coordinator and Director of the Deputy Prime Minister’s Cabinet of the Royal Government of Cambodia.