The double burden of malnutrition in Bolivia
Today we post another blog in the category country highlight. We hope you enjoyed reading about the situation in Brazil and Ecuador. Today, we want to inform you about the situation of the double burden of malnutrition in Bolivia. If you have any questions, please feel free to comment below.
Country overview
In the West-central of South America, you can find Bolivia. Bolivia has 11.7 million inhabitants and is classified as a lower-middle-income country. However, Bolivia is considered as one of the least developed and poorest countries in South America. While the official language is Spanish, other common languages are Quechua and Aymara. Furthermore, 1% of the population speaks Guarani. Bolivia is undergoing rapid urbanization and it is also seeing rapid changes in food systems due to the nutrition transition. This has a big impact on the living conditions and the health of populations.
Health system
The public health services in Bolivia are limited. The health system of Bolivia consists of three different sectors: the public-, social security- and private sub-sector. The public sector (which covers 30% of the population) involves the Ministry of Health. This ministry is responsible for providing national health policies at the central level. At the local level, they provide health facilities and services for the low-income population. Social security (which covers 27% of the population) is a sub-sector that is still developing. It provides social security for paid employees that work in the formal sector. The biggest fund for this sector is the National Health insurance. The private sub-sector covers 20% of the population and consists of profit and non-for-profit organizations that finance health care. These three sub-sectors are not enough to finance health care for the whole population of Bolivia. This is due to a lack of human, financial, and physical resources. As a result, many citizens of Bolivia experience a lack of health care facilities. The Bolivian government is therefore working to reform the healthcare system to ensure that all citizens have access to health care facilities, thereby improving the population’s overall health.
The double burden of malnutrition
Bolivia is first in the top 3 countries with the highest infant mortality rate in the district followed by Venezuela and Guyana. This is because there are high rates of inequality, due to tough economic and political situations. In rural areas, there is a lack of access to education, sanitation, electricity, and clean drinking water. Malnutrition and especially malnutrition in children under the age of five is prevalent. In rural areas, this is mostly stunting and in urban areas, this is mostly overweight and nutrient deficiencies.
Changes in nutrition, caused by the nutritional transition, are associated with lower physical activity and increased consumption of highly processed food. Together with rapid urbanization, this leads to an increase in individuals that are overweight. Undernutrition, overweight, micronutrient deficiencies, and child malnutrition cause a big problem in Bolivia. On a household level, you see both overweight and undernourished members and within individuals, you see overweight with anemia or slow growth. In rural areas the prevalence of anemia in women was 62.5% and in children 75%, while in urban areas 42.7% of women and 62.4% of children suffered from anemia. The percentage of individuals living with anemia in rural areas is thus higher than in urban areas. Stunting (20.5%) and overweight (12%) levels were highest for children in peri-urban areas. These numbers also show that the double burden of malnutrition is very prevalent on the population level.
Causes
There are a few causes that influence the double burden of malnutrition in Bolivia. A very important one is the difference in climate within the country due to the geographical variety. A few parts of Bolivia experience extreme droughts resulting in food shortages. This problem is getting bigger due to climate change. Populations living in poverty do not have the resources to access healthy and enough food. Both food shortage and low access to food could result in undernutrition. In urban areas, the most important cause is the nutrition transition linked with low physical activity and intake of highly processed food. This transition in lifestyle could cause an increase in the number of overweight people, while consumption of highly processed food over a longer period of time could cause micronutrient deficiency.
Interventions
Besides reforming the health systems reforming, the Bolivian government also implemented the Multi Sectoral Zero Malnutrition Program in 2008. This program focuses on food security and nutrition initiatives. To achieve this, stakeholders are being attracted, experiences are shared with other countries, and support and education will be offered to citizens on malnutrition prevention. This program includes the same initiatives that were in place in 1970. However, at that time the policy was failing. This time, a lot of plans were proposed, while only a few actions were taken. Nonetheless, these actions did prove to be successful and were mainly focused on reducing the prevalence of stunting. Even though the actions were successful, the government needs to take more action to make a change.
Conclusion
The double burden of malnutrition in Bolivia is very prevalent on the household level as well the population level. With urbanization and the nutrition transition still in place, it is thought that the double burden of malnutrition will increase even more in the future. The Bolivian government should interfere with clear policies to tackle the problem. This has been tried already with the Multi Sectoral Zero Malnutrition Program. However, the health system is being reformed with the goal to improve the population’s overall health. This is necessary to decrease the double burden of malnutrition.
