United Nations System
Report of the Sub-Committee on Nutrition at its Twenty-Eighth Session
Hosted by the World Food Programme,
A. Introduction1. Dr. Namanga Ngongi, SCN Chair, welcomed participants to the 28th Session of the ACC/SCN, hosted by the World Food Programme, Nairobi. He also welcomed representatives of bilateral agencies, non-governmental organizations, and colleagues working in government departments and agencies and academia. He noted the very large turn out for this 28th Session. Registration has surpassed all previous years. Dr. Ngongi emphasized that the SCN is a collective body aimed at promoting co-operation amongst UN agencies and partner organizations in support of national efforts to end malnutrition in this generation. Nutrition trends are encouraging in some parts of the world and worrying in others. New issues emerge continually. There are successful large-scale programmes, such as national iodization schemes in many countries, the Baby Friendly Hospital Initiative, and distribution of vitamin A capsules through national immunization days. These programmes have important and measurable impacts. However, there is much more to do.
2. Dr. Ngongi then called upon the SCN plenary body to observe a moment of silence for Dr. Abraham Horwitz who died on July 10, 2000. Dr. Horwitz served as chair of the SCN from 1986 to 1995.
B. 5th Report on the World Nutrition Situation3. The SCN had before it the draft outline for the 5th Report on the World Nutrition Situation. In introducing the draft outline the Technical Secretary noted that the 5th Report will be part of a series of publications on nutrition trends in the developing world, begun in the late 80s. The SCN Secretariat published the 1st Report on the World Nutrition Situation in November 1987, followed by the 2nd Report in two volumes in October 1992 and March 1993. A main feature of these reports was the presentation of regional and global trends in preschool underweight. As more national survey data became available in the mid 90s several updates were published to add to this collection. The 3rd Report, published in 1998, featured for the first time a full chapter on trends in stunting, i.e., low height for age.
4. The 4th Report was based on the theme nutrition throughout the lifecycle and covered available indicators of nutritional status from foetal life to the elderly. This report, produced in collaboration with IFPRI and launched during the 27th Session in Washington, included trends in breastfeeding and complementary feeding, as well as a full chapter on nutrition and human development. The report was well received; printed copies have been distributed worldwide. The full report is available on the SCN’s website and statistics available to the Secretariat indicate that the frequency of downloads ranged up to 800 full copies per month during 2000.
5. The Secretariat requested reactions and guidance from the SCN plenary on questions concerning both the content and style of presentation of the 5th Report. What audience do we really need to reach? How should the content differ from previous publications in this series? Should we use less technical language that might make the 5th Report more accessible to a readership outside the nutrition community? There was a general feeling that the report should provide an update of key nutrition indicators, as in the past. However, the report must go beyond this to highlight the key connections between nutrition and emerging issues in other sectors. The tracking of resource flows to nutrition, equity issues, HIV/AIDS, building capacity for nutrition and the role of physical activity in emergent nutrition-related non-communicable diseases were all mentioned. Several speakers highlighted the importance of adding value to the large body of work on-going this year in relation to the major conferences, and avoiding "an omnibus".
C. Kenya Coalition for Action in Nutrition (KCAN)6. The SCN welcomed Professor Ruth Oniang’o, Professor of Food Science and Nutrition at Jomo Kenyatta University of Agriculture and Technology and founding member of KCAN, Dr. Teresa Muthui, HIV/AIDS Coordinator for the Ministry of Agriculture and Interim Chair of KCAN, Ms. Margaret Lukoye, Education Officer in the Ministry of Education, and Ms. Debbie Gachuhi, KCAN member. The presenters explained how, under the Greater Horn of Africa Initiative and LINKAGES, both supported by the US government, nutrition advocacy has been revitalized in Tanzania, Uganda and Kenya. Nutrition is being placed as a key development issue that deserves greater allocation of resources. In Tanzania this work is carried out by a national consultative group and by a similar nutrition core group in Uganda.
7. The Kenya Coalition for Action in Nutrition (to read "Kenya CAN") is a non-political, multidisciplinary coalition of individuals, organizations and agencies dedicated to promoting good nutrition for all Kenyans through advocacy, networking and resource mobilization. KCAN uses Profiles, an interactive computer model for policy analysis and advocacy, to sensitize key decision makers on the importance of nutrition in national development. KCAN’s work is set against a backdrop of widespread poverty (60% of Kenyans live below the poverty line), an escalating HIV/AIDS pandemic and a stagnant economy.
D. Symposium on Nutrition and HIV/AIDS8. The symposium was opened by Dr. Sam Ongeri, Minister of Public Health of Kenya. Dr. Ongeri noted that the prevalence of HIV infection in Kenya is 14%, while some population subgroups have much higher rates of infection. There was one case of AIDS in Kenya in 1984, while now there are about 2.2 m cases. He spoke about the impacts of the HIV/AIDs epidemic in Kenya. There are one million AIDS orphans requiring care. This poses an enormous challenge for families and communities. About 50% of hospital beds in Kenya are occupied by AIDS patients, draining the health budget of the country. The cost of full treatment for all those infected would amount to about 12m Kenya Shillings yearly, while the annual total budget of the Kenyan Ministry of Health, encompassing all preventive and curative services, is about nine million Shillings. Dr. Ongeri reviewed the inter-relationships between nutrition and HIV/AIDS. In Kenya, as elsewhere, AIDS patients have high energy needs, reduced food intake and nutrent malabsorption. Weight loss and wasting are common in people living with AIDS, as are opportunistic infections. Tuberculosis is on the rise in Kenya because of the HIV/AIDS problem. Dr. Ongeri was optimistic about the role of nutrition in mitigating the worst effects of the HIV/AIDS epidemic, especially in light of the very high cost of anti-retrovirals.
9. The keynote address was given by Dr. Peter Piot, Executive Director of UNAIDS. Dr. Piot reminded the audience that in Africa in particular, AIDS emerged against a backdrop of many other problems – poverty, conflict, inadequate infrastructure. Its effects have been to make those problems and their consequences far worse, by eating away at social capital. In some countries in Africa, one in three adults is living with HIV/AIDS. The HIV epidemic is increasingly driven by many of those factors that also drive malnutrition – in particular poverty and inequity. Nutrition and HIV operate in tandem, at the level of both the individual and the society. For individuals, nutrition deficits probably make people with HIV more susceptible to disease and infections of all sorts. Malnutrition is one of the major clinical manifestations resulting from HIV infection, both in children and in adults. Dr. Piot urged the nutrition community to assist in applying proven strategies on a scale commensurate with the epidemic, and to reinforce within the HIV world key messages on nutrition as a core part of any essential care package.
10. Other speakers at the symposium were Mrs. Sophia Mukasa Monico, Director of the The AIDS Support Organization in Uganda, Professor Oliver Saasa, former Director of the Institute of Economic and Social Research at the University of Zambia, and Dr. Stuart Gillespie of IFPRI. The afternoon session was opened by Dr. Phetsile Dlamini, Minister of Health and Social Welfare, Swaziland. Dr. Dlamini said that a recent sentinel survey of women attending antenatal clinics in Swaziland showed that the rate of infection had climbed from 31% in 1998 to 34.6% in year 2000. Life expectancy is falling. Dr. Dlamini argued that pharmaceuticals, in the absence of good nutrition, cannot achieve major advances against HIV/AIDS. She also reviewed a range of programme interventions in place in Swaziland. These include development of a nutrition book for people living with AIDS, a nutrition help line, a quarterly nutrition newsletter circulated to parliamentarians and the public, community support to production of micronutrient-rich foods, and measures to protect optimal breastfeeding.
11. This was followed by a panel discussion on the implications of the HIV/AIDS epidemic for nutrition programmes. Panel members were Dr. Elizabeth Marum of the Centers for Disease Control and Prevention, Kenya; Dr. Ruth Nduati of the Department of Paediatrics, Kenyatta National Hospital, Kenya, and Dr. Phillip Mwalari of the National AIDS Control Council, Kenya.
12. The Dr. Abraham Horwitz Memorial Lecture was given by Ms. Lucy Thairu, a graduate student from Kenya studying international nutrition at Cornell University. Her topic was Infant feeding options for mothers with HIV: using women’s insights to guide policies. In introducing this year’s lecturer, the SCN Chair noted that Ms. Thairu was selected from amongst candidates who submitted proposals to an annual competition for consideration by the SCN Secretariat. This lectureship was inaugurated by Dr. Richard Jolly at the 24th session in Kathmandu in 1997 to foster the mentoring of young talent in the field of international nutrition, in keeping with Dr. Abraham Horwitz’ life long efforts.
13. In his wrap-up, Dr. Badara Samb (UNAIDS) noted that although the HIV epidemic is over 20 years old, this symposium provided a first occasion for the Executive Director of UNAIDS to address the nutrition community. The approach to both problems, HIV/AIDS and malnutrition, is multisectoral, and community action is essential to address both. The two communities can take action now by using existing networks, logistics capability and opportunities in programmes. For example, HIV/AIDS awareness in the workplace can be raised, and workplace care programmes for people living with AIDS can incorporate nutrition. Breaking the vicious cycle between food insecurity and HIV will require building on local responses, creativity and innovation. There are also areas that need more analysis and peer review. There are many guidelines and actions at country level, these need to be systematically reviewed. The UN system has not adopted any nutrition guidelines for people living with HIV/AIDS, except for breastfeeding and mother-to-child transmission. But here too we need less rhetoric and more concrete action. Dr. Samb concluded by reminding the audience that the ACC/SCN Working Group on Nutrition and HIV/AIDS needs to move ahead on these priorities, beginning with delivering a statement on nutrition at the OAU Summit in Abuja in mid April, as well as the UN General Assembly on HIV/AIDS in June.
14. Dr. Robert Mwadime, Regional Center for Quality of Health Care, Uganda, presented a work plan for eastern, central and southern African countries to improve access to nutritional care for people living with AIDS. These decisions were taken during the 28th Session at an informal meeting to share materials on nutritional care:
15. Mr. Mats Karlsson, Vice President for External Relations, the World Bank, emphasized the extreme importance of nutrition and food security to eradicate poverty. He commended the SCN for its innovation and commitment towards fostering dialogue amongst UN agencies, bilaterals and civil society. He noted the very strong African presence at the 28th Session. He stated that the World Bank is committed to the Millenium Declaration, which makes it possible for all partners to work within a common framework, in particular towards a set of poverty goals. The International Development Targets are central to the Bank’s work. Mr. Karlsson said that Bank involvement in HIV/AIDS programming for Africa had been "fast-tracked" following Mr. Wolfensohn’s visit with 22 heads of African states. He urged the SCN to take up the challenge set out by Dr. Piot to work with the HIV/AIDS community in moving the nutrition agenda forward for Africa.
E. Working Group Reports
E.1 Nutrition of school age children Chair: Don Bundy, World Bank. Rapporteurs: Joy del Rosso, Save the Children USA; Lesley Drake, Partnership for Child Development
16. An extraordinary meeting of the Working Group on Nutrition of School-age Children was held during the 28th Session for two reasons. Firstly, there is an enhanced focus on school feeding and food-for-education as a result of recent new initiatives. Secondly, there is increasing UN activity on school health and nutrition as a result of the launch of Focusing Resources on Effective School Health (FRESH) Partnership at the World Education Forum in Dakar, Senegal. Country programmes using the FRESH framework and supported by all four original partners are now being rolled out in at least 11 countries in Africa. The Working Group reported follow-up to recommendations of last year in four areas: preparation of a technical review of the health and nutritional status of school age children globally, compilation of good practices for school-based health and nutrition services, increased access to knowledge in the area of school nutrition and health via the internet, and harmonization of partner agencies’ approaches to nutrition in the education sector, with special regard to the place of food in the FRESH framework.
The Working Group recommended that:
E.2 Capacity development in food and nutrition (formerly capacity strengthening in food and nutrition) Co-Chairs: Cutberto Garza, UNU and Barbara Underwood, IUNS. Rapporteur: Fre Pepping, UNU
17. Progress over the one year existence of this Working Group was reviewed. Based on recommendations made last year, focus was placed on capacity development efforts in Africa. Africa faces many challenges with 47.3 million preschool children stunted. More than 50% of preschool deaths are related to malnutrition. The nutrition situation in many parts of Africa is deteriorating due to economic downturn, HIV/AIDS, reduced public sector spending and limited capacity to plan and implement effective programmes. Workshops were held in each of southern, eastern and western-central Africa over the past year. UNU and IUNS were facilitators. The workshops addressed the development of learning cooperatives, mechanisms for effective intra- and inter-regional cooperation, and training needs. Action plans were prepared through intensive consultation, and were driven by African professionals. The goals of these action plans are to inspire African leadership in nutrition to meet the challenges of combating malnutrition in a sustainable manner, drive national level nutrition agendas, and mobilize support for the sub-regional action plans and cooperation of stakeholders.
18. The Working Group recommended that:
E.3 Micronutrients Co-Chairs: Ian Darnton—Hill, HKI; Bruno de Benoist, WHO and Werner Schultink, UNICEF. Rapporteurs: Arjan de Wagt, UNICEF, Shawn Baker, HKI
19. This Working Group reviewed progress in four areas: iodine deficiency disorders, iron deficiency anemia, vitamin A deficiency, and multiple micronutrient deficiencies. There has been major progress in controlling IDD, predominantly through iodization of salt. The main challenges for the future include providing special support to countries affected by IDD but which have no control programme in place, and ensuring sustainability of salt iodization. These two issues can be addressed through mobilizing the international community, developing partnerships of various stake holders including the salt producers, reinforcing the capacity of labs at all levels, and undertaking independent assessments of progress made by countries.
20. Regarding iron, the Working Group noted that there have been a number of important activities in the area of control of anemia and iron deficiency over the past year. However, iron is still the ‘orphan’ among the three main micronutrients. The need to ensure a strong goal for reduction of anemia in the outcome document of the UN General Assembly Special Session on Children (Sept 19-21, 2001) was discussed. A small group met after the Working Group meeting and formulated new wording to be conveyed to Dr. Kul Gautum, Deputy Executive Director, UNICEF (see para 45).
21. Advances and evolution in thinking in the vitamin A area were reviewed by the Working Group. There is growing consensus to adopt a new terminology, vitamin A deficiency disorders or VADD, to replace both "clinical deficiency" and "sub-clinical deficiency". The rationale for this change will be published by the International Vitamin A Consultative Group later this year. Estimates of people with VADD are not yet available. The new terminology implies a new approach to deriving estimates, especially for women and adolescents. On the programme side, much progress has been made towards controlling vitamin A deficiency via national immunization days and child health weeks. However, the need to pursue a package of approaches including supplementation, food fortification and dietary diversification was emphasized.
22. Food fortification was discussed and presentations made by the Micronutrient Initiative and FAO. It was noted that food fortification should be part of a broad development strategy, i.e., part of an overall health and nutrition strategy which includes dietary improvement, supplementation and public health measures. However, some participants expressed concern about an emerging global alliance for fortification. There may be value in taking a cautious approach because of issues related to market protection and liberalization of food trade. Some felt that too little attention is paid to food composition databases and that knowledge of indigenous foods is quite poor. Several noted that fortification efforts also need to emphasize technologies for small-scale fortification to target those who lack access to centrally processed foods.
23. The following areas were identified by the Working Group as requiring priority attention in the coming year:
E.4 Nutrition, ethics and human rights Chair: Urban Jonsson, UNICEF. Rapporteurs: Wenche Barth Eide, WANAHR; Uwe Kracht, WANAHR
24. This Working Group convened its seventh meeting during the 28th Session. The chair recalled that human rights thinking was new to the nutrition community in the early 90s. Over the years, this Working Group has been effective in promoting a human rights approach to food and nutrition programming. Follow-up to recommendations made last year was discussed. This included background work on the preparation of a manual on the interpretation and use of General Comment number 12 on the right to adequate food, and a new focus on benchmarks and indicators for food and nutrition rights programming and monitoring. Three international meetings have been held over the past year where the content and use of General Comment number 12 was discussed, e-groups have been established for the exchange of views and knowledge, and several countries have announced interest in organizing national seminars on the General Comment. A task force meeting was held, prior to the 28th session, to review a draft paper on benchmarks and indicators. The task force felt that the draft paper would serve as a good basis for future work in this area.
25. The Working Group recommended that:
E.5 Breastfeeding and complementary feeding Co-Chairs: Miriam Labbok, USAID; Randa Saadeh, WHO. Rapporteurs: David Clark, UNICEF; Ted Greiner, Sida
26. The agenda of this Working Group was designed to include reporting on agency and other activities in follow-up to issues identified last year, exchange of information on scientific, programme and policy advances, and provision of advice to the SCN on these matters, as well as identification of critical issues for further discussion as part of one to two year work plan. WHO provided a progress report on the Infant and Young Child Feeding Strategy, and FAO presented a paper on infant and young child feeding emphasizing child feeding and household food security. UNICEF provided an update on the Code and implications of the Convention of the Rights of the Child (CRC). It was noted that progress on the implementation of the CRC is fundamental to infant and young child health and nutrition. WHO presented the results of a systematic review of published literature related to the optimal duration of exclusive breastfeeding. This work concluded that there is a scientific rationale for policy recommending exclusive breastfeeding "for six months". Work undertaken by Wellstart underlined that infants may not be physically ready for foods other than breast milk prior to 6-7 months. A study on breastfeeding in four countries in Africa showed that there has been a reduction in support for breastfeeding as a result of fears and misinterpretation of the UNAIDS/WHO/UNICEF guidance related to HIV and breastfeeding.
27. The Working Group recommended that
E.6 Nutrition in Emergencies Chair: Anna Taylor, SCF UK; Vice Chair: Sultana Khanum, WHO. Rapporteurs: Frances Mason AAF, UK; Annalies Borrel, USA
28. Adult malnutrition was first discussed by this Working Group in April 1999 and taken up last year in more depth. Subsequently, a supplement of the Refugee Nutrition Information System report was published summarizing knowledge on the assessment of adult and adolescent malnutrition in emergencies. This led to a one-day special meeting on adult malnutrition held during the SCN 28th Session, the aim of which was to reach a common understanding of the recommendations on the assessment of malnutrition in adults and to identify practical steps to improve practice. Interim recommendations for operational agencies cover the following issues:
29. The Working Group also reported back to the SCN on priority issues identified last year. A document entitled Infant and young child feeding in emergencies has been prepared, filling a need for practical guidance that can be used by both policy-makers and relief staff. The publication has been supported so far by 12 NGOs and two UN agencies; additional support is sought. Training modules for infant feeding in emergencies have also been prepared. The purpose of these modules is to prepare emergency relief staff to support appropriate infant feeding and to describe the process of applying operational guidance. Again, this work is the result of collaboration amongst a number of NGOs and several UN agencies. The Working Group had expressed serious concerns last year about the WHO’s pricing policy regarding a manual entitled Management of severe malnutrition. The manual is now available for downloading from the WHO website. The need to prioritize gaps in knowledge, skills and practice in emergency nutrition across agencies has led to the design of a tool (a matrix) to be applied by each agency involved in relief work. This process will help to identify areas in which new work needs to be initiated.
30. The Working Group will take on this new work in the coming year:
E.7 Household food security Chair: Kraisid Tontisirin, FAO. Rapporteurs: Ken Simler, IFPRI; Shakuntala Thilsted, Denmark and Brian Thompson, FAO
31. Dr. Tontisirin outlined the objectives of this meeting which were to take stock of what had been accomplished in the area of household food security since the last meeting, and to build consensus around a workplan to implement community approaches for achieving household food security and reducing malnutrition. The decline in the number of food insecure worldwide has been only 8 m/yr, while the target is 20 m/yr. The challenge is to find new strategies to accelerate the pace of improvement. FAO places emphasis on community-based approaches (a concept paper adapted from the CCPOQ endorsed document on household food security is available from FAO) that provide a viable and practical means to rapidly reduce malnutrition. These approaches involve mobilizing communities to take advantage of existing services. Factors contributing to malnutrition in Kenya were discussed. One problem is the decline in consumption of traditional foods. Support for women's groups in small scale food processing, to increase consumption as well as income, needs to be expanded
32. The Working Group recommended that
E.8 Prevention of foetal and infant malnutrition Chair: Jelka Zupan, WHO. Rapporteurs: Anna Ferro-Luzzi, Italy and Kathy Kurz, International Center for Research on Women
Dr. Zupan presented information on the new WHO global estimates of low birth weight, noting that data collection methods are improving. Sources are mostly surveys and hospital data. LBW is still prevalent in developing countries, the highest rates are seen in Asia. The new estimates show a slight improvement in the prevalence of LBW in some regions, although this could be because of better data. UNICEF supports LBW reduction programmes in eleven countries, offering an integrated package which includes provision of multi-micronutrient supplements. Core indicators are weight gain in pregnancy, birth weight, iron status and compliance. Informed consent is part of the protocol. Results will be available in about three years. A targeted programme aimed at reducing LBW amongst refugees in Tanzania was presented. Interventions addressed malaria and anemia and the quality of antenatal care; food rations were distributed. LBW was reduced from 33 to 14% in six months. The WHO antenatal care trial was presented. This trial (carried out in Argentina, Cuba, Thailand and Saudi Arabia) shows that a decrease in the number of antenatal visits does not adversely affect pregnancy outcomes. Working Group participants queried whether these results would pertain to regions with high rates of LBW. The merits of the life cycle approach to LBW were discussed in the context of work funded by the March of Dimes in the USA. The World Bank described a new initiative aimed at creating a global learning network. New evidence for the fetal origins of disease arising from a recent meeting in India was discussed.
F. Parallel working meeting of the UN Agencies
33. This meeting was chaired by Namanga Ngongi and Milla McLachlan. Approximately 40 people attended from 14 UN agencies, including ECA and OCHA for the first time. The SCN Chair briefed the UN agencies on the status of ACC reform and how it might affect the work of the SCN. The ACC, this week in Nairobi, endorsed the report of the High Level Committee on Programmes which met in Vienna in February. The special tripartite nature of the SCN was recognized, as well the SCN's work in raising awareness of nutrition and harmonizing nutrition policy and approaches across the UN system and partners. While ACC has decided to move away from the concept of permanent subsidiary machinery, it also recognized the need for continued interagency coordination in many of the areas where it is presently undertaken. In order to allow sufficient time for a review of the subsidiary machinery, ACC decided that the current year would be treated as a transitional period. During this time the Committees would be invited to engage in a reflection on their role and function and provide their view on the matter to the High Level Committee on Programmes to enable the latter to complete the review process requested by ACC. If necessary, this period could be adjusted to accommodate meeting schedules. In the future, the SCN or its successor arrangement may still wish to bring matters to the attention of the ACC by exception, and to use various advocacy and communication channels as appropriate. Our Strategic Plan will continue to guide our work. A suggested new name for the SCN is the UN Forum on Nutrition.
34. UN General Assembly Special Session on Children---Although nutrition did not figure strongly in earlier drafts of the outcome document (not a technical but a political document), the nutrition content had been significantly strengthened as a result of the Preparatory Committee meeting in February. FAO pointed out however that there was no reference to food and agriculture in the document, adding that a world fit for children is one where every child has access to safe and nutritious food. The current March 12 draft has gone to countries for review and will be discussed in mid June in New York. It was decided that the SCN should prepare a collective comment on the nutrition content, and convey this to Dr. Gautam along with improved wording for paragraph 30 on micronutrient deficiencies. There was a feeling though that too much emphasis is placed on nutrition actions in the post-natal period, rather than on reducing maternal and foetal malnutrition and low birthweight. This point could be included in the letter. Regarding the UN General Assembly on HIV/AIDS, June 25-27, the SCN will convey a message to this event, based on the outcomes of the Symposium on Nutrition and HIV/AIDS.
35. Implementation of the Strategic Plan---The UN agencies undertook to report on their efforts to implement the SCN Strategic Plan, against the three main strategic actions: promotion of harmonized policies and programmes for greater impact, review of the UN system response to malnutrition and advocacy and mobilization. Several themes emerged. Most agencies need to take more time to internalise the Strategic Plan and generate interest, buy-in and support from their colleagues. The nutrition community needs to be more involved in the common country assessment processes. There are also opportunities to incorporate nutrition into the UNDAF process, Poverty Reduction Strategy processes and the work of the ACC Network on Rural Development. The UNDAF is not used efficiently for nutrition. Sector-wide approaches (SWAPS) tend to marginalize nutrition when health is discussed, hence there is uncertainty as to what SWAPS can deliver for nutrition.
36. Budget and Financing---A comprehensive document covering the budget and financing of the Secretariat for 2000/01 and 2002/03 was presented by the Technical Secretary. The SCN had approved a core budget of $861,000 for 2000/01 at the 26th Session in Geneva in 1999. Projected expenditures (as of March 14, 2001) to the end of this biennium total $780,000, against income of $714,400. The deficit is partly due to UNDP having suspended its contributions totally for this biennium. The SCN Chair will write to agencies to request increased contributions for this calendar year. For the next biennium, the proposed core budget is set at $860,000. Increases in the contributions from some agencies are proposed; these include UNHCR, UNFPA, IFAD, FAO, WFP and IFPRI. The programme budget, which covers costs of the Secretariat’s publications programme, is implemented subject to funds raised by the Secretariat. For 2002/03 these costs are estimated to total up to $920,000. The UN agencies approved unanimously the core and programme budget, as presented, for the period 2002/03.
37. The 5th Report on the World Nutrition Situation---The UN agencies stressed the importance of knowing the audience. Good information is available from the Secretariat’s mailing lists as to current out-reach, but how are the reports used? Are we doing all that we can to maximize usage by communities outside the nutrition community? Ideally the report should speak to several audiences: the nutrition field, the policy makers and the public at large. It may be difficult to reach all three with the same document, so different presentations should be considered. The 5th Report must go beyond providing an update of regional and global trends. Key messages must be "front and center" to move the nutrition agenda forward.
38. On other matters, the Secretariat reported that Professor MS Swaminathan has agreed to serve as a Distinguished Nutrition Advocate. Additional names of possible Distinguished Nutrition Advocates for Africa are sought. The Secretariat reported that the German Federal Ministry for Economic Cooperation and Development has offered to host the 29th Session in Germany, in March 2002. This was greeted with enthusiasm.
G. Parallel working meeting of Bilateral Partners
39. This meeting was chaired by Arne Oshaug of Norway. The ACC/SCN bilateral parallel working session convened as scheduled during the week, including an additional evening meeting. The bilateral group is expanding: representatives from ministries in the Gambia, Kenya, Mali and South Africa took part. This reflects earlier discussions on the definition of what constitutes a "bilateral". In the spirit of the African Nutrition Capacity Development Initiative it was decided to shift from bilateral donors to bilateral partners. The bilateral partners emphasized that the Secretariat should invite both developed countries and developing governments to attend annual sessions through their normal communications channels, including the SCN News and the website. The following reflects the discussions and recommendations of the bilateral partners to the SCN:
H. Parallel working meeting of NGOs/Civil society40. This meeting was chaired by Ian Darnton-Hill (Helen Keller International), co-chairs were Professor Ruth Oniang’o (Jomo Kenyatta University), and Dr. Barbara Underwood (International Union of Nutritional Sciences). About 100 representatives NGOs/civil society attended, many for the first time. Two-thirds of those attending this parallel meeting were from international NGOs and academic institutions. The remaining participants were from national government ministries, agencies involved in emergency/relief work and advocacy organizations. The private sector was not represented. Much of the initial discussion centered on how this diversity can best be reflected.
41. Regarding representation on the SCN’s Steering Committee, three co-chairs have rotated in the one position on the Steering Committee allocated for the NGOs/civil society. This is an attempt to represent the diversity of the agencies and organizations in this cluster. This has proved effective over the past couple of years and should be continued. Ian Darnton-Hill indicated he could no longer serve as co-chair. Barbara Underwood, by popular acclaim, will serve another year in her individual capacity for purposes of continuity, as will Ruth Oniang’o. A maximum term of three years for co-chairs was suggested. Dr. Flavio Valente, of the Global Forum on Sustainable Food and Nutritional Security, and based in Brazil, was subsequently confirmed as the third representative.
42. Recommendations fell into three categories:
I. Informal report from the "non-Steering Committee" UN Agencies43. Those UN agencies who are not members of the SCN Steering Committee met during the week to exchange views and share information. This group asked that one full day be given to the UN-only segment of the 29th Session and that sufficient time be allocated for presentation and discussion of agencies’ activities. They also requested that minutes of the Steering Committee teleconference calls be circulated routinely to all UN member agencies throughout the year.
J. Summary of decisions taken during the final plenary
44. In the coming year the SCN will assess different organizational and reporting structures, taking into account decisions of the ACC and the High Level Committee on Programmes. The SCN will adopt a new structure at its 29th Session, just prior to the spring session of the ACC.
45. The 5th Report on the World Nutrition Situation will identify elements in the development process that serve as both obstacles and opportunities to improved nutrition outcomes. The report may take the form of several strong analytical pieces, backed up by illustrative panels and boxes. The report will also include, as annexes, updates on trends in nutrition indicators. Over the coming year background papers (up to four) will be prepared, to serve as the basis for a workshop just prior to the 29th Session. The Report will be launched at the 30th Session and will provide the theme for the symposium that year. A task force will be constituted by the Steering Committee. Volunteers will be asked to identify in writing what they can bring to the process.
46. A Statement on Nutrition and HIV/AIDS (annex 2) was approved for wide dissemination. The statement will be transmitted officially to Dr. Peter Piot (UNAIDS) in time for the HIV/AIDS Summit in Abuja, April 23 - 25, 2001. It will also be disseminated via the UN General Assembly Special Session on HIV/AIDS, put onto the SCN website and published in SCN News.
47. The SCN decided to provide to Dr Kul Gautam (UNICEF) new wording for paragraph 30 of the draft outcome document for the UN General Assembly Special Session for Children. The wording, which was agreed upon during a teleconference call on April 11, is: "Through public/private collaboration, ensure progress toward substantial reduction in anemia, including iron deficiency, in women and children, and the elimination of vitamin A deficiency disorders, by 2010; and achieve sustained elimination of iodine deficiency disorders by 2005."
48. The SCN accepted with warm appreciation an invitation from the German Federal Ministry for Economic Cooperation and Development to hold the 29th Session in Berlin, Germany, March 11 - 15, 2002.
K. Closure of the 28th Session49. Dr. Ngongi thanked the WFP/Nairobi office for hosting the 28th Session, and all involved in logistics and organization of all meetings held during the session for their capable work. He thanked participants for their commitment to the SCN and reflected on the success of the session. This year’s session was much more than good presentations; there was true participation and dialogue amongst all who attended. The SCN fosters communication amongst nutritionists. More importantly, the SCN packages nutrition messages for national actions. Indeed advocacy is one of the SCN’s main roles. Nutrition is not only a public health issue, it is a development issue. Nutrition is a powerful tool against HIV/AIDS, just as malnutrition is a powerful ally of the devastating effects of HIV/AIDS. Various indignations were underscored during the 28th Session. Chief amongst these is that hunger prevents people from seeking essential services. The SCN should work towards removing old structures that serve as obstacles for people to exercise their basic human rights. There is also hope that the battle is winnable. Nutrition can help people live more decently with HIV/AIDS. The nutrition community can work with the HIV/AIDS community to ensure that nutritional care is accessible to all those who need it.
Annex 1 List of Participants
Chair: Namanga Ngongi
Technical Secretary: Sonya Rabeneck
Abraham Horwitz Lecturer: Lucy Thairu, Cornell University
Annex 2. Statement
Statement by the ACC/SCN at its 28th Session 6 April 2001, Nairobi, Kenya NUTRITION AND HIV/AIDS
We, the ACC/SCN, recognize the devastating impact the HIV/AIDS epidemic is having on development, particularly in Africa. We further recognize that the epidemic is increasingly driven by factors that also create malnutrition - in particular, poverty, conflict and inequality.
HIV/AIDS and malnutrition often operate in tandem. Poor nutrition increases the risk and progression of disease. In turn, disease exacerbates malnutrition.
HIV/AIDS can be both a cause and a consequence of food insecurity. HIV/AIDS leads to reduced agricultural production, reduced income, increased medical expenses, thus causing reduced capacity to respond to the crisis. Food insecurity may lead to increased high-risk behaviors, for example, labour migration or engaging in transactional sex that increases the likelihood of infection.
Food and nutrition play an important role in prevention, care and mitigation activities in HIV/AIDS-impacted communities.
We, the ACC/SCN, recognize that:
We, the ACC/SCN, commit ourselves to collaborate with the international community and Heads of State in particular in this effort by: