United Nations System
Standing Committee on Nutrition

SCN's 26th Session Report

Report of the Sub-Committee on Nutrition at its Twenty-Sixth Session

 UNHCHR, Palais des Nations, Geneva 12-15 April 1999

Contents:

I. INTRODUCTION

1. The Chairman, Dr Richard Jolly, welcomed participants to the 26^th Session of the ACC/SCN, held at the invitation of the United Nations High Commissioner for Human Rights, Mrs Mary Robinson. He also welcomed the Director General of WHO, Dr Gro Harlem Brundtland and other guest speakers: Mr Namanga Ngongi, Deputy Executive Director, World Food Programme; Mr Chris Lovelace, Director, Health, Nutrition and Population, World Bank; Ms Amelia Bonifacio, Director, Operational Support, UNHCR, Mr Hartwig de Haen, Assistant Director-General, FAO; and Mr Stephen Lewis, Deputy Executive Director, United Nations Children's Fund. The attendance by so many senior UN Agency staff underlined the importance given to the human right to food and nutrition in the UN system.
2. A warm welcome was extended to representatives of bilateral agencies, AGN members, NGOs and other supporting groups. Created in 1977 by the ECOSOC, the ACC/SCN's tripartite structure is unique in the coordinating machinery of the UN. It is a practical expression of relating UN system activities with those of civil society which the UN Secretary General Mr Kofi Annan is promoting in the UN as the way of the future. In this respect the ACC/SCN has, from the beginning, embodied approaches which other parts of the UN now see as necessary. Nevertheless, the ACC/SCN should be asking itself whether its methods of meeting and interaction are adequate, and how to mobilize greater attention to nutrition in the years ahead, building on the commitments set out at the 1990 World Summit for Children, the 1992 International Conference on Nutrition and the 1996 World Food Summit.
3. The successes encouraged or sponsored by the ACC/SCN were recalled, e.g. the recognition in 1985 of the need for a major programme to eliminate iodine deficiency; the commitment in 1986 by the IMF to consider the protection of nutrition in programmes of economic adjustment; the proposal in 1989 to hold an International Conference on Nutrition; documentation in 1993 of the enormous impact of vitamin A deficiency on young child mortality; publication of Reports on the World Nutrition Situation, and the creation of a network of NGOs and UN agencies supporting nutrition for refugees and displaced persons. ACC/SCN publications attract a wide readership, at least 10,000 nutrition and development professionals, two thirds of whom are in developing countries.
4. Human rights and nutrition, the topic of this year's Symposium, has received increased attention ever since the ACC/SCN established a working group on this subject some five years ago. Following the UN Secretary-General's strong support for human rights, it is appropriate that UN agencies should explore a human rights approach to their mandates. In a world where global interaction in business and finance is gaining ground, human rights, notably the right to adequate food and nutrition, should not be overlooked. In this connection, the Chairman drew attention to the report of the Commission on the Nutrition Challenges of the 21^st Century "Ending Malnutrition by the Year 2020."
5. In her keynote speech Mrs Mary Robinson welcomed to the Symposium the many experts on food and nutrition. This Symposium, Mrs Robinson stated, is a practical example of the extensive cooperation between UN agencies and the Office of the High Commissioner for Human Rights towards the full realization of the human right to food and nutrition. Malnutrition often stems from multiple denials of the rights of children, adolescent girls and women in particular. The High Commissioner for Human Rights is committed to all human rights, be they civil, cultural, economic, political or social rights. Economic, social and cultural rights have, in the past, received too little attention. This is being rectified in cooperation with UNDP, ILO, WHO, FAO, UNESCO, The World Bank and others. According to FAO estimates more than 800 million people throughout the world do not have enough food to meet their needs. The right to adequate food has been recognized since the adoption of the Universal Declaration of Human Rights in 1948 as an important component of the right to an adequate standard of living. It has also been confirmed in the principal human rights conventions, and it is linked to a number of other human rights in the fields of health and education. Its realization is inseparable from appropriate economic, environmental and social policies, oriented towards eradication of poverty and the satisfaction of basic needs.
6. The right to adequate food and nutrition implies three types of obligations on States party to the International Covenant on Economic, Social and Cultural Rights: a) to respect access to adequate food under all circumstances, b) to protect the State’s responsibility of ensuring that private entities or individuals do not deprive individuals of their access to adequate food, and c) whenever an individual or a group is unable to enjoy the right to adequate food, States have the obligation to fulfil that right. Fulfilment includes legislative and administrative measures addressing all aspects of the food system, including the production, processing, distribution and consumption of food, as well as parallel measures in the field of health, education, employment and social security.
7. The realization of the right to adequate food has to happen at the country level. Incorporating this right in the national legislative framework is essential to ensure accountability by the State towards the "claim holders". All States have an obligation to cooperate not only in regard to individuals under their domestic jurisdiction, but also under the UN charter, to cooperate in solving problems of a social and humanitarian nature outside their jurisdiction. Mrs Robinson appealed strongly to UN agencies to adopt a rights-based approach to their mandates. While cooperation between the agencies and the treaty bodies has developed well during the last few years, greater emphasis should be put on sharing information and the development of joint indicators to measure achievements and shortcomings in the realization of food and nutrition rights. UN agencies can provide not only legal, political and administrative advice to States on how better to meet their obligations regarding the right to food and nutrition, but also help States in monitoring implementation of these rights.
8. The Director-General of the World Health Organization, Dr Gro Harlem Brundtland, stressed that human rights should not be compartmentalized since the issue cuts across all political and technical priorities. Nutrition is a key universal factor that affects, as much as it defines, the health of all people. The proper mix of nutrients under clean and safe conditions must be available to all. A world of inequity, poverty, underdevelopment, poor distribution and inadequate access to food, health and care is far from achieving this gold standard, and the tragic consequences of malnutrition are there for all to see. Poverty is the main obstacle to the attainment of health, while ill-health also breeds poverty. One reason for this unfulfilled agenda is the neglect of basic human rights, and it is often up to the health sector to deal with the disastrous results.
9. An explicit human-rights approach to health and nutrition means that mechanisms and procedures are gradually put into place to ensure that core values are underpinned in international human-rights law, are subsequently incorporated into national laws, and thereby have a chance of becoming a reality. A human-rights perspective provides the international community with yet another opportunity to support the development of sound public health policies and practices that promote healthy nutrition as a cornerstone of all social and economic development. This approach is consistent with how international organizations function, both as policy advocates and providers of technical support. Human rights should begin at home. This means that a "human-rights culture" should permeate each of the agencies present. Staff should be continually challenged to explore how they can make effective use of human-rights norms. The example set in the ACC/SCN has important implications, through the ACC, for how the entire UN system addresses the issue of human rights. Governmental accountability for human-rights standards requires an understanding of minimum standards of nutrition, of the body of operational laws and policies, and of monitoring mechanisms that help establish evidence of the contribution of health and nutrition to human rights. Advocacy for human rights contributes to a global public good that the UN system is there to promote. Doing it together will provide new energy for an important human cause.

II. MATTERS FOR THE ATTENTION OF CCPOQ AND ACC

1. Three major conferences in the 1990s on food and nutrition established a consensus for action to reduce poverty, food insecurity and undernutrition substantially over the next 15 to 20 years: the World Summit for Children, the International Conference for Nutrition and the World Food Summit. Since then there have been significant achievements in nutrition. To date 67% of countries affected by iodine deficiency disorders have made progress towards achieving universal salt iodization, and 48% have made substantial progress (defined as more than half the population currently consuming iodized salt). Underweight and stunting in preschool children have declined in all regions, except for sub-Saharan Africa. Severe vitamin A deficiency has decreased in all regions and the past several years have seen a significant expansion of vitamin A supplementation linked with immunization programmes. The nutrition community has reached important agreements on ways to address iron deficiency anaemia.
2. Much remains to be done and there are new challenges. Some 30 million infants are born each year in developing countries with intra-uterine growth retardation. Population wide interventions aimed at preventing foetal growth retardation are urgently needed. There are still more than 150 million underweight preschool children worldwide, and more than 200 million are stunted. Stunting is linked to mental impairment. High proportions of Asian and African mothers are undernourished: this is exacerbated by seasonal food shortages, especially in Africa. Maternal anaemia is pandemic, over 80% in some countries, and is associated with very high rates of maternal death. Sub-clinical vitamin A deficiency still affects between 140 to 250 million preschool children in developing countries, and is associated with high rates of morbidity and mortality. These numbers do not take into account vitamin A deficiency in older children and adults and thus seriously underestimate the total magnitude. Overweight and obesity are rapidly growing in all regions, affecting children and adults alike. These problems are now so common in some developing countries that they are beginning to replace more traditional public health concerns. Maternal and early childhood undernutrition are linked to increased susceptibility in adult life to diabetes, heart disease and hypertension.
3. The Commission on the Nutrition Challenges of the 21^st Century stresses that unless a major acceleration in action occurs, the goals of the international conferences will be largely unmet, and enormous opportunities will be missed. Reliance on current processes and levels of action will fail to grasp the opportunities and will condemn most nations to an escalating but preventable health burden that limit a society’s capacity to benefit economically. The UN is in a great position to give a lead by enhancing collaboration and action at the country level. This can be achieved through the UN Development Group, the UN Development Assistance Framework and the Resident Coordinator System. The ACC/SCN therefore asks the ACC to give positive support, focused on the agreed global nutrition goals, and to an enhanced effort at the country level.
 

B.  Business Matters

B.1. Chairmanship of the ACC/SCN

4. About one month before the 26^th Session Dr. Jolly had reminded the ACC/SCN that his second two-year term as chairman would come to a close in December, 1999. Accordingly, a meeting of the UN agencies, chaired by Dr Nevin Scrimshaw, UNU, discussed the matter. The following decisions and recommendations were arrived at by consensus.
5. The UN agencies:

• Wished to commend Dr Jolly for his effective leadership and express their appreciation of the increased visibility of the ACC/SCN in the UN system as evidenced at the current meeting, the restructuring initiative set in motion, identifying nutrition challenges in the millennium, and the development of a strategic plan for the ACC/SCN.

• Endorsed the concept of rotation of the ACC/SCN chair after two two-year terms. However in view of the need for his experienced continued leadership through the restructuring process and beginning the implementation of a strategic plan, recommended and requested a one-year extension of Dr Jolly’s appointment as chair.

• Recommended that a process for identifying a new chair to succeed him at the end of next year be initiated as soon as possible so that the selection process could be completed by the beginning of the next ACC/SCN meeting at the latest and preferably earlier.

• Designated a search committee to facilitate this process to be made up of one representative from each UN member agency of the ACC/SCN and chaired by Dr Cutberto Garza, UNU to begin the work as soon as possible. It would be expected to make optimum use of electronic consultations.

• Recommended that Dr Jolly’s successor should be designated as "Chair-elect" at the start of the year 2000 meeting, participate in this meeting and work with Dr Jolly and the Technical Secretary in planning an orderly succession, in working with the steering committee, in carrying out special tasks, and in planning for the 2001 meeting.

B.2. ACC/SCN Budget and Financing 1998-2001

Core Budget

1. Against an approved core budget for 1998-1999 of $905,000, expenditures were provisionally estimated at $840,000. Owing in part to a generous grant from the Government of Norway to cover costs of the 26^th Session, total contributions to the core budget for 1998-1999 are expected to be $929,000. This produces a surplus for the 1998-1999 period of about $89,000. This amount would be used to cover: a) any shortfall in core contributions for 2000-2001; b) a cash balance required by WHO on 1 January 2000 enabling the host agency to start paying the ACC/SCN’s expenses pending receipt of contributions, and c) any substantial increase in US dollar expenditures resulting from unfavourable developments in the US dollar/Swiss Franc relationship.
2. The core budget for 2000-2001, proposed at $861,000, continues to cover the cost of the Secretariat. This figure assumes that WHO will continue to provide office accommodation and other services to the Secretariat at no charge to the ACC/SCN. With the decision for the AGN to be in abeyance (see item D below), the Technical Secretary is authorized to use the amount of $45,000 for experts needed in working groups and for executing peer review and other functions that the AGN fulfilled. In clarification of the text on page 2 of the document ACC/SCN Budget and Financing 1998-2001, last sentence, it was suggested that the text should read: "The coordination of the core function is carried out by …" The proposed list of contributions to be paid by participating UN agencies totalled $899,000. While this amount exceeds the amount budgeted, there is the possibility that one or two smaller contributions may not be received. Disbursements of ACC/SCN’s expenses are handled by WHO. In order to facilitate WHO’s task in this respect the UN agencies are asked to pay their contributions promptly. The ACC/SCN approved the core budget for the period 2000-2001 in the amount of $861,000 unanimously.

Programme Budget, Carried out Subject to Funds Raised 1998-2001

3. The budget document presented the status of work in progress, accompanied by a table showing contributions (for 1998-1999) made or pledged, by donor, for programme activities, as well as the estimated cost of each activity. Financing was assured for each programme activity for the current biennium; the total estimated cost being $989,000. The Fourth Report on the World Nutrition Situation will be published in December 1999; quarterly reports of the Refugee Nutrition Information System are being issued; three Nutrition Policy Papers will be issued, as well as four issues of SCN News. These activities will be continued in the biennium 2000-2001. Proposed programme expenditures for the biennium 2000-2001 total $964,000. The ACC/SCN approved the programme activities, subject to funds becoming available, it being understood that minor adjustments may be made in light of available funds. During the discussion several agencies, WHO in particular, commended the Secretariat for providing a clear and transparent record of financial status.

B.3 Date and Place of Next meeting

1. The 27^th Session will take place from 10-15 April 2000. The Session will be hosted by UNICEF either in its headquarters in New York or at one of its regional offices. The Symposium theme will be confirmed by the steering committee. There was support for a symposium on "Nutrition 2000: A stocktaking and challenges for the future", to include issues of strategy, community and the global context.

B.4 The Advisory Group on Nutrition

2. Given the changing needs of the ACC/SCN and its Secretariat, as well as the growth in professional nutrition expertise within the ACC/SCN, it was decided to hold the AGN in abeyance for one year, pending recommendations of the steering committee. No appointments were made.

 

III. WORK IN PROGRESS: SUMMARY OF DISCUSSIONS AND CONCLUSIONS

A. Report of the Advisory Group on Nutrition (AGN)

3. The AGN met for one day and a half (April 8 and 9) in Geneva, under the chairmanship of Dr Ricardo Uauy. The AGN considered a range of agenda items pertinent to the work of the ACC/SCN and its Secretariat. A summary of recommendations is as follows.

• Conflict of Interest. The Chair of the AGN pointed out that full disclosure of not only potential conflict of financial interest of AGN members but also of other influences which may affect an AGN member’s opinion is warranted. This is preferable to requesting a member’s temporary exclusion. To this effect, the AGN suggesteds a change in wording of the ACC/SCN Potential Conflict of Interest Disclosure Statement to include self reporting of interests which may influence members’ independent opinion. The AGN further recommended that past members of the AGN should be invited to the AGN meeting when attendance falls below six.

• Fourth Report on the World Nutrition Situation. The AGN noted the overall approach to the Fourth Report on the World Nutrition Situation such as the life cycle approach in analyzing nutritional status. The AGN recommended that the elderly should be regarded as a distinct sub-set of the adult population in future reports. The implications of HIV/AIDS on nutrition, particularly in Africa, should be considered in future reports.

• Documenting Successful Programmes. The AGN noted that several UN agencies are involved in similar initiatives and recommended that the Secretariat should coordinate closely with these in order to maximize the usefulness of these publications. During discussion, the UNDP proposed that in order to more effectively learn lessons from the past it was necessary to critically examine unsuccessful programmes as well, not only successful programmes.

• Commission Report. The AGN suggested that the report of the ACC/SCN Commission on Nutrition Challenges for the 21^st Century should be published as an ACC/SCN document, and that a shorter version oriented towards policy makers should be translated into several UN languages and circulated. The AGN discussed the implementation of the Commission’s recommendations and endorsed capacity-building activities as a way to move forward.

• The Chair of the AGN summarized the ACC/SCN Editorial Policy and a Policy on Web Site Links to the ACC/SCN Site.

• The Refugee Nutrition Information System. The AGN concurred with the need to include in the RNIS information on the victims of natural disasters. During the discussion WFP and UNHCR raised concerns about incorporating natural disasters on a regular basis. Natural disasters come in cycles, in addition the data required to document nutrition under these circumstances must come from different sources, not those usually employed by the RNIS.

• The Draft General Comment on the Right to Food. The AGN identified a lack of clear operational definition and tools to evaluate the implementation of the Right to Food within the legal context at a national level, and suggested that the ACC/SCN Working Group on Nutrition, Ethics and Human Rights take up this issue. During the discussion Norway stressed the need to involve country representatives in the process of finalizing instruments important for reporting. WANAHR reminded the ACC/SCN to take the opportunity to provide information by the end of April to the Chair of the Committee on the Economic, Social and Cultural Rights and proposed that the Working Group on Nutrition, Ethics and Human Rights do this on behalf of the ACC/SCN.

• Zinc Nutrition. The AGN examined a proposal sent by Dr Ken Brown to the Secretariat to establish an international advisory panel on zinc nutrition under ACC/SCN auspices. Given the present status of zinc deficiency and its policy implications, the AGN supported the proposal. The matter was further discussed during the business meeting. It was decided that the Secretariat should not convene a zinc advisory panel, and further that WHO, UNU and UNICEF review findings from existing work on zinc that is underway in seven countries. These agencies will report back to the appropriate working group next year.

• Other matters. The AGN suggested one change to the AGN terms of reference: rather than "fund raising" it should say "mobilize opinion and resources".

B. Report of the Commission on the "Nutrition Challenges of the Twenty-First Century: What Role for the United Nations?"

1. The Commission was formed at the 1997 IUNS Conference in Montreal, and chaired by Professor Philip James. Terms of reference had been agreed upon at the 25^th Session in Kathmandu. Professor James noted that the Commission held five meetings and received a great deal of input from UN agencies, bilaterals, NGOs, and ACC/SCN Working Groups. Working as an independent body, the Commission acknowledged responsibility for the mix of recommendations that appear in its report, and offered to make editorial changes noted during this Session.
2. The Commission was charged with examining nutritional problems emerging in the 21^st century, and the problem of persistent malnutrition. They found that effective progress in controlling severe or clinical vitamin A deficiency and iodine deficiency is being made, but noted very high rates of stunting and underweight especially in South Asia.
3. Commission recommendations to the UN and other agencies: improve the speed of response mechanisms and capacity to integrate global data; take creative and coherent progressive action. The academic community, not as effective as they should be, needs to improve capacity-building mechanisms. UNU and IUNS need to re-consider their role, perhaps combining civil efforts with academic developments. A formal mechanism recommended by the Commission was to establish National Nutrition Councils, though avoiding weaknesses of earlier attempts.
4. The Commission was thanked by all ACC/SCN participants for this thought-provoking and challenging document. WHO supported the issues that the report brought to the forefront but offered several criticisms. Some of the data (especially numbers undernourished) differ from that published by UN agencies. New mechanisms, strategies, and approaches are proposed for UN agencies although the Commission did not analyse the UN's current mechanisms. Progress and achievements at country level are not adequately addressed.
5. FAO endorsed the need to bring these issues to the attention of agencies and the public. They agreed there is a need for accelerated action in coping with the problems in a multidisciplinary manner and that interagency action should address the issues of poverty, food insecurity and health in an integrated manner. FAO suggested the Commission report was an overly ambitious task ranging from undernutrition to biotechnology to world trade issues and human rights. FAO agreed with WHO regarding institutional innovations and that the UN system should learn how to utilize those already in place. Generally, FAO could not endorse the report as written but considered it a source from which to move forward
6. UNICEF recommended a document of approximately ten pages be extracted and edited for policy makers and political leaders. USAID concurred that a ten-page executive summary would be a stronger tool, than a large technical report. UNU welcomed this independent review. The challenges posed by the Commission to the nutrition community were acknowledged. UNU offered to publish the full report on behalf of the ACC/SCN if desired. UNU agreed with the suggestion to produce a ten-page executive summary. UNDP stated that it might be useful to consider adding agency commentaries to the final publication in which agencies could provide supplementary information, conclusions and recommendations in reaction to and in order to complement the independent report of the Commission. A similar approach is used successfully in the CGIAR.
7. The World Bank considered the report a call to the ACC/SCN that more needs to be done in nutrition, and noted that the Commission had been unable to review agencies’ achievements and constraints. Regarding data used in the report, it was felt that changing the numbers would not substantially change the Commission’s recommendations. The Asian Development Bank described how the document influenced deliberations on nutrition policy in house and was used to allocate funds using life-cycle arguments. ADB public policy staff felt this was a sound approach and hoped that the ACC/SCN becomes an active peer-reviewer of the ADB investment in this area.
8. The AGN Chair, as a member of the Commission, commented that the Commission experienced some difficulties in receiving comments back from some UN agencies. The Commission was unable to consider two critical reviews which did not reach the Secretariat in a timely manner. It was felt the implementation aspect of the report was weak and provided little guidance for capacity building, social mobilization and action in general at the national level. The document was informative but should prioritize actions and highlight major points more effectively.
9. Norway posed the question: with such rapid changes occurring in the world, and the need for reform, can the UN meet these challenges? Germany expressed a concern that the Barker hypothesis could be used to narrow investments in nutrition solely to prevention of intra-uterine growth retardation, whereas the human right to adequate food and nutrition is universal, and does not discriminate by age.
10. The Chairman summarized five action points:

• The Technical Secretary will work with WHO, FAO, UNICEF and World Bank representatives to correct the data presented in the Commission Report.

• As an independent Commission Report, references implying agreement or endorsement by the ACC/SCN in the document should be deleted.

• Any suggestion that the ACC/SCN endorses the Commission Report should be deleted.

• The Commission Report will be published solely as a report "to the ACC/SCN" and not as part of the ACC/SCN Nutrition Policy Paper series.

• Agencies’ comments on the Commission Report could be included in the document before being published. A disclaimer stating that views in the Report do not necessarily represent those of the agencies making up the ACC/SCN will be included.

C.   World Nutrition Situation: Fourth Report

1. The Technical Secretary introduced the Fourth Report, an outline for which was discussed in detail at the 25^th Session. This Report is being prepared jointly with the International Food Policy Research Institute (IFPRI). A full draft will be circulated for review in late July 1999; the publication date is December 1999. The Report draws on material from the UN agencies as much as possible. Preliminary results on trends in preschool underweight were presented. These estimates were produced by the WHO Nutrition Department for the ACC/SCN using the direct methods recommended by Dr. Tim Cole in his review paper on methodology. It was noted that the WHO Global Database on Child Growth and Development is now available on the Web at http://www.who.int/nutgrowthdb.
2. Sweden expressed concern that the Report should disaggregate nutrition trend data by age and gender. It was noted that the WHO Database is already disaggregated by age and sex. The Secretariat confirmed that adult BMI data would be disaggregated by sex. The UK requested a section on the elderly, given that this population is growing so rapidly. This might encourage systematic data collection on the nutritional status of the elderly and persuade governments to consider the problem of nutrition in the elderly. The Secretariat responded that a section on the elderly will be included in the Report and also noted that the December 1999 edition of the SCN News will focus on nutrition of the elderly.
3. The problem of disaggregating the data by country within a region was discussed. The Secretariat noted that the methodology employed to estimate trends does not allow analysis using single countries only, but those interested in data from single countries may refer to the WHO Database on the web. The Fourth Report will use the UN Population Division regions and sub-regions because (a) this is the format acceptable to most of the agencies, and (b) this definition is closer to geographical reality and hence is more easily understood by non-UN users. The Chairman suggested that the ACC/SCN might like to suggest to the ACC that the UN agencies should attempt to harmonize their definitions of regions in the future.
4. Several speakers noted that most of the Report is concerned with trends in nutritional status but there is little information on trends in the determinants of nutritional status, e.g.: diet, morbidity and access to health care. The World Bank suggested that Chapter 3 be revised to incorporate underlying and basic causes of malnutrition. Norway noted that it is possible to estimate trends in the amount of breastmilk produced and that this information would be useful as an advocacy tool. The Secretariat responded that there will be a section on the causes of childhood malnutrition. The Chairman remarked that suggestions on possible indicators of the determinants of nutritional status which could be easily collected would be most welcome.
5. The issue of data collection for future ACC/SCN publications, particularly the reports on the World Nutrition Situation, was brought up by UNU. UNU recommended that a process for drafting outlines for the Fifth and Sixth Reports be initiated with a clear eye to emerging issues (.e.g. non-communicable disease and important determinants of nutrition-related problems.) The Chairman asked the participants to consider how the ACC/SCN and the UN agencies could obtain better data in the future with these goals in mind and the objective of influencing survey activities.
6. The World Alliance for Nutrition and Human Rights (WANAHR) commented that some of the data presented should be re-framed in terms of human rights and strategic plans, e.g.: shortfalls from goals could be presented as well as actual status. It was further noted that the section on human rights should stand on its own. This section will probably be descriptive for now but it is hoped that as indicators are developed to measure progress towards a human rights approach to nutrition that it will become more quantitative.
7. Sweden suggested that a section describing the national plans of actions (NPANS) should be included for advocacy and strategic purposes. The Secretariat noted that it is not possible to include an analysis of NPANS in the Fourth Report without major input from WHO and FAO. WHO and FAO have information on the national plans of 173 countries and are undertaking an analysis of this information which they will share with the ACC/SCN when it is ready. Sweden further commented that the country updates which were previously published as supplements to the World Reports were useful tools for planners and policy makers with a non-nutritional background. Norway suggested that the Report could highlight the dangerous plight of those working for agencies in emergency situations. The Chairman noted that this might be more appropriate for the RNIS. PAHO offered to collaborate in producing a box on complementary feeding.

 

D. Report of Decisions taken in Working Groups

D. 1 life cycle consequences of foetal and infant malnutrition -- Report of the Working Group

(Chaired by UNU, UNICEF served as Rapporteur)

8. The mandate of this group is to assess the lasting significance of the nutritional and health status of the mother during pregnancy as it affects the development of the foetus and the infant. This group noted clear evidence that folic acid deficiency in early pregnancy contributes to neural tube defects, iodine deficiency in pregnancy shifts the distribution of IQ and iron deficiency in infancy has a similar effect as does undernutrition before two years of age. The group also discussed the origins, evidence and criticisms of the Barker hypothesis at length. Low birth weight (LBW) in the UK earlier in this century appears to have increased the adult onset of hypertension, coronary heart disease, diabetes and some other chronic degenerative diseases. This concept has been supported by studies from a number of other countries. The results of the 1996 workshop on the Causes and Consequences of Intra Uterine Growth Retardation (IUGR) sponsored by the International Dietary Energy Consultative Group (IDECG) reinforced these conclusions. IUGR is a major public health problem in most developing countries. Despite a World Summit for Children goal of reducing the prevalence of LBW to 10% or less, globally 20.5 million LBW babies are born each year -- 16.4% of all newborns in developing countries.
9. WHO and PAHO stated that reduction of LBW is a priority and improving essential obstetric practices has been emphasized. In 1998 PAHO held a workshop to review the appropriateness of anthropometric indicators during pregnancy. Other agencies stressed the need to present LBW prevention programmes as part of reproductive health care programmes, and the importance of the Barker hypothesis for policy makers. UNICEF and the World Bank in collaboration with ICCDR,B will hold a meeting in Bangladesh in June 1999 to explore issues related to LBW and IUGR.
10. Conclusions and priorities for action from the Group:

• there is a need to establish a core research protocol to investigate a longitudinal relationship between IUGR and disease in later life in different populations;

• programmes which address IUGR should be based on the Care for Women component of the UNICEF Care Initiative;

• there is a need to identify and document best practices for the prevention of LBW which could be integrated into new comprehensive programmes, including monitoring and evaluation;

• the successful approaches of Chile, Cuba and Costa Rica to reduce LBW should be reviewed for lessons to be learned;

• this new working group should be continued in order to provide the ACC/SCN with an annual critical assessment of developing scientific evidence and to stimulate research and policy formulation and programme guidelines on this topic;

• an inter-agency meeting similar to the iron consensus workshop could usefully explore these issues in greater depth;

• the ACC/SCN should consider a proposal from SIDA and Uppsala University for an international meeting in the year 2000 which will focus on women and nutrition, especially adolescent girls.

 

1. This Group reported that while some progress was being made, there was irrefutable evidence that vitamin A deficiency (VAD) was still widespread among children in the developing world. USAID, UNICEF, CIDA and the MI created a Global Initiative to secure commitment to achieving the year 2000 goal of eliminating vitamin A deficiency and to set benchmarks for countries unable to reach that goal by December 1997. Progress of the Global Vitamin A Initiative was reported as follows:

• 43 of 64 countries with VAD added vitamin A to national immunization days (NIDs);

• about 60% of children in sub-Saharan Africa received at least one dose of vitamin A in the last six months of 1998, doubling coverage from two years ago;

• globally 34 countries report over 80% coverage, mostly through NIDs;

• almost 400 million capsules provided by CIDA;

• significant new funding is available from CIDA for implementation of VAD programmes.

1. There was extensive discussion on the importance of other strategies, besides supplementation, to combat vitamin A deficiency. Biochemical assessment is one method to monitor the progress of the Global Initiative, and the need for reference laboratories in countries where vitamin A deficiency is a public health problem was discussed. Potential laboratories in Africa have been identified and reference materials, inventory of protocols and facilities, and on-site visits will be the basis for further training and follow-up.
2. The Iron Deficiency Anaemia Database was described. According to WHO, eighty percent of the world's population are likely to be suffering from iron deficiency. Thirty specialists attended a Technical Workshop at UNICEF in New York in October 1998 to resolve issues using a practical, field-oriented, science-based approach to preventing iron deficiency in women and children. This Workshop highlighted the need for greater attention to iron nutrition, given the massive economic and social costs of iron deficiency. Further, effective and feasible programme interventions are available. There was also discussion regarding multiple micronutrient supplementation and it was concluded that dietary intake of several micronutrients is often inadequate; that micronutrient status needs improvement not only during pregnancy but pre- and post-natally. The Group also stressed the importance of improving dietary intakes.

D.3 Breastfeeding and Complementary Feeding -- Report of the Working Group

(Chaired by UNICEF, WHO served as Rapporteur)

3. Recommendations for ACC/SCN action are:

• All implementing agencies should adopt a rights-based approach to all their infant feeding programmes.

• Maternity Legislation: The Working Group requests the Secretariat to utilize its good offices to approach the new Director General of ILO and express concern over the process towards the re-negotiation of the Maternity Protection Convention. In particular, the question should be raised as to whether the rights of working mothers and the importance of exclusive breastfeeding in assuring the child's right to the highest attainable standard of health have been duly considered by the ILO Secretariat in the drafting of the questionnaire and subsequent report to be considered by the International Labour Conference.

• The Care Approach - Early Childhood Care for Survival, Growth and Development: An intersectoral rights-based approach to child survival growth and development should be adopted by all implementing bodies.

• Complementary feeding: The Breastfeeding Counseling training course and its complementary feeding component needs to be more widely implemented, particularly in countries affected by the HIV epidemic to counter the tendency to abandon breastfeeding protection, promotion and support.

• International Code of Marketing of Breast-milk Substitutes: In the context of mother-to-child transmission (MTCT) of HIV, global implementation of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant WHA resolutions need to be accelerated and strengthened. UNICEF should prepare a briefing note explaining the continued relevance of the Code in the context of prevention of MTCT of HIV, explaining particularly the provisions concerning free and low cost supplies. It was suggested that ACC/SCN strongly encourage UNAIDS colleagues to attend the next Session of this Working Group.

• The Baby Friendly Hospital Initiative: Implementation of BFHI needs to continue and be strengthened.

• Economic Value of Breastfeeding: The Benefits of Breastfeeding Model for assessing the economic value of breastfeeding (BOB) should be used more widely to advocate for the introduction and strengthening of breastfeeding policies and programmes.

D.4 nutrition, ethics and human rights -- Report of the Working Group

(Chaired by UNICEF, the NGO WANAHR served as Rapporteur)

1. Dedicating the Symposium at the 26^th Session to the theme of nutrition and human rights was evidence that human rights are taking hold in the development work of the ACC/SCN and its member agencies. The question was no longer whether a rights-based approach should be adopted, but rather how it should be applied. The World Food Summit's renewed focus on the right to adequate food and the UN Secretary-General's reform proposals calling for the mainstreaming of human rights in all UN activities, have contributed significantly to creating an overall environment conducive to bringing an ethics and rights dimension to the fight against hunger and poverty.
2. The overall recommendation of the Group: To live up to the challenge of completing its unfinished agenda, the ACC/SCN needs to lift its human rights concerns from an isolated working group activity into the mainstream of its overall work programme. This must also be reflected in the ACC/SCN's resource mobilization and allocation within the work programme.
3. Recommendations for ACC/SCN action are:

• The ACC/SCN should institutionalize collaborative mechanisms with the Office of the High Commissioner for Human Rights (HCHR) to advance human rights approaches to nutrition problems. An important element of this activity is facilitating the flow of information regarding the experiences of ACC/SCN member agencies in adopting a human rights approach, including agency initiatives for internal capacity building. The Working Group will compile these experiences for the Secretariat.

• The Working Group should initiate work on developing appropriate indicators for monitoring the right to nutrition, in particular the right to food, by ACC/SCN member agencies and the HCHR.

• In response to the recommendation by the chairpersons of the Committees and of the Second Consultation organized by the HCHR and co-hosted by FAO on November 11, 1998, the Working Group should collaborate in the preparation of a meeting on the role of the international financial institutions in the realization of economic, social and cultural rights.

• The Working Group should prepare a report for the next annual ACC/SCN session on the experience from the UNDAF process in adopting a human rights approach to nutrition.

• The Working Group should pay special attention to the realization of the right to nutrition in emergency situations as part of its activities in between annual ACC/SCN sessions.

1. The Working Group identified three topics from last year's Session that needed to be taken forward: the interagency collaboration in food security programmes; operational methods for the targeting of food security interventions; and how to integrate household food security into sector-wide approaches. Presentations were given by FAO on locating food security at the national and regional levels using the Food Insecurity and Vulnerability Information Mapping Systems (FIVIMS); by IFPRI regarding targeting of projects at the community level; by UNHCR on targeting food aid in emergencies within communities and by Helen Keller International on targeting in the context of an economic crisis.
2. The Working Group proposed the following areas of work for 1999-2000:

• Explore the linkages between macro changes and food security at household and community level: It was suggested that the linkages between macro changes, including trade and economic and sectoral reforms, and efforts to address household food security at local level should be highlighted. One possibility may be to hold a symposium on this with international financial institutions including the World Bank, the IMF and World Trade Organization (WTO). The Working Group should explore this option in consultation with the Working Group on Nutrition, Ethics and Human Rights.

• Operationalization of a rights based approach to programming of household food security programmes: Case studies of innovative programmes which demonstrate the practical application of a rights based approach to nutrition and food security should be prepared by agencies for discussion at future meetings.

• Urban food insecurity: Urban food security is a growing concern, yet receives little attention. The Working Group should review the evidence on trends in urban food insecurity, coping strategies and policies and programmes.

 

D.6 nutrition in emergencies -- Report of the Working Group

(Co-chaired by WFP and UNHCR, the NGO MSF-Holland served as Rapporteur)

1. This Working Group addressed the evolution of nutrition responses in emergencies from 1976 and the impact of the recent nutrition crisis in South Sudan on adolescents and adults.
2. Recommendations for ACC/SCN action are:

• The need for programmes targeting adults and adolescents should be systematically investigated as part of any famine relief response.

• The ACC/SCN should take up the issue of adult and adolescent malnutrition to further standardise criteria and protocols, to determine survey methodology and population prevalence cut-offs for malnutrition, and to develop a common operational research agenda to prevent duplication of time and resources. WHO offered to take the lead on these issues.

• New strategies are needed to manage and implement infant feeding in emergencies amongst populations with a high rate of formula feeding prior to displacement.

• The RNIS should be enhanced to (i) include more reports from U.S. NGOs, and (ii) provide reports from the field on a timely basis through E-mail or on the ACC/SCN website. The Secretariat will take action on this.

• The Working Group also recommended that the chair of the group be rotated. UNICEF offered to chair, and WHO to serve as rapporteur.

 

D.7 Iodine Deficiency disorders

1. This Working Group did not meet during the ACC/SCN 26^th Session but presented a report on behalf of WHO, UNICEF and ICCIDD describing in detail the many activities undertaken over the last year. Significant progress has been made towards IDD elimination: it is estimated that 18% of IDD-affected countries have reached the goal of universal salt iodization, defined as more than 90% of the households having access to iodized salt. Over the past year activities concentrated on increasing salt iodisation coverage, assessment and monitoring, and training. Work also included:

• Organization of intercountry micronutrient workshops, for example Swaziland (1998)

• Planning meetings for the Salt 2000 symposium at the Hague

• An IDD assessment in Latin America (Colombia)

• Publications: Hyperthyroidism and other thyroid disorders. C. Todd. (In collaboration with ICCIDD), in press.

1. The goal of IDD elimination is within reach. However, success will only be achieved with sustained and continued effort. The challenge for the forthcoming year is two-fold: first to introduce salt iodisation in the 35 affected countries where it has not yet been implemented; second to sustain salt iodisation programmes. This is especially important in light of experience in some industrialized countries where iodine status has deteriorated.
2. Recommendations include:

• Governments should re-commit themselves to the elimination of IDD and mobilise human technical resources towards this goal by facilitating collaboration between the relevant sectors. Health, trade and legislation sectors need to work closely together, something they may be unfamiliar with.

• Systems to monitor the quality of iodized salt as well as the iodine status of the population need to be put in place. This implies reinforcing existing laboratories or developing a network of regional or sub-regional laboratories able to cover countries without properly equipped laboratories.

• Governments should adopt and enforce legislation on iodized salt.

E. Meeting of the UN Agencies

1. The UN agencies' separate meeting had a rich and fundamental review of the workings of the ACC/SCN. There was consensus on the need to make a range of structural and procedural changes that would strengthen the effectiveness of the ACC/SCN as a coordinating mechanism for UN agencies. The main agenda items included:

• The working arrangements of the ACC/SCN

• The role of the AGN

• The Strategic Plan of Action

• Symposium Topics for the 27^th Session

• The selection of the Chair

E. 1 The Working Arrangements of the ACC/SCN

1. This discussion focused on the structure of the annual meeting. It was proposed that:

• The UN agencies should meet together at the beginning of the ACC/SCN Session to update each other on nutrition activities undertaken during the preceding year, identify key scientific and operational issues, harmonize regional workplans and develop joint initiatives to be undertaken during the year.

• Where possible, regional nutrition advisers of the UN agencies should be brought to the Session. UNICEF, WHO and FAO thought this might be possible. In addition, and for some agencies as an alternative, regional nutrition advisers might meet within their region.

• The bilateral and NGO members of the ACC/SCN should be included in all the subsequent business meetings of the ACC/SCN as they have important, and indeed invaluable, roles to play in both technical discussions and in the formation of plans of action. The broadly inclusive nature of the ACC/SCN was reaffirmed as one of the unique strengths of this sub-committee, and an essential characteristic that must be preserved.

E.2 The Role of the AGN

1. The following points arose from the discussion:

• Historically, the AGN was introduced into the tripartite structure of the ACC/SCN at the request of the bilaterals in order to provide independent nutrition expertise to the UN agencies. The principle of making use of independent expertise was reconfirmed. The valuable work that the AGN has contributed in the past was commended by all present and the commitment of the AGN members to the ACC/SCN was much appreciated.

• Since its establishment, however, the base of nutrition expertise within the ACC/SCN has grown significantly and there now exists experienced nutrition professionals in most bilateral and UN agencies. This expertise will be strengthened further if the plan to invite regional advisers of the UN agencies to the ACC/SCN meetings is adopted.

• The ACC/SCN has also developed a wider network of contacts in the nutrition world, including groups such as International Union of Nutritional Sciences (IUNS) and various technical expert committees. It was suggested that the links between these groups and the ACC/SCN could be strengthened informally and that they could be asked to fulfil some of the roles of the AGN.

• If the AGN were to be dismantled, the funds previously used to cover their travels costs could be used to employ outside expertise in matters where the ACC/SCN has insufficient expertise and/or to strengthen the work of the working groups. Thus a "demand driven system for expertise" would be introduced.

• The current two-year terms of all AGN members would expire at the close of the 26^th Session. If the AGN is dismantled new strategies would be needed to fulfil the tasks currently carried out by the AGN. UNU offered to assist the Secretariat in setting up a peer review process.

1. The UN agencies proposed that the AGN should be held in abeyance for a one-year period. An interim programme steering committee should be appointed with a one-year life span. Its terms of reference would include identifying the best way to execute the tasks traditionally carried out by the AGN. These tasks include providing peer review for ACC/SCN publications and technical proposals that come to the SCN; advising ACC/SCN members on critical aspects of programme implementation at the national and regional level; providing external review of the effectiveness of the UN system work on nutrition; representing civil society and proposing ways to enhance action at the national level.
2. It was envisaged that the work of the steering committee would be advisory in nature and undertaken through electronic communication and/or conference calls. It was suggested that the committee should be composed of representatives of FAO, UNDP, UNICEF, the World Bank, WHO, an NGO representative, a bilateral representative and the current AGN chairman. The committee will confer regularly with other ACC/SCN members.
3. Finally, several agencies suggested that it was desirable for FAO to contribute to the ACC/SCN budget given that FAO will be represented on the steering committee. The FAO representatives said that they felt positively about the changes suggested and would discuss the matter with the appropriate persons at headquarters, and would recommend that FAO’s funding position be reconsidered.

 

E.3 The Strategic Plan for Accelerating Nutrition Improvement at Country Level

4. In addressing the issues of the ACC/SCN Draft Strategic Plan, the UN agencies focussed on the implementation aspects of improving interagency collaboration for nutrition. The main points which arose from this discussion were:

• The World Bank proposed three major activities: an advocacy campaign at the global level based on the Report of the Commission on the Nutrition Challenges of the Twenty First Century; a joint project by two or more agencies in each region on a specific theme. For example, the World Bank is teaming up with UNICEF in Africa; and Global initiatives on adolescent and maternal malnutrition.

• Similarly, ADB and UNICEF announced their plans for a regional nutrition meeting in Asia in September aimed at formulating a major initiative in Asia They suggested that representatives from UNDP and the NGOs should participate in the meeting. The group could then report back to the ACC/SCN at the 27^th Session, with recommendations and suggestions concerning the usefulness of inter-agency regional level nutrition meetings and on the directions of that initiative.

• General agreement was reached on the need to work through the UNDAF process in all regional and country level initiatives and on the usefulness of such initiatives to bring the CDF and CCA processes in line in a few selected countries.

• ADB proposed to draft a "clarion Call for Action" statement from the 26^th Session to stress the paradigm shifts discussed at this meeting. This would probably take the form of a brief statement, aimed at policy makers, and should emphasise human rights dimensions. The brief must emphasize the costs of inaction on the part of the international community in order to elevate nutrition concerns within and across UN agencies.

E.4 Symposium Topic for the 27^th Session

1. Three themes were proposed for the year 2000 Symposium:

• Nutritional Stocktaking and the Challenges Ahead - it was felt that this theme could give the ACC/SCN a chance to focus inwards on its achievements and needs

• Global change in the 21^st Century - focusing on advances in biotechnology and its effects on food safety and food availability

• Globalisation and Nutrition - focusing on the effects of the WTO and global trade agreements, the demographic transition, the information revolution and the globalisation of threats to human health, on the world nutritional situation.

F.  Bilateral Agencies

1. The bilaterals discussed a number of items relating to the ACC/SCN Agenda:
2. Commission Report on Challenges in the 21 Century. The bilaterals welcomed the report. An adequate and attractive executive summary needs to be elaborated. A one-to-two page policy brief is needed as an advocacy tool for use within agencies, member countries, UN agencies and the ACC. The brief should be written by a journalist for a non-nutrition audience. There is a need to alert agencies and governments of the speed of change in the field of nutrition and global nutrition problems as described by the Commission.
3. ACC/SCN Strategic Plan. A good beginning had been made but considerable work is needed to transform the current draft into a strategic plan. The openness of the text is impressive, but the Plan is not sufficiently country-driven and does not acknowledge the difficulty of country-level collaboration by UN agencies. Since neither the bilaterals nor the ACC/SCN members have the necessary expertise, the appropriate expert assistance should be recruited to develop a practical framework with countries as the prime actors. In addition, a planning group should be formed, which includes the main agencies, to guide the development of the Strategic Plan. The Strategic Plan should be written in relation to the ICN, the World Food Summit and the Convention on the Rights of the Child.
4. ACC/SCN Budget. The bilaterals are pleased with the presentation of the ACC/SCN budget.
5. Year 2000 Symposium. The bilaterals suggests the topic Globalization and Nutrition. The symposium should highlight the impact of macro level issues (for example trade liberalization, economic crisis, world prices) on the micro level. The objective of the symposium should guide the decision on venue of the next Session. The bilaterals appreciate the offer of joint sponsorship by the World Bank and UNICEF. If the symposium is intended to be purely informational, then, finances permitting, holding the next meeting in a developing country, possibly linked to a regional office of an ACC/SCN member, should be considered.
6. Successful Nutrition Programmes. It is important to learn from successful nutrition programmes. However, further work done by the ACC/SCN on documenting successful programmes should be done with caution, wherever possible using unbiased external evaluation results. Further work would also benefit from identifying and reviewing new examples through a process of consultation with governments. Finally, one goal of continued work in this area would be to realistically define the likely impact expected from even the most successfully implemented projects. This will help avoid over-ambitious planning and goal setting, which too often unfairly labels nutrition projects as failures.
7. Zinc: Proposal for a Working Group. The bilaterals recommend that the ACC/SCN consider having one micronutrient group only. This working group can assume responsibility for its own agenda from year to year and the micronutrients that will receive most attention from year to year. The bilaterals repeated their wish to see a greater emphasis on food-based strategies, communication and monitoring and evaluation for addressing all micronutrient deficiencies. On the issue of funding, before accepting funds from a new source, the ACC/SCN should proceed with caution in relation to potential conflict of interest.
8. IDD: World Health Assembly (WHA) Resolution. The bilaterals note the text of the May 1999 WHA resolution on IDD and will study it in their own countries. All stakeholders are urged to expand and consolidate ongoing programmes in support of IDD control and elimination. Issues of sustainability, monitoring and quality control are important.
9. HIV and Infant Feeding. The bilaterals expressed their concern at the way the issue of HIV transmission from mother to child via breastmilk is being addressed by the UN system. UNAIDS’ absence from the ACC/SCN discussion was noted. The research basis for the new UNAIDS/WHO/UNICEF guidelines needs to be expanded, particularly regarding the use of breastmilk based feeding regimens, such as short periods of exclusive breastfeeding, heat treatment of expressed milk, use of milk from breastmilk banks, and wet nursing. The bilaterals are concerned that, with no extra resources, WHO and UNICEF are required to work on the implementation and pilot testing of these guidelines. This has forced the diversion of staff time and other resources away from ongoing breastfeeding programmes. This is especially unfortunate given the increased need for breastfeeding protection and promotion that the implementation of these guidelines will require in order to prevent a spillover effect.
10. Sector-wide Approached and Nutrition. Sectoral funding from some ACC/SCN and bilateral agencies is acting as a constraint to countries’ efforts to implement nutrition programmes in a multisectoral fashion.
11. Food Aid and Nutrition. The bilaterals noted the changing nature of food aid in development as well as in emergency programmes focusing on nutrition and food securityand suggested that this subject should be considered for a future ACC/SCN activity.
12. The ILO Convention on Maternity Protection. The bilaterals brought to the ACC/SCN’s attention the ongoing review of the ILO Convention 103 on Maternity Protection. The bilaterals suggested that the ACC/SCN, through its Chairperson, approach the Director General of WHO, and decide whether one or both should approach the new Director General of ILO to consider extending the process of review and revision of ILO Convention 103.

 

G. Non-Governmental Organizations

(Chaired by WABA, Helen Keller International served as Rapporteur)

13. The meeting of non-governmental organizations was attended by representatives of twelve NGOs. The meeting started with a discussion on its purpose and specifically what role NGOs could play in supporting the aims of the ACC/SCN and how the ACC/SCN could promote and support the NGOs in achieving their aims. This was done by identifying the constituencies of the different players. These were thought to be:

• The ACC/SCN -- the constituent UN Agencies

• The UN Agencies -- their Member States

• The Advisory Group on Nutrition -- the ACC/SCN

• The NGOs -- the beneficiaries in countries.

1. The NGOs involved in food and nutrition are very diverse. Activities and mandates range from evidence-based scientific groups such as IUNS; science-based advisory, advocacy and service organizations such as ICCIDD, WABA; emergency situation NGOs such as ACF, Action Against Hunger, CARE, CONCERN; service organizations such as national NGOs; international NGOs and PVOs such as Helen Keller International; advocacy NGOs such as IBFAN and WANAHR; local NGOs such as those attending the Session several years ago in Ghana; and others such as the South African Human Rights Commission. This diversity has both strengths and constraints in speaking with more or less one voice. However, the need to be responsive to diverse clients is shared. Other common factors are advocacy, training, capacity building, providing expertise and information, and being operational in the field. These roles are useful to the UN agencies.
2. More specifically some of the mutual benefits discussed were:

• The NGOs are appreciative of the role the ACC/SCN plays, and appreciate being part of a process that encourages openness and stream-lining. The NGOs present felt they could assist in this process, by offering a somewhat different perspective and representing their clients.

• In an age of increasing specialization and reduction in staff in the agencies, the NGOs are an obvious and in some cases essential pool of expertise for implementation on the ground for the UN agencies.

• Given the on-the-ground experience (e.g. in emergencies but also in on-going country implementation) the NGOs are more clearly aware of the circumstances in-country, and have the relative freedom to bring issues to the attention of the agencies. NGOs could therefore be a conduit for the needs of the beneficiaries to the policy levels of the agencies through the ACC/SCN. NGOs can bring to the agencies’ attention the need to strengthen Agency in-country activities and the need to correct deficiencies.

• The publications of the ACC/SCN such as the World Nutrition Situation Reports are very useful and widely read.

• Agencies sometimes have problems coordinating sub-regionally and all partners should look for ways this might be improved, and NGOs could help.

Advantages of maintaining a grouping of NGOs:

• The NGOs group could help define how involved NGOs could work more effectively together.

• NGOs involved in emergencies should have a common voice and be heard, especially during emergencies, by the UN agencies.

• Some sort of overt support or statement of support from the ACC/SCN to active NGOs would be helpful when seeking funds. This should not prejudice freedom of action, and the right to bring criticisms to the table.

• As coordination is one of ACC/SCN’s roles, an NGO group could help the NGOs coordinate amongst themselves according to expertise and this needs to be explored further. Information exchange was also seen as a mutually helpful activity.

1. Other points:

There was some surprise in the group that while the NGOs generally find the ACC/SCN important in combating malnutrition, and addressing food and nutrition issues globally, not all UN agencies are supportive of the ACC/SCN, and some do not even contribute. There was a view expressed, with a broad degree of support, that the agencies most concerned with food and nutrition and health issues could be more pro-active and take a more visible profile. The example of environmental issues was given as an example, where NGOs had been able to play a major role in the higher profile environmental issues now have in the agencies (and subsequent action- which would not have taken place without NGO strong advocacy). Possibly the NGOs here could have a similar role in helping food and nutrition issues have the importance they deserve at national, and global level, and in the agencies. The NGOs would be able to help in this regard. About 30 NGOs are represented at the ACC/SCN. Other key NGOs could be identified and involved . An NGO Working Group on Nutrition could be formed.

2. Recommendations:

• That the NGO meeting be scheduled by the Secretariat in the same manner as the bilateral meeting.

• That the ACC/SCN express their continuing willingness to work with the NGOs and, in particular to demonstrate that they would be comfortable with the group acting as a critical, independent but constructive voice.

• That the ACC/SCN support the idea of the continuing exploration of the role of the NGO group, although the group understands that it would be up to NGO partners involved to continue the momentum.

1. This segment of the 26^th Session included representatives from UN agencies, bilaterals, NGOs and the AGN. Decisions were taken on matters arising during the separate meetings held the previous day. Decisions were the following:

• There was consensus on the need for a steering committee with a one-year life span. This committee will be made up of representatives of FAO, UNDP, UNICEF, the World Bank, WHO, an NGO representative, a representative of the bilaterals and the current AGN Chairman. The World Bank, UNICEF, UNDP and WANAHR offered to draft Terms of Reference. The main purpose of the committee will be to propose the content and format of the ACC/SCN Session and Symposium in 2000 and guide a restructuring process that would strengthen the activities of the ACC/SCN.

• The AGN will be held in abeyance for a one year period. New mechanisms to access independent expert opinion for the ACC/SCN (for example through the UNU and its links) will be identified by the steering committee.

• The working groups should work together throughout the year, not just during the ACC/SCN Session. This could be achieved via electronic mail and/or conference calls. The steering committee will identify new topics which could be addressed by working groups. The working groups will give priority to discussing follow-up on recommendations made at past meetings.

• A two-to-three page advocacy document will be drafted by ADB. This is intended for use as an ACC/SCN statement for the "non-converted". The ADB will work with the SCN News Editor on this document.

• A six to ten page executive summary of the Commission Report will be prepared by the Secretariat. The Secretariat will circulate a draft of this document electronically before finalizing it.

• The Commission Report will be published by the Secretariat with a disclaimer on ACC/SCN endorsement. Commentaries from UN agencies could be included as part of the publication. Agencies are requested to submit their comments on the Commission Report to the Secretariat by the end of May 1999.

• The bilaterals will assume responsibility for preparing sectoral briefs on nutrition. These briefs will use language pertinent to sectors and issues relevant for development such as: agriculture, health, education, environment, gender, poverty alleviation. The bilaterals will try to raise funds for this purpose and request ACC/SCN endorsement.

• Several UN agencies through the UNDAF process (UNICEF, WB, UNDP) will meet with UNDG to discuss their programme ideas. The ADB will also assist with these discussions. Based on these discussions the steering committee will further develop the Draft Strategic Plan.

70. The Secretariat will circulate the proposal on documenting successful programmes and request comments and opinions as to whether this project should be taken up by the Secretariat subject to funding.

Annex I

List of Participants

Chairman: Richard Jolly

Technical Secretary: Sonya Rabeneck

Symposium Chairman: Mr Bertrand Ramcharan, Deputy High Commissioner for Human Rights

Symposium Presenters: Mrs Mary Robinson, High Commissioner for Human Rights

Dr Gro Harlem Brundtland, Director-General, World Health Organization

Mr Namanga Ngongi, Deputy Executive Director, World Food Programme

Mr Chris Lovelace, Director, Human Development Department for Europe and Central Asia, World Bank

Ms Amelia Bonifacio, Director, Operational Support, UNHCR

Mr Hartwig de Haen, Assistant Director-General, FAO

Mr Stephen Lewis, Deputy Executive Director, United Nations Children’s Fund

Professor Virginia B. Dandan, Chairperson-Elect, Committee on Economic, Social and Cultural Rights

Dr Denise Coitinho, Ministry of Health, Brazil

Mr Tseliso Thipanyane, South African Human Rights Commission

Professor Soekirman, Indonesia

Dr Asbjorn Eide, Senior Fellow and Former Director, Norwegian Institute of Human Rights

Dr Michael Windfuhr, FIAN International Secretariat

Dr Urban Jonsson, UNICEF Regional Office for Eastern and Southern Africa

Dr Lawrence Haddad, Director, Food Consumption and Nutrition Division, IFPRI

Abraham Horwitz Lecture: Dr Brigit Toebes, Research Coordinator, T.M.C. Asser Institute, The Netherlands