La didáctica de la ERE

During colonial and occupation periods the nutritional status of the East Timorese was not a priority. Little effort was taken to improve the nutrition of the Timor-Leste people and those efforts were only partly implemented due to poor planning and insufficient funding. As a result, the number of children and pregnant women who suffered from moderate to severe malnutrition was still encountered in remote subdistricts of the country (UNDP 2009).

In the early days of its independence, Timor-Leste’s social and economic policies focused on lessening poverty to address the immediate needs of people, consolidating security and stability and providing a foundation for nationhood through building institutions.

Subsistence agriculture is the main economic sector of the country, with 80% of the country’s poor and 90% of the rural poor dependent on traditional staple foods like cassava and maize as a primary food source, but rice is replacing these as the preferred staple food (UN-WFP 2015). Timor-Leste’s food insecurity and vulnerability is aggravated by floods, strong winds, drought and annual pest infestations, and as a result, loss of food production. Low food production by small-holders, as well as under developed local markets, has led to a dependency on imports. Raising agricultural productivity and rural incomes remain key challenges (UNDP 2009).

According to a survey on malnutrition (TLDHS 2009-10) conducted after the 2006 crisis reported that there was a slight rise in the level of stunting, wasting, and underweight after the turmoil. Stunting increased from 49 percent to 53 percent, wasting increased from 12 percent to 17 percent, and being underweight increased from 46 percent to 52 percent (NSD 2010). Due to the issue of malnutrition and problems in other sectors after the unrest, the Timor-Leste government laid out the Fourth Constitutional Government Program for 2007-2012 as the country’s development strategy. The strategy defined its long term development goals in terms of reducing poverty and promoting the equitable growth and life of the Timorese population (NSD 2010).

In 2006, the Government of Timor-Leste focused its attention on recovering the economy and tackling the country’s social problems. The focus was to achieve food security and reduction of poverty in the remote areas by 2020. However, the nutritional status of children remained a serious problem and remains significantly below the acceptable world standard.

Agriculture is the main field of work for the East Timorese living in rural areas, followed by forestry and fisheries. About 85 % men and 40% women aged 15-49 years were employed in the agriculture sector in 2009 (NSD 2010). However, productivity remains relatively low.

Under-nutrition was a main problem since the country obtained its independence and it was reported that poor maternal and child health were two major public health issues that resulted from many factors, including unavailability of fortified nutrition food; food taboos and dietary practices that lead to low consumption of nutritional food; low knowledge of breastfeeding and time to initiate appropriate complementary foods; poor access to health services; high incidence of acute respiratory infection and diarrhoea; inadequate sanitation and hygiene practices; geographical isolation and a lack of adequate infrastructure (UN-WFP 2015).

Malnutrition in young children and under-nutrition among women has been highlighted through the country’s Demographic and Health Survey (TLDHS 2010) and recent surveys. For children, it was reported that 45% were underweight, 15% were severely underweight. Additionally, 58% of children aged under five years were stunted and

almost 33% were severely stunted. These three indicators show the severe state of malnutrition among young children (Noij 2011). According to the TLDHS 2010 the proportion of children who were thin for their height (wasted) had decreased from 25 percent to 19 percent and the percentage of underweight children had also declined by 8 percent over the previous two years. However, the percentage of severely underweight children remained the same. The report concluded that efforts to reduce malnutrition among children in Timor-Leste were showing positive results but still had a long way to go (NSD 2010).

Under-nutrition of women in Timor-Leste is especially a concern in remote areas. Reports over recent decades reveal the reduction of under-nutrition in women; however the figure remains high with more than one third of non-pregnant women aged 15–49 years and a quarter of men of the same age group suffering from chronic underweight with Body Mass Indexes below 18.5. This indicates a severe lack of food security (TL- SDP 2011). The most common forms of malnutrition found in Timor-Leste in 2010 were protein energy malnutrition (PEM) and micronutrient deficiencies (NSD 2010).

Timor-Leste’s Strategic Development Plan forms an integrated package and a road- map of strategic policies to achieve the country’s vision of a sustainable and inclusive development which aligns with United Nation’s Millennium Development Goals (MDGs). Through a joint effort between the Government of Timor-Leste and the United Nations-Millennium Development Goals Achievement Fund, (UN-MDGAF) a program to reduce malnutrition and under-nutrition was initiated in 2009. Several issues were covered by the program i.e. high level of food insecurity, inadequate access to health and nutrition services, high incidence of acute respiratory infection, malaria and diarrhoea, poor knowledge on young child feeding and caring practices (including breastfeeding) (GOTL 2009). In terms of food insecurity, it was reported that during the lean season (from October to March) the situation becomes more severe, especially in remote highland areas, among subsistence farmers and female-headed households. The main contributing factors of insecurity of food during the lean season were identified as inadequate staple food production and storage, recurrent natural disasters and low availability of quality seeds and other inputs for agriculture (Noij 2011).

According to Timor-Leste National Statistics Directorate, the country imported goods worth $670 million in 2012. Principal import categories in 2012 were electrical

machinery, fuel, electrical appliances, machinery, books, beverages, vegetables, cement, plastics, and cereals (including primary rice and sugar). Sugar imports into Timor-Leste are mainly from Indonesia and are 0.34 percent of all imported goods (National Policy and Strategy of the Ministry of Agriculture, Forestry and Fisheries 2004) (MAFF 2008). However, data on per capita sugar intake is not available. Rice and maize are mainly imported from Vietnam and Indonesia. In Timor-Leste, rice and maize are equally important as staple food crops, however, land suitable for rice production is limited and maize is more widely grown (National Policy and Strategy of the Ministry of Agriculture, Forestry and Fisheries 2004).

The UN-MDGs Achievement Fund identified agriculture of primary importance for 2020, aiming at attaining food security in the country and to diminish poverty in rural areas. Efforts are also being made to assist farmers to change the subsistence farming to commercial farming of crops, livestock and fisheries, improved farming practices and enhanced productivity. The program is especially focused on rice, maize and other staple food crops, fruits and vegetables and niche cash crop products and is implemented in districts of Timor-Leste which were identified as United Nations convergence districts, namely Baucau, Manatuto, Aileu and Oecusse (Noij 2011).

In order to improve the nutritional status of the Timorese, the Government of Timor- Leste (GOTL), via the analysis of MDG 1 on reduction of poverty and hunger, proposed an agenda for improving the nutritional condition of lactating women and young children (Noij 2011). It included prioritizing nutrition interventions for children under two years and pregnant, lactating mothers and adolescents, increasing the reach of education to promote increased feeding practices, including exclusive breastfeeding and timely introduction of complementary feeding; building community awareness, acceptance and engagement with nutritional services; establishing peer support mechanisms such as Mother Support Groups (MSG), Parent Teacher Associations (PTA), community health and nutritional champions and networks of community health volunteers; providing micro-nutrient supplementation (Vitamin A, ion, iodine, etc.) and food fortification (salt iodization) in consideration of food diversity; treating acute malnutrition at health facilities and at community level; the provision of safe drinking water and promotion of improved hygiene and sanitation in schools and communities (GOTL 2010, Noji 2011).

GOTL also started a program via community mobilization and Mother Support Groups in cooperation with a local Non-Government Organization (NGO): the Alola Foundation. This is a strong proponent for exclusive breastfeeding for children 0-6 months of age in Timor-Leste.