Exploring the intricate web of nutritional struggles in Sri Lanka, a dialogue with Retired Ministry Secretary, and Director of Food and Nutrition Policy Planning, Advisor on Food Policy, Dr. R. M. K. Ratnayake, unearths the truth behind the UNICEF Country Report and the nation’s resolute response to adversity.
In the wake of UNICEF’s Country Report for 2023, a candid conversation with Dr. R. M. K. Ratnayake, a distinguished authority in the domain of nutrition, paints a vivid picture of Sri Lanka’s nutritional landscape.
With data drawn from sporadic 2022 collections, the UN Agency for Children portrayed a distressing narrative of food insecurity.
Challenging
 Dr. R. M. K. Ratnayake |
However, as Dr. Ratnayake unwinds the intricacies, a tale of resilience emerges, challenging the constraints of the report’s methodology.
Framed by the UNICEF report, writers rallied under the banner “No milk, no eggs, small hope,” bringing into focus a narrative of adversity. Yet, as Dr. Ratnayake delves, Sri Lanka’s indomitable spirit rallied, surmounting food scarcity and financial turmoil, even amid the superimposition of a two-year economic crisis driven by the Covid-19 pandemic.
Undeterred by these challenges, the Government exhibited unwavering resolve in tackling the pandemic’s multifaceted impact.
With vigour and confidence, the administration extended economic assistance to approximately five million households, later scaling additional welfare payments of Rs 5,000 to three million families. In a determined bid to tackle the pandemic head-on, the nation sourced top-tier vaccines and adeptly curbed its worst manifestations.
Remarkably, amidst a declaration of bankruptcy to international lenders, the Government’s commitment to social welfare stood resolute.
Dr. Ratnayake’s insights spotlight the heroic efforts that sustained essential services, education, healthcare, and more, while simultaneously providing crucial support to society’s most vulnerable segments.
Bankruptcy
“Even after declaring bankruptcy to international lenders, the country continued to provide social welfare to 1.7 million people, disability and old age payments to a further 0.7 million people monthly while maintaining other much more comprehensive welfare programs such as education and health for all, unabated”, Dr. Ratnayake said.
Economic fluctuations come into sharp focus, with inflation spiraling to 67.4 percent in September 2022 before plummeting to 6.3 percent in July 2023. Correspondingly, food inflation, which had surged to a daunting 94.9 percent in September 2022, dwindled to a mere 1.4 percent by June 2023. Foreign exchange shortages gradually eased, paralleled by a substantial appreciation in the US Dollar (USD) to the Sri Lankan Rupee (LKR) parity rate, enhancing import accessibility.
Transitioning to the heart of the matter—the UNICEF report’s depiction of deteriorating food insecurity—Dr. Ratnayake probes deeper.
He elucidates that the report, while depicting challenges during the dry season, fails to acknowledge the mechanisms that spring into action as monsoon rains bring an abundance of food.
“The UNICEF report highlights that food insecurity in the country deteriorated between October 2022 and February 2023, and 28 percent of the population was moderately or acutely food insecure. Incidentally, this is the worst part of the dry period of the year; with monsoon rains, the situation eased by February, marking the end of the dry season when all types of food beginning to reach the markets.
People also gather wild food, collect green vegetables planted in gardens, and bring more vegetables to rural farming families for consumption”, Dr. Ratnayake said.
Expenditures
The report’s implications extend to a speculation that heightened food expenses compromise expenditures on education and healthcare. However, Dr. Ratnayake injects skepticism, underscoring the fragility of the data’s foundation.
He challenges the report’s assertion that 2.9 million children faced dire needs, emphasising the tendency of educated mothers to prioritise their children’s sustenance even amid dire economic circumstances.
“The information gathered from those sources is only helpful in making a conditional region-based awareness rather than making national predictions. Especially the statement that 2.9 million children were in need during the period was too dangerous.
It provided little evidence to measure the intra-household dynamics where educated mothers habitually allocate more food and feed young children even in a disastrous economic situation”
Amidst these intricacies, Dr. Ratnayake highlights the critical need for a comprehensive island-wide survey. Crafting a broad analysis based on sporadic sample studies, he said, paints an unrealistic picture.
His scrutiny extends to the report’s amalgamation of pandemic and seasonality issues, cautioning against drawing generalised conclusions from region-based awareness.
Dr. Ratnayake addresses a pivotal aspect—the impending health crisis as indicated by the disparities in data reporting. As the conversation delves into anthropometric standards, he unpacks the complexities surrounding underweight babies, stunting, and wasting.
These findings, though concerning, form part of an ongoing discourse aimed at comprehending their holistic implications.
“The observation that 5.3 million people were already skipping meals as a coping strategy is problematic and without much strong data foundation. The information presented in the report mixed up the seasonality issues and a pandemic situation.
Dismal
The purpose of the report is perhaps to attract international donors to provide more money for the excellent work carried out by the Agency by presenting a dismal case confined to the dry season scenario, which obviously will give a different picture of the harvesting period to follow.
Also included in the report is the incidence of very high wasting and the child malnutrition situation to worsen in the coming months”
The interview then navigated to protein requirements and shifting dietary patterns. Dr. Ratnayake shines a spotlight on Sri Lankan food tables compiled by the MRI, showcasing the availability of protein-rich vegetables. He aligns this with the evolving recommendations in global dietary trends, championing a balanced diet that embraces fish products and dairy.
“Yes, we encountered a severe issue and unsettled problem with nutritional measurements. To rectify this situation, the WHO commenced a “Multi-Centre Growth Reference” study commissioned to correct countrywide deviations of the anthropometric standards.
Many physiologists in this country who addressed the issue have not reached a final decision. We have an unresolved problem of underweight babies; for the last 25 years, the number remains mote static at 15 per thousand live births—both stunting and wasting increase with the advancement of age.
Also, waste among breastfed babies is larger than bottle-fed babies. The functional significance of these findings is yet to be studied comprehensively and certainly influences the life cycle performance of affected persons.
More importantly, in the long term, severe malnutrition affects children’s cognitive development in their future life and even physical performance. They will be susceptible to some Non-Communicable Diseases (NCDs) more than others, according to WHO findings. However, the effort of UNICEF to flag these issues is commendable, except for underweight; the other anthropometric measurements have many unresolved technical problems”, he said.
Methodology
Discrepancies in data reporting arise with the methodology and the timing of the survey period. For example, the more comprehensive DHS survey of 2016 found among the under-five population, 17.3 percent of stunting, 15.1 percent of wasting and 20.5 percent of underweight.
“It is too early for us to evaluate the outcomes of such a human disaster, where some results are long-term while others are near-term. The vital statistics published by the Family Health Bureau failed to show any difference in the outcome of a notable human disaster.
Though the protein requirements and how you assess it has changed worldwide, the recommended dietary allowance as per WHO to prevent deficiency of an average sedentary adult is 0.8 grams per Kg of body weight.
We still follow the old-fashioned guidelines and say we have less protein as we do not eat eggs, milk and butter in our food.
The Sri Lankan food tables compiled by the Medical Research Institute (MRI) show many vegetables with high protein and digestible ratios that provide sufficient protein to the population.
The US Department of Agriculture has given a new recommendation on food consumption, promoting more vegetable-based food and discouraging some types of red meat consumption. However, they encourage people to eat more fish products and some dairy products in a balanced diet.
He said that despite a financial crisis, the Government’s social welfare commitments remained unaffected. As per recent information (Institute of Health Policy), the Government spent an estimated 3.3 percent of its GDP on Health and 2.9 percent of its national income in 2018, just before the Covid-19 pandemic.
This included both public and private financing and was low compared to other developing countries and less than the average of 4.1 percent in lower-middle-income economies.
“Current spending on Health, excluding capital investment, came to Rs 423 billion, or Rs 20,000 per person (US$ 122) in 2018. Capital investments added another Rs. 58 billion. There appears to be a long-term increase in the public share of financing. This is comparable with the global experience, where countries have shifted to increased reliance on public funding as incomes have risen.
Spending
The Government—or public—share of spending reached 48 percent in 2018, up from 42 percent in 1990. Most spending is on in-patient care (41 percent), buying medicines from pharmacies (19 percent), and outpatient care (19 percent).
The recent trend has been for in-patient care to increase its share. Public Health Spending is equal mainly between provinces, but private spending is not, strongly favouring the better-off regions,” Dr. Ratnayake said.
A significant initiative, the Aswesuma program, takes centre stage, providing cash grants to low-income families and individuals grappling with disabilities, cancer, and other health challenges. These endeavours, as Dr. Ratnayake underscores, stand as a testament to the Government’s unwavering commitment to social welfare.
“This enables 2.1 million families (about 9 million people) to receive monthly cash grants varying from Rs. 5,000 to Rs. 15,000. Additionally, another 700,000 people with disabilities, Chronic Kidney Disease (CKD), cancer and old age pension receive monthly benefits up to Rs. 5,000. These payments are made in addition to 35 other social welfare programs implemented by the Government, Provincial Councils and Local Authorities”
Dr. Ratnayake presented a panoramic view of the nation’s resilience. Amidst challenges, he underscores the need for a balanced perspective, emphasising that while the crisis may be transient, the foundation laid by expanded social welfare programs and enhanced food production portends a more promising future. Reflecting on the nation’s positive deviation from global trends, he said Sri Lanka’s trajectory emerges as a beacon of hope and determination.