Presidency fast-tracks strategy to end child stunting by 2030

In a race against the clock to eradicate childhood stunting by 2030, the Presidency has kick-started an interdepartmental task team that anti-hunger advocates hope will break down silos of fragmented operations in the government.

South Africa has one of the highest stunting rates in the world, which the task team puts at 28.8% for children under five – above the global average. This means almost one in three young children is affected by chronic undernutrition.

Stunting has significant consequences, as it affects children’s cognitive development and learning ability and impacts their later lives in terms of work and productivity. Experts say children must get the nutrients in the early phase of life, which is the critical phase of development.

Delivering his State of the Nation Address in February, President Cyril Ramaphosa announced that the government was planning to eradicate child stunting by 2030. He characterised stunting as “a massive crisis” that demands attention and resources, saying allocations for what needs to be done would be set out in the Medium-Term Budget Policy Statement (MTBPS) later this year.

Following up on his pledge, Ramaphosa established a special task team chaired by Saul Musker, the Presidency’s head of strategy and delivery support.

In an interview, Musker acknowledged that 2030 is an ambitious target, but said “we think it is achievable”. To reach its goal, the team is developing a detailed, funded action plan cutting across multiple departments. The team hopes to finalise the action plan by September for adoption by the Cabinet before a budget allocation in the MTBPS.

According to Musker, one of the reasons it is difficult to address child stunting is its many different causes. They include undernourished pregnant women who have a higher chance of a low birthweight baby, which affects stunting. There is also alcohol use during pregnancy and foetal alcohol syndrome, which is a significant problem in South Africa and is also connected to stunting. A lack of access to nutritious protein-rich foods is another major problem.

Among its focus areas, the task team is considering a maternal support grant, which would extend the child support grant to ­cover pregnancy from the second trimester. “It is critical that we make sure children get the nutrients they need in the very early phases – during the first 1,000 days, which is the critical phase of cognitive development – so that they can thrive later in life,” said Musker.

“If we are able to address this challenge, then we would also reduce the burden on the education and health systems, which at the moment have to shoulder this burden. That is the scale of the challenge.”

The team is also looking at augmenting supplements for pregnant women, who currently receive iron and folate, by introducing multiple micronutrients.

Expanding access to nutritious food during the first two years of a child’s life is another focus area. In this regard, Musker said the team was also looking at “food fortification”, which would include vital vitamins and minerals.

‘Critical breakthrough’

The establishment of the interdepartmental task team headed by the Presidency is “an absolutely critical breakthrough”, according to Dr David Harrison, chief exe­cutive of the DG Murray Trust, which promotes child nutrition.

“Part of the reason we have not made progress on stunting and issues of nutrition in South Africa is that nutrition is every department’s responsibility, but nobody’s responsibility. It’s an issue that falls between the cracks precisely because so many departments have responsibility for components of it,” he said.

Harrison said the responsibility for stunting has previously been relegated to fairly junior officials in government departments. Many were committed, but they lacked the authority to influence their departments, let alone the ability to convene an across-government engagement needed to drive progress.

“So, centralising it [in the Presidency] provides clear leadership and a mechanism to be able to honestly collect the methods of the departments, but also to enable them to understand that what they’re doing is not sufficient,” he said.

Highlighting the critical importance of the first 1,000 days, which includes 280 days of pregnancy, Harrison said the “lifelong potential of a child is really concentrated or crammed” into this period.

“That is not to say the rest is unimportant. It sort of sets the rate of return for any further investments in a child. It’s an incredibly powerful and important phase of life and that’s why it’s important that we get it right.

“If we don’t, children are exposed to a vicious set of dominoes: moms don’t have enough nutrition, they’re exposed to alcohol during pregnancy and they’re exposed to HIV during pregnancy that’s untreated by ARVs, [and children are born into environments with too little food], dirty water and poor sanitation. All of these are cumulative insults – each of them is like a domino knocking down the next…”

Harrison drew on studies in India which found that stunted children have an IQ deficit of about four to five points on average compared with non-stunted children.

“What happens is that, even from birth, those children are not able to respond to parents’ stimulation or engagement with them. They’re already starting off on the lower path. Even if they get to an early learning programme, their ability to benefit from the programme is limited.”

Although there is catch-up growth and development, it’s harder for these children to learn. “They are the children that are more likely not to be able to read for meaning … drop out of school and ultimately are not going to be able to get jobs.”

Basic Education Minister Siviwe Gwarube’s spokesperson, Lukhanyo Vangqa, pointed out that the department spends more than R10-billion a year on the National School Nutrition Programme to provide 9.7 million meals per day.

The programme starts in primary school when children turn six. For early childhood development (ECD) centres, the department provides a subsidy of R24 per child per day to qualifying centres, which includes at least one meal a day.

“The department is now piloting an ECD nutrition programme in the Eastern Cape; the view is to roll this out to all ECD centres in the country,” Vangqa said.

He quoted a Thrive by Five Index statistic that 7% of children enrolled in ECD centres in South Africa are affected by stunting.

“The minister has maintained that child stunting is a blight on our collective consciousness,” he said. DM

This story was produced by The Education Desk, a non-profit newsroom dedicated to addressing schooling challenges in South Africa.

This story first appeared in our weekly DM168 newspaper, available countrywide for R35.