|Overview : |
Botswana is a country with good access to health care and where several interventions to address malnutrition prevention and management are institutionalised. Nevertheless, available data shows that in Botswana, stunting has remained consistently high between 1996 and 2007 (29 and 31 per cent, respectively) clearly showing a public health concern. Furthermore, 20 per cent of children remain chronically malnourished across many districts.
Stunting is associated with low birth weight (most often linked to poor nutritional status of pregnant women), inadequate nutrient intake and repeated infectious diseases. The costs of undernutrition are significant. On average, adults who were stunted as children earn 20 per cent less than their non-stunted counterparts. World Bank estimates show that a 1 per cent loss in adult height due to childhood stunting is associated with a 1.4 per cent loss in economic productivity.
As a mitigation to prevent stunting, the Government of Botswana introduced the Vulnerable Groups Feeding Programme (VGFP) in 1988. The VGFP package flagship product is a sorghum-soya fortified complementary food (Tsabana/Malutu), calculated to provide 30 percent of daily nutrient requirements for energy, protein and selected micronutrients of public health importance. In addition, cooking oil and beans are provided and the contents of the take-home rations vary depending on the beneficiary. The monthly rations consist of the complementary food Tsabana for children aged 6 to 36 months and Malutu for those aged 37 to 60 months. Beans and vegetable oil are also provided to medically selected pregnant and lactating women and to TB and leprosy outpatients.
The programme is being funded, spearheaded and implemented by the Government and distributed through the monthly Child Welfare Clinics (CWC) sessions. An estimated 85 per cent of children under-5 attend CWC, however, provision of the products is inconsistent. The 2014 Determinants of Malnutrition study, which covered 5 districts, revealed that only 63.7 per cent of eligible children who had attended CWC in the previous month had received their ration, with only 50.5 per cent of those attending rural health facilities receiving the ration. Administrative data on monthly ration coverage is reported at the national level, aggregated by facility. Furthermore, individual beneficiary data on ration received and anthropometry is available on the individual CWC cards, as well as log forms at facility, district and national level.
The Ministry of Local Government and Rural Development (MLGRD) procures the VGFP foods and delivers them to the clinics based on requests from the clinic staff and the previous months’ allocations. The Ministry of Health and Wellness (MOHW) develops product specifications, monitors food safety and oversees distribution to individuals and monitors coverage. According to the MOHW, all pregnant or nursing teenagers (up to 18 years old) receive the ration, while in remote areas, all households receive an extra ration.
Despite the universal coverage of the VGFP and substantial investments in feeding programmes, high prevalence of stunting seems to persist. The VGFP has not been evaluated since its inception. An evaluation of the utilization and effectiveness of the products, as well as a cost-effectiveness analysis to measure the relationship between allocated resources and achieved results, will inform policy and programme design for maximum outcomes in stunting prevention.
UNICEF, in support of the Government of Botswana, is seeking to contract the services of an institution to undertake an evaluation of the utilization, acceptability and effectiveness of the programme that will inform policy and programme design to, in turn, maximise social outcomes, including stunting in the country.