Agenda item 1: Food insecurity and vulnerability information and mapping systems (FIVIMS)-FAO initiative
9. The Consultation adopted the provisional agenda and the timetable (Appendices III and IV) as proposed by Dr B. K. Nandi. Dr Indra Tudawe from Agrarian Research and Training Institute of Sri Lanka was elected as Chairperson with Dr Maria Antonia G. Tuazon from the University of Philippines at Los Banos College, Laguna and Dr Lalita Bhattacharjee from Institute of Nutrition, Mahidol University, Thailand as the Rapporteurs.
10. Dr Nandi presented the overview of the Consultation emphasizing the two main agenda items as (i) country status reports with regard to establishment of FIVIMS and identification of future actions and (ii) specific country strategies for improving urban nutrition as a follow-up to NPAN. He recalled some of the salient features of FIVIMS in terms of its aims, dimensions, list of potential key indicators and components. The Consultation was reminded that the meeting was to focus on the current vulnerability assessment and mapping facility and food and nutrition monitoring and assessment.
11. He reviewed the conclusions arrived in the last Consultation in so far as what FAO was expected to undertake as well as what the Consultation members agreed to conduct as follow-up actions. Dr Nandi informed the Consultation of the focal points (Appendix V) that had been identified and the progress made with respect to establishment of FIVIMS in different countries.
12. In conclusion, Dr Nandi provided the rationale for the inclusion of urban nutrition as an agenda item, stating that it was very relevant and timely in the context of two important events namely International Conference on Nutrition (ICN) and World Food Summit (WFS) with the overall objective of providing safe and nutritious food for all. It was also mentioned that FIVIMS at all levels including those concerning urban nutrition data system would provide the information required to help governments and monitor the progress towards meeting the overall goals reflected at the World Food Summit. He mentioned that most countries in the Region are confronted with nutritional problems in urban areas. Citing Dr C. Gopalan, Dr Nandi informed the Consultation that the emergence of the "new rich" and the contributory factors of affluence, urbanization and industrialization had resulted in the double burden of malnutrition in urban areas. It was therefore imperative, that the Consultation took stock of strategies/interventions which had been identified and have been or are being implemented such as nutrition and health education, promotion of physical exercise and training in work areas so as to maintain a healthy lifestyle.
13. Dr Barbara A. Burlingame, updated the Consultation of the global initiatives in the establishment of FIVIMS. In particular, she emphasized that FIVIMS was a tool intended to draw attention to food security issues making it a potent advocacy tool. It was also a means to improving the quality of data at national and sub-national levels, and could help improve monitoring and evaluation capabilities.
14. She shared the organizational structures of FIVIMS at the international and national levels with special attention to the interagency working groups (IAWG), which met twice since its creation in 1997. The third meeting was due to take place in Bali, Indonesia from February 7 to 11, 2000 and was to be co-organized by Helen Keller International. Since the theme would be FIVIMS in Asia, she informed the Consultation that the forthcoming recommendations of the Consultation would be forwarded to this IAWG meeting.
15. Dr Burlingame reiterated the fact that FIVIMS was fundamentally multidisciplinary, requiring data from various sectors but identifying nutrition as an important component. Therefore, food composition data, food intake surveys, nutrition surveys (which include anthropometric, clinical and biochemical) and food balance sheets should form part of the important database on FIVIMS.
16. The Consultation was likewise informed of recent developments in FIVIMS such as availability of mapping software like the Key Indicator Mapping System (KIMS) which was a spin-off from Global Information and Early Warning Systems (GIEWS). To demonstrate the capability of mapping software from ESNA, Dr Burlingame presented the maps prepared from India's Nutrition Country Profile showing several indicators from country, state, and district levels.
17. The Consultation commended the fact that FIVIMS underscores the importance of nutrition but also noted several issues related to FIVIMS. For instance, the use of local versus international standards could have implications on the magnitude of the problem and definitely limit comparability between and among countries. While there were some countries with their own local standards, there was increasing recognition that for international comparability, National Centre for Health Statistics (NCHS) standards need to be used. Based on the Indonesian experience, FIVIMS was useful in food insecure situations. However, Vulnerability Assessment Mapping System (VAM) established by Indonesia and the Food and Nutrition Surveillance System (FNSS) proved to be more effective from the operational standpoint.
18. Dr Burlingame stressed on the flexibility of FIVIMS Software such that it could be customized depending on existing data information systems as well as the country's intended use of the data available from FIVIMS. Local and international standards could easily be incorporated into a National FIVIMS Software product.
19. There was also a suggestion to include low birth weight as an indicator and disaggregation by gender or physiological status, in addition to looking at data from FIVIMS in terms of availability of time-series data.
Agenda item 2: Country status with regard to implementation of FIVIMS and identification of future action
Bangladesh: presented by Messrs Mirza Altaf Hossain and Luqueman Ahmed
20. The Consultation noted that Bangladesh has recently designated Mr Luqueman Ahmed, Chief, Programming Division of the Planning Commission as the focal point for FIVIMS. Mr Altaf Hossain shared with the Consultation several maps showing the prevalence of nutritional problems in the country developed through the initiatives of the World Food Programme, as part of the organization's Vulnerability Assessment Mapping (VAM) programme. Government initiatives, particularly of the Ministry of Agriculture were being taken to update the nutrition country profile and develop a detailed nutrition mapping system for the country. Nutritionally vulnerable areas would be identified to address the malnutrition situation through a target - oriented approach.
21. Mr Ahmed shared with the Consultation relevant information regarding major Governmental Policy interventions to maintain food security such as incentives to growers, safety net programmes through improvement and enlargement of targeted food distribution, preservation and maintenance of security stocks and improving storage capacity and price stabilization of food grains.
22. While the nutrition mapping initiatives taken in Bangladesh were appreciated, the Consultation opined that both information on food availability and accessibility were very important in the context of FIVIMS. Such maps on food production and food accessibility were available with the World Food Programme (WFP). The FIVIMS focal point was advised to obtain them.
23. Recommendations were forwarded by Mr Altaf Hossain which were intended to enhance the commitments among consultation members. These included: i) FAO to consider the possibility of awarding merits of recognition/appreciation for the pro-active role taken by countries on work related to FIVIMS; and ii) measurable targets should be specified as a part of the agreements arrived at during the Consultation.
China: presented by Dr Zhai Fengying
24. Dr Zhai informed the Consultation that the FAO initiatives on FIVIMS in China started with the visit of Dr J.P. Cotier, Chief, ESNA during July/August 1999. Five collaborating institutions were identified to work on FIVIMS namely, the Institute of Nutrition and Food Hygiene of the Chinese Academy of Preventive Medicine of the Ministry of Health, the Ministry of Agriculture, State Council Leading Office of Poverty Alleviation and Development, National Statistical Bureau (NSB), the Institute of Geography. However, not much progress had taken place because of inadequate leadership between these organizations.
25. During the visit of Dr Cotier, data sets were identified which could be used for setting up the FIVIMS. These included: Surveillance and Improvement of Children's Nutrition in China (1990-95), China National Nutrition Survey, China Health and Nutrition Survey, Food and Nutrition Surveillance System and the various Household Food Consumption Surveys. The Consultation noted the possibility of overlaps in the data generated from the various surveys which posed some technical problems in consolidation and analysis. While the nutrition surveys carried out in China showed an improvement in the nutrition trends, there was a need to closely examine the nutrition profiles in relation to specific variables.
26. The Government of the People's Republic of China in support of FIVIMS had earmarked a budget for nutrition data bank to be established but were expecting support from FAO along with provision of software for mapping and manpower training for data banking. In the meantime, at the country level, preliminary mapping system had started and selection of key indicators was being done.
India: presented by Ms Shashi P. Gupta
27. As had been agreed upon in the last Consultation meeting, Ms Gupta reminded the Consultation that the nutrition component of FIVIMS could be called by any other name at the country level, and the Food and Nutrition Information System in India, therefore, was considered more appropriate. Historically, nutrition mapping in India had commenced with Diet and Nutrition Atlas in 1969. With the adoption of the National Nutrition Policy in 1993, efforts for establishing a National Nutrition Surveillance System in the country were initiated. In 1998, India Nutrition Profile was also released by the Food and Nutrition Board of the Department of Women and Child Development providing information at the district level covering 187 districts. The "Andhra Pradesh Model" of nutrition surveillance had mapped different grades of child malnutrition district-wise and demonstrated a significant reduction in child malnutrition.
28. Ms Gupta also added that "Mapping for Nutrition Interventions-The Orissa Model" was launched in 1998 in the State of Orissa which adopted block level mapping and that village level mapping was being experimented in the State of Rajasthan with the help of the National Informatics Centre. The State Governments had been advised to adopt the Orissa model of nutrition mapping.
29. UNICEF had also developed an extensive Child Info Data Base software. UN agencies were developing Dev Info which included a number of developmental indicators relating to agriculture, land use, economy, education, food and nutrition, environment, gender, health, housing, population, etc.
30. Actions that had been taken after the 1998 Consultation in Bangkok included the constitution of a coordination committee for developing FIVIMS in the country. This was followed by the support from FAO in hiring a National Consultant who had submitted a report for establishing FIVIMS in the country. The report had been shared with all concerned sectors and was under consideration of the Ministry of Food, the focal point for FIVIMS.
31. Ms Gupta also informed the Consultation that a concept paper on National Nutrition Mission had been developed which had three main areas of action namely, Vigorous Awareness Campaign, Direct Interventions in high malnutrition districts and Establishing Nutrition Monitoring, Mapping and Surveillance System in the country. Regional advocacy workshops on Nutrition had also been planned in order to sensitize policy makers and facilitate meeting the national nutrition goals.
Indonesia: presented by Ms Irawati Susalit
32. Ms Susalit provided results based on National Socio-Economics Survey 1998 (SUSENAS) and showed that PEM prevalence in under five children was 30 percent and severe malnutrition as 3 percent, but also stressed that the figure might no longer be valid because of the socio-economic crisis that had plagued the country since 1997.
33. Mapping had been done for 327 districts in Indonesia, 157 of which had been identified by using a score of _ 6 for food and nutrition insecure areas. Moreover, she informed the Consultation that there were two information systems currently in use, which included the Early Warning System from Agriculture Sector and Nutrition Surveillance System from Health sector. These were integrated into the system, "The Food and Nutrition Surveillance System (FNSS).
Nepal: presented by Mr Yogesh Vaidya
34. The Consultation was informed by Mr Vaidya that Nepal had yet to establish a Nutrition Surveillance that can be integrated with the existing infrastructure of the Government. With respect to FIVIMS the National Planning Commission (NPC) had been identified as a focal point and a task force had been constituted to facilitate the establishment of nutrition surveillance. The Ninth Plan of HMG, Nepal under its Poverty Alleviation Policy had emphasized on the Poverty Information and Mapping (GIS) System.
35. The National Nutrition Coordination Committee (NNCC) had requested for FAO assistance to initiate activities concerning identification of food insecure and vulnerable groups.
36. Mr Vaidya reported to the Consultation that a number of surveys namely Nepal Multiple Indicator Surveillance (1996-97) and Nepal Living Standard Surveys (1997-2002), Nepal Health Surveys (1996), Nepal National Micronutrient Status Survey (1998) and National Food Balance Sheets (Annual) by the Ministry of Agriculture had been conducted, the results of which could be used as database for FIVIMS.
37. Locational Information Collection and Mappings were also underway. District level data bases had been established at District Information Centres located in each of the District Development Committees (DDCS).
38. He also shared with the Consultation that the Department of Health Service in Nepal had established an integrated health management information system which linked local areas with Provincial Divisional Centers and Districts.
39. World Food Programme Nepal had started information and mapping surveys using a comprehensive set of socio-economic indicators to detect poverty and vulnerability in connection with its country programmes on FIVIMS to be implemented from 2002.
Philippines: presented by Ms Elsa M. Bayani
40. The Consultation was informed by Ms Elsa Bayani, that the National Nutrition Council (NNC) was designated as focal point for FIVIMS by the Department of Agriculture as early as January 1998. An orientation meeting, two workshops and a regional advocacy meeting were conducted by the NNC. These activities resulted in the formulation of definition of commonly used terms related to food security, insecurity and vulnerability, "wish" list of indicators, conceptual framework and preliminary design of the FIVIMS including formation of network and linkages. The organizational machinery for the establishment of the FIVIMS was likewise established namely: the FIVIMS National Steering Committee and the Task Force. A resolution was subsequently passed in October 1998 by the NNC Governing Board to establish and operationalize FIVIMS.
41. Ms Bayani also informed the Committee the proposed follow-up actions that included the identification of a minimum set of indicators, finalization of the FIVIMS design and the formulation of a Manual of Operations to pave the way for pilot testing and launching of FIVIMS by the year 2000. Support activities to be undertaken included capacity building on information technology, mapping, data analysis and utilization and conduct of advocacy and awareness campaigns for generation and mobilization of needed resources at all levels.
Sri Lanka: presented by Dr Indra Tudawe
42. Dr Tudawe apprised the Consultation that with the support from FAO one of the main activities undertaken under FIVIMS in Sri Lanka was the examination of existing literature relating to food insecurity, data and sources of data in order to establish FIVIMS in the country. This was intended to assess the vulnerable groups who were food insecure, identify indicators required for monitoring in FIVIMS, and examine quality of available data from different sources and assess their limitations. Data limitations included those that restricted spatial analysis of data and data gaps which hindered the construction of a system to assess and monitor food insecurity. However, re-analysis of existing household data was underway to enable monitoring of micro effects of macro policy changes on food security at different levels.
43. The nodal institution of FIVIMS was the Ministry of Agriculture and Lands with the Hector Kobbekaduwa Agrarian Research and Training Institute (HARTI) of the Ministry of Agriculture and Lands being the co-ordinating agency.
Thailand: presented by Dr Pattanee Winichagoon
44. Dr Winichagoon informed the Consultation that existing national information systems relevant to FIVIMS included health and nutrition information systems, basic minimum needs information systems, community development information systems, agricultural information systems and other similar information systems. A conceptual framework using the family and community as the core for development had been adapted for selection of indicators for FIVIMS in Thailand. The food and nutrition cycle was influenced by several food, agriculture and health variables, which ultimately was reflected in nutritional security outcomes.
45. Efforts to establish FIVIMS in Thailand with the assistance of FAO had included, two meetings with representatives from multisectoral agencies to jointly decide on the type of data to be used for FIVIMS and set up guidelines for its implementation. The mechanisms in developing and using data from various agencies, deciding on appropriate indicators and areas, using potential data from various agencies that link national and international agencies were discussed. Examples of nutrition maps had been developed differentiating nutrition problems using colour coding for sub-national geographical areas. The Institute of Nutrition Mahidol University (INMU) had served as an interim focal point for coordination with various agencies and the FAO. A need was still felt for strengthening political commitment and addressing institutional, technical and financial constraints in FIVIMS implementation.
Viet Nam: presented by Mr Ha Hai Ly
46. From the report of Mr Ly, the Consultation noted that the Viet Nam had made commendable progress in so far as establishment of FIVIMS was concerned. To date, a National Food Security Committee (NFSC) chaired by the Minister of Agriculture had taken overall responsibility for implementation of FIVIMS.
47. A FIVIMS focal point had been established and assisted by a core group of officials coming from key institutes like the National Institute of Nutrition (NIN) and the Ministry of Labour, Invalids and Social Affairs (MOLISA). A FIVIMS project was also being implemented with FAO support. A brainstorming session to identify vulnerable groups in Viet Nam was carried out in addition to a workshop to identify indicators for food insecurity. In collaboration with World Food Programme (WFP) vulnerability mapping was also being undertaken. Projects being taken up to strengthen FIVIMS included linking household food security and nutritional status monitoring, food marketing monitoring and food crop monitoring and policy strategies for sustainable national food security.
48. A thematic group on food security in Viet Nam was established within the UN resident coordinator system in the middle of 1999. FAO in Viet Nam was about to launch its own website providing information about the thematic group on food security. The core groups would mobilize the information of data sources from existing system using a standard format for analysis.
49. Under the FIVIMS - Asia Project, technical assistance and software had been promised by FAO assistance to enable volunteers to muster the possibility of using existing data and showing the FIVIMS data to the stakeholders.
50. Mr Ly shared with the Consultation that while Viet Nam was receiving modest support for FIVIMS -Asia Project funded by Japanese Government, other countries also had supposedly received similar support.
51. The countries were divided into two working groups--Group 1 consisting of participants from India, the Philippines, Thailand, Indonesia and Nepal and Group 2 included participants from Bangladesh, Viet Nam, China, Sri Lanka and the Philippines. The Working Groups reviewed the current status of FIVIMS with special reference to Nutrition Country Profiles (NCP) and other relevant databases and information resources; identified strengths and constraints in FIVIMS implementation; outlined action plans for implementation of FIVIMS based on progress of countries and identified possibilities for FAO support with regard to implementation of FIVIMS. The summaries of the working group outputs are tabulated in Appendices V, VI, VII and VIII.
52. Based on the working group outputs, the Consultation noted that the countries represented in the meeting were in varying stages of progress in so far as the establishment of FIVIMS was concerned. Focal points had been identified in some while others had yet to initiate activities. In countries like India, the Philippines, and Viet Nam, interagency committees had been created and orientation/advocacy meetings were conducted.
53. A number of facilitating factors were identified by the working groups. The multi-disciplinary nature of FIVIMS along with its nutrition component being built upon existing nutrition information structures was to be well recognized and optimally utilized. The Groups also recognized the importance of having an authoritative mandate for the establishment of FIVIMS and creation of appropriate organizational structures.
54. However, the countries noted that there were a number of constraints that hindered the establishment of FIVIMS; to name a few, inadequate awareness among policy-makers, and politicians on FIVIMS and its link with NPAN, lack of co-ordination and involvement of functionaries compounded by limited financial, technical and human resources.
55. The Consultation observed that another major problem for setting up FIVIMS was related to the selection of indicators, lack of clear definitions of terms used and limited technical capability for using mapping software.
56. Dr Nandi urged the Consultation to be more pro-active in seeking out and disseminating information about FIVIMS in as much as there was already a wealth of information and materials available about FIVIMS.
Specific recommendations for establishment and operationalization of FIVIMS
For country action:
For FAO action
Agenda item 3: Improving nutrition in urban areas: strategies adopted at country level as a follow-up to the National Plan of Action for Nutrition (NPAN)
Bangladesh: presented by Mr Mirza Altaf Hossain
58. Bangladesh experienced rapid urbanization over the last few decades with about 20 percent of the total population living in urban locations as reported in 1991. The majority had qualitatively and quantitatively deficient diets which were low in energy, protein as well as micronutrients. Daily per capita energy intake was around 1892 kcal in rural areas and 1779 kcal in urban locations. Malnutrition prevalence was uneven in the cities, being high in Chittagong (15 percent). Strategies adopted to improve health and nutrition situation in the urban areas included credit programmes, model food supply and home service programme, polyethylene free ward programme, education programme, advocacy and housing programmes for low paid female workers. In the private sector, a number of garment industries provided employment opportunities, especially for women which supported betterment of their nutrition and provided them empowerment. Women were getting employment in big markets, multi-storied buildings, florist shops, etc. In addition, medical facilities along with dietary guidance were also expanding in urban areas supported by both private and public sectors.
59. In the public sector, expanded credit programme, housing facilities, vegetable gardening, food demonstration, expanded programme of immunization, sanitation, and provision of safe water had particularly been adopted in urban areas. Events such as breast feeding week, nutrition week at various levels were being conducted. Vitamin A distribution had been strengthened in urban areas as well as the distribution of iodized salt and rice through open market sale. Poverty maps developed by the World Food Programme and Resource Use Map by UNICEF were being used for specific programmes such as Food-for-Work Programme, Food for Education Programme and Vulnerable Group Development Programme. Strong initiatives had been taken by the Ministry of Agriculture to update the mapping. This was intended to benefit related ministries and NGOs, particularly for examining issues related to food production and distribution which were crucial for ensuring food and nutrition security in urban areas.
China: presented by Dr Zhai Fengying
60. Dr Zhai reported to the Consultation the on-going programs for improving nutrition in urban areas. These included nutrition education which highlighted the dietary guidelines and for which various Information, Education and Communication (IEC) materials for different target groups had been developed with support from FAO. The soybean action plan was also in operation which promoted increased and wider utilization of soybean and its products, while the school lunch programme targeted urban school children. China also had a school milk feeding programme to promote the consumption of milk. This was particularly valuable for promoting growth and development of children and addressing the high prevalence of calcium deficiency among them.
61. For more effective actions, the Consultation was informed that China proposed to organize an intersectoral coordination committee. There was need for special attention to be given to food labelling and enforcement of laws regarding labelling and quality control of milk and dairy products.
India: presented by Ms Shashi P. Gupta
62. Ms Shashi P. Gupta highlighted that India's National Plan of Action on Nutrition (NPAN) had identified the role of as many as 14 sectors of the Government for nutrition promotion and all sectors had one or more programmes that addressed issues affecting the urban nutritional status. Some of the important programmes for improving urban nutrition included Public Distribution System of the Department of Civil Supplies, Food processing and food fortification initiatives of Ministry of Food Processing Industries, awareness generation programmes on social and gender issues of Ministry of Information and Broadcasting, Social Forestry Programmes, such as growing of fruit trees on the roadside under the Ministry of Environment and Forests, Urban Poverty Alleviation Programmes of Ministry of Urban Affairs and Employment, Integrated Child Development Services Scheme, and Food and Nutrition Programmes of Department of Women and Child Development. The Food and Nutrition Board, Department of Women and Child Development in pursuance of the National Nutrition Policy mobilized all concerned organizations to integrate basic messages on nutrition in their respective programmes.
63. The Department of Urban Poverty Alleviation implemented programmes for urban poor and ensured access to social services like health, nutrition, women and child development, pre-school and non-formal education. Community Empowerment and establishing community organizations formed the backbone of these programmes. Water Supply and sanitation facilities were also taken care of. Micro credit programmes for women, creches in Government buildings, dissemination of nutrition information to masses through exhibitions were some other programmes for improving nutrition of urban poor.
Indonesia: presented by Ms Irawati Susalit
64. In Indonesia, on-going programmes and approaches for strengthening action towards improving nutrition in urban areas were not separated from those in rural areas. As shown by the SUSENAS data in 1992 and 1998 presented by the World Bank in "Watching Brief 1999", the Government of Indonesia had taken efforts to strengthen their implementation of programmes in urban centers.
65. Under the circumstances of the economic crisis, the priority was to protect the poor and vulnerable groups such as children, adolescents, pregnant women and lactating mothers and subsequently adults.
66. In addition to the existing regular programme, during the last two years (1998/1999) due to economic crisis and drought, the government decided to introduce a specific programme to protect the poor and vulnerable group called Social Safety Net Programme (SSNP).
67. These programmes aimed to ensure food security; create job opportunities and develop small and medium enterprises as well as ensure social protection.
68. The other regular ongoing programmes included food diversification and nutrition programmes under the Ministry of Agriculture, and the nutrition improvement programme under the Ministry of Health. There were nationwide programmes aimed at alleviating nutrition problems of the whole country and address specific issues related to nutrition education, food fortification, training, MIS and food safety as well as research and development.
69. The Consultation noted that there were constraints in improving the quality of street foods. A pilot project aimed at strategic improvement was completed with UNDP and the Dutch government assistance; however, sustainability was an issue and the project needed to be improved.
Nepal: presented by Mr Yogesh Vaidya
70. Rapid urbanization was noted to be occurring in Nepal which had contributed heavily to the population pressure in urban areas. The urban population faced environmental and physical constraints including access to safe and wholesome food, drinking water, housing, health care and sanitation. A correct assessment and analysis of the urban malnutrition was required in order to focus priority actions towards addressing them. The National Nutrition Coordination Committee in the National Planning Commission was, therefore, in the process of strengthening the secretariat for creation of a national nutrition surveillance unit and technical bodies. The Ninth Plan had endorsed the NPAN and had a comprehensive set of strategies and programmes to address the relevant national nutrition problems for both rural and urban areas.
Philippines: presented by Ms Elsa M. Bayani
71. Ms Bayani shared with the Consultation the PPAN framework for addressing nutrition problems for both rural and urban areas emphasizing that basically the impact programs and enabling mechanisms remained the same. However, the nature of the programmes differed in terms of their actual implementation strategies in as much as they had to be location-specific. These impact programs included home, school and community food production, micronutrient supplementation, food fortification, nutrition education (particularly the promotion of Philippine Nutritional Guidelines), livelihood assistance and food assistance.
72. Ms Bayani cited Pateros, Metro Manila as an example, to demonstrate specific strategies and activities that were undertaken to reflectively address urban nutrition problems and their underlying causes through combined direct and indirect nutrition interventions.
73. The Consultation noted that several projects directed towards enhancing food availability and accessibility such as Enhanced Retail Access for the Poor (ERAP) sari-sari stores and establishment of People's Markets which provided food subsidy were undertaken. Street foods, a major concern in urban nutrition, were also being carefully looked into in terms of food quality and safety as they were fast becoming a major source of food for the urban poor as well as an income-generating activity.
74. Likewise, she forwarded a set of recommendations which included simultaneous and coordinated response to urban and rural nutrition problems, development of countryside and alternative urban centers and increased partnership with the academia and private sector among others.
Sri Lanka: presented by Dr Indra Tudawe
75. Information on urban nutrition problems in the country was very limited. However, available data did not show a significant difference between rural and urban areas in the country. While no specific programmes were directed toward urban areas, the national programmes included iodization of salt, food supplementation programme for pre-school children, pilot biscuit feeding programme and nutrition education which could also address urban nutrition problems. Legislation had been passed on food labelling and food standards.
Thailand: presented by Dr Pattanee Winichagoon
76. The Consultation was updated on the food and nutrition situation in urban areas of Thailand. While there were observable undernutrition and micronutrient deficiency disorders in the urban areas, the problems in the rural areas had received more attention. Data on overnutrition was more pronounced in urban than in rural areas.
77. It was noted that Thailand was implementing a number of programs to address nutrition problems in both rural and urban areas such as school lunch and school milk programmes, intensification of breastfeeding campaigns. The country was also presently undertaking improvement of urban food and nutrition security programmes by mobilizing people's participation, partnership building/networking, and strengthening access to needed support, for example, link with academia for research and public education and campaigns particularly related to food labelling.
78. Street foods were considered as an inexpensive and convenient source of nutrition in urban areas. However, strengthening the infrastructure with particular reference to quality control measures and sanitation aspects were to be pursued.
Viet Nam: prepared by Mr Le Danh Tuyen and delivered by Mr Ha Hai Ly
79. The Consultation was informed that since the last decade, Viet Nam's transition to a market economy had brought about economic improvements, markedly affecting the food and nutrition situation of the country, particularly urban areas. Protein and fat intakes had significantly increased and there was now a growing preference for processed, restaurant and street foods. Negative effects on infant feeding practices were likewise observed such as early weaning and increasing trend in the use of breast milk substitutes.
80. It was also reported to the Consultation that there was an increasing trend in the prevalence of non-communicable degenerative diseases like cardiovascular diseases, diabetes, obesity among adults. Prevalence of obesity among school children was observed to be higher in urban than rural areas.
81. Based on the analysis of the urban nutrition situation, a set of recommendations was suggested which included enforcement of regulations for protection of urban and peri-urban dwellers, strengthening private sector involvement in addressing urban health and nutrition problems, urban planning, food safety program and careful review of food supply and distribution policies.
82. Countries were again divided into two working groups to deliberate on common issues related to problems of urban nutrition in the context of FIVIMS. The Consultation noted that in urban areas all countries had common nutrition problems. These were the co-existence of under and overnutrition, micronutrient deficiencies, diet related non-communicable diseases/problems such as obesity, cardiovascular disease, diabetes mellitus and certain types of cancer. The prevalence of undernutrition (PEM) in particular, was higher in the urban slums. Low birth weight (LBW) was noted to be high in slum areas as well as episodes of infectious diseases.
83. Diet related non-communicable diseases were observed to be rising not only in the upper income groups but also in the low income categories. The rise in chronic degenerative diseases was attributed to sedentary and unhygienic lifestyles.
84. Another major concern in urban nutrition was food quality and safety with the increasing dependence of urban dwellers on street foods/fast foods and convenience foods. Microbial and chemical contamination of food was also a problem.
85. The Consultation observed that the intervention strategies undertaken for improving urban nutrition were similar to those applied in rural areas except that the modalities and focus differed. The programmes ranged from nutrition education, targeted food assistance, micronutrient supplementation, feeding of energy dense foods, improvement of environmental sanitation to enforcement of food laws and regulations to protect the consumers.
86. There was a consensus among participants that to successfully implement nutrition programmes in urban areas, there was need for advocacy, focused targeting and intervention, provision of technical support, research and development, institutional arrangements, community improvement and built-in monitoring evaluation. The Consultation also underscored the importance of building partnerships/alliance of various programmes of the countries with community based organizations (CBOs), NGOs, private sectors, professional organizations, academia, media and international agencies so that urban nutrition problem could be better addressed. Lastly, it was agreed that urban nutrition should be integrated into the overall FIVIMS infrastructure.
87. Specific recommendations to improve urban nutrition:
For country action
For FAO action
