Shortfalls in nutrition training efforts

Although efforts to alleviate malnutrition in the third world have been made for some time, progress has been dramatically uneven. On a worldwide scale, the situation continues to be alarming, despite a number of success stories. The number of malnourished people has increased as the level of poverty has increased in South Asia and sub-Saharan Africa, where it is projected that almost half the children will be significantly underweight by the year 2000 [1]. Several factors constrain our ability to make a greater impact. A partial list includes the following:

Lack of coordination: Institutions of nutrition sciences in both developing and developed countries have not coordinated their efforts. Rather, they compete for resources and may jealously guard their territory. If individual scientists and institutions form regional partnerships to work collectively and exchange ideas and technology, they can make significant contributions to the reduction of malnutrition.

Weak implementation, monitoring, and evaluation: Implementation of nutrition programmes too often has been weak. This is an area where third-world officials have requested help. The response from the developed world has been to focus attention on "nutrition planning," attempts to systematically diagnose malnutrition problems and delineate appropriate national strategies to solve them. In this way, a nutritional dimension is incorporated into national development planning. Such planning efforts may be important in enabling governments to channel their scarce resources more effectively towards the attainment of nutritional goals [6]. However, despite the progress that has been made in this area, effective implementation demands more than a plan. It requires management, which involves mobilizing, organizing, and directing human and physical resources in programme implementation. Further, the nutrition-planning approach presupposes the stability of governments and institutions, although changes in both are common occurrences.

The incongruence of training and practice: Developing-country nationals who train in the North are often not available to teach others in their countries. The perils of investing disproportionately in government institutes must be considered carefully. Universities also may have their drawbacks in this respect. In some countries, national universities may be effectively closed to foreign-trained intellectuals. The reasons include bureaucratic hurdles, low salaries, hierarchies based on seniority, and professional politics.

Political instability and unavailability of skilled human resources: In some regions of the developing world, training institutions have been destroyed or rendered ineffectual by a lack of political stability. Often, where the need for effective nutrition infrastructure is most critical, the resources tend to be the most limited. This calls for a new approach and may require starting from scratch. Unlike South and South-East Asia and Latin America, much of sub-Saharan Africa does not have first- and second-generation nutrition scientists working in their home countries. In other areas, such as the Palestinian territories. Southern Sudan, and Ethiopia, trained scientists have fled or have been forced to leave and are now scattered throughout the world.

Shortage of funds: Lastly, we are in an era of constricted funding worldwide. The last decade has seen a contraction rather than an expansion of the willingness and interest of the developed countries to invest in the human resources of the South. Despite these difficult times, we should not forget that there are viable centres of excellence in these countries and trained, committed scientists who are willing and able to invest their time and energy in alleviating malnutrition.