Programme News

INTERAGENCY

GAIN
Global Alliance for Improved Nutrition

During the last year, the global micronutrient community has created new mechanisms to strengthen collaboration on two major micronutrient initiatives: food fortification and vitamin A supplementation. Recognition of the need for collaboration among bilateral and multilateral donor agencies has never been higher as the technical and financial resources available through any single agency are, generally, insufficient to mount a successful micronutrient program.

Launched formally at the UN General Assembly Special Session on May 9, the Global Alliance for Improved Nutrition is preparing to solicit applications from interested countries to accelerate efforts to combat micronutrient deficiency through food fortification. Emphasis within GAIN will be on the fortification of staple foods consumed in sufficiently large quantities by a large proportion of the population to have a measurable impact on the micronutrient status of the population. GAIN partners will include bilateral donors, foundations, UN and other multilateral agencies, developing country governments and experts, PVOs/NGOs, industry and industry associations, and scientific institutions. In half a dozen countries, USAID has devoted resources from its micronutrient programs to assist countries considering applying to GAIN to create and/or strengthen the public/private partnership so critical for a successful fortification effort. Funds available for the first year of GAIN activities will be between US$20-25m with more than US$70m committed over five years. Further information is available on the GAIN web site, www.gainhealth.org.

This is a time when there needs to be greater advocacy to periodically deliver high-dose supplements en masse to children. Major donors support vitamin A supplementation as the most rapid and effective way to prevent vitamin A deficiency in pre-school children. Therefore, they have established a mechanism for coordinating and accelerating the effort to encourage national governments to adopt some form of active, periodic distribution of vitamin A for the post-National Immunization Days (NIDs) era. UNICEF has also established a database to assist monitoring events in countries related to vitamin A supplementation and periodic communications among partners is already serving to provide warning of potential problems arising as countries phase out their NIDs activities. The donor alliance, consisting of UNICEF, WHO, USAID, The Micronutrient Initiative, and CIDA, support the integration of a routine, but periodic, vitamin A distribution in order to maintain the high coverage established through NIDS. USAID, working closely with UNICEF, has had success in introducing periodic vitamin A supplementation in Zambia, Ghana and, more recently, Uganda.

Contact: Frances Davidson fdavidson@usaid.gov or
Monique Mosold mmosolf@usaid.gov

IFPRI
International Food Policy Research Institute

RENEWAL: Ensuring food and nutrition security in the time of AIDS

AIDS is a development problem, not a health issue has become a mantra in recent times, but what does it mean in practice? Mainstreaming requires an understanding of the interactions of the HIV infection s impacts on different sectoral concerns. More often than not, food is the number one priority for people affected by the pandemic.

IFPRI has collaborated with the International Service for National Agricultural Research (ISNAR) in a regional action research initiative aimed at filling key knowledge gaps regarding HIV/AIDS and food and nutrition security. The Regional Network on AIDS, Rural Livelihoods and Food Security (or RENEWAL for short) lays emphasis on local ownership, capacity development and the creation and strengthening of research-policy networks. It aims in particular to foster proactive linkages between national agricultural and public health organizations two sectors which normally do not talk to each other - and between academia and policy-makers.

RENEWAL is a process, not a project. Currently underway in Uganda and Malawi it will hopefully expand regionally, with Tanzania and Zambia having already expressed demand for this approach. Essentially the process involves a preparatory phase in which background papers on HIV/AIDS and food and nutrition security are prepared for each country. These papers then feed into a national multi-sectoral stakeholder workshop that generates priorities for action and research, as well as agreement on forms of governance of the initiative. Action research studies, focused on at least one of the priority areas and involving local partners are selected and funded out of an Action Research Fund (ARF). The findings of these studies along with the results of immediate policy modifications will be discussed in policy workshops to be held in 2003.

As part of RENEWAL, IFPRI is working with local partners in Uganda and Malawi to further understanding of the ways in which key food and nutrition-relevant policies and programs may be modified so as to minimize the spread and depth of the HIV/AIDS epidemics. In doing this, the focus will be on understanding the types of responses that affected households and communities have made to HIV/AIDS in selected livelihood systems; the way in which existing household and community-level capacities have been mobilized in these responses and where and how capacity gaps constrain alternative strategic responses. Finally, the pathways through which key nutrition-relevant actions may a) reduce the risk of HIV infection, and b) increase household and community resilience to HIV/AIDS impacts will be elucedated. RENEWAL has benefited from generous funding provided by Norway, CIDA, IDRC, USAID and WFP, but more is required as the initiative grows.

Various capacity strengthening training materials on HIV/AIDS, food and nutrition security are now available on the IFPRI website (www.ifpri.org) with a RENEWAL website planned for the near future.

Contact: Stuart Gillespie s.gillespie@cgiar.org

Efficacy Trials for Multiple Micronutrient Supplementation During Pregnancy

Report of a meeting held on March 4-8, 2002 at the Centre for International Child Health, Institute of Child Health, University College London, London, UK

The main aim of this meeting was to increase the collaboration across research groups developing trials to test the efficacy of a multiple micronutrient supplement for use among pregnant women in developing countries. Whilst WHO recommends universal distribution of iron/folate supplements to all mothers in developing countries, it is recognized that most women suffer from multiple micronutrient deficiencies, not just iron deficiency. The composition of the multiple micronutrient supplement agreed upon for use in trials at a meeting in 1999 organized by UNICEF, WHO and UNU, is now being used by research groups in trials funded by a variety of funding agencies. An interest was expressed to increase collaboration among the ongoing efficacy trials, and to that end a meeting was held at the Centre for International Child Health, Institute of Child Health, London, from March 4-8, 2002, funded by the Micronutrient Initiative.

The objectives of the meeting were related to increasing the efficiency of the research effort and speeding the translation of scientific results into policy. The first objective was to explore how to maximize the research outcomes that would be obtained from the various multiple micronutrient supplementation trials. The second objective was to seek ways of ensuring, as far as possible, improved comparability across the various trials, and if appropriate to maximize possibilities of pooling data across sites in the future. The third objective was to discuss mechanisms by which research findings would be fast-tracked to policy-makers and programmes as soon as results became available. The meeting was organized in two parts. The first four days mainly involved the principal investigators of five efficacy trials and the main UN agencies. On the final day, the meeting discussed the results of the consultation with a wider audience of policy and programme oriented participants.

The efficacy trials under consideration included:

· a study in Nepal looking at birthweight conducted by CICH with funds from the Wellcome Trust

· a study in Guinea-Bissau looking at birthweight conducted by the Copenhagen Agricultural University with funds from DANIDA

· a study in Bangladesh looking at birthweight conducted by ICDDR,B with funds from UNICEF

· a study in Pakistan looking at birthweight conducted by the Aga Khan University with funds from UNICEF, and

· a study in Indonesia looking at maternal mortality and birthweight conducted by Helen Keller International with funds from UNICEF and USAID

· In addition, the group discussed three other protocols:

· a study in Bangladesh looking at vitamin A supplementation during pregnancy and maternal mortality conducted by the Johns Hopkins University group with funds from USAID and The Gates Foundation

· a study in Tanzania looking at a different multiple micro-nutrient supplement during pregnancy and birthweight in non-HIV infected mothers conducted by the Harvard School of Public Health group with funds from NIH and UNICEF; and

· a completed study from Nepal looking at a different multiple micronutrient supplement during pregnancy and birthweight and early child morality conducted by the Johns Hopkins University group with funds from UNICEF and USAID.

A set of minimum requirements for study design, outcomes to be measured, and confounders or effect-modifiers was agreed. This will enhance the possibility of pooled analysis. It was also agreed that whilst the use of birthweight as an outcome is important, it does not fully capture the potential benefits of improved maternal nutritional status on birth outcomes. All trials should seek to capture information on perinatal mortality. Other maternal mortality trials should also be considered. Collaboration across sites in the sharing of experience in developing standardized tools, such as verbal autopsy (abortion/miscarriage, stillbirth/neonatal death), and night blindness was initiated. The desirability of developing local data safety and monitoring boards to manage the ongoing ethical aspects of such trials was agreed by all. Indonesia is most advanced in this and others would like to learn from this experience. Facilitating the process of policy change and enabling activities that could support the distribution of multiple micronutrient supplements within safer motherhood initiatives were also discussed, including the need for effectiveness trials to be run in parallel with the efficacy trials.

The group felt that the meeting had been very constructive and useful, and that continued efforts were needed to promote further collaboration across trial sites. Increased liaison was desirable for information sharing, keeping everybody updated, and even troubleshooting if necessary. A mailing list was suggested that should be expanded to include all those working on multiple micronutrient supplements, both efficacy and effectiveness studies, especially from developing countries. A further meeting was considered, which could be held in South Asia within a year, involving an expanded set of constituents and bringing extra expertise on board.

These findings and recommendations were presented to an expanded group of participants on the final day, which included representatives of CIDA, The Wellcome Trust Foundation, The World Bank, The Division of Reproductive Health of WHO, USAID, Helen Keller International and the Micronutrient Initiative. After discussion with this expanded group, it was largely agreed that the various organizations present could and should help support and carry forward the recommendations of the meeting.

Contact: Roger Shrimpton rshrimpton@btinternet.com

World Bank

Collaboration and partnerships have become central to how the World Bank (WB) does business. At country level, commitments to Poverty Reduction Strategy Papers (PRSP) and Sector Wide Approaches (SWAps) embody the principles of the Comprehensive Development Framework, which aims to put countries in the driving seat, and align international agency support behind country efforts to achieve poverty reduction and human development goals.

Country-level project collaboration

Regional teams are currently finalizing action plans to specify focus countries for WB Health, Nutrition and Population (HNP) activity in the next two-three years. The Africa Region in particular, plans to substantially expand its work on nutrition. These lists will be shared with interested agencies when they become available. Even where specific nutrition projects are not identified, UN agencies and other partners can advocate for, and provide technical input, to ensure nutrition content in poverty reduction strategy credits, sector wide approaches, and health sector development projects.

Nutrition and Gender

A new global partnership on nutrition and gender is taking shape. The aim is to build the evidence base for effective interventions to long-ignored issues of poor nutrition among women and to build research and program implementation capacity for community based action. Final approval for seed funding from the World Bank Development Grant Facility is expected in June 2002. Consultations with UN agencies, bilateral partners and foundations to join the proposed partnership, which will initially be coordinated by the International Centre for Research on Women (ICRW), are ongoing.

PRSP capacity building

Following the successful collaborative effort to include a nutrition module in the regional PRSP training course for country Health and Finance Ministry staff, which involved WB, UNICEF, AED, Commonwealth Regional Health Community Secretariat, and nutrition focal points from Ghana and the Gambia, there is interest in broadening and deepening training and technical support on nutrition and PRSP. Activities would include preparing a good practice guide on nutrition and PRSP based on a review of completed PRSPs; supporting training and orientation of nutrition leaders in selected countries for participation in PRSP preparation processes, and making funding available on a competitive grant basis to support preparatory analytical work for inclusion in country PRSP processes.

Strengthening country capacity to report on Millennium Development Goals (MDG) and PRSP nutrition goals

The WB endorses the use of a nutritional status indicator (weight for age) to monitor achievement of the MDG goal of poverty reduction. The Bank also supports countries that wish to track child malnutrition levels as part of its PRSP monitoring. In addition to the outcome indicators, the use of intermediate indicators, such as vitamin A supplementation coverage and exclusive breastfeeding rates, is also recommended. A rapid review of data available for the 30 International Development Association (IDA) countries for WB support indicates that recent trend data exist for about 50% of these countries. For the intermediate indicators, 50-60% of the IDA countries have recent estimates. The aim is to increase the proportion of IDA countries tracking nutrition indicators from 50% to 80% by 2005. We propose to work closely with partner agencies to prepare and implement an action plan for the rapid expansion of nutrition data collection and utilization. An initial meeting is scheduled for June 18 and 19, 2002.

Contact: Milla McLachlan mmclachlan@worldbank.org

ANTENNA

Spirulina

The nutritional benefits of Spirulina have been known for thousands of years. Grated or crushed, Spirulina can be added to daily meals to increase their nutritional value. In the Sahara region, Spirulina, sold as dihé and traded along the caravan routes, is highly sought-after as an indispensable supplement to the local diet. Rich in protein, essential amino-acids and anti-oxidants, Spirulina is an ideal dietary supplement.

This aquatic micro-organism is totally edible and can be grown in warm and even desert regions. Under a microscope, Spirulina looks like spiral filaments. The micronutrients in Spirulina are easily absorbed because there are no cellulose cell walls. It is also rich in beta-carotene, iron, vitamin B12, and gammalinoleic acid. A few grams of Spirulina taken daily could enhance conventional nutrition programmes.

Antenna Technologie has developed a Spirulina production system based on field trials, consisting of 4m² growing basins. Shallow (20cm) ponds are built using simple materials (plastic sheeting, planks, earth). Antenna Technologie provides beginners with a fast-growing strain of Spirulina. The high alkalinity of the liquid growing-medium prevents the survival of harmful micro-organisms. Toxicity tests conducted on Spirulina show it is safe. A 4m² basin produces around 40 grams of dry Spirulina per day. Producing Spirulina needs 10 times less water than growing soybean.

Once strained, Spirulina is dried and can be added in powder form to traditional foods. Although mass production and sale of Spirulina dates back more than 20 years, Spirulina is not widely available in the developed world.

Spirulina is produced at the Madurai Ecopark, Tamil Nadu, southwest India. The Ecopark is a two-hectare plot where Spirulina, family gardens and medicinal plants are cultivated and where fish are grown in ponds. About 30 people work at the site and several villages also produce Spirulina with the help of Ecopark.

A total 50kg of Spirulina is produced a month in a dozen 20m² ponds. Spirulina has been tested by the Madurai Medical College in clinical trials, and the college's paediatricians are closely involved in the Ecopark site.

For the past two years, Ecopark has been organizing courses in nutrition and health for women. Women are taught how to grow nourishing plants, the importance of a balanced diet and how to add Spirulina to meals or to weaning foods. These courses enable women to share their experiences and to get professional advice on improving the nutritional value of their family's daily ration with the means available.

Antenna Technologie, a non-profit association, was established in 1989 in Geneva, specifically for the development of appropriate technologies. Antenna Technologie is active in the sustainable improvement of the nutritional value of available food supplies by focussing on locally produced dietary supplements.

Contact: Isabelle Genoud antenna.geneve@worldcom.ch

FANTA

Food and Nutrition Technical Assistance

Editor's note: Because the theme of this issue of SCN News is nutrition in emergencies, it was felt that the USAID evaluation of Title II food aid (a total resource transfer of US$950m per year) deserves ample space and consideration. SCN News asks, do the results of this evaluation demonstrate a significant step forward in the use and impact of food aid? Does the evaluation address some of the issues raised at the SCN Symposium in Berlin?

Over 800m people in developing countries do not have, at all times, physical and economic access to sufficient, safe, and nutritious foods to meet their daily dietary needs and food preferences for an active and healthy life. A major response by the US Government to the problem of food insecurity is the nearly one billion dollars spent annually on food aid. The Title II development (non-emergency) food aid programme constitutes the single largest source of USAID funding focused on sustainable food security.

Title II development food aid directly supplements the diet of young children and pregnant and lactating mothers, and mobilizes poor people's labor to feed families and build local commercial and agricultural infrastructure necessary for sustainable rural development. Proceeds from the monetization of Title II development food aid are used to support the provision of basic health services, nutrition education, agricultural extension and training, and local capacity building, which help insure that the programme s longer-term objective of sustainable increases in food security is met. When Title II development food aid is integrated with other USAID resources, it enhances the effectiveness of child survival, agriculture, income generation, basic education and community development activities targeting the rural poor.

In 1995, USAID issued a Food Aid and Food Security Policy Paper (FAFSA) that defined the general purposes and use of food aid resources in developing countries. Over the past year, the Bureau for Democracy, Crisis and Humanitarian Response/Food For Peace (DCHA/FFP) and DCHA/Programme, Policy and Management (PPM), through the Global Health/Health, Infectious Diseases and Nutrition (GH/HIDN) FANTA project, carried out an assessment of the Title II food aid development programmes and their progress in meeting the food security goals laid out in the policy paper.

The assessment found that the DCHA/FFP and its Cooperating Sponsor (CS) and Mission partners have responded to the goals set forth in the policy paper including: greater focus on the most food insecure regions and countries, especially in Sub-Saharan Africa; increased emphasis on improving agricultural productivity and household nutrition, including a dramatic improvement in the design of Title II agricultural and nutrition programmes with the integration of complementary activities such as technical assistance and training, largely funded by monetization; better results and results reporting; and better collaboration among partners. The assessment also highlighted the constant tension arising from the pressure to use commodity resources as food and the need for cash resources for sustainable impacts.

The assessment report contains 21 key recommendations for programme and policy improvements in two priority technical sectors-agriculture and maternal and child health-and for improving the management of food aid re- sources. The recommendations are as follows:

Implementation of the Policy Paper Programmatic and Management Priorities

1. FFP should adopt the following as the primary determinants of whether food aid is used in the form of food, local currency or a combination of both: the nature of the food security problem, the design of the appropriate solution, local market conditions, availability of complementary resources and CSs management and technical capacity.

2. CSs should make greater efforts to find appropriate ways to use food to address food insecurity issues.

3. Congress should expand funds available through the current PL 480, Title II, section 202(e) mechanism, create a complementary source of cash funds for Title II programming and/or fund internal transport, shipping and handling costs directly, so that a larger share of the proceeds from monetization would be available for programming. Congress should reevaluate the effectiveness of the value-added mandate.

4. FFP should intensify its consultation with its food aid partners in formulating policy, particularly when the policy addresses a controversial issue.

5. FFP should put priority on developing a relief-to-development strategy for Title II resources that recognizes the oscillatory and coincident nature of most relief and development transitions.

6. FFP should prepare guidance on improving food security for HIV/AIDS-affected households and for households in urban and peri-urban environments.

7. CSs should intensify efforts to integrate their Title II activities with other complementary development efforts or partners. Missions should improve integration of the Title II programme with a broader spectrum of strategic objectives.

8. CSs should focus on institutionalizing their strengthened capacity and improving quality control in the field.

9. CSs and FFP should standardize the methodology for results reporting and widen the dissemination and use of best practices across the Title II programme.

10. FFP should allow greater flexibility in Development Assistance Programme (DAP) length in conjunction with stricter exit criteria. CSs should assist communities to find alternatives to CS services early in the programme cycle.

11. FFP should establish clear, concise DAP guidelines and not rewrite them each year. CSs should be held accountable to the guidance that was in place at the time DAPs were approved.

12. FFP should establish a clear line of authority and clarify for its Title II partners the roles of different management units within USAID (FFP, Regional Bureaus and Missions).

Agricultural Productivity Sector

13. CSs and FFP should make sure that DAP proposals demonstrate knowledge of local farming systems and market opportunities, emphasize interventions that ad dress the priority concerns and constraints of farm families and describe the information systems to be used to refine interventions during DAP implementation.

14. CSs need to make sure that they adequately deal with three potential problem areas: 1) finding the right balance between food and cash crops, 2) dealing with household cash flow and liquidity constraints, and 3) closing the seasonal food gap through an increased focus on improved storage, small-scale post-harvest transformation, crop diversification and market opportunities.

15. When a DAP includes a marketing component, it is absolutely necessary that the CS conduct a market study as part of the DAP proposal preparation and that it demonstrate adequate evidence of technical competency of the CS or a close collaborator.

16. CSs should build a gender strategy into DAPs and com mit to being persistent and creative in finding workable solutions throughout the Life of Activity (LOA).

Household Nutrition: Maternal Child Health and Nutrition Sector

17. CSs should put major emphasis on changing critical nutritional and health behaviors.

18. CSs should continue to use growth monitoring and promotion as a key strategy to improve the nutritional status of children under three years old and improve referral and follow-up of malnourished children.

19. CSs should focus increased attention on strategies to improve women s nutrition.

20. CSs should focus efforts with MOHs on the integration of nutrition into essential maternal and child health services.

21. CSs should establish country-specific criteria and verification methods to ensure that the neediest communities are selected and food resources are not used ineffectively.

The recommendations are being incorporated by FFP in their strategic planning process, and in efforts to streamline the management of the Title II food aid programme. In the recently approved Farm Bill, the US Congress increased the cash resources available to the Title II programme, one of the most important of the recommendations. CSs intend to use the report to help plan and recognize and then address specific problems they are facing.

Contact: Juliette Jack Banerjee for a hard copy of full report and more information jjbanerj@smtp.aed.org or visit website www.fantaproject.org

FIVIMS

Food Insecurity and Vulnerability Information and Mapping Systems

One of the central driving themes of FIVIMS is collaboration. The proposal for the Inter-Agency Working Group (IAWG) emerged from an expert consultation of 25 or so donors, international technical agencies and NGOs in 1996. The representatives from these institutions shared the commitments undertaken in the Plan of Action of the 1996 World Food Summit by improving inter-agency and national coordination on food security information systems. While the secretariat for FIVIMS is located within FAO, the programmeme s membership continues to increase, already including half a dozen bilateral and technical agencies, over a dozen UN-affiliated agencies, as well as numerous international NGOs and institutes. FIVIMS focal points have been identified within many of these key institutions, creating an expansive network for information exchange and greater opportunities for collaboration.

FIVIMS collaboration at international level 6^th Meeting of the Inter-Agency Working Group on FIVIMS

The IAWG recently held its annual meeting in Nicaragua jointly with the SISVAN network (Sistemas de Vigilancia Alimentaria y Nutricional). The major focuses were priority setting for the FIVIMS secretariat and IAWG members and a proposal for strategic review of FIVIMS. The meeting recommended increased interaction between IAWG partner agencies to share experiences and ideas and contribute to lessons learned documents. In addition, plans are being developed to strengthen collaboration with WHO regarding country studies on household food and nutrition insecurity and training modules. The World Bank has expressed interest in exploring possible ways of integrating FIVIMS and these nutrition modules into their distance learning network.

One new objective that emerged from the meetings in Nicaragua was more closely aligning international or global FIVIMS with the Millennium Development Goals (MDGs) process, in particular the monitoring, analysis and reporting of its food security and poverty indicators. The meeting identified FIVIMS representation and participation in the proposed MDG Hunger Task Force as a top priority FIVIMS MDG activity. Other areas of collaboration could be capitalised on as they develop. Linking FIVIMS with the MDG and Poverty Reduction Strategy Papers (PRSP) processes would be especially effective in improving information dissemination and in raising the profile of food security and FIVIMS within the international community. At the national level, it was re-emphasised that collaboration with local institutions and building national capacity is essential for long-term sustainability. For these to be successful, integrated and effective support from international agencies is necessary to complement national efforts and resources.

Integrating FIVIMS into the UNDAF/CCA Process

Within the context of the UN Development Assistance Framework (UNDAF), the UN Development Group (UNDG) has established a Common Country Assessment (CCA) process to encourage unified monitoring of follow-up to recent Summits and other international conferences, and provide an information base for better targeting of donor and World Bank resources. Although initially the CCA did not cover World Food Summit commitments, the UNDG and the FIVIMS secretariat have recently reached agreement on a set of proposals for using FIVIMS work to strengthen the CCA process through incorporation of a FIVIMS module, and use of FIVIMS-generated data management and data processing tools for the entire CCA. Piloting of this approach is needed in order to develop guidance of widespread applicability.

To develop and test an approach for integrating FIVIMS work into the UNDAF/CCA process at country level and to establish an operational integrated database management and monitoring capability for CCA, including a FIVIMS module, Bangladesh and Kenya have been selected as the two pilot countries.

Contact: Rene Verduijn Rene.Verduijn@fao.org.

FIVIMS has been active in the Comoros as part of an EU funded GCP/INT/742/EC project. Priorities have focused on the development of a food security progress report that would discuss the status of food security and vulnerability in the country, presenting a clear picture of how it has changed since 1996. UNDP expressed interest in the initiative and a commitment to collaborate has emerged whereby this activity will be carried out as a joint effort between FIVIMS, UNDP and the Government of Comoros Statistics Division. The report will serve as the 2002 Human Development Report for Comoros, focusing on the theme of food security and vulnerability.

The objective of the report will be to discuss progress in reducing food insecurity and vulnerability in the Comoros, drawing comparisons between urban and rural, as well as between the three islands. The report will rely on information and data already available, though individual case studies will be carried out on each of the islands. UNDP and FIVIMS will carry out an analysis of the principal factors causing and affecting food insecurity and vulnerability in the Comoros and what the implications are for food security in the future. The report will be published later this year.

Contact: Anna-Lea Jenny annalea.jenny@fao.org.

IAEA

International Atomic Energy Agency

In January 2002, the name of the sub-programme on Nutrition and Health Related Environmental Studies Section at IAEA was changed to Nutrition and Effects of Contaminants on Human Health. The overall objective is to strengthen the sub-programme by providing solutions to nutritional problems of high national and international significance, and at the same time to assist member states to improve and expand on their ability to use isotopic techniques. This reflects the important strategic principle of the Agency to enhance the contribution of nuclear technologies towards meeting, in a sustainable manner, the interests and needs of Member States in the areas of human nutrition and environmental health.

The new sub-programme addresses two issues: applied human nutrition assessment and the study of contaminants affecting human health using nuclear and isotopic techniques. Under these projects isotopic techniques will be highlighted as major tools in addressing health issues (preventive and diagnostic) affecting the entire human life cycle. The Co-ordinated Research Projects (CRP) just concluded (reference asian man, biomonitoring, osteoporosis and stunting), presently running (infection, infant growth monitoring, ageing, nutrition-pollution interactions, micronutrient interactions, mercury recycling in the environment, and impact of industries on food contamination) and planned (intrauterine growth retardation, energy metabolism in the elderly, bone health in the elderly, health promotion for adolescent girls, nutrition and HIV-AIDS, and toxic element atmospheric deposition and human diseases) indicate the vision and dynamism of this sub-programme built around the current UN objectives in the area of human health.

Another suite of activities is supported by the IAEA s Technical Co-operation Programme to ensure technology transfer of isotopic techniques to be applied in developing countries where they not only benefit millions through improved nutrition, but serve as specific indicators of broader social and economic advances.

The Reference Asian Man: Report of a CRP

A CRP was conducted recently on the daily dietary intake and organ contents of selected trace elements (calcium, cesium, iodine, potassium, strontium, thorium and uranium) of importance in radiation protection. This study was combined with another study on the intake of a few nutritionally important trace elements such as iron, zinc, copper, manganese, selenium, and chromium. The study was carried out for the adult population of nine Asian countries: Bangladesh, China, India, Indonesia, Japan, South Korea, Pakistan, Philippines and Vietnam, which represent 85% of the Asian and more than half (51%) of the world s population.

Knowledge of the biokinetic behaviour in relation to humans of the radionuclides cesium, strontium, uranium and thorium is needed for estimating the internal radiation dose to radiation workers during the production of nuclear electric power and to the general public at the time of an accident. Biokinetic behaviour of these radionuclides could be inferred from the behaviour of their stable counterparts. The data on intake and organ content of trace elements can provide information on their biokinetic behaviour.

The intake of most of the radiologically important trace elements was found to be lower in the Asian region in comparison to the International Commission on Radiological Protection Reference Man data, as well as for essential trace elements in comparison to the recommended dietary allowances of US National Academy of Sciences.

The Reference Asian Man study may enable recommendations for the first time of new population specific daily intake values for elements of importance in radiation protection as well as on the intake of some trace elements for the Asian region. The daily dietary intake values may also provide an opportunity to consider the new recommended dietary allowances for essential elements in the Asian region.

Contact: GV Iyengar V.Iyengar@iaea.org

IFAD

International Fund for Agricultural Development

In partnership with the Italian Institute for Food and Nutrition Research (INRAN) and other partners, IFAD recently initiated a series of project-level benchmark assessments of key indicators related to the Millennium Development Goals (MDGs).

Summary Objectives

This initiative addresses immediate and longer-term issues in improving the impact of IFAD projects. Specifically, the activities were designed to:

· Develop a short list of anchor indicators which are based on objective, quantifiable and comparable data (such as access to safe drinking water, prevalence of malnutrition and percentage of women who are literate). These are not intended to replace qualitative information, but to provide a base (anchor) around which the qualitative information can complete the explanatory framework

· Carry out the fieldwork necessary to operationalize the indicators for project management and for reporting on progress toward reaching the MDGs

· Produce training materials and guidelines for use in IFAD projects throughout the region, including the assessment methodology and specific assessment skills.

Two projects in two countries were identified:

· Guinea: Programme for Participatory Rural Development in Haute Guinée
· Cote d'Ivoire: Marketing and Local Initiatives Support Project

Activities and Outputs

Results

The first three steps were all successfully completed in May 2002, and materials production is underway. Fieldwork was greatly assisted by UNICEF, the Guinean Ministry of Health, and the Ivoirian National Institute of Public Health in obtaining the necessary equipment for the assessment.

Preliminary analysis of the assessment data indicates that levels of illiteracy, malnutrition and lack of access to safe water/sanitation are significantly higher in the two IFAD project areas than national or regional averages for Guinea and Côte d'Ivoire. The benchmark values for these anchor indicators support the conclusion that the project locations were well selected to reach vulnerable populations in marginal areas, and provide a solid base for assessing changes in areas such as literacy, nutrition and access to water/sanitation in future.

Notable features of this exercise have been the degree of co-operation between the various agencies and project partners, the high level of enthusiasm among project staff to gain practical experience with a straightforward assessment methodology, and the interest of project management in being able to track anchor indicators of impact in the project areas more effectively.

Contacts: Seán Kennedy s.kennedy@ifad.org or
Sylvie Marzin s.marzin@ifad.org

ILSI

International Life Sciences Institute

The ILSI is a non-profit, worldwide organization dedicated to contributing to improving public health nutrition and food safety globally. The organization includes 15 branches located throughout the world, the Research Foundation including the Human Nutrition Institute and Risk Science Institute, and the ILSI Center for Health Promotion. Dr. Eileen Kennedy, a former member of the SCN Advisory Group on Nutrition, became the ILSI Global Executive Director in March 2002.

Four of ILSI s top global public health priorities include overweight/obesity; biotechnology, food safety/risk assessment and functional foods. On July 17, 2002, ILSI held a round table discussion on the ILSI research framework for contributing to the prevention of overweight and obesity globally. Three principles guide the ILSI activities; first, the ILSI research should complement the activities of the branches. In addition, ILSI intends to emphasize public-private partnerships in addressing the overweight and obesity issues. Finally, a key ILSI strength is experience in bringing together government, industry and academic partners in identifying solutions to global public health issues. This is the paradigm that will be used in the ILSI overweight and obesity research program.

ILSI has a very active International Food Biotechnology Committee. In 2001, this ILSI committee convened a task force to construct a comprehensive, up-to-date, global database on the composition of crops, using data generated by the agricultural biotechnology industry. Composition data for food and feed crops are essential for substantial equivalence evaluations of products derived from agricultural biotechnology. Information obtained from such evaluations allows an assessment of whether there are unexpected effects due to genetic modifications. In addition, composition data for foods and feeds could be used to propose important nutritional and anti-nutritional endpoints relevant to public health. A robust database will further understanding of the phenotype diversity in the composition of conventional crops and their products, provide a context for the evaluation of the composition of biotechnology-derived crops and enhance the scientific basis for and confidence in the concept of substantial equivalence. Once a functional database is established, submission of other publicly available data that meet the acceptability criteria will be encouraged.

On May 21, 2002, ILSI presented the crop composition database at a meeting attended by representatives from the US, Canadian and European government agencies, academia, and international organizations. Through discussion at this meeting, ILSI obtained feedback that will contribute to the quality of the database and improve its usefulness. It is envisioned that the database will be available for public use via the Internet, and its release is anticipated in the fourth quarter of 2002.

Contact: Eileen Kennedy ekennedy@ilsi.org

UNHCR

UN High Commissioner for Refugees

UNHCR/WFP Food and Nutrition Regional Training Workshop

UNHCR and WFP organized a training workshop from 8-11 April 2002 in Belgrade. A joint training of this nature was last held in 1995 in Addis Ababa. About 30 participants from WFP, UNHCR, CARE, IFRC and ICRC representing Russia, Azerbaijan, Serbia, Montenegro, Kosovo, Albania and Macedonia attended. The participants were international and national staff coming from a wide range of backgrounds, including programmes, logistics, and technical areas. In addition to enhancing the knowledge of the participants, this workshop provided an excellent opportunity to strengthen partnerships and collaboration among the staff of WFP/UNHCR and their partners.

The objectives of the workshop were to:

· strengthen collaboration and information sharing among UNHCR, WFP and agency staff

· keep staff up-to-date with the latest developments and changes in both organizations (e.g. policy priorities, funding situations, decentralization, restructuring, etc.), and

· exchange technical knowledge on nutrition, registration, self-reliance and community participation.

The workshop was considered a success and provided an excellent opportunity for open discussion and exchange of views among WFP, UNHCR and partners. A website was created to facilitate communication among the participants: www.30.brinkster.com/trainet/default.htm For other regions, similar workshops will be organized.

Contact: Zahra Mirghani mirghani@unhcr.ch

UNU

United Nations University

Food and Nutrition Program Capacity Development

The focus of last year s SCN Capacity Development Working Group session was on the capacity development plans that were elaborated by ad hoc regional African groups convened by UNU and IUNS as co-chairs of the referenced working group. These were convened as a mechanism:

1. for developing long-term capacity development plans that are driven and owned by the regions

2. to promote intra- and inter-regional dependence, and

3. to explore the viability of a mechanism that goes beyond the predominant stove pipe approach to capacity development and leads individual UN agencies, NGOs, and bilaterals to pursue capacity development in important areas, but fails to maximize returns because these usually disparate efforts are not guided by comprehensive, long term plans that are integrated maximally into regional agendas.

UNU and IUNS are seeking partners to broaden the implementation of other aspects of African regional plans (e.g. developing infrastructures for supporting micronutrient fortification, exploring the appropriate role of biotechnology applied to nutritional problems, enhancing food safety protocols) and to help develop appropriately analogous mechanisms in Asia, Latin America, and the Middle East to facilitate long term plans for capacity development in those regions and to reconvene and expand the groups that were convened in Africa.

Growth References for Children: Moving beyond the 0 to 5 to preadolescents

The increasing prevalence of childhood obesity worldwide underscores the need for appropriate anthropometric references. Current approaches for developing anthropometric references are based on the representative sampling of disease free individuals and the diagnosis of overweight is determined statistically. This leads to the paradoxical situation that children classified as obese by a reference developed 25 years ago may be classified as lean today because the proportion of overweight individuals is increasing worldwide. The UNU seeks partners in accomplishing three important tasks:

· evaluate functional approaches for developing school age, preadolescent anthropometric references capable of identifying growing children in the process of becoming overweight

· assess the feasibility of developing a single international reference based on measurements obtained from participants from the world s major regions

· and, if appropriate, design a protocol for developing a single new international reference based on data that describe how children should grow rather than describe how they presently grow.

After consultation with the UN, bilateral agencies and NGOs, a task force was appointed to develop 10 year plans for capacity development in Asia. The first task force meeting of the Asian Capacity Development Initiative was held in Bangkok, Thailand on April 26 and 27^th. The task force is composed of Dr. Abdul R. Kemal, Director, Pakistan Institute of Development Economics (PIDE), Islamabad, Pakistan; Dr. Nguyen Cong Khan, Vice Director, National Institute of Nutrition, Hanoi, Vietnam; Professor Khor Geok Lin, Professor of Community Nutrition, Department of Nutrition and Health Sciences, Faculty of Medicine and Health Sciences, University Putra, Malaysia; Dr. Widjaja Lukito, SEAMEO TROPMED, Gedung SEAMEO, Jakarta, Indonesia; Professor Eiji Marui, Chairman, Japan Research Committee on Nutrition Transition, Department of Public Health, Juntendo University School of Medicine, Tokyo, Japan; Dr. V. Prakash, Director, Central Food Technological Research Institute, Mysore, India; Dr. Emorn Wasantwisut, Deputy Director for Research and Academic Affairs, Institute of Nutrition, Mahidol University, Salaya, Phut-thamonthon, Nakhon Pathom Thailand (also serves as the task force's chair); Professor C.R. Yajnik, Director, Diabetes Unit, KEM Hospital Research Center, Rasta Peth, Pune India; Prof. Dr. Xiaoguang Yang, Director, Institute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine, Bejing.

Within the task force, three working groups will examine capacity from three perspectives: capacity clusters, life-cycle approach and ongoing activities in the region.

Contact: Cutberto Garza cg30@cornell.edu

WHO

World Health Organization

WHO Study on Nutrition and Non-Communicable Diseases in Countries in Transition

Changes in food systems, patterns of work, travel, and leisure are leading to changes in diets and physical activity in large parts of the world. It is clear that these changes are occurring in less developed countries, especially in big cities, at a speed that greatly exceeds the predictions based on the historical experience in economically developed regions. Of particular concern is that these changes are linked to increasing incidence of non-communicable diseases (NCD) in developing countries. Population based prevention is the most cost-effective public health measure to tackle the epidemic of diet- and physical inactivity-related NCDs.

To meet the urgent need to develop an understanding of the role of changes in the environment at the macro- and community level we propose a 12-country collaborative project in a broad range of environments and ethnic subpopulations. The multi-country study will generate an information base necessary to WHO to formulate its policy, and, at the same time, it will build capacity for strong data use and analysis in the participating countries.

The countries included in this proposed study are Brazil, Chile, Mexico, Egypt, Morocco, Iran, Nigeria, South Africa, China, India, Indonesia, and Thailand. The baseline study will consist of approximately 72,000 individuals sampled in big cities (6,000 per country, 3,000 men and women). The study will assess the prevalence and distribution of common NCDs as well as NCD risk factors, physical activity and diets in detail as well as numerous environmental and community factors. The study will be a five-year project. A prospective design can be built into the study with the possibility of follow-up.

The original idea of the study came out of a one week seminar on nutrition transition, held in Bellagio, Italy, in August 2001. Researchers from different countries expressed their wish manage this study as a WHO study to help in implementation and exploitation of results. The first methodological workshop to plan the protocol was held at the University of North Carolina, Chapel Hill in February 2002 and the first meeting with the country Principal Investigators took place in Sao Paulo from 30 April to 2 May, 2002. Country proposals and an overall proposal will be prepared in June.

In pursuit of the necessary funding preliminary contacts have been made in the NIH (USA), Wellcome Trust (UK), Rockefeller Foundation (USA), and the World Bank. WHO and the University of North Carolina have supported financially the early planning. The study budget will be used for the study implementation in the countries and for the costs of study coordination, analysis and reporting.

The study PIs will be Professor Carlos Monteiro from the University of Sao Paulo (carlosam@usp.br) and Professor Barry Popkin (popkin@unc.edu) from the University of North Carolina, and the two management centres will be located at these two universities. At WHO, the coordinator is Dr Pekka Puska (puskap@who.int), Director, NonCommunicable Diseases and Health Promotion (NMH cluster).

Contact: Dr Pekka Puska and Dr Pirjo Pietinen pietinenp@who.int or visit www.cpc.unc.edu/projects/who

Objectives were to learn of the hardships faced by Indigenous Peoples with respect to food, to define common elements and strengthen ties of cooperation, and to prepare a strategy to overcome hardships related to food security and food sovereignty. It was recognized that Indigenous Peoples, as the poorest of the poor in many countries, face a higher risk of suffering the consequences of food insecurity, and that the situation appears to be worsening in many places.

Elements of the Declaration

The Declaration notes agreement that the right to food by Indigeneous Peoples is a collective right, based on spiritual relationships with Mother Earth, lands and territories, environment and natural resources that provide traditional nutrition. It underscores and emphasizes that the right to food for Indigenous Peoples is a matter not only of physical survival, but also of social organization, language, culture, spirituality, sovereignty and total identity. To deny the right to food is to deny the collective indigenous existence.

It was recognized that food security means "the access to all people to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and health life." Food sovereignty is the "right of Peoples to define their own policies and strategies for the sustainable production, distribution, and consumption of food, with respect for their own cultures and their own systems of managing natural resources and rural areas," and is considered to be a precondition for Food Security. The Declaration also considered Article 5 of the Declaration on the Right to Development (1986) which states that "the refusal to recognize the fundamental right of Peoples to self-determination" is an injustice against which States should take resolute steps. Further, the International Covenant on Economic, Social, and Cultural Rights recognizes that all peoples may implement their own economic, social, and cultural development, based on their own vision, and that "in no case may a people be deprived of its own means of subsistence." Thus Indigenous Peoples maintain that their rights to land, water and territory, as well as self-determination, are essential for food security and food sovereignty.

Obstacles to food security and food sovereignty

The Declaration is explicit in noting many obstacles to food security and food sovereignty. These include free trade, the imposition of industrialized mono-agriculture causing erosion of genetic diversity and loss of seeds, species and breeds of animals, and the extension of intellectual property rights in favour of multinational corporations. The introduction of genetically altered food is stated to cause loss of traditional foods and health, and loss of the relationship to Mother Earth, including traditional plants and medicines. Pesticides and chemical fertilizers are noted for their poisoning effect on The Earth, and the Indigenous Peoples in communities that work The Earth, affecting food production, nutrition and health, and increasing morbidity and mortality rates, especially for women and children. Obstacles also reported are the imposition of projects by governments and private companies without consultation or prior informed consent, and the policies and demands of international financial institutions and their structural adjustment programs. Militarization and repression in indigenous territories, and national policies which impose inadequate and exclusionary models and practices resulting in loss of lands and territories and collective indigenous identity are also included as generating increased food insecurity.

Resolutions

The Declaration calls for the adoption of the Draft Declaration on the Rights of Indigenous Peoples by the United Nations. It calls on States to ratify the Convention on the Elimination of Persistent Organic Pollutants, the Kyoto Protocol on Climate Change, and the ILO Convention 169 for the rights of Indigenous Peoples. It recommends to the World Food Summit: 5 Years Later, the World Summit on Sustainable Development, and the States participating to prioritize as fundamental the rights for food, health, and education from the perspective and worldviews of Indigenous Peoples, and that international trade and financing entities recognize and respect these rights. It urges FAO to establish an open-ended working group so that Indigenous Peoples may consult in the development and implementation of policies that affect their Food Security and Food Sovereignty. The Declaration also requests the UN Commission on Sustainable Development and the FAO to support campaigns of Indigenous Peoples to inform communities of their rights to food and development, and social, cultural, economic and political rights.

Firm demands are stated to eliminate development policies imposed by States that run counter to philosophies and worldviews of Indigenous Peoples in different parts of the world. Such policies include the privatization of water, usurpation of lands and natural resources and destruction of the environment, appropriation of traditional knowledge and genetic resources. It asks for prohibition of patenting of all forms of life. It demands that governments and multinational corporations inform in a full, truthful and comprehensible manner about the productions, use, transport and export of pollutants that affect food systems, environment and health of Indigenous Peoples, and that substances considered dangerous to human health, and already banned in other countries, be prohibited entirely.

Commitments

Participants in the consultation committed on a local level to revitalize the world views of Indigenous People, to de-colonize communities, and to strengthen indigenous food productions systems. The need to provide families and communities with information regarding benefits of consuming traditional food was affirmed, as was the need for providing information on health risks associated with consuming non-traditional food, including items produced with chemicals and genetically modified products.

At national and regional levels the consultation called for networks of communication and capacity building among Indigenous Peoples for food security and food sovereignty, and the strengthening of cooperation among Indigenous Peoples and Nations. Constructive ties to Civil Society are to be sought, as are policies of self determination which avoid dependency on international financial institutions.

Closure

The document closes with an expression from the Maya language. "Iximulew, job'Imox, Oxi'Kej." Ixim Ulew in Maya Kaqchikel means Solid Earth, granulated Earth, the Earth of the Jungles and of trees that resemble corn. Job' in K'iche language means five; Imox, is a day on the Sacred Mayan calendar. The day the consultation closed, April 19, addresses the qualities of instability, surprise, irrationality, and creation in emotion.

Steven Esrey 1953-2001 Dr Steven Esrey died on 20 December 2001 after a long, valiant struggle against cancer. He had built a highly respected career in nutrition and public health from his doctoral student days at Cornell, as a professor at Johns Hopkins and McGill Universities, and during his last years in the Programme Division at UNICEF New York. His PhD thesis advisor has described him as a world leader in relating nutrition to environmental sanitation and water supply. This area represented for Steven an important entry point for effective interventions to reduce diarrhoea and thus protect nutritional well-being. Those who are familiar with the concept of ecological sanitation recognize Steven’s pioneering work in this area and will miss his leadership in developing systems that close the loop in wastewater management and sanitation to best protect both the environment and human health in an ecologically and economically sustainable way. For his students, he was a professor who set high academic goals. He urged his students to high achievement with the philosophy that a pupil must become better than his teacher. His colleagues at work will remember his strong commitment. Even in the advanced stages of his illness, Steven continued to work and travel to promote a cause that inspired others. His friends will remember a man whose conversation reflected a well-read mind and good sense of humour. Steven did not ask “why me?” thus he was able to live his days to the fullest. Throughout his illness, Steven was closely accompanied and cared for by two people: Katja, his wife, and Lara, his daughter. Adelheid W. Onyango Department of Nutrition for Health and Development WHO/HQ