Putting nutrition on the table in Cambodia

Grant project name: Sahakkom Kon Laor project, Nutrition Programme
Funded by: The Innovation Fund, World Vision United States
Time frame: July 2013- June 2015

Purpose and Objective: Sahakkom Kon Laor (SKL) nutrition program aims to reduce malnutrition of children under five years living in urban slums of Phnom Penh through a combination of community led growth monitoring, behaviour change activities and community responses to malnutrition.

The SKL program consists of three innovative approaches that were specifically designed for the urban environment; partnering with vendors to provide nutritious food, mobile nutrition education and producing a promotional film to educate the community. 

To date, World Vision has reached more than 3,000 people in 20 villages, with nearly 80 percent of its 400 registered children that ranked as severely or moderately underweight before entering the program having now ‘graduated’ from the program. To graduate, the children have gained at least 200 grams and made significant progress toward being in the healthy weight range.

The project goal will be measured at the end of two years of implementation by measuring the prevalence of malnutrition of children under five years of age.

Meet a family benefitting from this project: 

With ruinous effects on health, malnutrition is an ongoing cause of alarm in Cambodia. And as recognition of the issue grows, innovation is key to putting nutrition on the table.

Pheang Sokleap sits on a bright green stool doling out breakfast bowls of ‘borbor’, the rice porridge which is a daily staple for families all over Cambodia. But the 36-year-old’s take on the classic dish marks a change.

Normally prepared with white rice and served with meat and soy sauce, plus MSG, salt and sugar, her borbor is instead packed with vegetables and healthy oils as part of a new push to boost nutrition in the country.

Malnutrition in Cambodia far outweighs that of its neighbours: over 32% of children under five are stunted.

Stubbornly resistant, malnutrition in Cambodia far outweighs that of its neighbours, with 32 percent of children under five having stunted growth, compared to 23 percent in Vietnam and just 16 percent in Thailand.

The first two years of life are crucial for physical and mental development, and without adequate nutrition, children are at risk of diarrhoea – the biggest killer of the nation’s under-fives – and respiratory infections, as well as insufficient physical growth.

In Khan Mean Chey, a community of refuse collectors and factory workers in Phnom Penh’s dusty outskirts, Sokleap has sold borbor for eight years. Starting work at 4 am every day, she began serving the new, more labour-intensive recipe seven months ago.

Mixing beans, oil, pumpkin and morning glory with the rice to cover the primary food groups, Sokleap stirs the thick porridge, spotted with green and yellow, which fills a large blackened pot atop a crude charcoal grill.

“Even though I don’t use salt or sugar, it’s tasty,” says Sokleap, who runs the business despite being illiterate. Dressed in a mustard blouse and grey trousers, she says she’s gained weight thanks to the new mix, her wide smile scrunching her nose as she chuckles.

The mother of two is one of seven vendors participating in World Vision’s local nutrition programme, which targets communities with high malnutrition rates by raising awareness of healthy eating, hygiene and common illnesses, while also supporting caregivers.

When Sin Srey Nang joined the health sessions, her then six-month-old son weighed only 3.3 kilograms and was often sick, meaning frequent overnight stays in hospital each costing five US dollars – her husband’s daily earnings as a driver. The family’s money evaporated with each new infection, forcing them to borrow from neighbours and spiralling them into debt.

“I was scared I wouldn’t be able to afford my son’s treatment,” says Nang, sitting in her concrete house, rented for 35 US dollars a month, which is on a small lane lined with bricks and carts for recyclable rubbish.

During the first round of sessions, Nang’s son moved from severely to moderately malnourished, while the second round saw him advance to the healthy category, coloured green on the group’s progress charts. “After just a week, my son looked much better,” she says while breastfeeding her now-plump 14-month-old.

Previously preparing a simple porridge for the boy before work, Nang began buying the nutrition-packed borbor each morning and changed the way she cooks. “Now I make dishes with green vegetables because I know better,” says the mother, who also buys fruit for her banana-loving children.

“My son isn’t sick as much as before, so we don’t need to spend money [on health care],” she adds.

Nearby Nang’s home, similar stories echo among the adults circled around a low wooden table for a nutrition meeting. Many of the mostly female attendees are grandparents, standing in as caregivers while their children work.

The group meets regularly to learn about food groups and cook together. Many say they saw positive changes within 15 days of switching to healthier diets.

The group meets regularly to learn about food groups and cook together, with each member contributing food or money, depending on their means, and receiving follow-up home visits from volunteers. Many say they saw positive changes within 15 days of switching to healthier diets.

Sok Oun, 52, says her six grandchildren are now healthier, after frequently being sick in the past. Also eating healthy food, she has been surprised by her faster recovery from illnesses. “I have more energy,” she comments. “I want my grandchildren to know [about eating healthily] and for them to teach it to their kids.”

Focusing on nutrition in Cambodia since 2006, World Vision has used innovative approaches, such as monitoring child growth through community action and automated voice messages providing health advice for new mothers.

Contributing to Cambodia’s UN-set millennium development goals, the project is also aligned with the country’s national nutrition strategy, which aims to decrease stunting to 22 percent by 2015, improve nutrition for women and reduce childhood mortality.

But while learning sessions have improved child nutrition, success has been mixed for the borbor vendors, with Sokleap explaining she has lost customers for cutting the meat content and charging slightly higher prices due to the balanced dish’s more costly ingredients.

For now, World Vision is compensating the vendors’ potential losses by paying for up to 10 servings a day, while also planning to promote the new borbor to boost sales and explore ways to decrease production costs. But sustainability among a population committed to the traditional rice porridge remains to be seen.

Challenges also exist in promoting nutrition countrywide. Though the government, UN and non-profit organisations have adopted multi-sector approaches to the problem, nutrition experts say monitoring should be ramped up and greater coordination is needed between different players.

Those tackling malnutrition also have to battle deeply entrenched mindsets towards food, as well as prioritise the health of mothers, to finally break the cycle of malnutrition.

Proud to be a pioneer, Sokleap plans to stick with the new borbor, but experiment with new recipes to win back former customers and gain new ones. “Even though it’s difficult, I think it [the healthier porridge] is good for children, including my own,” she says. “It’s good for everyone.”