Foregrounding 'Community' in Community Management of Severe Acute Malnutrition

An Indian Perspective

Abstract

The issue of widespread food insecurity amongst children in Africa and Asia has often been narrowed to the discourse on 'severe acute malnutrition (SAM)' in the last decade. Further, conflicting notions exist in relation to the root causes and solutions for SAM; ranging from the dominant view that it is a medical emergency needing medical/technical assistance, to it being perceived as a socio-economic-political phenomenon, to be managed largely by enhancing the agency of the affected families and communities. Much recent experience, and some evidence, has emerged that suggests that SAM in India is a unique phenomenon with distinct differences from its counterpart in Africa. Nonetheless, the technical community has been slow to acknowledge these differences, leave alone alter their recommendations accordingly. These differences in understanding are sharply evident in the interpretation of community management of acute malnutrition (CMAM) in particular.

This paper examines these differences; factual and perceptual, and critically interrogates the definition and programmatic interpretation of CMAM that is in current usage, which results in the further marginalization and dependence of the affected community upon external resources. It also highlights the characteristics of alternate programmes for CMAM using a few models for illustration.