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.
Highlights
Though food security remains a major concern for the majority of people in Africa and South Asia, it is as ‘malnutrition’ that the issue has gained much priority in the last decade
This paper examines these differences; factual and perceptual, and critically interrogates the definition and programmatic interpretation of community management of acute malnutrition (CMAM) that is in current usage, which results in the further marginalization and dependence of the affected community upon external resources
The Action Against Malnutrition (AAM) Project, which has been initiated in 7 blocks in the states of Jharkhand, Odisha, Chattigarh and Bihar, shows how community management of malnutrition can be truly empowering for the community and family, and treat and prevent malnutrition at the same time in a more sustainable way [4]
Summary
Though food security remains a major concern for the majority of people in Africa and South Asia, it is as ‘malnutrition’ that the issue has gained much priority in the last decade. There is undisputable evidence that the bulk of the infant mortality in India arises from deaths in the neonatal period which have no relationship to SAM per se, but are linked to larger social determinants of food security, care during pregnancy and delivery and gender equity These facts should have created greater confidence for a shift from a medicalised short-term strategy to the promotion of longer-term strategies that empower communities, but they are not generally acknowledged in discussions. For CMAM to be truly successful in reducing severe acute undernutrition; it has to be comprehensive rather than segmented It must, at a minimum, focus on the underlying immediate causes of care, health and nutrition simultaneously and attempt to tackle distal determinants such as poverty, gender discrimination and access to services. It must treat and save lives, and simultaneously prevent acute malnutrition at individual and community level
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