Nutritional intervention in Mozambique: Policies and progress?

Despite numerous interventions over the years, Mozambique is still grappling with persistent chronic malnutrition, with 37% of children aged under 5 years in the country being stunted. This exploratory study considered Demographic and Health Surveys (DHS), Family Budget Surveys (FBS), Standardized Monitoring and Assessment of Relief and Transition (SMART) Surveys, Integrated Classification of Food Security Phase (IPC), Economic and Social Plans (PES), and FAO Database (FAOSTAT) – as well as other more specific survey data pertinent to the country – to determine how malnutrition rates were affected by various policies that were implemented concurrently.

This is a crude analysis which can only provide a high-level summary of the situation in Mozambique. Heterogeneity (of different surveys) remains a key challenge, as it is not appropriate to compare exact figures from different surveys, using different methods, across multiple years. Nevertheless, when comparing the same surveys across different time points, it is clear that little impact has been achieved, for stunting and wasting, despite the implementation of several initiatives: PARPA (2001–2005, 2006–2009), ESAN II (2008–2015), and PAMRDC (2010–2020). Both stunting and wasting prevalence have remained broadly stable between 2003 and 2023, with minor oscillations. Wasting prevalence did fall from 11% in 1997 to 4% in 2003 (DHS) – the only notable change during the study period.

As is seen in many countries, stunting rates vary dramatically by region (from 46.7% in Nampula and 45% in Cabo Delgado to 8.1% in Maputo province, in 2021), which in turn reflects an urban–rural disparity. Notably, illiteracy rates were higher in the northern, high-burden provinces (up to 61.1% in Cabo Delgado). Access to drinking water mirrored this trend, with 80% of families reporting access in the south, compared to less than 50% in the north and under 70% in the centre. More generally, the authors highlight the role of hidden debt, armed conflict, COVID-19, cyclones, and poor monitoring and reporting data, citing these as barriers to adequate nutrition. This led the authors to recommend the following policy steps:

“Ensure an equitable distribution of resources to all provinces and between rural and urban areas, control the situation of peace and stability throughout the national territory, invest in agricultural technology policies, increase the number of hospitals with a focus on rural areas, establish strengthening policies on climate change and, finally, to bet on a robust and realistic monitoring and evaluation system for the public policies created.”

Such policy focuses have achieved success in other countries and the authors are optimistic in their conclusion that ‘the country remains on course to reverse the situation’. However, it remains to be seen how Mozambique can find a way to implement each of these suggestions when facing such a variety of development challenges. Reducing the urban–rural divide, focusing on higher-burden regions, may be an appropriate place to start.