IHP 501 Module Nine 9-1 Project

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1 9-1 Project: Humanitarian Aid Trip Jennifer Morales Southern New Hampshire University IHP 501: Global Health and Diversity Dr. Carolina Baldwin April 28, 2024

2 9-1 Project: Humanitarian Aid Trip Kiribati is a nation of 33 atolls and reef islands in the central Pacific Ocean. Malnutrition is a serious health issue the nation faces despite its breathtaking natural beauty. This problem poses serious risks to women's and children's health and wellbeing, making it especially serious for them. In addition to the present population, addressing malnutrition in Kiribati is essential for the country's sustainability and future economic growth. In this situation, it is critical to comprehend the causes of malnutrition and to put into practice efficient interventions. Overview Kiribati is a nation of 33 atolls and reef islands in the central Pacific Ocean. Based on interpolation of the most recent United Nations data, Kiribati's population as of April 25, 2024, is 142,423 ( Statistics Times , n.d.). The nation is confronted with noteworthy socioeconomic obstacles, such as restricted availability of healthcare facilities, a high rate of poverty, and dependence on subsistence farming and fishing. Food insecurity and malnutrition are problems that are exacerbated by these factors, especially for children under five and women who are pregnant or nursing. Upwards of 90% of children in the island nation of Kiribati live in food poverty, a condition marked by daily diets consisting of one to four different food groups rather than the advised five to eight. This information comes from a disturbing new study conducted by UNICEF (Keck, 2022). The fact that anemia is common among women who can bear children emphasizes how serious Kiribati's malnutrition crisis is (Keck, 2022). Purpose and Value The main causes of malnutrition must be addressed to prevent malnutrition in women and children in Kiribati. This was undoubtedly a difficult task given the many complicating factors,

3 including Kiribati's remote location, its reliance on imported foods—particularly rice that is subsidized—the overcrowding in Tarawa, inadequate sanitation, and a general lack of knowledge about how eating a healthy diet improves one's quality of life (MEYER Business On The Frontlines Program, n.d.). The objective is to combat malnutrition using traditional methods like micronutrient powders, deworming tablets, vitamin A capsules, ready-to-use therapeutic foods (RUTF), and folic acid tablets ( The Changing Face of Malnutrition , 2019). Analysis Resource Availability Undernutrition (wasting, stunting, and underweight), insufficient vitamins and minerals, overweight, obesity, and the ensuing noncommunicable diseases linked to diet are all considered forms of malnutrition (World Health Organization: WHO, 2024). In Kiribati, secondary education is competitive, with less than twenty percent of primary school graduates going on to secondary school ( Kiribati , n.d.). Access to Care and Quality of Health Services Regional and international mobility is necessary for Kiribati's healthcare system to function (MarazitaIII, 2021). Advanced illness treatment needs to be outsourced to hospitals outside of Kiribati, like those in Fiji or India (MarazitaIII, 2021). Cultural Context Despite being one of the poorest and most remote countries in the Pacific, Kiribati boasts the most productive tuna industry, according to Webb (2020). The World Bank classifies Kiribati as a low-income nation, and the UN lists it as a least developed nation (Webb, 2020). There are

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4 two distinct periods in the economy: before and after the Vessel Day Scheme (VDS) was put into effect (Webb, 2020). Other Determinants To quantify the disparity in the distribution of services in developing regions, an analysis was finished ( Inequality of Opportunity: Who Are Those Left Behind?: Kiribati , 2021). According to Inequality of Opportunity: Who Are Those Left Behind?: Kiribati (2021), nine opportunities were found to be impeding the potential of the people of Kiribati. Having access to clean fuels, electricity, education, clean drinking water, and sanitation are a few of these factors ( Inequality of Opportunity: Who Are Those Left Behind?: Kiribati , 2021). Evaluation Policies The country's commitment to improving the nutritional well-being of all Kiribati and mitigating the problem of malnutrition in the population is embodied in the Nutrition Policy and Plan of Action of Kiribati, which lays out the policies the government adopts as a manifestation of this commitment along with the national plan of action to carry these policies out (KANAM, n.d.). The goal of WHO's Mental Health Gap Action Program (mhGAP) is to raise awareness and educate people about mental health issues for those who are experiencing or know someone who is experiencing mental illness (World Health Organization: WHO, 2022). Tekinano said, "Mental health is a problem in Kiribati because of stigma, a lack of understanding, and people's belief that mental health is a spiritual issue and requires treatment with magic." (World Health Organization: WHO, 2022). Information on the prevalence of mental illness in Kiribati is lacking (World Health Organization: WHO, 2022).

5 Systems There are many obstacles facing Kiribati's healthcare system that affect social justice, equity, and healthcare access, especially in relation to malnutrition. Given the information above, the population of Kiribati is being significantly impacted by the high and rising prevalence of NCDs and infectious diseases. It is thought that the two most vulnerable groups affected by disease and climate change are women and children. Due to poverty and restricted access to healthcare, more than 22% of the population does not have access to necessities (Thelwell, 2020). People on the island find it challenging to get medical attention before their conditions worsen because of where the hospitals are located (Thelwell, 2020). Due to a shortage of qualified professionals, many severe medical conditions are treated outside of the island (Thelwell, 2020). It is practically impossible for women and children to be seen because of these challenging circumstances (Thelwell, 2020). While their nation is expanding, Kiribati is still working to lower its rates of poverty and enhance its healthcare system, but there is still more work to be done (Thelwell, 2020). The high rates of malnutrition among women and children in Kiribati are a direct result of these challenges, which also contribute to negative health outcomes and disparities. Resolving these systemic issues is essential to improving healthcare outcomes and access in the nation. Recommendations Intervention The objective is to combat malnutrition using traditional methods like micronutrient powders, deworming tablets, vitamin A capsules, ready-to-use therapeutic foods (RUTF), and folic acid tablets ( The Changing Face of Malnutrition , 2019). To achieve the greatest

6 improvement in women's and children's nutritional status, this intervention should be used in conjunction with the traditional intervention. A group of highly skilled people who can support the Nutrition social and behavior change communication program should be present in addition to the core personnel staff (SBCC). Owing to the SBCC's planned process, each step will be the focus of a team consisting of two people (USAID Advancing Nutrition, 2022). Education supplies and assessment tools to gauge Kiribati's population are required to carry out this CIH intervention. These resources will be used to interact with people, families, government officials, business executives, and religious leaders (USAID Advancing Nutrition, 2022). The supplies needed to carry out the conventional intervention should also be regarded as supplies for the CIH intervention because this type of intervention should be used in conjunction with it. The cost of the evaluation and instructional materials required to implement SBCC could range from $5000 to $100,000 because the materials must be specifically developed with the Kiribati people in mind, with a focus on women and children. This also covers the price of printing every material. Social Justice To accomplish objectives and transform communities, a thorough understanding of nutritional justice as social justice is necessary (Hanieh et al., 2020). The goal of social and behavior change (SBC) programming is to apply astute understanding of human motivations, the ways in which economic systems influence behavior, and the ways in which these kinds of behaviors lead to favorable consequences (USAID Advancing Nutrition, 2022). To support families and lower barriers to malnutrition, nutrition social and behavior change communication (SBCC) combines several interventions with interpersonal communication, social change, and advocacy (USAID Advancing Nutrition, 2022). People in Kiribati will benefit from this intervention when combined with the traditional intervention because eating decisions and

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7 behaviors are often made daily and are often very unconscious habits (USAID Advancing Nutrition, 2022). The impact of malnutrition is significant because eating habits and nutritional decisions can be connected to social and cultural norms (USAID Advancing Nutrition, 2022). The behaviors related to nutrition are important because Kiribati suffers with inadequate care and feeding practices, food insecurity, unhygienic environments, and inadequate healthcare services (USAID Advancing Nutrition, 2022). Strengthen Communities and Reduce Health Disparities There will always be a need for more services in communities, claims (Stevenson University (n.d.). It will be necessary to have an emergency response manager to oversee the mission and serve as the primary disaster coordinator (Duncan et al., 2023). The logistics coordinator will be responsible for managing the transportation, storage, and distribution of any aid for the trip. This position will also help to oversee grants and other financial matters (Duncan et al., 2023). A technical advisor will help with food security and nutrition programming (Duncan et al., 2023). The partnership manager will help secure supplies from other organizations so that Kiribati residents can receive additional supplements (Duncan et al., 2023). A communications officer will facilitate team-island communications and collect additional data for media coverage (Duncan et al., 2023). Scales, glucometers, lab supplies, screening tools, and additional educational materials for individuals with low literacy levels are among the other items that might be required. The low cost of vitamin A supplementation (VAS), which varies between 0.50 and 1.50 USD per capsule depending on geographic and temporal variations while maintaining high efficacy in lowering VAD, has made it a popular intervention (Kannan et al., 2022). The cost of a single Fortitech micronutrient powder box is approximately $0.61 (UNICEF, 2021). First aid kits range in price from $10 to $50 per kit, depending on the kind of

8 supplies required. However, creating several customized kits could be more affordable ( American Red Cross Training Services , n.d.). Depending on the quantity, silverware, bottles, plates, bowls, diapers, and sanitary supplies can cost anywhere from $2000-5000. Depending on quantity, educational materials may cost up to $1000. The cost of screening and lab supplies could range from about $4,000 to $10,000 (Chartercapdev, 2021). Effectiveness and Sustainability When aid is received, people will benefit and their lives will be altered because of the services offered (Stevenson University, n.d.). By helping with this, relationships are formed, and those helping decide to help others while also picking up important life lessons (Stevenson University, n.d.). Combating malnutrition in Kiribati necessitates an all-encompassing, team- based strategy that combines traditional interventions with complementary and integrative health (CIH) techniques. By addressing underlying causes and promoting general health and well- being, CIH approaches have the potential to increase the effectiveness of nutritional interventions. Long-term solutions to malnutrition can also benefit from alternative intervention strategies that emphasize sustainable food systems and community empowerment. By integrating these strategies, we can endeavor to guarantee that Kiribati's women and children have access to the tools and assistance required to attain the best possible nutrition and health results. Conclusion In conclusion, despite its breathtaking natural beauty, Kiribati, with its 33 atolls and reef islands, struggles with the serious health issue of malnutrition. The seriousness of this issue is highlighted by the fact that it poses a serious threat to women's and children's health and wellbeing. In addition to being critical for the country's present population, addressing

9 malnutrition is also necessary for the country's sustainability and future economic expansion. It is essential to comprehend the root causes of this problem and put effective interventions in place to address it successfully. Kiribati can strive toward eliminating the scourge of malnutrition and guaranteeing a healthier future for its people by combining focused strategies and concerted efforts.

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10 References American Red Cross Training Services. (n.d.). First aid Kits, & Supplies | Red Cross Store . Red Cross. https://www.redcross.org/store/first-aid-supplies Chartercapdev. (2021, June 10). Lab Startup Equipment List and Average Costs - Charter Capital . Charter Capital. https://charteraz.com/2021/06/10/lab-startup-equipment-list- average-costs/ Duncan, Duncan, & Duncan. (2023, April 20). 13 Humanitarian jobs that let you travel the world . Humanitarian Careers - LAUNCH YOUR CAREER IN HUMANITARIAN AID. https://humanitariancareers.com/humanitarian-jobs-travel/ Eme, P. E., Kim, N. D., Douwes, J., Burlingame, B., Foliaki, S., & Wham, C. (2020). Are households in Kiribati nutrition secure? A case study of South Tarawa and Butaritari. Food and Nutrition Bulletin , 41 (1), 131–146. https://doi.org/10.1177/0379572119891024 Hanieh, S., High, H., & Boulton, J. (2020). Nutrition Justice: Uncovering Invisible Pathways to Malnutrition. Frontiers in Endocrinology , 11 . https://doi.org/10.3389/fendo.2020.00150 Inequality of opportunity : who are those left behind? : Kiribati . (2021, December 21). ESCAP. Retrieved April 24, 2024, from https://www.unescap.org/kp/2021/inequality-opportunity- who-are-those-left-behind-kiribati# KANAM. (n.d.). NUTRITION POLICY AND PLAN OF ACTION of KIRIBATI . https://faolex.fao.org/docs/pdf/kir160259.pdf Kannan, A., Tsoi, D., Xie, Y., Horst, C., Collins, J. K., & Flaxman, A. D. (2022). Cost- effectiveness of Vitamin A supplementation among children in three sub-Saharan African countries: An individual-based simulation model using estimates from Global Burden of Disease 2019. PloS One , 17 (4), e0266495. https://doi.org/10.1371/journal.pone.0266495

11 Keck, M. (2022, November 10). Over 9 in 10 children in Kiribati are living in food poverty: report . Global Citizen. https://www.globalcitizen.org/en/content/child-food-poverty- pacific-unicef/ Kiribati . (n.d.). https://education.stateuniversity.com/pages/781/Kiribati.html MarazitaIII, J. (2021). Healthcare Denied? Covid-19 and Kiribati’s Shrinking Transnational Space. In COVID in the Islands: A comparative perspective on the Caribbean and the Pacific (pp. 193–206). https://doi.org/10.1007/978-981-16-5285-1_10 MEYER Business On The Frontlines Program. (n.d.). Combating Malnutrition . University of Notre Dame. Retrieved April 19, 2024, from https://businessonthefrontlines.nd.edu/partners-projects/projects/2017-kiribati-combating- malnutrition Population of Kiribati . (n.d.). Statistics Times. Retrieved April 19, 2024, from https://statisticstimes.com/demographics/country/kiribati-population.php#:~:text=The %20current%20population%20of%20Kiribati,people%20for%20the%20year%202020 . Stevenson University. (n.d.). Stevenson University . https://www.stevenson.edu/online/about-us/news/service-strengthening-communities/ The changing face of malnutrition . (2019, October 14). Retrieved April 21, 2024, from https://sites.unicef.org/features/state-of-the-worlds-children-2019-nutrition/policy- agenda/ Thelwell, K. (2020, September 14). 5 Facts about healthcare in Kiribati . The Borgen Project. https://borgenproject.org/seo-key-term-healthcare-in-kiribati/

12 UNICEF. (2021). Multiple Micronutrient powder Supply and Market update . https://www.unicef.org/supply/media/566/file/Multiple-Micronutrient-Power-Market- Note-July-2021.pdf USAID Advancing Nutrition. (2022). Measuring social and behavior change in nutrition programs [Guide]. In A Guide for Evaluators . https://www.advancingnutrition.org/sites/default/files/2022-04/measuring_sbc_2022_0.p df Webb, J. (2020). Kiribati economic survey: Oceans of opportunity. Asia & the Pacific Policy Studies , 7 (1), 5–26. https://doi.org/10.1002/app5.297 World Health Organization: WHO. (2024, March 1). Malnutrition . https://www.who.int/news- room/fact-sheets/detail/malnutrition

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