UN agencies warn economic impact of COVID-19 and worsening inequalities will fuel malnutrition for billions in Asia and the Pacific

February 5, Thimphu:  The economic impact of COVID-19 is threatening to further undermine efforts to improve diets and nutrition of nearly two billion people in Asia and the Pacific, warns a new report published recently by Food and Agriculture Organization (FAO), the United Nations Children’s Fund (UNICEF), the World Food Programme (WFP) and the World Health Organization (WHO).

South Asia is already home to a vast majority of severe food insecure people (86 percent) and disruptions in the economic, food, and health systems resulting from the COVID-19 pandemic are expected to have impacts on all forms of malnutrition.

The pandemic’s impacts on the state of food security and nutrition in Bhutan is equally of concern.

FAO estimates that the number of undernourished people globally could increase by 132 million, assuming a decline of global GDP of 10 percent attributable to the impact of the economic recession associated with COVID-19. 

In Bhutan, one of the immediate impacts of the pandemic were felt by the most vulnerable section of the population, the urban residents, who depend totally on imports from across the borders and supplies from the rural farming community. As international borders closed and in-country movements got restrained, supplies of fresh vegetables, fruits and livestock products stopped. Further, employees within the private sector particularly those related to tourism lost their jobs.

FAO partnered with the Department of Agriculture in intensive and commercial scale vegetable production in urban and peri-urban by displaced employees. The support focused on technology-induced production of different types of vegetables in a few urban sites of Thimphu, Bumthang, Punakha and Sarpang districts. Recognizing the immediate benefits in domestic vegetable production, to substitute imports and employment generation, the government replicated the urban vegetable programme in all 20 districts.

Besides safe food and access to varieties of food items, there is also a need to change people’s mind sets and behavior towards nutrition. The Behaviour Change Communications Strategy for nutrition, and a seven–minute video on “nutrition garden” that were developed highlight the importance of kitchen gardens for family nutrition.

Food prices and available incomes govern household decisions on food and dietary intake, said the FAO Bhutan’s Assistant Resident Representative, Chadho Tenzin.

“But the outbreak of COVID-19 and a lack of decent work opportunities in many parts of the region, alongside significant uncertainty of food systems and markets, has led to a worsening of inequality, as poorer families with dwindling incomes further alter their diets to choose cheaper, less nutritious foods,” he said.

The COVID-19 pandemic continues to exacerbate malnutrition rates in the poorest countries, overloading their already strained food and health systems. By November 2020, WFP estimated that an additional 137 million people could face acute food insecurity by the end of 2020, an 82 percent increase compared to the pre-COVID-19 estimate.

Bhutan’s food and nutrition security are fragile to events such as disasters and pandemics as the country still imports about 50 percent of its total food consumption. Food prices have increased by approximately 15 percent over the last year and have cast a shadow on food security and livelihoods of vulnerable people.

Nutritious foods such as eggs, fruits and vegetables are often much more expensive than staples such as wheat, rice and maize, which fill stomachs and provide calories, but offer little in terms of vitamins and minerals. In times of crisis, vulnerable households have to give up nutrient-rich foods to preserve their caloric intake. The nutrition of Bhutanese people is likely to be affected by the pandemic as people shift diets to more affordable food and shelf-stable and pre-packaged foods, which generally are less nutritious.

The national lockdowns caused by COVID-19 in Bhutan have affected school feeding programmes with schools remaining closed for almost the entire academic year. Of the 90,000 school children entitled for school meals, almost 71 percent missed out on the fortified school meals, which means they couldn’t access the nutrition needed for their growth, health and cognitive development. The report has a case study on Bhutan’s transition from school feeding to national integrated school nutrition programmes with increased focus on achieving nutritional outcomes for school children in addition to educational goals, thereby strengthening Bhutan’s human capital.

In view of food price volatility and possible interruption in supplies, increasing food self-sufficiency is a means to achieve food and nutrition security. Increasing local food production (including home and community gardens) through appropriate stimulus packages, farmer linkages to local markets and schools and capacity strengthening initiatives are important to build a self-sustaining ecosystem.

 “This report is a timely reminder of all the work that remains to be done in the region, given that the pandemic has significantly halted and in some instances even reversed the progress made so far,” said the Head of WFP Bhutan, Svante Helms. “We believe that safe and nutritious diets is critical for healthy children who in turn have a better chance to thrive and fulfil their potential as adults. We are supporting the Government’s systemic approach to solving Bhutan’s malnutrition and dietary challenges through policy and programme reforms, effective partnerships and joint implementation, data and knowledge management, innovations, and social and behaviour change communication. WFP stands committed to support the Royal Government of Bhutan as they take on the post pandemic challenges.”

The COVID-19 pandemic has been unprecedented and has put tremendous pressure on health systems including in Bhutan. As a close partner and technical agency, WHO Bhutan continues to support the Ministry of Health and its role in nutrition interventions has become crucial during pandemic.

WHO Bhutan has been supporting the Ministry with regular technical updates on preventive measures and patient management guidance and protocols since the detection of COVID-19 cases in the country.

Recognizing the need to ensure health and wellbeing of the Bhutanese population, the continuity of essential healthcare services without disruption was accorded priority during lockdowns. As such, WHO Bhutan collaborated with the Ministry by providing regular technical updates on essential healthcare services, which aimed to prevent parallel disease outbreaks and ensure healthcare services to the people affected by COVID-19. Essential supplies such as noncommunicable disease kits were provided.

With COVID-19 vaccine development and approval process making impressive progress, we hope that the vaccination will mitigate impacts of the pandemic. We will have to continue to advocate and reinforce preventive measures until COVID-19 poses health threats to our population.

WHO Bhutan is committed to extend its full support to the Ministry of Health in its efforts to address priority health challenges and issues including our aim to make the world free of malnutrition. We continue to support Ministry’s efforts to improve adequate nutrition interventions, Water, Sanitation and Hygiene programs and education to promote behavior change in the communities given its importance for overall physical health and mental wellbeing.

“The Report is timely in reflecting nutritional status and needs while also featuring key solutions to achieve our nutritional goals and thus enhancing health and wellbeing, particularly of our women and children in Asia and the Pacific Region during pandemic era,” WHO Bhutan’s Representative Dr Rui Paulo de Jesus said.

At the beginning of the pandemic, UNICEF estimated a 30 percent overall reduction in essential nutrition services coverage, reaching 75–100 percent in lockdown contexts. Estimates predict a 14.3 percent increase in the prevalence of moderate or severe wasting among children under 5 years of age, equal to an additional 6.7 million children.

In Bhutan, 41 percent of children under five years are not growing well, wasted or overweight. Nearly 35 percent of children in Bhutan are stunted, 5.9 percent under five years are suffering from wasting, 11.7 percent of children have low birth weight and 7.6 percent of children under five are overweight.

Around 35 percent of women of reproductive age in Bhutan have anaemia. The report states that Bhutan is among the four countries along with Nepal, the Philippines and Vanuatu in reducing the burden of anaemia in women of reproductive age between 2000 and 2016 –– with all other countries experiencing slower or no progress, or even a worsening status. Among subregions, Southern Asia has the highest prevalence, at 49 percent, with Pakistan, India, Maldives and Afghanistan having a prevalence of 40 percent or higher.

While gaps remain in critical areas, including implementation, the report found that health systems’ enabling environments across countries in South Asia are strong and robust with sound policies and systems to support the delivery of services to improve diets. Except for Bangladesh, Bhutan and Nepal, most countries experience moderate to significant bottlenecks in the delivery of counselling by community health workers to mothers on healthy eating to prevent excessive weight gain during pregnancy. However, challenges remain in ensuring effective counselling on diversified and nutritious diet for children and adolescents to prevent childhood overweight. 

The impact of a poor diet is most severe in the first 1,000 days, from conception through the first two years, and improving nutrition for women and children in the first 1,000 days would contribute to stunting prevention and improve cognitive ability of children.

The challenges in accessing quality and diversified nutrition services due to and during the pandemic, will leave deep impacts on early life nutrition with possible intergenerational consequences for child growth and development, life-long impacts on education, chronic disease risks, and overall human capital formation.

UNICEF Bhutan Representative Dr Will Parks said that the report is a call to not lose momentum in the efforts that are made for the wellbeing of mothers and children.

“UNICEF remains committed to support the Royal Government of Bhutan in building back better by implementing nutrition-sensitive polices such as the 1,000 golden days programme that can nurture the health of every child and mother.”

Recommendations

The report calls for a transformation of food systems in Asia and the Pacific, with an aim to increase the affordability of, and families’ access to, nutritious, safe, and sustainable diets.

It recommends mainstreaming nutrition-focused behaviour change campaigns would help people achieve healthy diets. Education on what constitutes a healthy diet and how to create hygienic environments at home, in schools and in the community, together with investment in girl’s education and infrastructure that underlies good water, sanitation and hygiene practices, are critical.

Providing a nutritious, safe, affordable and sustainable diet for all requires coordinating with partners in the Food, Water and Sanitation, Health, Social Protection and Education systems, to collectively create an enabling environment.

Greater attention is also needed to operationalize national policies and plans to improve the delivery of health services for maternal and child diets and good nutrition outcomes. Services to improve the diets of mothers and young children should be prioritized as part of the essential package of health services needed to address undernutrition, overweight and obesity and to achieve universal health coverage.

These actions are needed now more than ever because the face of malnutrition is changing in Asia and the Pacific, with highly processed and inexpensive foods readily available throughout the region.

Governments need to invest in nutrition and food safety in fresh and street food markets to promote healthy diets. Regulation of sales and marketing of food for consumers, especially children, is important to curb overweight, obesity and related diseases and illness.  

The report also calls for action within the private sector, as it has an important role to play in supporting the transformation of the food system and its value chains for achieving healthy diets.

Leveraging these systems, in a coordinated fashion that expands the opportunities to address barriers to accessing and consuming healthy diets, will help Bhutan and other countries of Asia and the Pacific to recover faster from the economic impact of COVID-19, and be better prepared for future crises.

The report, ‘Asia and the Pacific Regional Overview of Food Security and Nutrition 2020: Maternal and Child Diets at the Heart of Improving Nutrition’ was launched on January 20 in Bangkok and can be accessed at https://www.unicef.org/rosa/reports/asia-and-pacific-regional-overview-food-security-and-nutrition.