Programme News

Editor’s Note: For this issue, Programme News contributors were asked not just to provide information on current activities, but also to focus on their use of, and experience with, nutrition goals and targets.

INTERAGENCY

United Nations University/International Nutrition Foundation/Micronutrient Initiative/Centres for Disease Control

Micronutrient goals aim build on progress

In September 2001, over 120 Heads of State are expected to attend the United Nations General Assembly Special Session (UNGASS) on Children. The outcome document, to be signed at the meeting, is tentatively titled A World Fit for Children. It will touch on the overall environment of children throughout the world and include basic principles, general goals and the more detailed strategies and actions needed to achieve during the current decade a world fit for children.

The document is being developed by a Preparatory Committee with support from UNICEF. Each draft has drawn extensive comments by national delegations, UN agencies, concerned NGOs, expert bodies and a wide variety of other groups. UNGASS preparatory documentation including the various drafts of A World Fit for Children, can be viewed on the UNICEF web site at www.unicef.org.

Before and during the UNGASS Preparatory Committee Session in January 2001, there was an effort to assure that A World Fit for Children included a goal whereby each country would commit to reducing the prevalence of nutritional anaemia in children less than two years of age and women by 30% by 2010. The proposed wording, developed through broad consultation, expanded on the goal set in 1990 at the World Summit for Children that was not achieved by the year 2000.

The United Nations University (UNU), International Nutrition Foundation (INF), the Micronutrient Initiative (MI), the US Centers for Disease Control (CDC), WHO, UNICEF, Helen Keller International (HKI) as well as the ACC/SCN and other groups have monitored the development of this outcome document in relation to anaemia and iron deficiency. Following its 28^th Session, the SCN proposed specific wording for the section of A World Fit for Children that deals explicitly with iron deficiency, vitamin A deficiency and iodine deficiency disorders.

At the third Preparatory Committee Session at the United Nations in mid-June, issues related to nutrition, both general and specific, had gained considerable prominence. As agreed by national delegations at that meeting, A World Fit for Children will contain explicit wording on anaemia and iron deficiency under actions and strategies needed to achieve health and nutrition goals during the current decade. The relevant paragraph reads:

Achieve sustainable elimination of iodine deficiency disorders by 2005 and vitamin A deficiency by 2010; reduce by one third the prevalence of anaemia, including iron deficiency, by 2010; and accelerate progress towards reduction of other micronutrient deficiencies, through dietary diversity, food fortification and supplementation.

This wording was also used in the Call for Action agreed upon by experts from 45 countries who participated in the conference Forging Effective Strategies to Prevent Iron Deficiency, sponsored by ILSI, MI, and Emory University 5-7 May in Atlanta. In addition the wording was endorsed at an international review on a multi-micronutrient supplementation for children held in Peru in May, sponsored by the German Government.

Senior advisors on international nutrition in UNICEF, the World Bank, the Micronutrient Initiative, Helen Keller International, Centers of Disease Control, the UNU and INF all agree that this wording provides an adequate framework for advocacy and monitoring. The consensus is that efforts should now shift toward the actions necessary to assure there is no repeat of the last decade’s global failure to achieve the less ambitious goal of reducing iron deficiency anaemia in pregnant women.

This new commitment calls for reducing the prevalence of anaemia including iron deficiency in all groups. Support for new and expanded national efforts will be needed. The pace and scope of work during the past two years has accelerated, showing progress toward improved interventions, new funding and organizational resources, better documentation of existing programmes, new advocacy tools and on mechanisms that better link field projects with technical assistance and information. Support in all these areas should be intensified to provide more ideas that are constructive, dedicated advocacy, and committed effort to support key groups.

Following-up on the UN General Assembly Special Session on Children in September will require support to move the national commitments to reduce iron deficiency into operational form. The list below suggests the scope of this work and, while not complete, draws from recent discussions during the Atlanta meeting and other professional venues.

Political leaders will need:

· Concise explanations of the prevalence and consequences of anaemia and iron deficiency
· Brief, clear and convincing arguments that iron deficiency can be reduced during the decade

· Practical information showing that reducing iron deficiency is a true life cycle issue that is affordable, “doable,” and essential to basic child and women rights.

· Practical information on the overall “package” of iron interventions, including guidance on setting goals, sequencing and phasing major interventions, phasing activities, and obtaining new resources.

· Updated summaries of current actions to improve interventions and sources of technical skills.

· An outline of the expanded sectoral partnerships including health, education, agriculture, labour, trade and most importantly the private sector and NGOs dealing with child and women’s rights

· Broader strategies for generating the resources needed to organize programmes to improve iron nutrition such as food fortification and preventive supplementation

· A stronger voice on setting research agendas, and better access to information on work in process and all relevant results

· Better access to useful guidelines, current research, technical information and operational lessons learned

· More comprehensive and professional communication strategies supporting advocacy and resource generation and in partnership building and maintenance, motivation and training of service delivery personnel and community level communication to generate demand for products and services leading to improved iron nutrition

· Stronger channels that are more active and links among laboratories, efficacy sites and large population-based intervention programmes

· Improved sequencing and collaboration on similar research and acceleration of work needed to bring improve intervention components to wide-scale use

From the perspective of the INF and UNU the global acceptance of a goal for each country to reduce the prevalence of anaemia including iron deficiency by 30% by 2010 will be extremely useful. Comments are most welcome on how the setting of this goal can best be exploited by those working to improve iron nutrition.

Contact: Gary Gleason, International Nutrition Foundation/UNU: ggleason@inffoundation.org

Nevin Scrimshaw, UNU: nevin@cyberportal.net

The latest drafts of both the Official and NGO outcome documents are available on the UNICEF website: www.unicef.org

AUSTRALIA

Primary Prevention Section, Commonwealth Department of Health and Aged Care, Canberra

The Primary Prevention Section develops, implements and evaluates national level public health nutrition policy and initiatives, as well as physical activity and weight control so as to increase the number of Australians who consume a diet consistent with the national dietary guidelines. For this purpose, a Strategic Intergovernmental Nutrition Alliance was established. It has since developed Eat Well Australia, the 2000/2010 framework for public health nutrition.

Rather than setting goals and targets for nutrition, the framework outlines strategic directions for health gain, capacity building and strategic management in nutrition, e.g. promotion of vegetable and fruit consumption, of a healthy weight, good nutrition for mothers, infants and school-aged children and improving nutrition for vulnerable groups.

Other initiatives include recommendations for healthy eating, a national breastfeeding strategy, a community grants program addressing child nutrition, and the development of a national food and nutrition monitoring and surveillance system. For further information or a copy of resources, visit the following web pages:

For Eat Well Australia -

http://www.dhs.vic.gov.au/nphp/signal/priority.htm

http://www.health.gov.au/pubhlth/strateg/food/index.htm

http://www.health.gov.au/pubhlth/strateg/brfeed/index.htm

http://www.health.gov.au/pubhlth/strateg/childnutrition/index.htm

http://www.acithn.uq.edu.au/nutrition/monitoring

ECA

Economic Commission for Africa

Editor’s note: SCN News is delighted to welcome the ECA to the SCN family. The ECA attended the recent SCN annual session for the first time.

Partnerships for sustainable development

Much of the African continent has been experiencing a stagnation. Nevertheless, encouraging progress has also been made by many countries in reforming their economies to ensure equitable growth and reduce poverty. But such improvements remain fragile in an intensely competitive global environment.

As a member of the UN and as part of the African institutional landscape, the ECA’s mandate is to support the economic and social development of its 53 member States, foster regional integration, and promote international co-operation for Africa’s development. Partnerships are central to ECA’s vision and involve cooperation with African intergovernmental organizations, UN agencies, the donor community, African universities, research centres and civil society groups. Work includes research, advisory services, seminars and workshops, information transfers, advocacy, capacity building through fellowships, internships and lectureships in support of varied research.

The African Development Forum (ADF)

One of the ECA’s initiatives is the ADF; it aims at establishing an African development agenda that reflects consensus among partners on a new, shared vision for the continent. It focuses on Africans taking the lead in formulating shared goals and priorities, drafting action programmes and defining the environment that will enable its countries to implement their own development agenda with appropriate support from the international community. The Forum meets annually in Addis Ababa, Ethiopia. The 1999 Forum was the first and focused on The Challenge to Africa: Globalisation and the Information Age. ADF 2000, organized in partnership with the OAU, ILO and UNAIDS focused on “AIDS: the greatest leadership challenge”. ADF 2001 will focus on regional co-operation and integration.

ADF 2000 resulted in an African Consensus and Plan of Action: Leadership to overcome HIV/AIDS. The document spells out commitments made (by governments, international organisations, civil society organisations and individuals) and how to implement them. ECA and its partners will monitor the implementation of the plan. Moreover, given the destructive impact of HIV/AIDS on all development efforts, ECA is incorporating HIV/AIDS components in all its work programmes.

Food security as a component of Africa’s Sustainable Development

Consensus has been reached that sustainable development calls for a greater emphasis on food security, social development and environmental security, all key to poverty reduction. This calls for an urgent reorientation of current policies for which member states require assistance.

The mission of the Food Security and Sustainable Development Division of the ECA is to provide this assistance. It lobbies policy-makers to make them aware of the urgency of making the needed changes in policy and in strategic planning. The Division has developed an advocacy tool - the Population, Environment, Development and Agriculture model - which is an interactive computer simulation model to illustrate the likely impact of alternative policy options on the food security status of the population. The model demonstrates the relationships between these fields. Recently, an HIV/AIDS component has been introduced to account for its impact on development variables. The Division organised a workshop on women’s reproductive health and household food security (the relationships between reproductive health and household food security) aimed at proposing evidence-based recommendations that will lead to policies that improve the quality of life of women and their families. The workshop set out guidelines for a research agenda.

Contact: ecainfo@uneca.org www.uneca.org

The goal of abolishing stunting cannot be achieved in a short term. That is why national governments have to make long - term commitments to reducing it by a certain percentage per year. George Kent (see p 13)

FAO

‘Too little progress in fighting hunger since 1996 - FAO calls for new political commitment’ This was the conclusion of the Committee on World Food Security (June 2001) which met to discuss, among other items, preparations for the World Food Summit: five years later (WFS:5YL), Rome, November, 2001.

Concern over hunger tends to be confined largely to highly visible emergency situations. This delays action, because of an indifference towards finding the needed urgent solutions to chronic hunger.

FAO’s most up-to-date monitoring on the efforts by nations and the international community to fulfil their WFS commitments shows that although headway has been made and some success stories can be found in individual countries and communities, much remains to be done.

Some 792 million people in developing counties and 34 million in the developed world remain chronically hungry in spite of the success of farmers in generating enough food to meet everyone’s needs.

The number of undernourished is falling at a rate of 8 m/yr, far below the average rate of 20 m/yr needed to reach the target of halving the number of food insecure people by the year 2015 to 400 million. The target will not be reached unless there is renewed political commitment and more resources are forthcoming.

The purpose of WFS:5YL is to do just that, to raise both the political commitment and the financial resources to fight hunger and to translate these into practical programmes. Participants will then consider ways to accelerate the process. The pledge to cut the number of hungry people in half by 2015 provides a time-bound, measurable target through which progress can be measured and through which governments and decision-makers can be made accountable. This nutritional goal thus remains a critical point of reference for the Organisation.

Given the high level of dependency of many of the world’s poor and nutritionally vulnerable on agriculture, the primary importance of the food and agriculture sector in alleviating and preventing malnutrition is clear. Consequently, FAO argues that priority actions are needed to stimulate agriculture and rural development. More determination is required at a time when the commitments are wavering and there are fewer resources being made available.

One of the positive consequences of the WFS is that the Right to Food is now recognised as a human right under international law.

Achieving the WFS goals requires that the elimination of hunger be made a vital first step in the eradication of poverty and be included as a specific objective of poverty reduction strategies. A sharper focus on agricultural development to achieve improvements in household food and nutrition security is thus needed within the broader objective of poverty reduction.

FAO believes that relatively modest investments and simple technology changes will raise small farmers’ productivity, improve food security and reduce hunger and poverty. However, sufficient resources to do just that are not being allocated. There is no evidence, in the last five years, of a rise in international or domestic resources for agricultural development; ODA for agriculture has rather fallen steadily. Actually, at the same time, a number of the most food insecure countries have increased their military expenditure. Following the WFS in 1996, very few governments took actions massive enough to fight hunger and few international institutions included the reduction of hunger as a central element in their development portfolios.

FAO’s long-term strategy is to focus more on the hunger eradication component of poverty reduction programmes and modifying investment projects to increase their impact on hunger reduction. Its Special Programme for Food Security is to become a people-centred demand-driven instrument through which communities are empowered to address hunger in its multiple dimensions.

Contact: brian.thompson@fao.org

www.fao.org/unfao/bodies/cfs/cfs27/cfs2001-e.htm

HKI

Helen Keller International

HKI, the international division of Helen Keller Worldwide, was founded in 1915 by Helen Keller with the mandate to educate and rehabilitate soldiers blinded during World War I. In the 70s, the mandate shifted from education and rehabilitation of the blind to include blindness prevention. In 1999, the agency was renamed Helen Keller Worldwide, with HKI becoming the international division.

HKI’s work in nutrition started in the 70s with programs to combat vitamin A deficiency, the leading cause of childhood blindness. Work with the Government of Indonesia and Johns Hopkins University laid the basis for demonstrating the links between vitamin A and child survival. This led to a significant expansion of vitamin A programs. In 1992, the nutrition activities were expanded to include iron and iodine deficiency prevention and control, and subsequently, other micronutrients. Currently, operations research on multiple micronutrients, birth weight and maternal mortality is being conducted in Indonesia and Niger. Food-based approaches, such as the national home-gardening program in Bangladesh, are important strategies in achieving the micronutrient goals of any country.

As a technical assistance organization, HKI seeks to work with partners in government, communities and NGOs to put in place solutions to respond to the immediate, medium and long term micronutrient needs of vulnerable populations throughout the life cycle. Within countries, HKI collaborates with health and other ministries, national NGOs, bilateral agencies such as USAID, the Micronutrient Initiative, as well as with WHO.

The micronutrient goals of the World Summit for Children and confirmed at the FAO/WHO International Conference on Nutrition, have provided direction to HKI’s work. HKI currently operates nutrition programmes in a total of 15 countries in Africa and Asia. HKI also takes active part in international fora such as the ACC/SCN and various expert committees, usually providing an operational perspective for moving the science into programs.

Highlights of HKI’s recent work include:

· Integration of vitamin A into National Immunization Days, and assisting in the organization of national/regional micronutrient days including vitamin A and iron/folate in Burkina Faso, Guinea, Mali, Morocco, Mozambique and Niger.

· Implementation of nutrition-focused child survival projects in Mali and Niger that improve quality of nutrition services and counseling in health centers and community education on nutrition and diarrhea case management.

· Piloting of various models of improving iron/folate supplementation of pregnant and lactating women through the existing health care system, through traditional birth attendants and mass campaigns, as well as by integrating with the community-directed river blindness control activities.

· Introduction of home gardening approaches to improve micronutrient intake, including the introduction of sweet potatoes in Burkina Faso, Niger and Mozambique.

· Identification of potential food vehicles for micronutrient fortification.

· Development of a nutrition focal point networks covering the 15 countries of the Economic Community of West African States.

· Implementation of home gardening programmes in Bangladesh, Cambodia and Nepal to improve micronutrient intake through increased consumption of micronutrient-rich plant foods year-round, increased income (from the sale of garden produce) to supplement household purchasing power, and empowerment of women in support of improved household caring practices.

· Operation of nutrition and health information systems in Bangladesh and Indonesia to monitor nutrition and health trends.

· Nutrition/health interventions in Indonesia with the USAID Food For Work initiative in support of the country’s economic recovery efforts.

· Advocacy for linkages between food policy and nutrition (using nutrition surveillance data) in Bangladesh and Indonesia.

· Provision of technical assistance to governments and other organizations throughout the region (most recently in Cambodia, Pakistan and Viet Nam) to conduct large-scale surveys to assess the prevalence of micronutrient deficiencies.

· Trial in Indonesia to assess the impact of a multiple micronutrient supplementation on reducing maternal mortality and enhancing child survival.

· Provision of technical assistance to the national vitamin A supplementation programmes in Bangladesh, Cambodia, China, Indonesia, Nepal, Philippines and Viet Nam.

· Implementation of nutrition education/social marketing activities in Bangladesh, Cambodia, Nepal and the Philippines.

· Active support of the Garantisadong Pambata campaign (integrated child health weeks) in the Philippines in nine regions, as well as work with local authorities on decentralizination and on IMCI.

With further success in work on VADD and on ICCIDD, we anticipate working to sustain this progress, and continue to be actively involved in reducing iron deficiency and other causes of micronutrient malnutrition.

Contact: idarnton-hill@hki.org

IAEA

International Atomic Energy Agency

The International Atomic Energy Agency’s contribution to the growing discipline of Nutritional Metrology

Standardization of analytical techniques and harmonisation of measurement approaches by developing careful protocols for various food and nutritional tests have enhanced the accuracy, precision and reliability of the same. This has led to the emergence of a sub-discipline entitled nutritional metrology, the science of measurement.

Several methods for evaluation of the health and nutritional status of human subjects are presently in use. These include simple anthropometrics which also reflects the components of the human body (e.g. fat), nutrient balance studies which reflect nutrients bioavailability, and calorimetry and balance studies to determine the utilization of nutrients. More advanced methods include biochemical assessments for the different nutrients, hormonal assays that look into their regulatory functions, and gene mapping and proteinomics that study genetic influences. Innovative approaches that calibrate and validate methods have now become routine in an effort to assure their precision.

Several nutritional metrology applications use stable isotopes and are very useful in human nutritional studies. Isotopes, both radioactive and non-radioactive, allow detailed evaluation of nutrient intake, body composition, energy expenditure, as well as status of micronutrients and their bioavailability. The doubly labelled water technique combines the use of the stable isotopes to measure total energy expenditure in humans, as well as to investigate the magnitude and causes of undernutrition and emerging obesity in developing countries. The deuterium dilution technique is a reliable tool to measure breast milk intake and thereby infant growth and development. In collaboration with WHO’s Growth Monitoring Programme, this is generating new data on growth standards for children in the developing countries. The technique is also used in the measurement of body composition. Moreover, stable isotopes of Fe and Zn have been successfully used to assess the nutritional impact of several nation-wide food supplementation programmes for pregnant and lactating women and children in both developed and developing countries.

Isotopic techniques are also proving to be especially suitable for monitoring changes in body composition, energy metabolism and mineral status in the elderly (especially in cases of osteoporosis). Additionally, nuclear methods have served to develop models for a Physiological Reference Man in Asia, to establish the elemental composition of foods and to measure pollutants in the environment.

Stable isotopic tracers are completely safe, are non-invasive, and can be used in free living humans. They emit no externally measurable radiation and their presence in excess of natural levels is detectable by an isotope ratio mass spectrometer.

In sum, isotopes are widely used in a number of Co-ordinated Research Projects and Technical Co-operation Projects of IAEA.

Contact: v.iyengar@iaea.org

IBFAN

International Baby Food Action Network

The year 2000 saw important steps forward in the adoption of international instruments. The challenge for 2001 and onwards is to advocate for the promotion, implementation and monitoring of these instruments, namely ILO’s convention 183 recommendation 191 on maternity protection at work and World Health Assembly’s Resolution on six months duration of exclusive breastfeeding.

IBFAN together with others have warned the UN against abandoning its key role in setting international standards and in assisting governments to implement and safeguard the same. IBFAN has also expressed its concerns in relation to the interaction between the UN and corporations for which no mechanisms have been incorporated to ensure transparency and/or external assessment.

There are currently five IBFAN regional offices in all continents. Working groups on focused issues and special global task forces have been established. They will all get involved in these new challenges. IBFAN is not registered as an international organisation. National groups are autonomous and each is registered independently.

Africa: ibfanswd@realnet.co.sz
Asia-Pacific: ibfapg@tm.net.my
Europe: gifa@iprolink.ch
Latin America and the Caribbean: ruth.arango@starnet.net.gt
North America: infact@ftn.net - www.ibfan.org

ICCIDD

International Council for the Control of Iodine Deficiency Disorders

With the aim to eliminate iodine deficiency and to promote sustainable optimal iodine nutrition throughout the world, ICCIDD was formed in 1985. Iodine is distributed unevenly over the earth’s surface, and currently, about 2.2 billion people (over one-third of the world’s population) live in areas of iodine deficiency and risk its consequences, mainly on the fetus and infant. These consequences include foetal and neonatal deaths, short stature, permanent mental retardation, deaf mutism, other developmental defects, goiter, poor educability, and low economic productivity.

Collaboration with UNICEF (and its global network doing most of the work), with WHO, and work with other partners and donors (Kiwanis International and the Gates Foundation among others), as well as with national governments has led to great progress. ICCIDD members include endocrinologists, public health experts, practicing health professionals, communicators, agriculturists, the salt industry and representatives of major international organizations. Financial support has come from bilateral international aid (particularly Canada, Australia, the Netherlands, the United States, and Sweden) and from multilateral agencies, especially the World Bank and UNICEF. The total membership of ICCIDD is about 600 individuals from about 100 countries. The Board of Directors has 40 members, including special committees. A system of national coordinators in countries is now being set up.

Activities: ICCIDD provides technical assistance for countries and institutions, it sponsors meetings, and supplies assorted publications. It assesses programmes and carries out in-country technical reviews with emphasis on monitoring and sustainability It gives high priority to information exchange and publishes a quarterly newsletter. It keeps a database on progress in each country. ICCIDD also gets involved in programme implementation assisting all efforts to improve iodine nutrition (mostly those related to iodized salt). Finally, ICCIDD sponsors and carries out targeted research on methods to assess and improve iodine nutrition.

Remarkable progress has been made in IDD during the past decade. Many previously deficient populations now show good biochemical evidence of sufficiency. Worldwide, about 70% of households now consume iodized salt. Current emphasis is to provide adequate iodine for the rest of the population, and to support mechanisms for sustaining optimal iodine nutrition by monitoring iodine status in people and iodized salt distribution channels.

Use of goals and targets: ICCIDD supports the setting of goals and targets for achieving optimal iodine nutrition. Together with WHO and UNICEF, ICCIDD has developed indicators to measure adequate iodine nutrition. These are chiefly urinary iodine concentration in representative population samples, and satisfactory levels of iodine in salt in the market. These criteria provide a quantitative means to assess progress and to recognise countries and activities in need of help. The goal of “virtual elimination of iodine deficiency by the year 2000,” pledged by the 1990 World Summit for Children, helped mobilize a large number of agencies, donors, NGOs, and countries to achieve major progress. Experience in dealing with these goals is now helping to shape a longer term strategy for sustainability through effective monitoring, a major focus for ICCIDD current work.

Contact: jtd@virginia.edu www.iccidd.org

- PROGRAMME NEWS - Please keep sending news of your activities - we receive countless letters from readers saying this is the only way they have of keeping up to date with what’s being done by the movers and shakers in the field of nutrition Contact us on: accscn@who.int

International development goals and targets are periodically set; and there is every sign that this will continue. I do not think there is evidence that the targets/goals have had any actual impact in the field, one way or the other. But they clearly have a political importance to some significant players. Otherwise, heads of state, and the directors of UN agencies would not keep setting them. Sean Kennedy, IFAD, s.kennedy@ifad.org

IFAD

International Fund for Agricultural Development

Progress in Household Food Security and Nutrition

The essential mission of IFAD is to expand the range of opportunities for the rural poor - primarily through improved agricultural production, rural finance and local capacity-building. Through the design and operation of its loan portfolio, technical assistance grants and cooperation with NGOs, IFAD has decided to focus on achieving impact, particularly on food security and on the nutritional status of the rural poor.

The IFAD Plan of Action 2000-2002 identifies complementary building blocks: (1) impact assessment; (2) knowledge management; (3) policy and institutional environment improvement; and (4) strategic partnerships. Progress to date on implementing the household food security and nutrition elements of the Action Plan are:

Impact Assessment

· Together with WFP, a rapid baseline child malnutrition survey was field-tested in China in late 2000. Trained project personnel was then able to carry out the same survey in an adjacent project area without further external assistance.

· IFAD is preparing an inter-agency workshop on Nutrition, Development and Community Action that will include discussions of case studies on the use of key nutrition baseline indicators to estimate project impact.

Recently issued publications, information and advocacy materials include:

· Knowledge base on Gender and Household Food Security, 2001.

· Rapid Nutrition Surveys for Estimating Project Impact, 2001.

· Guidance Note on Household Food Security and Nutrition. Hi-Memory CD-card: Household Food Security and Gender - At the Centre of IFAD’s Poverty Alleviation Strategy.

· FAO, IFAD and WFP jointly prepared the document Toward System-wide Guidance on Household Food Security and Nutrition. This paper was presented to the UN Consultative Committee on Programme and Operational Questions in April 2000. Extensive comments were provided by 15+ agencies and were consolidated into a unified document. The final version was approved in New York in September 2000 and subsequently distributed throughout the UN system.

· IFAD’s Corporate Strategy for the years 2000/2001 now includes reference to the use of nutrition indicators in IFAD projects, and the link between poverty reduction and the reduction of malnutrition.

· IFAD participated again in the SCN at the 27^th Session in Washington, following a three-year absence. In 2001, IFAD was able to resume support for the core budget of the SCN.

· IFAD participated in the discussion on the need for improved data and additional research on the factors determining development progress (“From consensus to action: a seminar on the international development goals”, Washington, March 2001).

· IFAD is an active partner in the inter-agency working group on Food Insecurity and Vulnerability Information and Mapping Systems (FIVIMS).

IFPRI

International Food Policy Research Institute

IFPRI Collaborates with CARE on Urban Programming

In 1997, IFPRI formed a partnership with Care International to improve the effectiveness of urban livelihood security projects. As part of this collaboration, and as part of the diagnostic phase of project development, IFPRI and CARE carried out rapid urban assessments in Bangladesh, Mozambique, and Tanzania. Integrated projects to improve livelihood security based on these assessments are now underway in four cities in Bangladesh and in Mozambique. In these countries, IFPRI is currently supporting project operations by helping CARE staff set up monitoring and evaluation systems and undertaking baseline and operational surveys. In addition, IFPRI will produce case studies of projects in Peru and Ethiopia that will identify key lessons learned from urban experiences there.

Working with UNICEF in Ghana

IFPRI is working with UNICEF/Ghana to evaluate the impact of UNICEF interventions on maternal and child nutrition, with a special focus on food-based strategies and microcredit to increase the production and intake of foods rich in micronutrients. The study will examine the individual and combined effects of the different components of UNICEF’s programme in the Savelugu/Nanton district of northern Ghana. Preliminary fieldwork to understand the local food system and habits was completed in 2000, and a baseline survey is currently underway. This will be followed by an operations research of implementation alternatives in 2002, and a follow-up survey in 2003.

Working with the Government on Nicaragua’s Social Safety Net programme

The ‘Red de Proteccion Social’ (RPS) is a pilot safety-net programme designed to increase the human capital of children in rural Nicaragua. In a novel approach, RPS provides cash transfers to households contingent upon children’s primary school attendance, up-to-date vaccination schedules, and participation in growth monitoring. IFPRI is evaluating the impact of the pilot project and is collaborating with the Government in the design of an expansion of the programme. The design, implementation, and analysis of a census of the beneficiary population (65,000 individuals living in 11,000 households) have been conducted. A baseline household survey was carried out on a representative sample of 2,000 households. The data are now being analyzed.

Contact: b.mcclafferty@cgiar.org

ITALY

Italian Research Institute for Food and Nutrition (INRAN)

A recent publication entitled Strategies to fight anaemia and growth retardation in Saharawi refugee children presents the rationale, efficacy and effectiveness of food-based supplementation trials in the prevention and control of stunting among refugees living in chronic vulnerability. More specifically, the monograph addresses issues of food technology, practical aspects of the implementation of field programmes, potential benefits of these nutrition interventions and draws conclusions and recommendations for future research. This document has been prepared as a pragmatic approach intended to be useful to field workers and all nutritionists interested in nutrition intervention programmes.

A video illustrating this publication is also available, in both English and Spanish, entitled Managing Child Anaemia and Growth Retardation: A food-based Intervention among Saharawi refugees.

Dr. F. Branca and C.Loprior

http://inn.ingrm.it/Ricerca/scheletro/scheletro.htm

IVACG

International Vitamin A Consultative Group

IVACG Meeting - 12-15 February 2001 - Hanoi, Vietnam

More than 550 policy makers, program managers, planners and scientists from 64 countries participated in the 25^th anniversary celebration for IVACG. The meeting focused on the best strategies to eliminate vitamin A deficiency. The meeting report will be published in The Journal of Nutrition later this year.

IVACG proposed that the term Vitamin A Deficiency Disorders (VADD) be used to describe the various states of vitamin A deficiency from keratomalacia and corneal scaring to sub-clinical signs or tissue deficiency.

Night blindness in pregnant women is to be considered a major risk factor: for vitamin A deficiency, for severe anaemia, for malnutrition, and for reproductive and infectious morbidity. Improving the mother’s vitamin A status benefits her health, as well as that of her child.

It was recommended that a 5% prevalence of maternal night blindness (defined as the occurrence of night blindness in women during their last term-delivery in the past three years) be used as the cut-off point to establish vitamin A deficiency ‘as a public health problem’ in a specific area.

The safety of high-dose supplementation was affirmed. WHO and IVACG will publish a new dosing schedule for infants (more frequent dosing with larger doses during EPI contacts) and routine supplementation of lactating women.

The concurrent implementation of multiple strategies to combat vitamin A deficiency, i.e. supplementation, food fortification and dietary diversification, was recommended for all countries with VADD. The specific mix of these strategies is to be determined by each national and/or regional situation.

The U.S. National Academy of Sciences now estimates that the conversion of beta-carotene to vitamin A, in otherwise healthy well-nourished American children, is half what it had previously been assumed. Recent data from developing countries suggest the conversion ratio in these populations (particularly of dark green leafy vegetables and orange/yellow fruits) is even less than half. These data indicate that it is virtually impossible for young children, with their limited food intake, to achieve normal vitamin A status on vegetables and fruits alone.

Contact: sharris@ilsi.org

INACG

International Nutritional Anaemia Consultative Group

INACG Meeting - 16-17 February 2001 - Hanoi, Vietnam

More than 500 policy makers, program managers, planners and scientists from over 70 countries gathered in Hanoi to discuss the latest scientific and programme findings related to iron deficiency and iron deficiency anaemia (IDA).

The Symposium highlighted the importance of accurate diagnosis of iron deficiency and IDA and stressed the need to demonstrate functional impacts of iron deficiency with and without anaemia. Nutrition and public health strategies to combat iron deficiency and IDA were presented and discussed by experts in the field.

Dr Julia Tagwireyi of Zimbabwe, opened the Symposium calling it “a scandal” that the world’s most prevalent nutritional problem - iron deficiency - has received only limited attention. Very little has been done to reduce its impact on child development and maternal health and the keynote speaker focused on the frequently asked question “why has so little progress been made?”. Obviously, there are no simple answers to this. There is a clear need to re-evaluate the impact of existing programmes focusing on at - risk individuals. In particular, the benefit of iron supplementation during pregnancy has to be evaluated in women with moderate or severe anemia since the risk of maternal mortality is related to the severity of anemia. More information is also needed on the importance of iron deficiency and IDA in early life, in particular on the functional outcome of deficiencies at different stages during early development. New data supporting a causal relationship between IDA in very young children and poorer behavior and development as they grow older were presented at the Symposium.

The complex etiology of anemia, and the difficulties related to accurate diagnosis of iron deficiency, must be considered when establishing strategies to combat iron deficiency and IDA. Iron deficiency is a major factor in the etiology of nutritional anemia and interventions to increase iron intake by food fortification and/or supplementation programs remain key to combat IDA. A commitment to comprehensive approaches is needed - including actions in the areas of malaria control, of deworming and improved sanitation, of access to health care and of overall better nutrition. Only by recognizing the complexity of this public health problem, will realistic local strategies and goals be set for real progress to be made. The meeting report will be available later this year.

Contact: sharris@ilsi.org

IVACG’S and INACG’S

use of goals and targets

IVACG and INACG serve as fora for discussion of issues surrounding the establishment of goals and targets in their respective fields, but IVACG and INACG have not expressly used these in their work. It is clear that to be effective, such goals and targets must be measurable with well-defined, scientifically-sound indicators and must be measurable under field conditions; baseline data must be collected and resources made available to measure changes in the indicator selected. Under these conditions, goals and targets can be very useful policy and strategic tools allowing international bodies and national governments to plan and to measure progress.

Contact: sharris@ilsi.org

IZINCG

International Zinc Nutrition Consultative Group

The International Zinc Nutrition Consultative Group (IZiNCG) has been established with the broad goal of controlling zinc deficiency. A pre-requisite to establishing specific goals for the elimination of zinc deficiency is knowledge of the prevalence and distribution of this condition. Currently, national prevalence estimates based on direct assessment of zinc status in populations are lacking.

There is first a need to establish standard techniques and references for assessment methods. At the moment, zinc deficiency can only be estimated based on indirect indicators such as the adequacy of zinc in the food supply and prevalence of stunting among children. IZiNCG is engaged in the compilation of information needed to assess population zinc status using both direct and indirect indicators. The following information is required:

· Additional biochemical and functional tests for the direct assessment of zinc status. Serum zinc concentration offers an acceptable measure at the population level. However, more sensitive tests are sought.

· Population-based studies to establish associations between indicators of zinc status and functional outcomes of zinc deficiency (to establish cut-offs points). Assessment of these indicators in relation to functional outcomes before and after zinc supplementation.

· Standardized analytical techniques and standards for quality control.

· Quantification of the zinc content of food and factors that affect the absorption of zinc (e.g. phytate). This information will assist in assessing the risk of zinc deficiency, based on local food supply and consumption, and in the development of appropriate food-based interventions, such as fortification programs.

www.izincg.ucdavis.edu

Our website: http://acc.unsystem.org/scn/ - provides links to many partners’ websites

LINKAGES

Changing measures to better assess change:

LINKAGES’s Experience with Breastfeeding Indicators

Changes in child mortality due to breastfeeding cannot easily be attributed to specific programme interventions. Attitudes towards breastfeeding, awareness of the importance of exclusive breastfeeding, and support to enable mothers to breastfeed are important outcomes of promotional activities, but are difficult to quantify and interpret, and may not reflect actual practice. Conversely, indicators of current breastfeeding practices can be more easily measured and are sensitive to changes resulting from program activities.

LINKAGES, a USAID-funded global program providing technical assistance to organizations promoting breastfeeding, has promoted a set of breastfeeding indicators to standardize the assessment of breastfeeding behaviors. These few indicators have all been field-tested, are fairly easy to measure and interpret, are operationally useful, and address worldwide breastfeeding goals.

Collecting these indicators presents several methodological challenges.

· The use of 24-hour recall data tends to overestimate the percentage of infants who have been exclusively breastfed since birth:

24-hour recalls reflect current breastfeeding status and may overestimate the proportion of exclusively breastfed infants, since some infants who are given other liquids irregularly may not have received them in the 24 hours before the survey.

The best estimates of exclusive breastfeeding are obtained from current status data that includes all births in a specified time period. The measure should be interpreted as the percent of infants who “are currently being exclusively breastfed” rather than the percent who have been exclusively breastfed since birth.

· Measuring changes in infant feeding behaviours requires a large sample for a sub-population that represents a small proportion of the population:

Any assessment of behavioural change in infant feeding requires attention to the size of the comparison groups. The detection of changes in breastfeeding and other infant feeding behaviours of five to ten percentage points over 1-3 years requires large sample sizes.

· Breastfeeding questions typically require more than a “yes” or “no” response:

Multiple factors determine whether breastfeeding is optimal, including what foods or liquids, if any, were given in the preceding 24 hours. For comparability, this list of foods and liquids should be consistent with Demographic Health Survey (DHS) instruments.

· Lactational Amenorrhea (LAM) measurements do not reflect an appropriate use of the method:

LAM measurements are based on a woman’s indication that LAM is deliberately used as a method of family planning. The woman who states she is using LAM actually should meet three criteria for use of LAM; most cannot identify these three criteria.

After assessments and advocacy were carried out in 1999, LINKAGES with local partners designed and implemented behaviour change interventions to increase optimal breastfeeding practices. In 2000, rapid assessments were conducted to quantify the initiation of breastfeeding within one hour of birth, six months of exclusive breastfeeding, and LAM acceptance rates in women with infants under six months. Results were drawn after six to nine months of field intervention. Baseline, DHS, and control data served as comparison.

Results: Initiation of breastfeeding within one hour increased markedly in all three countries. In Madagascar, it doubled (73% compared with 34% at baseline). In Ghana, it doubled (50% compared with 25% in control areas). In Bolivia, it increased 64% over baseline data.

Exclusive breastfeeding increased dramatically in Ghana and Madagascar but showed little to moderate change in Bolivia: Madagascar, 68% against 45% at baseline; in Ghana, 68% against 44%; and the DHS (31%). The data are a true reflection of increases in behaviour adoption.

LAM acceptance showed a modest increase in Madagascar and no change in Bolivia. It increased from 2-13% in Madagascar and in Bolivia it remained the same (7-8%). LAM was only recently introduced into the Ghana program, so no data are available.

Applying Lessons Learned to Other Programme Areas

LINKAGES continues to support the use of these indicators. The approach used requires that 1) the indicators chosen measure programmatic success; 2) programme data be comparable with international data; 3) indicators address international goals; and 4) new indicators are pre-tested before their application.

Tools that LINKAGES and partners are now using include behaviour change methodologies, training modules for health care providers and community workers, mother-to-mother support groups, social marketing strategies, policy analysis and advocacy materials, and monitoring and evaluation instruments. Besides Bolivia, Ghana and Madagascar, LINKAGES is active in India, Jordan, Malawi and Zambia. LINKAGES is also involved with WHO, UNICEF and IBFAN to address key issues pertinent to breastfeeding promotion.

Contact: Dr. Nadra Franklin, nfrankli@aed.org or linkages@aed.org

www.linkagesproject.org.

Children who have iron deficiency anaemia in infancy are at risk for long-lasting developmental disadvantage as compared to peers with better iron status Dr Stanley Zlotkin, Professor, Department of Pediatrics and Nutritional Sciences, University of Toronto and the Hospital for Sick Children, Toronto, Canada

MARCH OF DIMES

The March of Dimes, in its mission to improve the health of infants, is leading a 29-member international task force of nutrition scientists, administrators, and policy makers to address the public health concerns of women and infants around the world.

Nutrition problems should not be looked at only as under-consumption. Dietary imbalances and excesses are also important. Many countries have developed dietary guidelines for the general population. Unfortunately, the needs of pregnant and lactating women, and of infants under two years of age are not adequately addressed.

The task force will publish a comprehensive report, based on two years of work, by the end of 2001. The report will review the best available scientific evidence supporting four public health priorities, from undernutrition to overnutrition, and will present food-based dietary recommendations to promote optimal human development. Actionable messages will be provided for community leaders, policy makers and health care providers.

The report will be presented in a life-cycle format starting with the period before birth. Throughout the report, three key interrelated messages will be highlighted:

· Improved perinatal outcomes begin with healthy women.
· Inadequate nutrition early in life may lead to long-term consequences.
· Weight matters.

Other activities of The March of Dimes include:

· Publications and continuing education for health professionals.

· Education and media-based campaigns for consumers.

· Evaluation activities.

· Advocacy to promote legislation for food/water safety, food fortification, micronutrient supplementation, and funding for consumer education.

· Support of non-nutritional strategies required for success (for example, infection control, physical activity).

THE NETHERLANDS

Royal Tropical Institute (KIT)

Since 1956, KIT staff have been involved in nutrition surveys and surveillance, rapid needs assessments, research and programme implementation in the field of maternal and child nutrition, dietary approaches to alleviate micronutrient deficiencies and nutrition in primary health care. Long term involvement in maternal and child health projects has given KIT the expertise to address health and nutritional problems in a life cycle approach.

A district-level, participatory approach to the assessment, planning and implementation of nutrition needs was pilot-tested and then replicated in several African and South-East Asian countries.

Currently, KIT is also integrating nutrition in other sub-sectors such as disease control and reproductive health.

Together with partners in Kenya and Egypt, KIT staff are planning an intervention/study involving micronutrient supplementation in tuberculosis control programmes. The main objective is to reduce the burden of TB (with or without concomitant HIV/AIDS) through a family approach with a focus on reducing mortality and relapses, as well as the prevention of new cases through protection of contacts.

KIT nutrition staff are working with colleagues of the Reproductive Health and AIDS Unit on the nutrition and food security aspects of an AIDS mitigation and prevention strategy. Now, KIT is collaborating with UNAIDS on creating an enabling environment that stimulates community problem analysis and action planning to mitigate the consequences of the epidemic on food security. At policy level, our interest is to position nutrition in the context of broader health and poverty policies such as sector-wide approaches and World Bank-sponsored Poverty Reduction Strategy Papers. This implies asking: Where and how should one place nutrition in poverty reduction strategies?, and How can we nutritionists make clear to non-nutritionists that nutrition is not only a great indicator of poverty, but also a goal on its own that deserves direct attention and funding?

KIT’s view is that nutrition goals and targets, the topic of this issue of SCN News, are useful and desirable as long as they remain realistic with sufficient long time frames (10-15 years) and address relevant target groups: children up to three years old, adolescent girls, pregnant and lactating women.

Contact: m.v.liere@kit.nl www.kit.nl

PAMM

Program Against Micronutrient Malnutrition

The Program Against Micronutrient Malnutrition is an alliance that supports national leaders to reach the goals of eliminating micronutrient malnutrition. These goals were set at the 1990 World Summit and the record shows that the goals became a rallying point for advocacy, resources mobilization, definition of what needed to be done as a priority, and for monitoring the achievement of outcomes. Now, ten years later, the time has come to look at the score card of accomplishments and, more importantly, to come up with the new goals for, say, 2015. PAMM believes these goals will be helpful.

During the immediate past period, PAMM focused more on activities to eliminate IDD globally by mobilizing direct involvement of salt producers and their associations to become part of the global thus joining UN, bilateral, non-governmental and scientific organisations. A Summit of Leaders held in Paris in January 2001, with 25 high-level participants from 16 key international organizations, concluded that the time was ripe to formalise the ongoing relationship, and a Partnership for Sustained Elimination of Iodine Deficiency was formed. The group’s board includes UNICEF, the MI, WHO, the Salt Institute (USA), the China National Salt Industry Corp, the European Salt Producer’s Association, Kiwanis International, ICCIDD and PAMM/CDC. The Advisory Board has met twice this year and actions are in progress. Rapid progress is expected in universal salt iodization. A presentation will be made at an upcoming round table during the UNGASS on Children.

Contact: Frits van der Haar fvander@sph.emory.edu

http://www.sph.emory.edu/PAMM/alliances.htm

PHA

People’s Health Assembly

People’s Charter for Health

The PHA - a worldwide coalition of grassroots people’s organisations working on health and nutrition - held its first assembly last December in Bangladesh. 1,500 participants came from 94 countries. The week-long highly successful meeting consolidated a global network that will make the voices of the unheard heard. The centre piece of the deliberations was the approval of the organisation’s Charter. The document is an expression of common concerns, presents a vision of a healthier and better nourished world, at the same time that it calls for radical action to change the deteriorating conditions of the health and nutrition of the poor both in the North and in the South. The Charter is being used as an advocacy tool, as a rallying point for a global health movement. It was presented during the World Health Assembly in Geneva last May.

Six principles underlie the Charter:

· health is a fundamental human right

· primary health care is our non-negotiable basis for policy;

· governments have the fundamental responsibility to ensure access to quality health care

· people and people’s organisations are essential to formulate, implement and monitor health programmes

· political/economic/social/environmental issues are the primary determinants of health and must get top priority in policy making, and

· actions at all levels (from individual to global) are needed to tackle the current health crisis.

· The first call is for health to be considered as a human right;

· the second, third and fourth are calls to tackle the economic, social, political and environmental challenges of this day and age;

· the fifth calls for tackling the problems of war, violence and conflict.

· demands a return to comprehensive Primary Health Care strategies;

· will pressure governments to enforce national health, nutrition and essential drug policies;

· opposes privatisation of public health services:

· encourages people’s power and control in decision making in health;

· demands that people’s organisations be represented in local, national and international fora;

· promotes traditional healing systems;

· demands changes in the training of health personnel;

· demands that health and nutrition research respects universal ethical principles;

· opposes coercion in population and family planning policies; and

· supports local initiatives fostering participatory democracy and the consolidation of a people-centred international solidarity network.

Contact: PHA Secretariat at gksavar@citechco.net www.pha2000.org

SCF-UK

Save the Children - UK

Nutrition goals and targets - SCF-UK’s perspective

Save the Children UK has a four-year global Programme Strategic Plan which set objectives and indicators for each of our core areas of work, including nutrition. These objectives provide clarity and focus to our work, and enable us to evaluate the impact of our programmes. Advocacy work as well as programming is based on these objectives. For the area of nutrition, these are:

· to prevent and mitigate the worst effects of malnutrition in emergencies through improved policy and practice

· to protect children’s rights in relation to infant feeding as a means of avoiding preventable malnutrition, and infant morbidity and mortality.

· to influence nutrition policy and practice to ensure child-appropriate and sustainable solutions to malnutrition.

We use a household economy approach to emphasise the economic context in which child malnutrition exists and to identify its real root causes, as well as the impact of natural and manmade shocks as they are linked to actual macroeconomic conditions. This encourages discussions about social, economic and investment issues and their realistic potential to combat poverty/destitution. This is in contrast to spending great sums on acute emergencies - as an acute response - when they develop.

SCF also looks at alternative community-level interventions more broadly, particularly linking them to overall livelihood interventions with greater and more lasting potential impact on reducing malnutrition long-term. Pilot programmes are being designed, the outcomes of which should provide useful information on alternative approaches to nutrition programming.

Contact: a.taylor@scfuk.org.uk

Just as the construction of a building or bridge is only possible with detailed planning and periodic course corrections during the process of working toward the goal, the human right to adequate food and nutrition can only be fully realized through carefully designed and implemented programmes of action. The formulation of strategies only begins with the formulation of clear goals and targets. George Kent (see p 13)

UNAIDS

The AIDS epidemic is posing a broad challenge to all sectors of society, turning back hard-won development progress. The epidemic undermines food and nutritional security, devastates family incomes, kills agricultural workers and thus decreases food production.

The International Partnership for AIDS in Africa (IPAA) is a coalition that works to curtail the spread of HIV, to reduce its impact and to halt the further reversal of human, social and economic development. UNAIDS serves as the secretariat for the IPAA.

The IPAA addresses the epidemic by advocating joint planning and implementation of AIDS activities. Organizations concerned with nutrition are encouraged to join the Partnership by becoming involved in planning and policy-making. Such mechanisms take on different forms in different countries. In many countries UNAIDS has placed a Country Programme Adviser, who is the best contact for getting involved.

IPAA advocates for the creation of high-level political coalitions for attacking AIDS; for increased Government leadership; for increased political and financial commitments from all actors; for equitable access to care; and for the need for a growing involvement of all sectors of society. IPAA’s strategy is presented in Framework for Action available from UNAIDS

Contact: huntc@unaids.org

www.unaids.org/africapartnership

USAID

Progress on Vitamin A work

USAID has continued in its efforts to convert research findings regarding the impact of vitamin A on child survival into ongoing programs. It has expanded its investment in both vitamin A supplementation and in improving dietary practices including the consumption of fortified foods. It has also emphasised establishing performance indicators to measure how many children are reached by children vitamin A programs.

USAID has encouraged the institutionalization of periodic (six months apart) distribution of vitamin A supplements to children under five years of age. It insists that promotional activities be put in place prior to each distribution round to encourage mothers to bring their children. USAID has also lobbied for such periodic outreach programs being incorporated into the mandate of national health service delivery systems. Where possible, vitamin A distribution is coupled with other child survival services such as de-worming. Experience to date suggests that countries can achieve close to 80% coverage with vitamin A supplements rapidly and efficiently using this approach.

In the past year, USAID, along with a number of other donors, has continued to support programmes in Nepal, Indonesia, the Philippines, Bangladesh and Nicaragua. New national programmes have been launched in Zambia and Ghana and preparations for similar programs are underway in Uganda, Mali, Niger and Mozambique. Regional programs are starting in India and South Africa. Typically, these programmes include a monitoring component of coverage estimates; in some cases, surveys follow the distribution.

Fortification is viewed as a parallel intervention that has the potential of allowing later more targeted supplementation and, in many cases, the phase-out of universal supplementation. In developing countries, where poverty levels make cost-recovery of the fortification process difficult, the path to fortification will be longer and more challenging.

In the past year, USAID has continued to support the Government of Zambia in its effort to improve its program to fortify sugar with vitamin A and has been a major contributor to the launch of sugar fortification in Nicaragua. In the Philippines, USAID is supporting the Food Fortification Task Force to accelerate efforts to develop a multi-pronged programme to fortify both staple and processed foods.

Contact: rmiller@ilsiinc.com

WABA

World Alliance for Breastfeeding Action

Vitality in diversity

The World Alliance for Breastfeeding Action was civil societies’ response to the need for a coordinated effort to support the Innocenti Declaration targets. Born on 14 February 1991, in the basement of UNICEF, a meeting brought together a rainbow of groups and individuals working on the breastfeeding issue from lactation consultants to nutrition experts. Everybody who was anybody in the breastfeeding movement, was there. One of the icons of the movement, the late Dr Derrick Jelliffe, even wrote a calypso song, the WABA Crawl, which has been set to pulsating happy music by a great South African band, giving it a beat and a rhythm that reverberates with joy and solidarity.

WABA developed, giving groups and individuals of every spectrum of the movement an entry point to participate. It dared and its members to make a difference and to let WABA become a world wide force.

Everyone, Everywhere

WABA’s World Breastfeeding Week became its single most effective popularising campaign involving over 120 countries. During that week, thousands of groups and individuals across the globe get involved in social mobilisation activities including the press, street plays, demonstration and workshops. The core materials appear in some 16 languages in flyers, balloons, stickers, bookmarks and radio programmes. Each year, the theme changes, but it is always linked to the Innocenti Declaration goals. Themes have included Mother Friendly Workplace Initiative, Making the Code Work, Breastfeeding: Nature’s Way, Breastfeeding: the Best Investment and Breastfeeding: Empowering Women. This year, the theme is Breastfeeding in the Information Age. The week has become the single most powerful unifying activity of the breastfeeding movement. Communities, governments, and even businesses have taken it on and it is beginning to take a life of its own in many places - a mark of a healthy social movement.

The Baby Friendly Hospital Initiative became a major UNICEF programme with WABA playing a popularising role. With its partners, WABA started a Women and Work Initiative. It fights for Mother Friendly Workplaces and has developed into a major campaign on strengthen maternity protection. The initiative resulted in stronger wording in the ILO Convention 183 on Maternity Protection in June 2000. New links with trade unions have also been formed. WABA was present at the Conference on Women in Beijing (1995), the International Conference on Population and Development (1994) and the World Food Summit (1996). In the latter, WABA was chosen as the NGO community representative.

A New Environment

More recently, WABA has been establishing partnerships with the environmental movement to develop joint strategies for campaigns against toxins in breastmilk (see SCN News No. 21, p.23). WABA has also been active on the issue of HIV transmission via breastmilk. A new vigilance and better coordinated efforts are called for on these two issues; challenges are greater than ever before.

WABA’s strength lies in the creativity of its actors, in its ability to think vertically and horizontally, in its capacity to act at many levels, in its avoidance of duplicating efforts, and in its courage to go beyond traditionally defined issues and actions to establish new linkages. WABA is a successful new social movement.

Critical Issues

For the future, WABA has developed a 10-point forward looking action document as a global, universal linking tool. The framework Ten links for nurturing the Future covers the following “critical” issues:

· Human rights and responsibilities
· Food security
· Women’s empowerment
· Community participation
· Baby-friendly cultures
· Integrity
· International Code
· Capacity building
· Advocacy
· Networking

Contact: Anwar Fazal secr@waba.po.my

www.waba.org.br

WFP

World Food Programme

School Feeding and Public Health Training Workshop

WFP and WHO conducted a School Feeding and Public Health workshop in East Africa with Canadian support. The workshop highlighted how combining food aid, education and health interventions reinforce each other. The workshop took place in Entebbe, Uganda in April 2001 and brought together representatives from WFP and ministries of health and education of Uganda, Kenya, The Gambia, Tanzania, Malawi, Eritrea, and Zambia. All these countries have a WFP-assisted school feeding programme, and have evidence of a high prevalence of schistosomiasis and soil transmitted helminthic infections; national governments had shown interest to implement a pilot deworming intervention. The World Bank funded the participation of government officials from Zambia and Eritrea which will get WFP - supported school health national programmes. The training included practical field experience in a school setting. Participating countries are now in the process of preparing project proposals for pilot deworming interventions in their respective countries.

Contact: rita.bhatia@wfp.org

WHO

World Health Organization

Infant and young child nutrition

This year’s World Health Assembly adopted a comprehensive resolution on infant and young child nutrition. The Resolution calls for exclusive breastfeeding for six months and for safe and appropriate complementary foods, with continued breastfeeding, for up to two years of age or beyond. (See a related article in the STOP PRESS section of this issue). The resolution also addresses the risk of HIV transmission through breastfeeding.

More than a year into a two-year preparatory process to arrive at a new Global Strategy on Infant and Young Child Feeding, WHO has organized country consultations in Brazil, China, Philippines, Scotland, Sri Lanka, Thailand and Zimbabwe. The first regional consultation took place in Bangkok in March 2001. Additional regional consultations were held for the Region of the Americas and the European Region in May and the African Region in June. The Eastern Mediterranean Region will have one in September, and the Western Pacific Region in October. By October 2001 over 100 WHO Member States will have taken part in this aspect of the preparatory process. The final revised text of the draft strategy will be submitted for endorsement to WHO’s Executive Board in January 2002 and to the upcoming World Health Assembly in 2002.

Micronutrient Databanks

In SCN News 21, we reported that we were finalising work to bring the IDD database up-to-date. This data is now being checked and cleared by the respective governments and ministries of health so that it can be loaded onto our web site.

One of the delaying factors in overhauling the databases has been requesting and locating final survey reports. WHO’s NHD would therefore like to take the opportunity of using this SCN issue to request readers to contact its offices if they have survey reports on Iodine Deficiency Disorders, Vitamin A Deficiency Disorders and Anaemia. Ideally, we are looking for final reports for national-level surveys, but we are also interested in sub-national, regional, district and even local level surveys if no others exist. Please help. Contact: Henrietta Allen at allenh@who.int or Ines Egli at eglii@who.int

Contact: clugstong@who.int

www.who.int

WORLD BANK

The World Bank nutrition activities for 2001/2002 focus on integrating nutrition into poverty reduction strategies, and increasing the quality and quantity of the Bank’s investment in nutrition; additionally, iron, low birthweight and institutional capacity development are getting special emphasis.

A focus on iron has now become a significant component of the Bank’s overall nutrition operations, and on the issue of low birthweight, the Bank is focusing its attention on the non-pregnant adolescent and on maternal nutritional antecedents of poor pregnancy outcomes.

Staff have been involved in finalising the joint WB/UNICEF Nutrition Assessment which reviews the Bank’s and UNICEF’s nutrition portfolios over the past 15 years from 1984-1999. The final report will be published in August 2001. The Assessment is providing the basis for the Nutrition Strategy Note that will guide the Bank’s nutrition operations over the next few years.

Bank staff were instrumental in including nutrition contents in the Poverty Reduction Strategy Papers (PRSP) Sourcebook (available at www.worldbank.org/poverty). A Seminar on Food Security and Nutrition in PRSPs was held in May. Another workshop on “Health, Nutrition and Population in PRSPs in the Context of Debt Relief” was held in West Africa, in collaboration with UNICEF and WHO, also in May 2001.

The Bank has produced a Nutrition Toolkit. The Toolkit offers a set of 12 tools to design, appraise, implement, monitor and evaluate nutrition interventions. Nine tools are available so far, and can be accessed at www.worldbank.org/nutritiontoolkit, or can be ordered by e-mail from address below. Some of the tools are: Tool # 1 Nutrition in Project Design that covers the integration of nutrition into the project development process; Tool # 2 Basic Facts: Nuts and Bolts of Nutrition which is directed at managers involved in the preparation of nutrition situation analyses; Tool # 4 Growth Promotion; Tool # 5 Food Supplementation and Tool # 9 School Nutrition.

Nutrition At-A-Glance is a four-page document that summarizes priority nutrition issues and interventions most appropriate for addressing them. It is a useful tool for non-nutritionists dealing with nutrition operations.

An issues paper on Institutional Development/Capacity Building for Nutrition, was recently prepared. It includes recommendations for a focused work program on management and capacity development. The paper will be released in July 2001.

Two case studies on management issues, one on Thailand and the other on the Tamil Nadu Integrated Nutrition Project are also currently being finalised.

An analysis of the three major IDD projects, in China, Madagascar and Indonesia was recently completed; it was found that collaboration between the private sector and the public sector is proving to be effective.

An analysis of the Nutrition situation of Europe and Central Asia was also recently completed.

Other activities

Infant feeding recommendations are being developed in Laos. In Cambodia, anaemia control is getting support. Review of the nutrition work in Indonesia, Bolivia, Pakistan, Sri Lanka and Nigeria is currently under way. The Bank is also providing support for a nutrition relevant conference in Eastern Europe and a conference on salt-iodisation in Central Asia. Nutrition communication components are being incorporated in a project in El Salvador and to food security operations in Ethiopia. The Bank has supported the IUNS/UNU-led initiative on nutrition capacity building in Africa. A regional nutrition action plan is being supported in the Middle East and in North Africa.

World Bank investments in nutrition (as projects or components of projects) have totalled around $700m in the 1996-2001 period. For 2000, total spending for nutrition was $128m, and 2001 total new spending on nutrition is estimated to be $42m.

A total of 48 projects from 1989-2000 had both a nutrition and an HIV/AIDS component, 33 of which were in Africa.

Contact: nutrition@worldbank.org

WORLD VISION CANADA

World Vision Canada’s Micronutrient and Health Program (MICAH) is a CIDA funded initiative that uses a collaborative integrated approach to improve the nutrition and health status of women and children through cost-effective and sustainable interventions. To implement this program, World Vision Canada works with other NGOs, national governments and its own offices in Ghana, Senegal, Tanzania, Ethiopia and Malawi.

The purposes of MICAH are to:

· reduce the prevalence of micronutrient deficiencies through increased intake and bioavailability of iron, iodine and vitamin A

· reduce the prevalence of diseases that affect micronutrient status (diarrhoea, parasitic and vaccine preventable diseases)

· enhance local capacity to deliver micronutrients and health programmes.

In MICAH, using nutrition goals and targets has presented both challenges and benefits. Because of the numerous partners involved, goals provide a framework to guide programme implementation. Targets have been useful in monitoring programme efficacy. For example, the effectiveness of vitamin A interventions was measured through targets such as reducing the prevalence of night blindness to 0.5%. This target was surpassed in Ethiopia where current levels of night blindness of 0.3% show an improvement over baseline levels of 0.5% in 1997. Community involvement and use of local resources are part of program design. This will help to ensure sustainability of outcome.

Highlights of other MICAH results:

Indicator	Baseline (1997)	Final (2000)	Country
Stunting in children <5 years	56%	40%	Malawi
Malaria in pregnant women	17%	2%	Tanzania
Wasting in children <5 years	24%	10%	Senegal
Anaemia in non-pregnant women	43%	29%	Ghana

While using goals and targets has been beneficial in our case, the use of these indicators can have limitations. Realistic programme goals can be difficult to establish due to demographic, health status and cultural differences between countries and local communities. Additionally, it is difficult to agree on the appropriate target levels: if levels are set too high or too low, this can hinder the work of program facilitators. However, if these limitations are considered during programme design, goals and targets can then play an important role in implementation.

Contact: colleentaylor@worldvision.ca

Survey on NGOs NGOs have earned a far greater level of trust than Group of Eight governments, media and transnational corporations. These are the findings of a survey carried out last year among 500 well-educated, media-attentive people from Australia, France, the UK and the US. NGOs are trusted nearly 2:1 to “do what is right” compared to governments, the media and corporations. Two thirds of respondents said that corporations only care about profits while over half said that NGOs represent values they believe in. NGOs ranked significantly higher as a source of credible information than media outlets. Two thirds thought NGO influence had increased significantly over the past decade. www.edelman.com

Tough year for the hungry WFP’s World Hunger Map illustrates the extent of hunger currently affecting an estimated 830 million people around the world. Most of the hungry go without food primarily because they are poor. Otherwise, war and drought are the main culprits. Sudan, Ethiopia, Eritrea, Indonesia, Afghanistan, Sierra Leone, Guinea and Tajikistan are most seriously affected. Both more money and political resolve must be committed before these crises grow worse. This is a global problem in need of global responses. Contact: Jeffrey.rowland@wfp.org www.wfp.org WFP’s colour map can be ordered free of charge for schools or organizations on line at: www.wfp.org/maprequest.htm Some 28 million people in Sub-Saharan Africa are facing severe food shortages according to Food supply situation and crop prospects in Sub-Saharan Africa published by FAO. The situation is most critical in Eastern Africa where 20 million of the affected live. Kenya is added to the WFP list above. Giews1@fao.org www.fao.org/WAICENT/faoinfo/economic/giews/english/giewse.htm

Editor’s note: Elsewhere in this issue of SCN News contributors have stressed that expanded efforts are urgently needed to reduce iron deficiency, and the resulting impairment in physical productivity and cognitive capacity. The Asian Development Bank has a growing interest in this area, and in particular working towards new alliances.

ASIAN DEVELOPMENT BANK STRATEGIES TO ELIMINATE IRON DEFICIENCY ANAEMIA (IDA) Asia’s ability to reduce the alarmingly high rates of maternal mortality and cognitive impairment in children depend substantially on major efforts to reduce anaemia (IDA). IDA afflicts 60% of all pregnant women (88% in South Asia), half the women of reproductive age, and 40% of preschoolers in Asia ADB is supporting three regional initiatives that focus on the public and private sectors cooperating to solve the problem of IDA. Two regional studies on food fortification and rice plantbreeding are ongoing, with the expectation that by 2003 ADB will lead major initiatives in the region to raise the iron density of essential staples consumed by the poor at affordable prices. A third sub-regional initiative in the Trans-Caucasus Central Asia (TCCA) will help seven countries fortify flour and salt through integrated attention to production, regulation and trade. The regional food fortification project (cosponsored by International Life Sciences Institute and Danida) focuses on the iron fortification of wheat flour and condiments such as soy sauce and fish sauce, all widely consumed by the poor in the region. Six countries (China, India, Indonesia, Pakistan, Thailand, and Viet Nam) are participating in the project. Iron fortification emerged as a regional priority at a regional strategy meeting hosted by the ADB in February 20001. Prominent government food regulators and captains of Asian food industries pledged to cooperate in reducing micronutrient malnutrition in the region. IDA was identified as the top priority for concerted action. The project will develop a regional investment plan based on country studies, regional workshops on food technology, regulation and trade. The second regional strategy is rice plantbreeding through a donor consortium led by ADB in association with the International Rice Research Institute and the International Food Policy Research Institute and four DMCs (Bangladesh, Indonesia, Philippines, and Viet Nam). A three-year research study ending in 2003 will test promising rice varieties with high iron and zinc density to ensure that their yield is adequate, that the iron and zinc are bioavailable to consumers, that consumers are willing to eat the varieties, that the production and dissemination of the new varieties is feasible for national agricultural research systems and seed companies, and that the rice will be affordable to the poor. The third regional activity, supported by the Japan Fund for Poverty Reduction, responds to the breakdown in production of fortified flour and salt in the TCCA sub-region. The project aims to set up production systems and build capacity for improved regulation, quality control and trade of fortified flour and salt, so that poor women and their children will get adequate iron and iodine through daily consumption of these staples. 1 Manila Forum 2000: Strategies to Fortify Essential Foods in Asia and the Pacific - Proceedings of a Forum on Food Fortification Policy. Manila: Asian Development Bank. Contact: jhunt@adb.org