6. Summary action plan
National governments, working closely with the private sector and non-governmental organizations as appropriate, have primary responsibility for the development and implementation of programmes to overcome micronutrient deficiencies. Although approaches will vary according to conditions within individual countries, this summary action plan highlights key points that should always be considered in the establishment of programmes to improve micronutrient status.
1. Conduct an in depth situation analysis. (See Exhibit 6.1.)
2. Establish goals and objectives and plan pilot programmes on the basis of the findings of the situation analysis. (See Exhibit 6.2.) In accordance with these goals and objectives, select from the wide array of possible food-based approaches those likely to be the most appropriate. (See Exhibit 6.3.) Take into account local conditions and the traditional agriculture and food patterns.
3. Implement pilot programmes.
4. Monitor and evaluate the effectiveness of the pilot programmes and plan for large-scale implementation. Modify and retest as required.
5. Use mass media and other communication strategies to create awareness of the benefits of food-based strategies among policy makers, programme planners, local government officials and local communities.
6. Implement programmes on a scale necessary to eliminate micronutrient deficiencies as public health problems.
7. Establish monitoring systems to ensure sustainability and continued effectiveness and to ensure that appropriate adjustments are made as required.
8. Continue advocacy and communication activities on a routine basis.
Exhibit 6.1. Components of a Situation Analysis
A situation analysis should identify:
n the dimensions of a micronutrient deficiency problem, paying particular attention to the special needs of key vulnerable groups such as children and women of childbearing age;
n factors causing or contributing to the problem (e.g., household food insecurity; incidence of relevant disease, inhibitors and enhancers of micronutrient absorption);
n existing infrastructure in the health, agriculture and communication sectors; existence of a food industry (especially important if food fortification is being considered) and food marketing expertise;
n resources available to expand current programmes (e.g., relevant government budgets, community and private sector resources, including the food industry and potential donor agencies); and
n existing political commitment and need for advocacy.
Exhibit 6.2. Steps in Planning Pilot Programmes
Steps to take on the basis of the findings of the situation analysis:
n Form intersectoral groups or task forces for each micronutrient whose deficiency is a public health problem or, if appropriate, a combined micronutrient committee.
n Determine the need for short-term supplementation for specific vulnerable groups with acute needs that are unlikely to be met by diet-based approaches.
n Determine how best to achieve the dietary changes required to prevent deficiencies in a sustainable way.
n Determine the need for and feasibility of food fortification.
Issues to consider in the development of strategies to achieve dietary change:
n Increasing production of key micronutrient-rich foods at household and village levels should be a key consideration. Both animal and plant food sources should be considered, although for economic reasons plant foods are likely to be the major focus. The potential contributions of the food industry should also receive attention.
n Issues of storage, preservation and food safety, as well as the possible need for improved methods of home preparation and processing of key micronutrient-rich foods, should be given adequate attention.
n Measures to protect, support and promote breastfeeding and appropriate complementary feeding of infants should be included in almost all food-based micronutrient programmes.
n Appropriate information, education and communication (IEC) strategies should be developed. Best results are achieved when IEC strategies are combined with increased production of micronutrientrich foods.
Exhibit 6.3. List of food-based approaches to deficiency
The following list presents possible food-based approaches/activities that may be taken into account to combat micronutrient deficiencies. Activities should be selected based on geographic, demographic and socioeconomic conditions. Community participation in the design and implementation is a crucial component of successful, sustainable programmes.
n Training for extension agents and other trainers about food and nutrition.
n Training for farmers to make them aware that growing micronutrient-rich plants not only enriches their families' daily diet but may bring extra income.
n Developing home, community and school gardens.
n Promoting mixed farming systems that supply families with a more varied diet.
n Introducing higher-yielding vitamin A-rich varieties.
n Promoting fruit and vegetable cultivation throughout the year to overcome seasonality of food supply.
n Supporting small-scale animal husbandry as a source of micronutrient-rich food and extra income.
n Promoting aquaculture, including skill training for community members and extension agents.
n Preventing post-harvest losses through proper food handling, transport, storage, preservation or processing techniques, and facilities.
n Strengthening collection of horticultural statistics including micronutrient-rich and traditional crops (vegetables and fruit).
n Integrating micronutrient activities into rural and agricultural development programmes, horticulture production projects' women's activities, projects to reduce food losses, communication and information programmes, and community forestry and fishery activities.
n Establishing small-scale credit systems accessible to low-income producers.
Education and training
n Preparing materials or guidelines on safer methods of processing and preserving micronutrient-rich foods. These materials and guidelines should be addressed to the general public as well as specifically to women, farmers, small-scale merchants, and community workers.
n Training nutrition or agricultural extension workers, community workers, health personnel, religious leaders, schoolteachers, students, women and family members on the following topics:
importance of vitamin A, iron, vitamin C and fat in the diet and identification of micronutrient-rich foods,
safe methods of processing and preservation of micronutrient-rich foods, e.g., cooking methods, storage places, use of solar dryers,
home gardening as rich source of vitamin A, vitamin C and other micronutrients,
small-scale animal husbandry and aquaculture as rich sources of vitamin A, iron and calcium, and
importance of using salt fortified with iodine.
n Integrating nutrition, with special emphasis on prevention of micronutrient deficiencies, into curricula of primary and secondary schools as well as teachers training colleges and training institutes responsible for adult education and youth groups.
n Promoting breastfeeding by emphasizing the richness of mothers' milk and the importance of breast milk in preventing infectious diseases.
n Using social marketing to promote production and consumption of micronutrient-rich foods.
n Establishing local markets to ensure availability of micronutrient-rich foods.
n Improving local infrastructure system to allow distribution of micronutrient-rich foods even in remote areas.
n Providing economic credits to women's groups producing and marketing fruit and vegetables.
n Assessing food availability of micronutrient-rich foods, including traditional foods in local markets.
n Assessing food consumption patterns of different age groups and reasons why and when certain foods are not eaten.
n Evaluating existing nutrition interventions.
n Identifying international and national organizations, NGOs, voluntary groups, women's groups and others working on micronutrient programmes.
n Identifying traditional foods rich in micronutrients and developing national food composition tables.
n Supporting research institutes developing plant varieties with higher vitamin A and other micronutrient values.
n Evaluating training curricula for nutrition and health staff regarding micronutrients.
Food industry, trade, commerce
n Fortifying appropriate foods with needed micronutrients and promoting these foods to specific groups that lack access to highquality nutritious foods.
n Economical packaging of micronutrient-rich foods for poor consumer groups.
n Improving labelling and advertising of micronutrient-rich processed foods.
n Instituting food regulatory systems to enable nutritionally appropriate fortification.
n Training food inspectors and food control laboratories to analyze fortified foods for the added micronutrients.
n Setting up intersectoral groups to coordinate activities between sectors.
n Providing information about the importance of preventing micronutrient deficiencies to decision and policy makers in commerce, education and communications.
n Organizing women's groups to give special attention to home food production and preparation and to small-scale animal rearing.
n Involving community participation in programme design, implementation and evaluation.
n Involving NGOs in providing technical support and training.
n. Providing short-term training for professional staff.
n Developing or strengthening existing surveillance systems to monitor the effectiveness of micronutrient programs.