5. Political Economy of Malnutrition in Sri Lanka

Nutrition in Sri Lanka has traditionally been assigned to the medical profession. After the recent 2001 elections, the government elevated nutrition to a ministerial level and created the Ministry of Healthcare and Nutrition (MOH). Several departments are involved with nutrition in this ministry: the Nutrition Coordination Division, Directorate of Nutrition, Family Health Bureau, Medical Research Institute, Health Education Bureau, and Epidemiology Unit. All but one of these agencies are under the Deputy Director General of Health Services-Public Health (DDGPHS). The Medical Research Institute functions under the Deputy Director General of Health Services-Education, Training and Research (DDGET and R). The primary responsibility for nutrition lies with the Family Health Bureau (FHB), which makes most decisions regarding policy and strategy. The Public Health Midwives (PHMs) are the key implementation agents. The Nutrition Coordination Division coordinates among agencies external to the MOH, and the Directorate of Nutrition coordinates all nutrition-relevant activities within the MOH. However, many agree that there is little functional coordination among these units, as is the case in other countries. In the Estate sector, most service delivery for the social sectors, including health and nutrition, is through the Plantation Human Development Trust which is not linked or accountable to the public sector. This chapter attempts to outline the complex political economy of nutrition in Sri Lanka. The political discourse in post-colonial Sri Lanka has led to divergent views about nutrition, its causes, and potential solutions. Under the circumstances, the policy choices adopted have not always been based on evidence of what works. Policy-makers and program designers rarely appreciate the multifaceted causes (and potential demand-side solutions) for undernutrition.