2017年-世界发展银行全球_Malnutrition_in_Timor-Leste___A_Review_of_the_Burden_Drivers_and_Potential_Response_176页_4mb

Summary of Malnutrition in Timor-Leste: A Review of the Burden, Drivers, and Potential Response

Core Content

This report provides a comprehensive review of the burden, drivers, and potential response to malnutrition in Timor-Leste, with a focus on maternal and child undernutrition. It outlines the current state of the nutrition system, the key determinants of malnutrition, and the political and institutional commitment to addressing the issue. The report also highlights the role of development partners and the need for increased investment and coordination to improve nutrition outcomes.

Main Findings

• Malnutrition Burden:
  Malnutrition remains a significant public health issue in Timor-Leste. In 2013, over half (50.2%) of children under five were stunted, making it the third highest in the world. Nearly one in three (63.2%) children aged 6-59 months and 39.5% of women aged 14-60 were anemic. Wasting prevalence (11%) exceeds WHO thresholds, indicating a high public health concern.

  • Stunting: Reflects chronic malnutrition, often due to undernutrition and infections since and before birth.
  • Anemia: Affects women and children, with iron-deficiency anemia being a major cause.
  • Wasting: A symptom of acute undernutrition, associated with child mortality.
  • Overweight: Although low compared to global averages, it has increased fivefold among adult women in the last decade.

• Economic Impact:
  Malnutrition results in an annual loss of US$41.0 million in economic activity, equivalent to nearly the entire Ministry of Health (MOH) budget and about 2% of non-oil sector economic activity.

• Determinants of Malnutrition:
  Malnutrition is influenced by a combination of immediate, underlying, and basic determinants:

  • Immediate: Nutrient intake and disease burden (e.g., infections, malaria, hookworm).
  • Underlying: Child care and feeding practices, reproductive health, household hygiene, dietary diversity, and access to health services.
  • Basic: Household poverty, macroeconomic context, sociocultural factors, and political context.

• Political Commitment and Institutional Frameworks:
  Timor-Leste has strong political commitment and strategic frameworks, including the National Strategic Development Plan (2011-2030) and the National Council on Food Security, Sovereignty, and Nutrition (KONSSANTIL). However, the focus of KONSSANTIL is primarily on food security and food sovereignty, with nutrition being one of five pillars.

• Nutrition-Specific and Nutrition-Sensitive Interventions:

  • Nutrition-Specific Interventions target immediate causes (e.g., breastfeeding, complementary feeding, anemia treatment).
  • Nutrition-Sensitive Interventions address underlying determinants (e.g., food security, access to health services, education, and social protection).
  • Despite these efforts, gaps persist in program coverage, quality, and financing.

• Role of Development Partners:
  Development partners have been instrumental in supporting nutrition programs, but there is a need for better coordination and leadership to maximize impact.

• Fiscal and Resource Constraints:
  The current level of investment is insufficient. The Zero Hunger Action Plan estimates that US$176.0 million annually is needed to implement the plan over ten years. However, due to declining oil revenues and budgetary constraints, ministries increasingly rely on donor support to deliver nutrition services.

Key Recommendations

• Strengthen Institutional Leadership: Enhance the MOH's leadership and ownership in strategic directions, development partner coordination, and technical guidance.
• Finalize Policy and Strategy Frameworks: Develop and finalize supportive policy and strategy frameworks to guide future interventions.
• Scale Up Nutrition-Specific Interventions: Expand the coverage and quality of the Specific Nutrition Intervention Package (SNIP) and address anemia.
• Build Nutrition Capacity: Improve the skills and knowledge of frontline health workers to enhance service delivery.
• Enhance Community-Based Delivery: Promote community-based approaches to deliver nutrition services effectively.
• Increase Budget Allocations: Advocate for increased budget allocations for nutrition from the Ministry of Finance and Parliamentarians.
• Improve Data Collection and Use: Strengthen data collection systems to support evidence-informed decision-making.
• Enhance Coordination: Develop a more harmonized and convergent approach among development partners and ministries for social and behavior change communication, training, and programming.

Conclusion

Malnutrition is a critical challenge in Timor-Leste, with severe implications for health, human capital, and economic development. While the country has made progress in some areas, the persistent high levels of undernutrition require urgent and coordinated action. The report emphasizes the need for increased investment, better coordination, and strengthened institutional capacity to address the root causes of malnutrition and improve nutrition outcomes.