Conflict and political crises continue to dominate Afghanistan’s media profile. At the same time, there is another crisis that does not make it into the headlines. That is the silent crisis of malnutrition. Six of the country’s top ten risk factors that drive morbidity and mortality are linked to malnutrition. This burden undermines the development efforts of all stakeholders: the government, the private sector, civil society, the UN and other development partners. Many malnourished infants will not see their fifth birthday.
As schoolchildren most will not learn as much in the classroom as they could. As adults they will not do as well in the labour market, and they will be more susceptible to diseases like type 2 diabetes, high blood pressure and some cancers. Parents who are malnourished are more likely to have malnourished children and so the legacy of malnutrition cascades across generations.
For nearly a decade, GAIN supported national partners and stakeholders in Afghanistan to improve the enabling environment for nutritious food systems. A significant part of this effort focused on scaling up food fortification, through salt iodisation and wheat flour fortification (approximately 70% of the energy intake of Afghans is from wheat flour with average daily consumption of 400g).
The results of these efforts, which ended in early 2018, include:
- a functioning revolving fund for the procurement and distribution of iodine;
- new trade agreements for fortified wheat flour between Kazakh millers and Afghan traders and an increase to 50,000 MT of imported fortified flour to Afghanistan from Kazakhstan;
- improved harmonisation of standards for fortification in countries of Central Asia region, and Afghanistan; and
- final regulations for fortified wheat flour and edible oils agreed with the Ministry of Health.
Large-scale food fortification is just one of the many strategies and interventions needed to reduce malnutrition rates. And despite these improvements, Afghanistan has one of the highest burdens of malnutrition in the world. With almost 40% of children under five suffering from stunting (low height for age) and a large segment of population affected by wasting (low weight for height) and micronutrient deficiencies, the nutritional situation of the country is alarming.
Leading drivers of malnutrition include poverty, low literacy rates, low awareness of nutrition and the lack of nutrition professionals to inform the public and develop relevant nutrition programmes and policies based on scientific evidence. Major players such as the Afghanistan government, international community and others are doing their best to address the high burden of malnutrition in the country, but the absence of a qualified nutrition "workforce" is a bottleneck to malnutrition reduction.
There are too few frontline workers who have knowledge about nutrition; too few policy makers who understand the consequences of malnutrition and what policy can do about it; too few business leaders who understand the nature of the problem and the commercial opportunities to do something about it; too few researchers who can collect and analyse data on malnutrition and propose and evaluate solutions; and too few advocates who can keep this issue at the forefront of people’s minds and avoid it being a permanently silent crisis.
Currently, there is no organisation in Afghanistan that is focused on building this capacity. To fill this gap, Dr Mohibullah Wahdati – GAIN’s former Country Director in Afghanistan who has remained committed to improving nutrition – has established the new Afghanistan Institute of Nutrition and Home Economics (AINHE).
The Institute is currently scaling up efforts to collaborate with national and international organisations to eliminate all forms of malnutrition in the country. It needs profile, partners, financial and non-financial support if it is to fill the nutrition workforce gaps that it is determined to eliminate. If you work in Afghanistan, consider investing your hope, energy and resources in the Institute.
If you do, you will help accelerate the end of the silent crisis of malnutrition and you will help ensure that there are some inspiring media headlines coming out of this proud nation.