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Peruvian Welfare State

Human rights in Peru

Malnutrition in Peru

Good Article but not very much is represented on what has been done to alleviate malnutrition in Peru besides government help. I'm thinking of making this article more diverse by adding efforts from global and local non-government organizations. The article also seems to be outdated in terms of statistics and shows little quantitative information which I think would be very useful to add. The information and sources are good but could be expanded, especially in regards to the JUNTOS cash transfer program.

Not enough statistics from outside global groups

Not enough statistics from local groups, needs more quan data

Much of existing data is old and could use new sources.

Would benefit from pictures, graphs

Malnutrition

This article is not very well developed on global efforts to help solve the issue of malnutrition and their effectiveness. The current information under global initiatives is underdeveloped, while some organizations are named there is little about the details of what they tried to accomplish, how they tried to, and if it worked or not. I am thinking of bolstering up this area by expanding more on the groups mentioned in the global initiatives section and adding more.

"The evidence for benefit of supplementary feeding is poor. This is due to the small amount of research done on this treatment." this should not be on Wikipedia due to low notability then.

Management section is poorly organized and makes little sense. No cohesive structure that relates to title 'management', recommend a title change as well as restructuring.

The section "Society and Culture" is about what society as a whole has done to alleviate global malnutrition and thus could be combined with global initiatives for further organization of the article

Programa Nacional de Población

NiUnaMenos (Peru)

Cusco

Beginning Bibliography

Malnutrition

Considers the role of structural forces and their interactions with place-specific conditions in causing collapse of regular methods of food production and livelihoods, which produces widespread hunger and malnutrition. I'll use this very detailed book to talk about some of the theories to why malnutrition exists.

This journal looks at two impoverished states in India that experienced large economic growth, which in the past was seen as one of the primary solutions for malnutrition and poverty. However these two states did not experience equal malnutrition alleviation, this paper details what programs were effective. I'll use this paper to talk about what may be more effective malnutrition alleviation efforts.

Universal Declaration on the Eradication of Hunger and Malnutrition adopted by the United Nations in 1974. This was one of the first major global efforts to recognize and mobilize against malnutrition. I'll use it as an important landmark in global efforts.

This article looks at the effectiveness of condicional cash transfer programs throughout the world and their effectiveness on reducing malnutrition. The results are based off of a study that in Pakistan.

This massive article looks at the necessary political framework and political intervention that aids in ending malnutrition in countries. This is guided by the right to food and the shift from the goal of quantity of food to the quality of the food, as today many malnurished people recieve enough calories but not enough nutrients. It also asserts that government must accept responsibility for national food programs and subsidizations while respecting other nations food soverignty. Policies should self-enable local communities the production of healthy food while respecting the environment.

Malnutrition in Peru

This article describes the experience of the MEF's impact evaluation management as one of the RBB instruments and documents the design and results obtained from three impact evaluations of the most emblematic government social programs. The Service of Visiting Families (SAF) of the National Program "Cuna Mas", conditional cash transfer Program "JUNTOS" and National Program "Pension 65" focusing on objective population's health the outcomes. I'll use this article as examples to what has already been done and how effective they were.

This study of the Vaso de Leche (“Glass of Milk”) feeding program in Peru looks for evidence that this in-kind transfer program aimed at young children furthers nutritional objectives. This will be used as another example as to what has been done in Peru.

The objective of this study is to evaluate the impact of Juntos on children under 6 years, pregnant women and mothers of children under 17 years. I'll use this study to look more in depth at conditional cash transfers and the effectiveness of the JUNOTS program in Peru.

Stunting prevalence in children less than 5 years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. This study aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. I'll primarily use this in relationship to the anti-malnutrition programs to see why there was stagnated malnutrition and then a rapid reduction.

This study is about the politics of success in Peru over recent years in reducing chronic malnutrition and stunting. The government repoted a reduction in stunting rates of nearly 10 points, from 29.8% in 2005 to 18.1% in 2011. This study acknoledges the government's role in reducing malnutrition and how it structurally accomplished these reductions. It also looks at the coordination between the government and ngo's.

This study reviews information from Peru and Ethiopia to estimate the level of malnutrition and poverty correlated with human capital possessed. It focuses on children age 0-15 that have lots of little of human capital invested and then the results as seen in physical and mental cognition.

Malnutrition Article:
Hello to those who are peer editing my work, just to givre you clarification everything in this section except the Global Initives Section is not my writing, it is reorganized from the actualy wiki page into what I think is a much more clear order. Please give me your thoughts about my titles though.

Breastfeeding[edit]
As of 2016 is estimated that about 821,000 deaths of children less than five years old could be prevented globally per year through more widespread breastfeeding.

Fortified foods[edit]
Manufacturers are trying to fortify everyday foods with micronutrients that can be sold to consumers such as wheat flour for Beladi bread in Egypt or fish sauce in Vietnam and the iodization of salt.

For example, flour has been fortified with iron, zinc, folic acid and other B vitamins such as thiamine, riboflavin, niacin and vitamin B12.

Food[edit]
The evidence for benefit of supplementary feeding is poor. This is due to the small amount of research done on this treatment.

Specially formulated foods do however appear useful in those from the developing world with moderate acute malnutrition. In young children with severe acute malnutrition it is unclear if ready-to-use therapeutic food differs from a normal diet. They may have some benefits in humanitarian emergencies as they can be eaten directly from the packet, do not require refrigeration or mixing with clean water, and can be stored for years.

In those who are severely malnourished, feeding too much too quickly can result in refeeding syndrome. This can result regardless of route of feeding and can present itself a couple of days after eating with heart failure, dysrhythmias and confusion that can result in death.

Micronutrients[edit]
Treating malnutrition, mostly through fortifying foods with micronutrients (vitamins and minerals), improves lives at a lower cost and shorter time than other forms of aid, according to the World Bank. The Copenhagen Consensus, which look at a variety of development proposals, ranked micronutrient supplements as number one.

In those with diarrhea, once an initial four-hour rehydration period is completed, zinc supplementation is recommended. Daily zinc increases the chances of reducing the severity and duration of the diarrhea, and continuing with daily zinc for ten to fourteen days makes diarrhea less likely recur in the next two to three months.

In addition, malnourished children need both potassium and magnesium. This can be obtained by following the above recommendations for the dehydrated child to continue eating within two to three hours of starting rehydration, and including foods rich in potassium as above. Low blood potassium is worsened when base (as in Ringer's/Hartmann's) is given to treat acidosis without simultaneously providing potassium. As above, available home products such as salted and unsalted cereal water, salted and unsalted vegetable broth can be given early during the course of a child's diarrhea along with continued eating. Vitamin A, potassium, magnesium, and zinc should be added with other vitamins and minerals if available.

For a malnourished child with diarrhea from any cause, this should include foods rich in potassium such as bananas, green coconut water, and unsweetened fresh fruit juice.

Diarrhea[edit]
Examples of commercially available oral rehydration salts (Nepal on left, Peru on right). The World Health Organization (WHO) recommends rehydrating a severely undernourished child who has diarrhea relatively slowly. The preferred method is with fluids by mouth using a drink called oral rehydration solution (ORS). The oral rehydration solution is both slightly sweet and slightly salty and the one recommended in those with severe undernutrition should have half the usual sodium and greater potassium. Fluids by nasogastric tube may be use in those who do not drink. Intravenous fluids are recommended only in those who have significant dehydration due to their potential complications. These complications include congestive heart failure. Over time, ORS developed into ORT, or oral rehydration therapy, which focused on increasing fluids by supplying salts, carbohydrates, and water. This switch from type of fluid to amount of fluid was crucial in order to prevent dehydration from diarrhea.

Breast feeding and eating should resume as soon as possible. Drinks such as soft drinks, fruit juices, or sweetened teas are not recommended as they contain too much sugar and may worsen diarrhea. Broad spectrum antibiotics are recommended in all severely undernourished children with diarrhea requiring admission to hospital.

To prevent dehydration readily available fluids, preferably with a modest amount of sugars and salt such as vegetable broth or salted rice water, may be used. The drinking of additional clean water is also recommended. Once dehydration develops oral rehydration solutions are preferred. As much of these drinks as the person wants can be given, unless there are signs of swelling. If vomiting occurs, fluids can be paused for 5–10 minutes and then restarting more slowly. Vomiting rarely prevents rehydration as fluid are still absorbed and the vomiting rarely last long. A severely malnourished child with what appears to be dehydration but who has not had diarrhea should be treated as if they have an infection.

For babies a dropper or syringe without the needle can be used to put small amounts of fluid into the mouth; for children under 2, a teaspoon every one to two minutes; and for older children and adults, frequent sips directly from a cup. After the first two hours, rehydration should be continued at the same or slower rate, determined by how much fluid the child wants and any ongoing diarrheal loses. After the first two hours of rehydration it is recommended that to alternate between rehydration and food.

In 2003, WHO and UNICEF recommended a reduced-osmolarity ORS which still treats dehydration but also reduced stool volume and vomiting. Reduced-osmolarity ORS is the current standard ORS with reasonably wide availability. For general use, one packet of ORS (glucose sugar, salt, potassium chloride, and trisodium citrate) is added to one liter of water; however, for malnourished children it is recommended that one packet of ORS be added to two liters of water along with an extra 50 grams of sucrose sugar and some stock potassium solution.

Malnourished children have an excess of body sodium. Recommendations for home remedies agree with one liter of water (34 oz.) and 6 teaspoons sugar and disagree regarding whether it is then one teaspoon of salt added or only 1/2, with perhaps most sources recommending 1/2 teaspoon of added salt to one liter water.

Low blood sugar[edit]
Hypoglycemia, whether known or suspected, can be treated with a mixture of sugar and water. If the child is conscious, the initial dose of sugar and water can be given by mouth. If the child is unconscious, give glucose by intravenous or nasogastric tube. If seizures occur after despite glucose, rectal diazepam is recommended. Blood sugar levels should be re-checked on two hour intervals.

Hypothermia[edit]
Hypothermia can occur. To prevent or treat this, the child can be kept warm with covering including of the head or by direct skin-to-skin contact with the mother or father and then covering both parent and child. Prolonged bathing or prolonged medical exams should be avoided. Warming methods are usually most important at night.

Government Prevention
Roughly $300 million of aid goes to basic nutrition each year, less than $2 for each child below two in the 20 worst affected countries. In contrast, HIV/AIDS, which causes fewer deaths than child malnutrition, received $2.2 billion—$67 per person with HIV in all countries.

Economics
There is a growing realization among aid groups that giving cash or cash vouchers instead of food is a cheaper, faster, and more efficient way to deliver help to the hungry, particularly in areas where food is available but unaffordable. The UN's World Food Program, the biggest non-governmental distributor of food, announced that it will begin distributing cash and vouchers instead of food in some areas, which Josette Sheeran, the WFP's executive director, described as a "revolution" in food aid. The aid agency Concern Worldwide is piloting a method through a mobile phone operator, Safaricom, which runs a money transfer program that allows cash to be sent from one part of the country to another.

However, for people in a drought living a long way from and with limited access to markets, delivering food may be the most appropriate way to help. Fred Cuny stated that "the chances of saving lives at the outset of a relief operation are greatly reduced when food is imported. By the time it arrives in the country and gets to people, many will have died." U.S. law, which requires buying food at home rather than where the hungry live, is inefficient because approximately half of what is spent goes for transport. Cuny further pointed out "studies of every recent famine have shown that food was available in-country — though not always in the immediate food deficit area" and "even though by local standards the prices are too high for the poor to purchase it, it would usually be cheaper for a donor to buy the hoarded food at the inflated price than to import it from abroad."

Ethiopia has been pioneering a program that has now become part of the World Bank's prescribed method for coping with a food crisis and had been seen by aid organizations as a model of how to best help hungry nations. Through the country's main food assistance program, the Productive Safety Net Program, Ethiopia has been giving rural residents who are chronically short of food, a chance to work for food or cash. Foreign aid organizations like the World Food Program were then able to buy food locally from surplus areas to distribute in areas with a shortage of food. Ethiopia been pioneering a program, and Brazil has established a recycling program for organic waste that benefits farmers, urban poor, and the city in general. City residents separate organic waste from their garbage, bag it, and then exchange it for fresh fruit and vegetables from local farmers. As a result, the country's waste is reduced and the urban poor get a steady supply of nutritious food.

Food security
Main article: Food security

The effort to bring modern agricultural techniques found in the West, such as nitrogen fertilizers and pesticides, to Asia, called the Green Revolution, resulted in decreases in malnutrition similar to those seen earlier in Western nations. This was possible because of existing infrastructure and institutions that are in short supply in Africa, such as a system of roads or public seed companies that made seeds available. Investments in agriculture, such as subsidized fertilizers and seeds, increases food harvest and reduces food prices. For example, in the case of Malawi, almost five million of its 13 million people used to need emergency food aid. However, after the government changed policy and subsidies for fertilizer and seed were introduced against World Bank strictures, farmers produced record-breaking corn harvests as production leaped to 3.4 million in 2007 from 1.2 million in 2005, making Malawi a major food exporter. This lowered food prices and increased wages for farm workers. Such investments in agriculture are still needed in other African countries like the Democratic Republic of the Congo. The country has one of the highest prevalence of malnutrition even though it is blessed with great agricultural potential John Ulimwengu explains in his article for D+C. Proponents for investing in agriculture include Jeffrey Sachs, who has championed the idea that wealthy countries should invest in fertilizer and seed for Africa’s farmers.

New technology in agricultural production also has great potential to combat undernutrition. By improving agricultural yields, farmers could reduce poverty by increasing income as well as open up area for diversification of crops for household use. The World Bank itself claims to be part of the solution to malnutrition, asserting that the best way for countries to succeed in breaking the cycle of poverty and malnutrition is to build export-led economies that will give them the financial means to buy foodstuffs on the world market.

Food sovereignty
Main article: Food sovereignty

One suggested policy framework to resolve access issues is termed food sovereignty—the right of peoples to define their own food, agriculture, livestock, and fisheries systems, in contrast to having food largely subjected to international market forces. Food First is one of the primary think tanks working to build support for food sovereignty. Neoliberals advocate for an increasing role of the free market.

Health facilities
Another possible long term solution would be to increase access to health facilities to rural parts of the world. These facilities could monitor undernourished children, act as supplemental food distribution centers, and provide education on dietary needs. These types of facilities have already proven very successful in countries such as Peru and G

World population
Restricting population size is a proposed solution. Thomas Malthus argued that population growth could be controlled by natural disasters and voluntary limits through "moral restraint." Robert Chapman suggests that an intervention through government policies is a necessary ingredient of curtailing global population growth. However, there are many who believe that the world has more than enough resources to sustain its population. Instead, these theorists point to unequal distribution of resources and under- or unutilized arable land as the cause for malnutrition problems. For example, Amartya Sen advocates that, "no matter how a famine is caused, methods of breaking it call for a large supply of food in the public distribution system. This applies not only to organizing rationing and control, but also to undertaking work programmes and other methods of increasing purchasing power for those hit by shifts in exchange entitlements in a general inflationary situation."

Global initiatives
Food security and global malnutrition has long been a topic of international concern, with one of the first official global documents addressing it being the 1948 Universal Declaration of Human Rights(UDHR). Within this document it stated that access to food was part of an adequate right to a standard of living. The Right to food was asserted in the International Covenant on Economic, Social and Cultural Rights, a treaty adopted by the United Nations General Assembly on December 16th, 1966. The Right to food is a human right for people to feed themselves in dignity, be free from hunger, food insecurity, and malnutrition. As of 2018, the treaty has been signed by 166 countries, by signing states agreed to take steps to the maximum of their available resources to achieve the right to adequate food.

However after the 1966 International Covenant the global concern for the access to sufficient food only became more present, leading to the first ever World Food Conference that was held in 1974 in Rome, Italy. The Universal Declaration on the Eradication of Hunger and Malnutrition was a UN resolution adopted November 16th, 1974 by all 135 countries that attended the 1974 World Food Conference. This non-legally binding document set forth certain aspirations for countries to follow to sufficiently take action on the global food problem. Ultimately this document outline and provided guidance as to how the international community as one could work towards fighting and solving the growing global issue of malnutrition and hunger.

Adoption of the right to food was included in the Additional Protocol to the American Convention on Human Rights in the area of Economic, Social, and Cultural Rights, this 1978 document was adopted by many countries in the the Americas, the purpose of the document is, "to consolidate in this hemisphere, within the framework of democratic institutions, a system of personal liberty and social justice based on respect for the essential rights of man."

The next document in the timeline of global inititaves for malnutrition was the 1996 Rome Declaration on World Food Security, organized by the Food and Agriculture Organization. This document reaffirmed the right to have access to safe and nutritous food by everyone, also considering that everyone gets sufficient food, and set the goals for all nations to improve their commitment to food security by halfing their amount of undernourished people by 2015. In 2004 the Food and Agriculture Organization adopted the Right to Food Guidelines, which offered states a framework of how to increase the right to food on a national basis.

One of the most recent and powerful global policies to reduce hunger and poverty are the Sustainable Development Goals. In particular Goal 2: Zero hunger sets globally agreed targets to end hunger, achieve food security and improved nutrition and promote sustainable agriculture. The partnership Compact2025, led by IFPRI with the involvement of UN organisations, NGOs and private foundations develops and disseminates evidence-based advice to politicians and other decision-makers aimed at ending hunger and undernutrition in the coming 10 years, by 2025.

In April 2012, the Food Assistance Convention was signed, the world's first legally binding international agreement on food aid. The May 2012 Copenhagen Consensus recommended that efforts to combat hunger and malnutrition should be the first priority for politicians and private sector philanthropists looking to maximize the effectiveness of aid spending. They put this ahead of other priorities, like the fight against malaria and AIDS.

The EndingHunger campaign is an online communication campaign aimed at raising awareness of the hunger problem. It has many worked through viral videos depicting celebrities voicing their anger about the large number of hungry people in the world. Another initiative focused on improving the hunger situation by improving nutrition is the Scaling up Nutrition movement (SUN). Started in 2010 this movement of people from governments, civil society, the United Nations, donors, businesses and researchers, publishes a yearly progress report on the changes in their 55 partner countries.

The International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), a member of the CGIAR consortium, partners with farmers, governments, researchers and NGOs to help farmers grow nutritious crops, such as chickpea, groundnut, pigeonpea, millet and sorghum. This helps their communities have more balanced diets and become more resilient to pests and drought. The Harnessing Opportunities for Productivity Enhancement of Sorghum and Millets in Sub-Saharan Africa and the Indian-Subcontinent (HOPE) project, for example, is increasing yields of finger millet in Tanzania by encouraging farmers to grow improved varieties. Finger millet is very high in calcium, rich in iron and fiber, and has a better energy content than other cereals. These characteristics make it ideal for feeding to infants and the elderly.

Malnutrition in Peru
Hello Peer Reviewer, all of the work here is written by me, and for this article I'm mostly focusing on adding backround and information on Government iniative Food Security and ?nourishment programs. Don't worry if you don't see a source, the first long section is all from the same journal.

History of Government Intervention
The Peruvian Government has a long history of government lead and working with NGO social initiatives and policies that have been key in reducing malnutrition in Peru.

The first government intervention against malnutrition was the creation of the National Office for Food Support in 1972 followed by the creation of the Ministry of Nourishment in 1974. These offices were created with the goal of coordinating the many overseas aid donations. However the Ministry of Nourishment closed shortly after its creation and the National Office for Food Support only coordinated a fraction of food aid, leaving NGOs the majority of the coordination.

During the 1980s the government began to take a more active role in food security for its citizens, creating the Direct Assitance Program (Programa de Asistencia Directra- PAD) for employment-based food assistance and the Glass of Milk Program (Vaso de Leche) to benefit children under 6 years old.

Starting in the 1990s food assistance programs began to become more centralized, with the National Office for Food Support and the Direct Assitance Program becoming merged into the National Program for Food Assistance, which was put under direct control of the Office of the Prime Minister.

However during this time NGOs and other non-governmental organized efforts were still very important to the food network of Peru, exemplified by the Comedores Populares. These were neighborhood organizations initially started by churches or NGOs that eventually became supervised by the National Program for Food Assitance with the purpose of feeding the local population. In 1994 there were approximately 5,000 Comdedores Populares organizations in the Lima Metropolitan Area with more than 13,000 other nationwide, almost half of them were self-managed.

By 2002, Peru was spending $220 million on food and nutrition interventions per year, however the efforts remained insufficient to further reduce child stunting rates. The failure to further reduce stunting rates was attributed to the lack of coordination and integration of the many different food programs, mostly Vaso de Leche, Commedores Populares, and Desayunos Escolares (a school feeding program established in 1966), "stunting rates declined from 36.5 per cent to 25.8 per cent between 1992 and 1996 but then flattened for the next ten years." Many of these programs had poor targeting, low access and usage, and inadequate funding schemes.

Thus, Peru switched it's intervention strategies following a new administration in 2001 that focused on the right to food as a right, resulting in 2007 with the establishment of the CRECER program. This was The National Strategy CRECER was created through an Executive Decree in 2007, as a "coordinated poverty reduction strategy that articulates all public offices in the National, Regional and Local Government, as well as the private sector, international cooperation and civil society in general, to promote, facilitate and execute poverty reduction and human development goals." The CRECER program stressed central points of going beyond food distribution and include elements such as sanitation, training, cooking programs, access to clean water, and conditional cash transfer programs such as JUNTOS to alleviate malnutrition, to promote integration of programs, to decentralize the scope of interventions, and to adequately fund policy interventions. There are three main axis to the CRECER program: (1) the development of human capabilities and respect of fundamental rights, (2) the promotion of opportunities and economic capacities, and (3) the establishment of a social protection network.

Another Program was the the Child Nutrition Initiative. The CNI program that was started in 2006 is an advocacy agency that was formed from the integration of existing NGOs and government agencies to promote good policies for healthcare, education, housing, and public financing. Some of the programs that were integrated into the Child Nutrition Initiative included: Action Against Hunger, UN Population Fund, CARE Peru, World Food Program, and USAID. The CNI offered a coordinated space where differing agencies working resolve malnutrition could work together, this space also allowed the funding and donations to fight malnutrition to unify under what works and avoid fragmented efforts that did not reach all people.

The CNI plays a key role in asserting the main goal of poverty alleviation was nutrition focused, establishing a coordination agency that could direct technical and financial donations from different agencies, and serve as a public platform where government led malnutrition reduction efforts could be debated on a national level. The CNI serves another purpose of advocating for presidents and regional elected officials to keep their promise to reducing malnutrition, establishing long-term commitment from these leaders.

The Service of Visting Familes (SAF) of the National Program "Cuna Mas"
Among the main results, it was found the SAF generated improvements in cognitive and communication development in children, but had no impact on mothers’ child care practices or children’s nutritional status. "En el Perú, el 2005 se implementó el Programa Juntos en 2005 y en octubre de 2011 se creó el Ministerio de Desarrollo e Inclusión Social (MIDIS) con el objeto de liderar la agenda de inclusión social, a partir de la estrategia nacional “Incluir para crecer”."

National Program "Pension 65"
In the case of Pension 65, there were increases in household consumption and improvements in elderly’s emotional health (depression, self valoration); but there was no evidence of increases in the use of health services by the elderly or improvements in their physical health.

JUNTOS
In the case of JUNTOS, there were increases in per capita spending, food expenditure, decreases in severity and poverty gap, increases in school attendance and reductions of school dropout. However, no significant results were found in most indicators of prenatal health, child health, or chronic malnutrition.