Peru: Coming together to improve Nutrition
It was a perfect April morning in Puno, Peru, sunshine covering every inch of earth in sight. Standing atop a hill in a small district of Huancané, I took it all in. Encircled by indigenous women in traditional dress, wearing white tunics with soft touches of lace and beautifully embellished skirts in a striking shade of green, I inhaled crisp cold air and attempted to permanently engrain the moment in my memory. Views of Lake Titicaca, surrounded by rolling green hills and tiny mudbrick houses, are beautiful distractions from the truth. Puno, while breath-taking, is one of the most difficult Peruvian states to live in. At 12,420 feet, winter in the Andes is brutal, with long months of sub-zero temperatures, increasing incidence of floods, and bitter high winds— it mercilessly takes lives every year, often children plagued with respiratory disease resulting from lack of warm clothing and shelter, with many more left suffering, hungry, and fearful that they will not be resilience enough to withstand another winter.
While Peru has been recently classified by the World Bank as an upper-middle-income economy, its economy flourishing with tourism and foreign investment, rampant malnutrition continues to hinder its rapid development. For this reason, leading humanitarian organization CARE convened the Initiative against Chronic Infant Malnutrition, a multi-actor alliance to advocate for children all across Peru. Through advocacy at the highest level of government, the alliance obtained political commitment from presidential candidates in every election from 2006 to date, making the reduction of chronic infant malnutrition a national priority and the result is staggering. The government, held accountable by the Initiative against Chronic Infant Malnutrition, led and implemented the necessary policies and actions to have a lasting impact on its citizens, reducing chronic infant malnutrition from 28.5% in 2007 to 14.6% in 2014, preventing 430,000 children from becoming malnourished.
While the success of this initiative is evident, Peru continues to grapple with addressing the disparity between rural and urban communities. In 2010, the Pan American Health Organization reported a 24.7% difference in prevalence of chronic infant malnutrition between urban and rural areas, that’s 14.1% and 38.8% respectively. When compared to urban areas, children (under the age of 5) in rural communities are 12.7% more likely to have anemia, 35.3% less likely to have institutional care during childbirth, 94% more likely to die during childhood, and 36% more likely to die during infancy. Nearly 50% of rural populations live in poverty. In an effort to combat the chronic infant malnutrition and extreme poverty, the Peruvian government launched “JUNTOS”, a national conditional cash-transfer program that operates in some of the poorest districts across Peru. This flagship social welfare program provides a cash-transfer of 200 Peruvian Soles every two months, given beneficiaries meet the requirements of the program such as enrolling their children in school and taking them to the community health center for regular visits. While some of its key objectives are to reduce poverty and build human capital, the program also aims to impact the nutritional status of children—reducing malnutrition and anemia in some of the most marginalized communities throughout the country.
On that perfect April morning, atop that hill in Huancané, I saw the JUNTOS program first hand. The beneficiaries welcomed us with intricately woven flower necklaces, shy smiles, and a buzz of excitement. It was electrifying. We proceeded to a quaint room where we witnessed a cooking demonstration that left the visitors laughing, bellies full, and a step closer to understanding the real life changes these women are making to improve the nutritional status of their children. With more than 3,800 types of potatoes, native quinoa, and naturally freeze dried yucca, the variety of nutritious meals and local recipes presented was astonishing. The staff, driven by passion and love for what they do, were visibly connected to the program’s mission. Their interactions with JUNTO’s beneficiaries was serious at times, driving home one of the main objectives their work—to reduce chronic infant malnutrition and anemia among their children. While I was surprised at their tone initially, the more I understood the context, the more I recognized the pressure to succeed. In the province of Puno, 56% of the population are poor. Per capita income, on average, is almost half the national average. One out of every two children has anemia and 21% are chronically malnourished. Children under the age of 5 are more than twice as likely to die. As grim as the statistics may be, on this day, I could see nothing but pride in each and every individual around me. Even more, I was astonished at how strong people can be. How they, year after year, withstand the harsh conditions that chill you to the bone. With the help of JUNTOS staff, these families are doing whatever it takes to change the status quo so that one day, in Peru, it won’t matter where you are born or what ethnic group you belong to—you can live a life without fear of hunger and suffering. You can live a life of dignity and know, with certainty, that you are strong enough to withstand the winter.
About the Author: Maria Hinson is the Senior Program Officer for the Cargill Partnership for the Food and Nutrition Security Unit at CARE USA. She has 2 years of experience in global health and international development, working with communities to improve ongoing program interventions. She has a Master’s in Global Health from the University of Notre Dame.
About the Program: The National Program of Direct Support to the Poorest –"JUNTOS", is a program of conditioned monetary transferences that is part of the Peruvian Government´s social policy and the fight against poverty policy. JUNTO was created in April 7, 2005 with the aim of contributing to poverty reduction, by granting incentives for the access and use of health services – nutrition and education. The program is based on the approach of returning basic rights to the population, with the organized participation and the surveillance of social leaders from the community. The incentive is conditioned to fulfilling assumed commitments, which are intended to promote and guarantee access and participation of households in extreme poverty (with children and adolescents up to 19 years of age and pregnant women) in the areas of health-nutrition, education and identity; thus promoting by this the principle of joint responsibility. The JUNTOS Program started to operate in Puno in 2006 in 36 districts, with 8 231 affiliated households. Today, JUNTOS reaches 13 provinces that include 104 intervened districts with 63,529 affiliated households.