AGENCIES REPORT ON NUTRITION ACTIVITIES
ACC/SCN Strategic Plan
At the ACC/SCN 27th Session, SCN members adopted by acclamation a Strategic Plan to mobilize the effort required to meet the challenges and new opportunities for nutrition. Part 3 of the Strategic Plan is reprinted below. It will form the basis for operational plans for the SCN for the next ten years. Part 4 is also included as it describes the implications for the structure and function of the SCN. The full text is available at <http://acc.unsystem.org/scn>
PART 3 - STRATEGIC ACTIONS
12. In accord with the stated mandate, three main areas for action can be identified. These are: (i) Promote harmonized approaches among the UN agencies, and between the UN agencies and governmental and non-governmental partners, for greater overall impact on malnutrition. (ii) Review the UN system response to malnutrition overall, monitor resource allocation and collate information on trends and achievements reported to specific UN bodies. (iii) Advocate and mobilize to raise awareness of nutrition issues at global, regional and country levels and mobilize accelerated action against malnutrition. These three functions are all vital and of equal importance and can be seen as a triangle, one dependent on the other.
13. These areas of strategic action relate to global, regional and national levels. However, it is recognized that the SCN is primarily a global forum. It can impact on regional action by improved involvement of regional agency representatives in SCN activities, exchange of information through its regular publications, and through inputs from regional entities in the SCN's global work. The SCN will develop ways to interact constructively with regional nutrition fora. The SCN itself does not have a country-level presence. Nevertheless a particularly important focus is to facilitate UN agency collaboration in support of country action particularly in the context of the United Nations Development Assistance Framework (UNDAF) and Comprehensive Development Framework (CDF) processes. To measure progress, identify problems and maintain accountability in SCN activities, a streamlined monitoring and evaluation system will be implemented. It will be based on a biennial work programme, prepared on the basis of the Strategic Plan to reflect specific outputs and outcomes, with measurable indicators and time frame. The annual report of the SCN will indicate progress against these agreed milestones.
Promotion of harmonised policies and programmes for greater impact
14. The SCN will promote convergence between the policies and programmes of UN agencies, and between agencies and other development partners through four key actions:
· The SCN will work through the agencies to ensure that nutrition receives consistent and coherent attention in the UNDAF process, by ensuring that training programmes (eg, for managers at the UN Training College in Turin) have a strong nutrition component, proposing nutrition indicators for the common country assessments (CCAs), and providing guidelines for theme groups on nutrition. The SCN will monitor pilot initiatives to integrate nutrition into the UNDAF process in selected countries, and prepare case studies, sectoral briefs and guidelines based on these experiences for wide dissemination.Review of the UN system response to malnutrition
· Linking theory and practice. Through its symposia and working groups, the SCN will strengthen the bridge between the science and the practice of nutrition by providing a forum for systematic review of the policy and programmatic implications of new nutrition research findings. Through reflection on programmatic experience, new areas for research will also be identified.
· Sharing information about good practice. Drawing upon regional and country level experience, the SCN will disseminate information on good field practice and programmatic innovations through annual sessions, workshops, worldwide web and publications. This process will build consensus on programmatic approaches among key players in nutrition worldwide.
· Signalling the need for norms and standards. The SCN will identify for the attention of technical agencies or other bodies critical areas where norms and standards are missing or out-of-date and holding programmes back. This includes (especially) identifying knowledge gaps and significant areas in dispute or controversy; as well as identifying areas requiring operational research, and facilitating this work.
15. Since its inception, the SCN has been tasked with the responsibility to oversee the UN response to the malnutrition problem. It must answer the question is the UN system meeting the malnutrition challenge with sufficient resources, allocated effectively and efficiently? Over time, specialized agencies and other UN bodies have been given responsibility to monitor progress toward the achievement of specific targets, such as those agreed at the 1990 World Summit for Children, the 1992 International Conference on Nutrition and the 1996 World Food Summit. The SCN will complement these initiatives in the following four ways:
· Keeping score. The SCN will develop a tool for reporting on the magnitude of the nutrition challenge and countries' responses to it, in the style of the Progress of Nations which ranks countries according to performance.Advocacy and mobilization
· Keeping a watching brief on resources devoted to nutrition. The SCN will maintain a database on country and regional level capacity in nutrition in the UN system, and report on trends in such capacity at regular intervals. It will collate and disseminate information on the actions of various UN bodies and partner organizations with regard to innovation, experimentation, scaling up, quality control, and monitoring and evaluation of nutrition-relevant actions.
· Making information count. The SCN will facilitate global and country level decision making to achieve nutritional goals, by supporting the development and use of global and national databases and information sharing through, for example, the Food Insecurity and Vulnerability Information Management Systems (FIVIMS) initiative, part of the follow-up to the World Food Summit. This will include the introduction of indicators of performance of countries in reducing food insecurity and malnutrition.
· Reporting on progress. The SCN will serve as a clearing house for reports on actions against malnutrition and progress achieved, disseminate standard definitions of indicators, catalogue the response of UN governing bodies to reported trends, and monitor follow-up action.
16. The multifaceted nature of the nutrition problem means that it requires attention from a wide range of agencies, but is seldom the primary concern or chief focus of the agendas of those agencies. Furthermore, there are no simple, direct and quick solutions to the malnutrition problem. It requires people working together over a period of time to achieve sustainable results. Ongoing advocacy, to keep nutrition in the eye of decision makers at all levels is therefore an essential activity for a body charged with co-ordination of the UN system response to nutrition. The SCN will intensify its advocacy activities in three ways:
· Recognizing nutrition as a human right and elevating nutrition as a development imperative. The SCN will implement a systematic campaign to position nutrition as a key development problem and human rights challenge, and advocate for increased attention to nutrition in UN assemblies and other international and regional fora. It will make strategic use of information generated through its review of the UN system response to malnutrition so as to deliver key nutrition messages to global, regional and national leaders.PART 4 - IMPLICATIONS FOR THE STRUCTURE AND FUNCTION OF THE SCN
· Reframing the issues. The advocacy strategy will include working with partners on global initiatives focusing on emerging nutrition issues. Such campaigns will serve to reframe and reposition nutrition issues, build new partnerships, and inject renewed vitality into the fight against malnutrition and poverty. An example of an appropriate first theme might be the intergenerational transmission of poverty through growth failure.
· Disseminating success stories. The SCN will capture and disseminate successful examples of nutrition directed efforts that have significantly reduced malnutrition, especially where these can be scaled-up by national governmental agencies, and promoted by UN agencies and others.
17. The SCN's tripartite nature - From its inception in the 1970s the SCN has pioneered the bringing together of three clusters of participants. These are the UN agencies, other international and regional development finance institutions, and intergovernmental bodies; the bilateral donor governments; and civil society, including international non-governmental organizations (NGOs), academic institutions and other civil society representatives. The SCN annual sessions will include parallel meetings for each of the three clusters; a public symposium, working group and business meetings will be open to all participants. The SCN will make special efforts to ensure a reasonable balance of participants from the developing world at its meetings. The work of the SCN is based on the principle of consensus-building and inclusiveness and this will continue.
18. The NGOs can provide a broad spectrum of scientific, technical and service expertise to link the SCN to civil society. This includes, for example, links to academics and technical groups, international NGOs, and emergency and disaster relief service groups. The NGOs provide a conduit not only for extending the SCN to civil society but also to provide feedback as a credible voice of the people the agencies' programmes are meant to serve. They may provide independent review at several levels, such as technical and scientific soundness of publications, projects and programmes, and an onsite analysis of needs, opportunities and constraints to agency programme effectiveness and their implementation with a human rights context.
19. The SCN acknowledges the commercial private sector as an important actor engaged in nutrition related activities. The SCN will seek to engage this sector so as to maximize positive nutrition impacts. The SCN will develop guidelines for such participation in its meetings, above all being open and clear about potential conflicts of interest.
20. The Working Groups - The working groups are at the heart of the SCN. Through working groups, participants take an active role in the work programme of the SCN to achieve the harmonizing, information sharing, advocacy and review tasks in the substantive areas deemed of greatest importance by the collective SCN body. The working groups will host workshops as an integral part of the annual sessions of the SCN. Generic terms of reference for working groups further explain their mandates and responsibilities.
21. The Chair - The SCN Chair provides outstanding leadership in the field of nutrition. The Chair advocates and mobilizes actors and actions aimed at accelerating the reduction of malnutrition and the achievement of global goals. Specifically the Chair maintains regular high-level interaction with the ACC, ECOSOC, and other UN bodies, bilaterals and the NGO community and engages all bodies that have a role in the reduction of malnutrition worldwide. The Chair guides the SCN in developing a strategic approach to bringing substantive nutrition matters to the attention of the ACC.
22. The Steering Committee - A Steering Committee of not more than nine members (composed of at least five UN agencies, and at least one each from the bilateral and NGO clusters) under the leadership of the SCN Chair, will guide and monitor the implementation of the Strategic Plan. The Steering Committee will monitor the implementation of recommendations arising from working groups. Steering Committee members will be appointed by the Chair for a two to three year period after broad consultation with the SCN. Membership is rotational. One of the UN agencies on the Steering Committee should represent the 'smaller' agencies.
23. Distinguished Nutrition Advocates - The nutrition field is very broad, involving many sectors, and influenced by socio-economic processes over a wide front. SCN participants collectively do not possess all the knowledge needed to address all issues. There is also a need for an independent voice in the SCN to inform and guide its work, to bring to the SCN's attention emerging issues and to assist the Chair in the implementation of the SCN's advocacy efforts. To meet these needs the SCN will benefit from the involvement of up to four distinguished experts in relevant fields. These advocates will bring global excellence in nutrition and development research and practice, and have outstanding records in development leadership. They will be appointed by the SCN Chair for a two to three year period after broad consultation with the SCN.
24. The Secretariat - The Secretariat carries out the tasks assigned to it by the SCN, supports the Chair in executing his or her executive functions, facilitates the work of the Steering Committee, and acts dynamically to strengthen networking and follow-up. A key task is the organization and follow-up of the annual sessions and working group activities, and preparation of reports for the ACC. The Secretariat is also responsible for managing a peer review process in support of SCN publications to ensure their high quality.
Ed. Note: Summaries of the ACC/SCN Working Groups will be printed in the December issue of the SCN News. Full reports are posted on our Website <http://acc.unsystem.org/scn>
United Nations Department of Economic and Social Affairs
As part of the preparations for the high-level segment of the substantive session of the Economic and Social Council in 1999, a meeting of a panel of experts, sponsored by the Department of Economic and Social Affairs of the United Nations and the World Bank, focused on the theme: "Food security, basic infrastructure and natural resources as imperative dimensions of poverty eradication strategies".
Hunger and Poverty
By the year 2025, as many as 1 billion people out of the estimated 8 billion world population, could suffer from malnutrition. While in relative terms there has been some progress over the last forty years, in absolute terms, the number of undernourished people has diminished very little. The situation is particularly worrying in Africa, where population growth (2.6% towards 2020) exceeded the food production capacity. 70% of the poor people in the developing world live in rural areas, with a high proportion of extremely poor. In the urban setting, food security problems relate to inadequate purchasing power rather than rising food prices or supply difficulties. The panel stressed the need for further research and action, in as much as hunger is the first obstacle to ending poverty. In addition, development strategies should focus on investing in the poor and in their food security.
Basic Infrastructure for Access to Food
Without basic infrastructure, poor families have little resilience to shocks and cannot build assets for their future. In the developing world, particularly LDCs, there are massive differences between infrastructures in rural and urban settings. Low-income populations in many cities experience difficulties in accessing urban infrastructures, due inter alia to inadequate public transportation. Thus, there is a need for basic infrastructures, in particular: a) physical infrastructures, such as roads, water management and storage facilities; b) social infrastructures, such as schools, other training facilities, as well as healthcare institutions; c) nutritional infrastructures, e.g. access to the right kind of food, especially for children. In this regard, it was noted that in the early 1990s, 1.6 billion people were at risk of iodine deficiency and 2 billion were affected by iron deficiency. The panel agreed that decentralization and community-based approaches were more effective than top-down bureaucratic mechanisms. Also, an adequate urban planning for cities should take into account proper access to basic services by the poor.
Environmental Concerns and Poverty Eradication
By the year 2020, 2.5 billion more people would have to be fed, which would require long term growth in agricultural output. As most of existing areas are already under cultivation, solutions must come primarily from rising biological yields. Doubling yields in complex farming systems without damaging the environment is an enormous challenge; hence, the need to improve the profitability of agriculture through the use of biotechnologies. Since most of the poor lived in rural areas where their economy and their survival depend exclusively on natural resources, namely on "biomass" resources (water, wood, crops, etc.) and as degradation of these natural resources increase and, consequently poverty, the panel stressed the need for an ecological definition of poverty, based on biomass resources to meet basic survival needs.
The Role of Women
Recognizing that women are the main caretakers of household food security, hunger and poverty eradication strategies need to target women. Development initiatives should also take into account the role of women farmers as users and careers of the natural environment. These policies could be enhanced and sustained with the empowerment and advancement of women. Education of girls had proved to have positive results in future earning potentials, better health, smaller families and decreasing hunger. On the basis of a rights-based approach, it was stressed that it was necessary to promote and support conditions where girls could go to school.
The panel made a number of recommendations, among which:
At the country level
States and international development agencies should:
à place a major emphasis on the development of lasting community infrastructure build around local agriculture production and getting food to the market;NGOs and the civil society should:
à finance the creation of schools and health centers in both urban and rural settings, providing special attention to girls and women, including pregnant and breastfeeding mothers;
à address poverty alleviation through regeneration of ecological wealth, in particular water;
à reduce the ecological "footprint" of the cities through increased urban planning and environmental protection (i.e. recycling of water and solid waste products); increased technical assistance from the developed world in this field is highly needed.
à engage in significant land redistribution programmes;
à develop sustainable agricultural production systems capable of doubling outputs, which requires increased public agricultural research and stronger partnership with the private sector;
à engage in decentralization and promote programmes that delegate the responsibilities for revenue raising, expenditures and decision-making to local communities (participatory democracy).
à sensitize people and involve communities in natural resources management, thus increasing the sense of ownership and reducing the misuse of government funds;At the regional level
à publicize success stories of development initiatives;
à increase partnership with international agencies for both emergency programmes and development projects.
à in absence of a major regional integration process, sub-regional cooperation among LDCs and South-South cooperation should be strengthened and supported by developed countries;At the international level
à given the links between poverty eradication and agricultural development, the latter, as well as agro-industries, should be a priority for Africa, as stated by the Tokyo International Conference on African Development (TICAD-II, held in 1998).
à the international community should pursue and strengthen its efforts to provide emergency food aid to countries in need;Contact: Alfred R Haemmerli, Chief, Development Cooperation Policy Branch, ECOSOC, UN, Rm DC1-1454, I UN Plaza, New York, NY 10017 USA; Phone: 212 963 5796; Fax: 212 963 2812; Email: <firstname.lastname@example.org>
à the issue of extreme poverty in least developed countries should be high on the international agenda, and donor countries should maintain a high level of ODA, in particular to LDCs;
à developing countries should have improved access to markets for their agricultural production;
à the United Nations and the World Bank should work towards ensuring a global right to survival for the world's poor;
à United Nations agencies and Bretton Woods Institutions should increase their cooperation and build up a real partnership, together with NGOs, on poverty eradication through its various forms, including combining food aid and development strategies;
à ECOSOC should increase visibility in this field and lead the work at the international level, with specialized agencies and financial institutions reporting to the Council on their field activities.
International Atomic Energy Agency
Isotope Based Techniques in Support of Human Health Investigations in Latin America
Nuclear and isotopic techniques are valuable tools in human nutrition studies. They have also served to develop models for 'Physiological Reference' in support of radiological safety issues, and for monitoring health in ageing (e.g. osteoporosis and body composition) populations. Isotopes, both radioactive and non-radioactive, enable detailed evaluations of nutrient intake, status of micronutrients, body composition, energy expenditure, and nutrient bioavailability, i.e., the proportion that is absorbed and utilised by the body. Isotopic methodologies have been currently used in a number of Coordinated Research Projects and Technical Cooperation Projects in the IAEA's Nutrition Programme. Deuterium kinetics is a reliable technique to measure breast milk intake, infant growth and development. Field studies are being conducted to generate new data on growth of children in the developing countries in collaboration with the WHO Growth Monitoring Programme. This technique has also been used to assess nutritional impact of several nation-wide food supplementation programmes during pregnancy, lactation, and childhood. The doubly labelled water (DLW) technique combines 18O and deuterium kinetics to measure human energy expenditure in free-living subjects. A number of studies are being conducted to investigate the magnitude and causes of obesity in developing countries using DLW.
In order to address the problem of micronutrient malnutrition in several developing areas around the world, isotope aided methods are used to measure:
1) bioavailability of iron and zinc in traditional foods, fortified food products, and supplements,In Latin America, the IAEA has been assisting many countries in the use of both radioactive and stable isotopes in a variety of nutrition studies through its Coordinated Research Projects (CRP)and Technical Cooperation (TC) Projects. Isotopic techniques enable detailed evaluations of i) nutrient intake, ii) status of micronutrients, iii) body composition, iv) energy expenditure, and v) nutrient bioavailability, which are essential for monitoring and evaluating national nutrition intervention schemes.
2) vitamin A stores in mothers and children in support of efforts to alleviate vitamin A deficiency,
3) interaction between essential micronutrients (iron, zinc, selenium, vitamin A, folate, etc.) in vulnerable population groups. In addition,
4) 13C-labelled substrates are being used to examine causes of infection by Helicobacter pylori (urea breath test), and poor assimilation of macronutrients, as consequences of diarrhoeal disease, in children from several developing countries.
Some examples of TC Projects in Latin America include:
à In Peru, a model project (1994-1997) where isotopic techniques were used to assess and monitor nutritional improvements in underprivileged children participating in a national school breakfast programme, a supplementation programme for pre-school age children, and in women receiving iron fortified flour from socio-economically depressed regions.Contact: Dr. G.V. Iyengar, International Atomic Energy Agency, Head, Nutritional and Health Related Environmental Studies Section (NAHRES) Division of Human Health, Wagramer Strasse 5, A-1400 Vienna, AUSTRIA; Email: <email@example.com>
à In Chile (1994-1999) a project entitled "Isotopes in Nutrition" aimed at reducing national zinc deficiency by identifying appropriate sources of zinc in the national diet, and to update the national database on human energy requirements.
à Also in Chile (1999), a second project on "Mineral Interaction in Vulnerable Groups" investigating interactions between essential (iron, zinc) and toxic (cadmium, lead) elements, for improving the efficacy of national nutritional and environmental programmes.
à A Regional Latin America Project (1999) on "Isotopes for Evaluating Nutrition Intervention Programmes" initiated with the participation of Argentina, Brazil, Chile, Cuba & Mexico. Validated isotopic techniques are being used to assess current nutrition intervention programmes in the region in order to: optimize the programmes and improve the impact on the nutritional status and long term health of the population; to evaluate national supplementary feeding "take-home" programmes for mothers and children, measuring their effects on body composition, lactation performance and changes in energy expenditure; evaluate iron and zinc supplementation programmes by using stable and radioactive isotopes; and evaluate the impact of food assistance to pre-school children attending day care centres by measuring energy intake, energy expenditure and body composition.
à A CRP with almost exclusive Latin American participation on "Isotopic Evaluations of Maternal and Child Nutrition to Help Prevent Stunting" was recently completed. Deuterium kinetics proved to be a reliable technique to measure breast milk intake, infant growth and body composition in the region.
à Latin American countries are also active participants in the Agency's current Nutrition CRPs, namely "Applications of Nuclear Techniques in the Prevention of Degenerative Diseases in Ageing", "Isotopic Evaluations in Infant Growth Monitoring in Collaboration with WHO" and "Use of Isotopic Techniques to Examine the Significance of Infection and Other Insults in Early Childhood to Diarrhoea Morbidity, Mal-Assimilation and Failure to Thrive".
International Fund for Agricultural Development
General Overview of IFAD's Work Related to Food Security
IFAD's mandate within the UN system is "to work with developing countries to alleviate rural poverty, and to reduce food insecurity and malnutrition". In part, IFAD implements this mandate by providing loans to governments of developing countries. These loans are used to finance agricultural development projects in rural areas. Much of the work of IFAD staff resides in the conception and design of these projects. IFAD describes Household Food Security (HFS) as "...the capacity of households to procure a stable and sustainable basket of adequate food". More important than any specific definition of HFS is that issues of food availability, access, utilization and stability be addressed in the design and implementation of IFAD projects. Many actions contribute to building HFS and each action requires a gender perspective to hold the structure together (see figure). Many IFAD projects promote actions such as agricultural extension services to increase food availability; rural savings and credit to improve access to food and crop storage facilities for stability in food supply. Each action requires a gender perspective to assess the different opportunities and impacts for men and women. In IFAD's structure, the 'Gender and Household Food Security Desk' is comprised of three persons: the Technical Advisor, a Consultant for Social Dimensions, and an Associate in Nutrition and Public Health. This 'Desk' reports to the director of IFAD's Technical Advisory Division which is under the Programme Management Department. Currently, IFAD is increasingly interested in demonstrating project impact. To estimate impact, it is necessary to establish key indicators of food security, and to measure these indicators at baseline, mid-term review and during the final evaluation. The Gender & HFS Desk is committed to ensuring that anthropometric indicators are included at baseline in 10 new projects during the year 2000. Already this year the Desk participated in a Rapid Nutrition Survey in Morocco that included anthropometric indicators for a sample of 740 children. The Gender & HFS Desk has also recently published "Rural Women in IFAD's Projects: The Key to Poverty Alleviation" and "Household Food Security and Gender: Memory Checks for Programme and Project Design". IFAD has been serving as a task manager with FAO and WFP in preparing a document entitled "Toward System-Wide Guidance on HFS and Nutrition". IFAD's ongoing activities include developing a knowledge base on gender and HFS which includes an intranet website and CD-ROM set.
Contact: Dr Eve Crowley, Technical Advisor, IFAD, via del Serafico No. 107, 00142, Rome, Italy; Phone: 39 06 5459 2452; Email: <firstname.lastname@example.org> OR Sean Kennedy, APO, IFAD Nutrition; Phone: 39 06 5459 2514; Email: <email@example.com>
World Food Programme
Capacity Building in Nutrition
The demand for basic technical information is increasing in WFP, especially as we move to a cluster structure whereby more tasks will become the responsibility of the field offices. To strengthen WFP's knowledge base, and to make it more accessible, the WFP Food and Nutrition Handbook was prepared. Using this handbook as a resource document, a set of training materials has been designed which covers fundamental nutrition knowledge relevant to WFP staff. The training is a two-tier process. The first stage is to conduct training in eight WFP regional offices. Twenty participants will be trained from offices in the region. The first training took place in Nairobi in April 2000, which was followed by one in Uganda in August. The second stage is to bring the training to Country offices using the training packages designed and using WFP Staff with nutrition expertise where it is available.
Contact the Nutrition Unit in WFP, Phone: 39 06 6513 2718; Fax: 39 06 6513 2837; Email: <firstname.lastname@example.org>
WHO - EURO
First Food and Nutrition Action Plan
On 14 September 2000 during WHO-EURO's Regional Committee meeting, the First Food and Nutrition Action Plan for the European Region was unanimously approved by its 50 Member States. A WHO Ministerial Conference is planned for 2005 in order to assess the progress made by Member States and the impact of the Food and Nutrition Action Plan.
The action plan will serve as a guide for all countries, according to their various cultures and social, legal and economic environments, to develop policies to reduce the burden of food-related ill health and its concomitant cost. This includes developing a comprehensive, multisectoral approach to food and nutrition issues; national food and nutrition monitoring systems, a relevant scientific knowledge base, advisory and coordinating mechanisms in countries, and finally, national action plans on food and nutrition.
The action plan provides a unique framework within which WHO Member States can begin to address the issue. The framework consists of three strategies:
à a food safety strategy, highlighting the need to prevent contamination, both chemical and biological, at all stages of the food chain;The latest draft of the Plan can be found on the WHO-EURO Website <http://www.who.dk>
à a nutrition strategy, to ensure optimal health, especially in low-income groups and during critical periods throughout life, such as infancy, childhood, pregnancy and lactation, and old age;
à and a sustainable food-supply (food security) strategy to ensure enough food of good quality, while helping to stimulate rural economies and to promote the social and environmental aspects of sustainable development.
International Food Policy Research Institute
Nutrition Trends, Policies and Strategies in Asia and the Pacific
The ADB-IFPRI RETA Initiative
As the Fourth World Nutrition Situation Report shows, the nutrition situation in Asia remains very serious. The 1990s saw some progress but not enough to make a significant dent in the problem. Three quarters of all underweight under-fives (180 million) in the world are in Asia. Maternal malnutrition leads to substantial incidence of low birthweight babies (25-50 percent in South Asia) that have higher risk of dying compared to normal birth weights.
Around 35-55 percent of children are underweight in South Asia and Indochina, and 15-40 percent in Southeast Asia. Southeast Asia is improving, but too slowly relative to long-term patterns of economic growth. The vast majority of people suffering from micronutrient deficiency disorders (especially vitamin A, iron and iodine) are in Asia. Substantial progress has been made with vitamin A and iodine deficiency disorders, but not iron. More than half of global deaths of mothers during pregnancy or immediately following birth are in Asia; globally almost one fourth of these preventable deaths are associated with severe iron deficiency anemia.
Between 1996 and 1998, the Asian Development Bank (ADB) and the United Nations Children's Fund (UNICEF) collaborated with seven Asian countries, responding to the challenge of child malnutrition. These seven countries contain two-thirds of the world's malnourished children. By regional technical assistance (RETA), an important policy process was built within governments. This process developed and endorsed ten-year investment plans for children through interagency steering committees led by the planning commissions.
This has now been followed with a second RETA, with the ADB collaborating with a team led by the International Food Policy Research Institute (IFPRI) including international nutrition specialists from the University of California at Davis, University of Toronto, University of North Carolina and the Micronutrient Initiative in Ottawa. This second RETA intends to build upon this policy process and extend the perspective to include nutrition-relevant policies that will sustain life-long health, productivity and achievement.
The aim of the RETA is to assess nutrition status in the region and identify priority strategies and policy options. The specific objectives are to:
à assess progress made in reducing malnutrition in the region and the benefits of such reduction;The proposed RETA is addressing complementary themes that will help to complete a regional picture on key issues and approaches to improve nutrition throughout the life cycle in a sustainable manner. Case studies have been prepared, along with the following papers on a variety of issues:
à link priority strategies to reduce child malnutrition developed under the first RETA with women's health and nutrition programs and with early childhood development programmes, and develop strategies for public nutrition addressing the needs of adults;
à assist developing countries with major nutrition problems in formulating priorities for nutrition policy and regulatory reform, implementing cost-effective programs, and identifying vulnerable groups for public sector intervention;
à support regional and subregional dialogue on the priorities for public nutrition, the roles of governments and external donors (including the ADB), as well as public and private sectors; and
à develop a set of principles for preparing the ADB's nutrition policy paper.
à Options for Interventions to Improve Human Nutrition: A Review of Efficacy and EffectivenessAn Integrated Report is currently being developed which draws on the work of both RETA projects. A draft of this report will be reviewed by representatives from several countries in Asia and the Pacific along with a steering committee within the ADB, and discussed at a Regional Seminar to be held in Manila in late August 2000. This integrated report will in turn serve as the basis for the development of a nutrition strategy for the ADB.
à The Nutrition Transition and Diet-Related Chronic Disease in Asia: Implications for Prevention
à Building Capacity to Improve Nutrition
à Food Policy and Nutrition Security
à Regional Approaches to Fortification of Staples and Complementary Foods
For more information, please contact Stuart Gillespie, IFPRI, 2033 K St NW, Washington DC 20006 USA; Phone: 202 862 5638; Fax: 202 467 4439; Email: <email@example.com>; Web: <www.ifpri.org>
Improving the Nutritional Status of Children by Transforming
Poverty Alleviation Programmes in Honduras
In Honduras, IFPRI is working with the Family Allowance Program (PRAF) to improve the nutritional status of children in the rural southwest of the country, where up to 60% of children aged 12-71 months are stunted and the prevalence of malnutrition has been increasing over the past decade. The new PRAF project is based on a decision to transform a previous short-term poverty alleviation program into one that can contribute to a longer-term strategy of creating a new generation of healthy, educated young adults in a highly disadvantaged area of the country. Currently, over 70% of households in this area have insufficient means to assure an adequate diet.
The new project has been funded in large part from a concessional loan from the Inter-american Development Bank and aims to establish whether public funds are best spent on direct transfers to poor households, or on improving the ability of the health services to deliver effective support to vulnerable groups or both. Seventy municipalities out of a total of nearly 300 in the country have been targeted on the basis of exceptionally high rates of stunting recorded in the 1997 National Census of First-Graders' Height. Of these seventy municipalities, twenty will receive a package of household-level interventions including a cash transfer: the Health and Nutrition Allowance. This allowance, worth just under US$50 per annum per beneficiary, will be paid to all pregnant women and mothers of children 0-35 months of age (up to two transfers per household), on the condition that they remain up-to-date on antenatal care, vaccinations, and growth monitoring. The value of the allowance is intended to compensate women for the loss of one day's work each month when they are expected to present at the health center. Currently, less than half of all pregnant women in the intervention area receive five or more antenatal checks, and only 68% of children under 3 regularly attend growth monitoring.
In a further ten municipalities, the government health centers will receive a cash transfer averaging approximately US$6,000 per annum, which they will use to improve the quality of the services they provide to pregnant and lactating women and children aged 0-35 months. The exact value of the transfer depends on the size of the facility's target population and the number of staff employed. All the health centers will receive training in quality planning, and will develop an expenditure plan for the additional funds in conjunction with newly formed local Committees for Health Improvement. Part of the payment will be conditional on the service obtaining an adequate rating from a random sample of facility users. In addition, the project will work towards the expansion of the community-based growth promotion program known as AIN/comunitario, originally developed by the USAID-funded BASICS program in conjunction with the Ministry of Health. The AIN combines successful elements from previous community-based nutrition programs in Indonesia, Tamil Nadu, and Tanzania, and has been heralded as a breakthrough in community nutrition. In twenty other municipalities, all the interventions described will be implemented, leaving twenty municipalities that will serve as control communities. The allocation of the seventy municipalities to the four groups was decided in an open session by lottery.
The project will also implement a number of complementary education interventions focused on children aged 6-12 years. The health and nutrition interventions enjoy the strong support of the Ministry of Health, in addition to that of the ministry to which PRAF itself belongs, the Office of the Presidency. The International Food Policy Research Institute has been contracted by PRAF to assist with the targeting strategy, provide technical advice and analysis on appropriate interventions, develop a system for routine monitoring of program delivery, and design and implement an objective impact evaluation. All the interventions will begin in August 2000. Prior to this, a complete household census will be undertaken in the municipalities selected to receive the household allowances, and an extensive baseline survey will be conducted in a random sample of 80 households in each of the seventy municipalities. The baseline survey will cover areas such as: anthropometric status of children under 5; child feeding and hygiene practices; demand for health services, and quality of care from the service-user's perspective; women's time use, and household expenditures on food and other consumables. An interim impact evaluation survey will be conducted one year after the baseline survey, and a "final" impact evaluation survey will be conducted after two years. Constant monitoring of process and impact will be begin as soon as the interventions are delivered.
Contact IFPRI's web-site at <www.ifpri.org> for further information.
International Union of Food Science and Technology
New Initiatives at Chilean Meeting
The International Union of Food Science and Technology announced the development of a broad range of programmes aimed at the international food science and technology community at its recent Governing Council meeting in Chile. The meeting, held at the invitation of SOCHITAL, The Chilean Association of Food Science and Technology, was in conjunction with the XI Latin American, Caribbean Seminar and XIII National Congress of Food Science and Technology, in which the IUFoST Governing Council members participated. Some highlights of the meeting are listed below.
The Korean Organizing Committee has developed an excellent and well-rounded programme for IUFoST Congress XI under the title Paradigm Shift -Harmonization of Eastern and Western Food Systems. The second circular is now available. Five short courses have been added to the pre-Congress Programme and other ways of distributing short courses and scientific information, for example, through videotape or internet, are being explored. Development of smaller congresses, on a yearly basis, in association with trade exhibitions, is moving forward. Preliminary discussions are underway with Egypt and South Africa. IUFoST will work with its other members to establish these annual regional congresses.
The joint IUFoST/IFT Electronic Magazine, entitled The World of Food Science, has been officially launched. This magazine incorporates news from our reporters and associates around the world and covers such topics as regulatory affairs, in-depth country reports, hot topics, business developments and much more. Internet Discussion groups related to topics such as hygiene, functional foods, labelling, management problems of small and medium enterprise are being established. These discussion groups will produce information statements issued by IUFoST, through the Academy and Scientific Council. An impressive number of databases have been added to the IUFoST homepage. More are being incorporated into the site on a continuing basis. IUFoST will consider consultancy listings in the form of "yellow pages". Individuals in related industry, services, labs will be invited to advertise.
An overall strategy for food science and technology is needed and efforts have begun to bring together leading scientists and industry to debate and plan for the future. Scientific and technological needs from the perspective of developing countries including post harvest, food quality, food safety and transportation are being investigated. The emphasis will be on export activity as it provides the revenue base. The need to harmonize regulations is being considered.
Another working party is examining the scientific needs of developed countries. This will be addressed with the objective of developing a strategic plan for food science and technology that will incorporate national, regional and international needs. Identifying food-related problems, research needs and ultimately providing recommendations for national strategy consideration on such issues as nutrition, hygiene, and food engineering is the final objective.
Significant progress has been made in the area of IUFoST education initiatives. A working group on core curricula has been established and material is being gathered from members. IUFoST partnership in an education website is being explored. Discussions with the United Nations University are underway. A proposed core curricula and non-academic training guidelines project, Definition of Professional Terminology, is a joint venture with IUNS. There is need for a compilation of food science/food technology terminology to be prepared and distributed in major languages.
Contact: J Meech, Secretary-General, IUFoST, 522 Maple Ave, Oakville, Ontario, Canada L6J 2J4; Phone: 905 815 1926; Fax: 905 815 1574; Email: <firstname.lastname@example.org> Web: <www.inforamp.net~iufost>
United States Agency for International Development
LINKAGES (USAID's Breastfeeding, Complementary Feeding, and Maternal Nutrition Project) has undertaken four applied research projects to identify program strategies that are most effective in bringing about positive behavior change and improved health of infants and women of reproductive age. Behavior change strategies being tested in community-based studies include mother-to-mother support groups, home visits, informal contacts, counseling, modified trials of improved practices, "positive deviance" and social marketing. A brief description of each study follows.
Study 1: Testing the La Leche League model in Guatemala: Does mother-to-mother breastfeeding support work?
This is the first study to rigorously test the most well-known and widespread strategy for promoting breastfeeding: mother-to-mother support groups pioneered by La Leche League International. For the past ten years, La Leche League Guatemala has trained and supported more than 200 volunteer breastfeeding counselors in low-income, peri-urban areas of Guatemala. The study uses a pre-/post cross-sectional design to compare 650 infants less than six months of age and includes a census, a survey of mothers, and interviews with breastfeeding counselors. One hundred additional breastfeeding counselors will be trained as part of the study. Timeline: 9/99-9/01
Study 2: Informing Zimbabwean women about HIV transmission through breastfeeding: Does counseling affect infant feeding decisions, skills and behaviors?
LINKAGES is conducting research through the ZVITAMBO (Zimbabwe Vitamin A for Mothers and Babies) Project to understand the context within which women make infant feeding decisions in countries where HIV prevalence is high. Information was gathered to assess costs associated with each feeding option; the availability of replacement foods; potential stigmatization of women who choose not to breastfeed; and caregivers' ability to properly breastfeed, express and heat-treat breastmilk, and prepare commercial infant formula. This information was used in developing an intervention to inform women of infant feeding options. Timeline: 2/99-2/01
Study 3: Improving breastfeeding and complementary feeding practices in Vietnam: How does a positive deviance approach work?
Save the Children's "positive deviance" programme in Vietnam helps parents of poorly nourished children learn how the parents of positive deviant children are able to keep their children well nourished, in spite of tremendous poverty. A large part of this study on positive deviance focuses on complementary feeding of children 6-24 months of age. Several sub-studies focus on the breastfeeding practices of mothers of infants 0-6 months of age and the impact of their labor outside of the household on breastfeeding practices. Timeline: 4/99-4/01
Study 4: Improving micronutrient status of women of reproductive age in Bolivia: Does social marketing of a micronutrient supplement work?
This research tests whether increasing the availability of a commercial, low-cost multiple vitamin and mineral supplement (VitalDía) affects use of the supplement by women of reproductive age in the Department of Santa Cruz, Bolivia. VitalDía is being promoted through the media, workshops, seminars, and point of sale materials. The overall social marketing strategy also includes an information campaign to raise awareness among women, particularly focusing on pregnant and lactating women, about the importance of nutrition to their health, emphasizing the consumption of fruits and vegetables. Timeline: 7/98-6/00
Contact: LINKAGES, AED, 1825 Connecticut Ave, Washington DC 20009 USA; Phone: 202 884 8000; Fax: 202 884 8977; Email: <email@example.com>
Bangladesh National Nutrition Programme
The World Bank has approved the first phase of a National Nutrition Program (NNP) in Bangladesh, expected to cover the entire country within the next 12 years. Building on the existing Bangladesh Integrated Nutrition Project, the program includes a broad array of community-based and national activities, with a micronutrient component that may be the most extensive in any large scale nutrition program in the world.
The micronutrient component, developed with assistance from Ml, and representing the country's national micronutrient strategy, emerged from the work of a National Micronutrient Committee established with Ml assistance. The component includes antenatal and postpartum micronutrient supplementation, vitamin A capsule distribution, and, for the first time, supplementation for adolescent girls and newly married women.
The NNP gives significant attention to food fortification - of wheat flour and edible oil - and calls for modernization of the salt industry to improve iodization activities in the country.
Community-based nutrition services in every village participating in the program will include home garden activities to increase the consumption of micronutrient-rich foods and improve household food security. This activity, originally introduced into the project by Ml and Tufts University, and employing an approach developed by Helen Keller International, has become a model for home garden programmes worldwide.
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Final Report to the ACC/SCN by the Commission on the Nutrition Challenges of the 21st Century
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This study is being carried out by Ml in collaboration with BRAC (the largest indigenous NGO in the world). It will employ a drink produced by Procter and Gamble and schools established by BRAC. In large part, because of BRAC's contributions, over a quarter of adolescent girls in rural Bangladesh are now attending school and the numbers are increasing rapidly. Many BRAC schools already provide nutrition counselling (recently evaluated with Ml/Tufts assistance.)
The MI/BRAC study will assess the extent to which BRAC can attract non-school going adolescent girls to the schools for brief periods during the day to consume the drink and receive nutrition education messages. The study also will compare the acceptability and "drawing power" of the drink with that of capsules. If effective, this intervention may become an important element in Bangladesh's national effort to combat malnutrition.
Contact: Ibrahim Daibes, MI, c/0 IDRC, PO Box 8500, 250 Albert St, Ottawa, Ontario, Canada K1G 3H9; Phone: 613 236 6163; Fax: 613 236 9579; Email: <email@example.com>. For a full listing of Ml publications, and to order your copies, follow this link to <http://www.idrc.ca/booktique/index_e.cfm>
The Fourth Report on the World Nutrition Situation
This book is part of a series of ACC/SCN reports initiated in the mid-80s on the nutritional status of populations in developing countries. It provides important information for the many individuals, institutions, governments and NGOs working to accelerate nutrition action. This report focuses on nutrition throughout the life cycle and provides the latest statistics in areas such as undernutrition, micronutrients, infant feeding and refugees. Please see our Publications Order Form or download from the web at: