II. CONCLUSIONS AND RECOMMENDATIONS FROM THE
PAPERS PRESENTED AND DISCUSSED
- Biplab K. Nandi discussed FAO’s
perspective of integrating nutrition orientation to food production. He started
by defining food security and nutritional security. Food security was said to
exist when all people, at all times, have physical and economic access to
sufficient, safe and nutritious foods to meet their dietary needs and food
preferences for an active and healthy life. Nutrition security, on the other
hand, was ensured when there was adequate intake and utilization of macro- and
micronutrients by the body. Given these definitions, Mr. Nandi informed the Consultation
that as far as FAO was concerned the two were synonymous for all practical
purposes.
- He reminded the Consultation that FAO’s
mandate was to raise the levels of nutrition and standards of living of the
people, securing improvements in the efficiency of the production of and
distribution of all food and agricultural products, bettering the condition of
the rural populations and thus contributing towards an expanding world economy
and ensuring humanity’s freedom from hunger.
- The global and regional nutrition
situation was also presented, reiterating some of the figures cited by Ms.
Latief. In particular, he mentioned the global nutrition paradox where FAO
estimated 852 million as being undernourished and WHO estimated 300 million
obese adults. Of the latter, about 115 million were from developing countries.
He brought to the attention of the Consultation the fact that while
undernutrition, micronutrient deficiencies and low birthweight continued to
persist globally, there were new, emerging concerns like diet-related,
non-communicable diseases and cancers. Food safety and quality issues were also
of global importance.
- Mr. Nandi further shared a number of
important international resolutions and recent events of which the MDGs had
taken center stage. He also discussed how investing in nutrition was critical
in achieving the MDGs. Important publications, specifically the SCN and the World
Bank policy document entitled “Repositioning Nutrition as Central to
Development: Strategy for Large Scale Action” were also brought to the
attention of the Consultation. In brief, the message was “Investing in
Nutrition” was to nourish a nation.
- With reference to the ADG’s
opening remarks on FAO reform, Mr. Nandi shared with the Consultation the
rationale for the transfer of the Nutrition Division to the new Nutrition and
Consumer Protection Division within the Agriculture Department. The move was
viewed as a means to create sustainable improvements in nutrition, especially for
nutritionally vulnerable groups, raise awareness on the benefits of ending
hunger and reducing malnutrition, assist countries in identifing the food
insecure and nutritionally vulnerable, promote food safety and prevent
food-borne illnesses and focus on consumer protection and fair practices in
food trade.
- He also informed the
Consultation about FAO supported projects on food-based strategies and some of
the lessons learned in countries like India,
Indonesia, Lao PDR, Sri Lanka, Thailand
and Viet Nam
which had demonstrated increased consumption of micronutrient rich foods and
concomitant improvements in nutritional status.
- The important agriculture and
nutrition linkages were also revisited in terms of how agriculture could
contribute to nutrition goals, challenges and opportunities, increasing
synergies between agriculture and nutrition.
- A number of recommendations for
future action and conclusions were also shared by Mr. Nandi for discussion and
consideration at the Consultation.
Nutrition promotion: special remarks by Kraisid Tontisirin
- Kraisid Tontisirin
mentioned that a network such as ANFN
only existed in Asia. He likewise
congratulated the ANFN Secretary for
the choice of a very timely topic. Moreover, he congratulated Mr. Nandi for
making a very comprehensive presentation which truly reflected FAO’s mandate
and views. He emphasized that the link between food, nutrition and health
covered a wide range of food and nutrition security issues. Hence, in addition
to the definition of food security which included availability, accessibility,
consumption and utilization, sustainability, at the global, national and
household levels should also be considered.
- He stressed to the
Consultation the need to reemphasize important concepts like the need for
promotion of healthy practices like basic hygiene and the need to target
different vulnerable groups. Adequate food supply was laying the foundation for
nutritional well-being and had the potential of bringing this about either
through income and non-income means. The importance of food quality and safety
issues involving the private sector was also stressed.
- However, he also reminded
the Consultation that demand for nutritious and safe foods must be created.
Practical examples from Indonesia
on running home gardens were cited. Recently, school gardens have been
emphasised to promote learning about production by school children and to increase
the food supply for school meals. Urban food production should also be the
subject of government actions by exploring technologies like hydroponics. This has
the potential for providing food supply for hotels and the tourism industry and
can thereby generate income.
- He mentioned that FAO had
developed the Anti-hunger Programme employing twin track approaches to address
hunger and malnutrition. One was by improving the efficiency of food production
through efficient, supportive and facilitating rural infrastructures and
communities based programmes, the other was through social safety nets for the
poor and vulnerable groups of the population. He also encouraged the use of
nutrition indicators in all food and nutrition programmes to help achieve the MDGs.
Presentation by Mirza Altaf Hossain
- The Consultation noted
that Bangladesh
had made commendable progress in cereals (rice, wheat and maize) production
since independence. However, production and availability of other food items
were far below the requirements. As a result, the food basket both at the
national and household level was seriously imbalanced. Due to such a situation,
there was a wide prevalence of malnutrition particularly among pre-schoolers,
adolescents and women. In view of this, various measures had been undertaken by
government and non-governmental organizations following several policies
related to food and nutrition. Still, the country required further initiatives
with special emphasis on nutrition orientation to food production to ensure a
balanced food basket at all levels.
- Non-food factors such as
sanitation, safe water and nutrition education in the context of Bangladesh
were also recognized as equally important to improve the malnutrition situation
in the country. A number of programmes and projects had been initiated by
government and non-government organizations to take care of these aspects such
as updating relevant policies, increasing horticultural crops, ensuring safe
food, safety net programme, safe water and sanitation along with nutrition
education.
- A set of recommendations
were also shared with the Consultation. These included promotion of nutrition
orientation among policy-makers, implementers, consumers and producers.
Relevant policies needed to be updated to include a nutrition focus and
incorporation of nutrition objectives in development, use of nutrition
indicators for monitoring and evaluation and increased allocation of national
budget for nutrition programmes, food based strategies in particular.
- The Consultation noted
that, despite low food production, improvements in maternal mortality rates
were observed which could be largely attributed to other nutrition
interventions like micronutrient supplementation and provision and access to
better maternal health care services.
- It
was also suggested that countries’ data could link up with FAOSTAT to come up
with good quality and comparable data that would allow intercountry
comparisons. In Bangladesh,
the Consultation was informed that the Bangladesh Bureau of Statistics was
responsible for generating agricultural and related data.
Presentation by Hongju He
- The
Consultation was informed that substantial improvements in comprehensive
production capacity for food was China’s primary concern. While grain
production had grown steadily, production of meat, eggs, aquatic products,
fruits and vegetables had all increased rapidly, laying a solid foundation for
the improvement of people’s living standards. An obvious improvement in the
quality of food consumed was documented. However, problems related to
fluctuations in food production, consumption and nutrition, and the hidden
perils in food quality, safety and sanitation conditions, which might impair
people’s health continue to exist.
- The
Consultation was informed that China’s
goal of food and nutrition development in the year 2010 was to guarantee an appropriate
nutrient intake by all Chinese. Specifically, the goal was to have a per capita
energy intake of 2 300 kilocalories, of which 80 percent was of plant-origin
and 20 percent animal origin. For protein, the target per capita intake was 77
grams, of which 30 percent was of animal origin. The target average intake of
fat was 70 grams, accounting for 25 percent of the total energy intake. The
average intake of calcium would be 580 mg, iron 23 mg, zinc 12 mg, vitamin B1
1.2 mg, vitamin B2 1.4 mg, and Vitamin A 775 ug.
- In the next decade, priorities would be
given to dairy products, soybean production and food processing. Meanwhile, it
was recognized that China
should also strive to promote food and nutrition security in two key areas:
rural areas and western China,
and also in three key vulnerable groups, namely, young children, pregnant and
lactating women and elderly people.
- The Consultation noted that
those living in rural areas had better diets than their urban counterparts.
Specifically, the high fat largely meat-based diets of urban dwellers result in
overweight and obesity. To address this problem, China was promoting physical
activity and the use of the Chinese food pagoda as a guide to ensure a more
balanced diet.
- It was also noted that
putting the reduction of hunger high on the agenda of the Chinese Government
had contributed tremendously to nutrition improvement. This had also led to an
appreciation of the important link between food and nutrition.
Presentation by Shashi P.
Gupta
- Shashi P. Gupta highlighted the
importance of the subject of the Consultation stating that nutrition was
critical to achieving six of the eight MDGs and that nutrition orientation to
food production, both farm as well as processed foods, was essential to
achieving food and nutrition security at the household level.
- The nutrition and health
scenario in the country was projected through the human development index, nutrition
and health, food production and food security indicators. It was pointed out
that, while India
had conquered the florid nutritional deficiency disorders and severe
malnutrition had reduced significantly, child malnutrition, anaemia and
mortality rates continued to be a cause for concern.
- There had been a significant
achievement in food security at the household level also as revealed by the
reduction in the number of households not receiving two square meals a day from
7 percent to 0.5 percent for rural and 3 percent to 0.1 percent for urban
households over the past two decades.
- A number of direct and indirect nutrition
interventions were being made by the concerned sectors of the government. To
name a few, the Integrated Child Development Services, Food and Nutrition
Education and Training Programmes, Nutrition Programme for Adolescent Girls of
the Ministry of Women and Child Development and National Rural Health Mission
including Reproductive and Child Health Programme II, Iron and Folic Acid and Vitamin
A Supplementation Programme and National Iodine Deficiency Disorders Control
Programme of the Ministry of Health and Family Welfare were the direct
programmes. Examples of indirect interventions of great importance included
various food production and horticultural interventions, poverty alleviation
programmes and targeted public distribution systems.
- Food production had progressed
satisfactorily over the years and India was not only self-sufficient
in food grains, it also had adequate buffer stocks and exported a number of
foods. However, the challenge that remained included achieving nutrition
security at the household level, ensuring adequate production and supply of
protective foods like pulses, coarse grains (particularly for below poverty
line people), fruits and vegetables, milk and milk products, fats and oils etc.
at affordable prices both in rural and urban areas.
- The National Horticulture
Mission, the National Commission on Farmers, the centrally sponsored integrated
scheme of oilseeds, pulses, oil palm and maize, and fixing minimum support
prices for pulses were some of the initiatives for meeting this challenge.
- Food fortification programmes
were also gaining momentum. The Government of Gujarat was fortifying wheat
floor with iron, folic acid and other nutrients and supplied fortified flour
both through the public distribution system and open market throughout the
entire State. Double fortified salt (DFS) was also made available in a number
of States.
- Strategies for nutrition
orientation of polices and programmes of key sectors viz. Agricultural, Food
and Civil Supplies, Food Processing Industries, Health and Family Welfare,
Women and Child Development were being promoted through regional consultative meetings
on nutrition organized by the Food and Nutrition Board during 2005-06 and the
Working Group Reports for the 11th Five Year Plan.
- Greater collaboration between
the Ministries of Agriculture, Food and Public Distribution, Food Processing
Industries, Health and Family Welfare and Women and Child Development was
advocated for achieving synergistic impact of these programmes.
- The nine action-oriented themes
of the World Declaration on Nutrition in 1992 included “integration of
nutritional concerns in policies and programmes of the development sector”.
This theme continued to be and was even more relevant to date in the context of
achieving the MDGs.
- It was emphasized in the
Consultation that nutrition ought to become a national agendum and malnutrition
a national problem. It is only when a multi-dimensional and a multi-level
action was planned to address the problem of malnutrition that the vision of a
“malnutrition free India”
could be achieved.
- “Achieving better nutrition for
health and development” needed to be the goal of the National Nutrition
Programmes with contributions from every stakeholder.
Presentation by Maria Antonia G. Tuazon
- Maria Antonia G. Tuazon updated the
Consultation on recent developments in nutrition in the Philippines.
The Philippine Plan of Action for Nutrition was now referred to as the Medium
Term Philippine Plan of Action for Nutrition (MTPPAN) which was an integral component
of the country’s Medium Term Development Plan (MTDP). This move was reflective
of the underlying perspective that nutrition was a basic human right and there
was a need to pursue nutrition in a development perspective to attain
sustainable nutrition improvements.
- The Philippines
food production in the past year had grown, with the biggest sub-sector, crops,
registering a 0.48 percent growth in production compared to last year’s
performance. The sub-sector accounted for 46.74 percent of total agricultural
output. Likewise, the livestock
sub-sector posted a 2.04 percent growth, the poultry sub-sector registered a
1.41 percent increase, and the fishery production was up by 6.47 percent.
However, compared to its neighbours in Asia,
the Philippines
lagged behind in terms of food production of major food crops, particularly
cereals, fruits, vegetables, meats and milk.
- The Food Balance Sheet (FBS) estimated
the per capita daily supply of food in 1990 and 2000 and 2001 as 132 percent
and 120 percent, respectively. This was well within FAO’s recommendation of
120-130 percent for evaluating adequacy of food supply. However, this seemingly
food adequacy at the national level did not translate into household food security.
Around 57 percent of Filipino households had per capita food intake below 100
percent of the Recommended Energy and Nutrient Intake (RENI) based on the latest
FNRI survey.
- The overall dietary
pattern of Philippine households remained that of rice, vegetables and fish,
which contributed 34, 13, and 12 percent, respectively, of the total food
weight of 2003, which was 886 g/day. Fruit and vegetable consumption was also a
far cry from international recommendations.
- In
terms of the nutrition scenario, 27 percent of Filipino children under 6 years old
were underweight, an improvement over the prevalence rate of 34.5 percent in
1989-1990. Wasting among the same age group slightly increased from 5 percent
in 1989-1990, to 5.5 percent in 2003.
The prevalence of underweight among children 6-10 years was at 26.7
percent, while overweight among children aged 6-10 years increased dramatically
within the period of over ten years from 0.1 percent in 1989-1990 to 1.3
percent in 2003. The prevalence of undernutrition among nutritionally-at-risk pregnant
women decreased from 30.7 percent in 1998 to 26.6 percent in 2003.
- Micronutrient deficiencies continued to plague the population. An increase in the prevalence of low to
deficient serum vitamin A levels among children 6 months to 5 years was also
shown from the last survey. Iron deficiency anaemia remained consistently high
among pregnant women, but had decreased for lactating women. The highest
prevalence was observed among 6 months to 1 year old infants at around 66
percent. IDD among 6-12 year old children, however, improved significantly.
- High-impact
programs employing several approaches to promote and realize nutritional
adequacy in the country had been implemented. From the experiences in the
implementation of these programs a number of best practices had been
documented. For food production, programs like Bio-Intensive Gardening (BIG)
and Food Always in the Home (FAITH), vegetable gardening had been undertaken
alongside backyard poultry, swine and goat raising and fisheries with the
involvement of nutritionally at-risk groups as well as the entire community. Key
elements of success included the provision of technical, material, and
financial assistance. A self-sustaining format with community involvement and
focus on indigenous, easy to grow crops also contributed to successful programme
implementation and sustainability.
- Supplementary feeding continued
to have a place in the Philippines
in its fight against undernutrition. It was basically implemented as a safety
net and not as a long-term strategy. Best practices documented in supplementary
feeding included complementation with other programs like home food production
and income generating activities and use of indigenous foods to lower reliance
on donated foods.
- Food Fortification seeks to
increase micronutrient intakes without necessarily changing eating habits.
Under this flagship programme, the country had launched Sangkap Pinoy Seal
(SPS) or seal of acceptance by the Department of Health (DoH) which informed
the consumers that the product had been fortified with important
micronutrients. Fortification for Iodine Deficiency Elimination (FIDEL) for the
promotion of consumption of iodized salt was another programme which was
anchored on a strong Government–NGO partnership and capacity-building among
local government units and small entrepreneurs.
- Key elements of success in micronutrient supplementation included
assurance of timely delivery of supplies and mass media campaigns as
complementary activities to generate awareness and participation.
- For nutrition information, education and communication (NIEC), documented
best practices included putting emphasis on doable actions, and user friendly
and focused messages. NIEC materials need to be laymanized as well as
translated into local dialects. Messages must be synchronized as well as
consistent, especially if they were coming from various sources, and private
sector involvement was also critical.
- It was emphasized that most of these programmes form part of what was
referred to as integrated programmes. Notable examples of integrated programmes
included the Barangay Integrated Development Approach for Nutrition Improvement
of the Rural Poor (BIDANI) and Lalakas ang Katawan sa Sapat na Sustansiya
(LAKASS). Key elements of success included capacity-building of various
stakeholders, clear delineation of functions, setting up an effective
monitoring and evaluation system, promotion of community participation in all
aspects of programme planning and management, GO-NGO- academe-private sector partnerships
and mobilization of indigenous workers.
- Lastly, citing the evaluation conducted by Florentino et al. 1993,
the Consultation was informed that nutrition orientation to food production was
a viable option for achieving MDGs, however, considering the multisectorial
nature of malnutrition, the solution often required a multi-pronged approach.
One should also recognize that while the potential was there, its small scale,
seasonality and human behavior undermined the potential impact of food production.
Likewise, our propensity to consume foodstuffs like fruits and vegetables was
only so much.
Presentation
by Rose Rupasinghe Samuel
- The Consultation noted that
departments/programmes in the Ministries of Agriculture and Health played
pivotal roles in food production and nutrition improvement programmes in Sri Lanka
which has an agriculture-based economy. Conducting research, implementing
programmes and disseminating information on food production, health and
nutrition are the core activities performed by these two ministries. The
resources of these two ministries are productively utilized by a multitude of
nutritional interventions in the country (example, Poverty Alleviation
Programme – “samurdhi”, schools, World Food Programme, etc.). It was
recommended that a synergistic formal link between the two Ministries be
established.
- The
food crop sector comes under the purview of the Department of Agriculture which
was established in 1912 with the objective of serving the farming community. Today
the major thrust of the Department is to be self-sufficient in the staple rice,
other field crops (for consumption and industry), fruits (for consumption and
export) and vegetables (for consumption). This is to be realized through
establishment of crop specialization regions which were identified in 2005.
Rice, the staple, attained almost self-sufficiency (97 percent, 2004/2005)
through its Grannary Area Programme which commenced in the 2003/2004 cropping
season in selected, high potential rice growing areas in collaboration with
relevant stakeholders A project assisted by the World Bank was in progress with
the research division of the Department of Agriculture from 2004 to breed a
rice variety with higher iron content. The only programme which dealt with
nutrition from its inception (1970) was the Women’s Agricultural Extension
programme of the Agricultural Extension and Training Division of the Department
of Agriculture. Its goal from 2005-2009 was stated as “Enhance nutritional
status and living standards of family units through increased contribution of
women to agricultural production”. The Family Business
Garden concept, commenced
in 2000 in the western province
of Sri Lanka (urban
agriculture), also promotes family nutrition in agricultural extension
programmes.
- Although Sri Lanka reports success in life
expectancy, a non-significant improvement was observed in some nutritional
indicators as compared in 2004 and 2005. Three micronutrient deficiencies,
namely iron, vitamin A and iodine were identified as public health problems. A
food-based approach was recommended by the Ministry of Health along with a supplementary
approach and public health interventions. The Medical Research Institute of the
Ministry of Health conducted health oriented applied research to keep vigil
over the nutritional status of the country. The Family Health Bureau focussed
on pregnant and lactating women and children up to 5 years through their
island-wide network of medical clinics (common locations are used too) to reach
the targeted population. The Health
Education Bureau uses printed media widely (less of electronic – budget
constraints) to educate the local masses and targeted groups (example, school
children and teachers, youth etc.) on general health issues and disease
outbreaks (example, Dengue).
- The most recent (2006)
interventions to uplift food production and nutrition in Sri Lanka were initiated by the
present political leadership of the country. The strategy was to identify the
needy groups in their geographical locations and to direct the necessary
resources to them. Although political mobilization and consciousness-raising
were vital elements for a successful development process, it is too early to
assess the results. It was recommended to establish a national focal/nodal body
of relevant actors (government, non-government, private sector participation)
to facilitate food production programmes (growing and processing) to address
the nutritional problems in Sri
Lanka. This focal point may guide the policy
formulation and allied activities pertaining to agriculture and nutrition
(example, programme development and implementation, capacity building, media,
programmes, etc.). The focal point may be used to strengthen the weak areas in
the sphere of agriculture and nutrition (example, addressing all the needy
groups: elderly, children etc., urban and rural sectors separately), promotion
of production and consumption of foods of animal origin.
Presentation
by Emorn Wasantwisut
- Emorn Wasantwisut informed the
Consultation that Thailand,
as an agriculture-based economy, had achieved food production levels that meet
the needs of the population for domestic consumption and at the same time was
able to export surplus foods produced to other countries. Thailand’s food
production index number rose from 98 in 1995-97 to 104 in 2001-03, while food
distribution, accessibility and affordability varied within the country as
depicted by the food consumption and income inequalities (Gini coefficients) of
0.16 and 0.43, respectively.
- In terms of food consumption, there was a
slight increase in consumption of fats, particularly in the urban population. Malnutrition
among 0-5 year old children had declined primarily due to an effective Primary
Health Care programme and successful poverty alleviation programs. Even after
the economic crisis that hit the country in 1997, the nutrition situation was
not adversely affected. The prevalence of iodine deficiency disorders had also
decreased due to implementation of a number of nutrition interventions. It was
projected that, in the next ten years, deaths from infectious diseases,
maternal and perinatal deaths and nutritional deficiencies combined would
decline by about 3 percent. However, an important problem that must be
addressed was obesity, the prevalence of which rose from 12.2 percent to 15
percent among 5-12 year old children in just two years.
- Ms. Wasantwisut informed the Consultation
of the changes that had taken place in the focus and approach for addressing
malnutrition. The First National Food and Nutrition Plan focused on nutritional
deficiencies, attacking the problems from all corners. Significant improvements
were noted due to the integrative and consensus building approach as well as
capacity-building. The 7th to the 9th National Economic
and Social Development Plan (NESDP) ushered in a new era as separation of
responsibilities took place. Food production and supply had been under the
responsibility of the Ministry of Agriculture and Cooperatives and the private
sector; food safety issues are under the responsibility of the Ministry of
Agriculture and Cooperatives and Food and Drug Administration; nutrition became
mainly the responsibility of the Department of Health of the Ministry of Public
Health. The 10th NESDP was recently launched which would address the
double burden of malnutrition, again in an integrated fashion and involving
academia and civil society. Inclusion of nutrition indicators at the
individual, community and societal levels were also highlighted.
- The Consultation was informed of a number
of food production and nutrition programs such as the Agriculture for School
Lunch Programme, H.M. the King’s “New Theory” on Agriculture, We Love Green
Vegetables project and Indigenous Karen Children’s project. These projects
empowered communities to proactively engage them in improving the health and
nutritional status of their children by consuming nutritious foods produced and
knowing how to become self-reliant through a holistic and cost effective
management of their lands.
- The new challenge for Thailand was to go beyond food
production and strike a balance between imports and exports where healthy foods,
either produced, imported or manufactured, were retained and promoted. At the
same time, the country must deal with obesity and other chronic diseases and
promote an integrated and intersectoral approach.
- Sumalee
Soontornnarurungsi also shared with the Consultation some of the programmes
implemented by the Ministry of Agriculture and Cooperatives specifically in the
conduct of training and education of farmers and farm women groups to enable
them to become more self reliant. Home gardening, livestock production, food
preservation, integrated farming systems and organic food production were some
of the topics tackled in these trainings. Accomplishments included setting up
of around 23 000 groups of farm women groups, 2 006 self sufficient
integrated farms, 598 school lunch programs and around 5 000 rice
community centers, among others.
Presentation
by Gamini Keerthisinghe
- Gamini Keerthisinghe shared with the Consultation the
challenges to crop production for enhanced food security. These included
increased population, limited availability of fertile land and water resources
and continued degradation of the resource base that posed major constraints to
food security. Integrated management practices needed to be identified for
increasing crop/food production with minimal adverse effects to the environment. Increased investments and
policy reforms were needed for supporting these activities.
- He added that there was a need for integrated
strategies for conservation and efficient utilization of the already limited
and fragile biological resources. The main approaches to integrated plant
nutrient management were shared which included improved cropping systems,
development and use of crop germplasm with superior resource use efficiency and
use of management practices for the efficient use of locally available nutrient
resources, fertilizers and water in cropping systems.
- The Consultation was informed that the development and
transfer of promising technologies was one important strategy to be adopted.
Extension services should be designed in such a way that promising technologies
were disseminated for the adoption of farmers. This entails active policy
intervention in supporting research and development as well as consideration of
the socio-economic and agricultural practices of the farmers.
Presentation
by Dini Latief
- Consultation noted the presentation entitled:
Strategic Directions for Improving Nutritional Status Using the Life Cycle
Approach.
- Ms. Latief informed the Consultation of the
rationale for adopting a life cycle approach. She mentioned that sustainable
agriculture lagged behind MDGs. Undernutrition and overnutrition was still
prevalent in the region, the quality of nutrition care was poor and the effects
of malnutrition truly detrimental to the individual, community and nation. One
should recognize that nutritional status effects were passed on from generation
to generation although it took quite a while to see the long-term effects.
- The framework for achieving better nutrition for health and development
was presented to the Consultation. There were four guiding principles which WHO
adhered to, namely, human rights, life cycle, obligatory functions and equity.
Human rights address inequity, respect and protection of human rights. Equity
should be viewed in a larger context and not just address gender and
socio-economic inequalities. Life cycle, on the other hand, recognized the need
for continued care from before and around birth, infancy, childhood,
adolescence and old age. Obligatory functions encompassed not only the
delegation of authority in a decentralized form of government but also tackled
how authority was delegated. Vertical as well as horizontal integration should
be pursued.
- A number of strategic directions were also suggested to the Consultation.
These were management of nutrition programmes, capacity-building of human
resources, innovative approaches and research, besides public-private
partnerships.
Presentation by Hardinsyah
- The Consultation noted that the
Government of Indonesia viewed food security in a holistic way encompassing
both social and economic sectors. For this reason, the national food security
policy and programmes is coordinated by the National Food Security Council
(NFSC), which is chaired by the President of the Republic of Indonesia.
The Chair of the NFSC is the Ministry of Agriculture, and the Secretary to the
NFSC is the Head of the National Food Security Board (NFSB).
- The Development Policy stressed
the importance of nutrition and food security programmes for better quality of
human resources and for improved national economy and security. The nutrition
policy prioritized nutrition and health of vulnerable groups, especially
pregnant women, lactating women and children from lower income families. The
food policy focused on improving food production, food availability, food
safety, and dietary quality, as mandated by Food Act no 7/1996.
- The Government adopted global
commitments on food, nutrition and health such as the International Conference
of Nutrition (ICN), World Food Summit (WFS) in the context of the UN Millennium
Development Goals (MDGs). This could be seen through the existence of the NFSC,
the NFSB, the Food Based Dietary Guidelines, the Food and Nutrition Plan of
Action, and the Food and Nutrition Surveillance, and the well designed policy
and programmes on nutritional health and food security which gave priority to
poor people and underdeveloped areas.
- The agricultural sector played a
significant role in Indonesia’s
economy, work force and food supply for about 220 million Indonesian people. Some
food commodities were produced in significant amounts such as rice, corn,
cassava, fruit and palm oil. Some of them showed rapid annual growth such as
fruits, palm oil, poultry and eggs.
- The food consumption data
showed that the food consumption pattern of Indonesians was highly dependent on
carbohydrate food sources (cereals) and lacking in animal food and fruits. However,
the trend for meat and milk intake was increasing parallel to the improvement
in people’s income. To fulfil local
demand, meat and milk was imported. The availability and the intake of energy and
protein was relatively stable during the last three years, but the dietary
quality, measured by the Desirable Dietary Pattern Score (DDS) increased from
72.6 percent in 2002 to 78.2 in 2005.
- Data on nutritional status
showed that the prevalence of underweight children decreased from 37.5 percent
in 1989 to 24.6 in 2000, and slightly increased to 27.5 percent in 2003. About
one-third of the underweight children were categorized as severely underweight.
The prevalence of iodine deficiency disorders (IDD) decreased significantly
from 27.9 percent in 1990 to 11.1 percent in 2003. The prevalence of iron deficiency anaemia
(IDA) decreased for pregnant women from 50.9 percent in 1995 to 40 percent in
2001. However, the prevalence of IDA among children increased from 40 percent
in 1995 to 48.1 percent in 2001.
- In terms of mortality, the
infant mortality rate (IMR) decreased from 68 per 1 000 live births in
1991 to 35 per 1 000 live births in 2002. The under-five mortality rate
declined from 97 per 1 000 live births in 1991 to 46 per 1 000 live
births in 2002. The data also indicated some reduction in maternal mortality –
down to 307 per 100 000 live births for the period 1998-2002. These
figures were still higher compared to neighbouring countries such as Malaysia, the Philippines,
Singapore and Thailand.
This might be due to lack of care, undernutrition and lack of sanitation.
- Although, in general, the food
security situation at the macro level was getting better, both macro- and
micro-nutrient deficiencies were still prevalent among Indonesian children and
women, particularly among the poor. Solving the above problems would require better
leadership and resource allocation and it could not be done alone by the
Government of Indonesia. The solidarity
amongst countries in Asia was critical as well
as global partnership and cooperation for the achievement of the goals of the
ICN, WFS and MDGs.
Presentation by Cao Van Hung
- The Consultation was informed that, although Viet Nam implemented an
agricultural diversification programme, the country still faced many problems
relating to processing, preservation, pricing and marketing. At the community
and household levels, food production had not been stable and sustainable.
Despite this situation food and nutrition security had
clearly improved, although some risk factors still existed.
- In
Viet Nam,
recent experiences showed that food insecurity accounted for 26 percent of
malnutrition. Malnutrition reduced the annual GDP
growth by 2.4 percent, if simply based on physical work capacity. In terms of
mental retardation due to lack of nutrition care in early childhood and cost of
treatment, it was estimated that PEM, IDD and anaemia lowered GDP by 0.3
percent, 1 percent and 1.1 percent, respectively. Investment in nutrition had
high economic returns. An investment of 1 billion VND in the PEM and anaemia
control programme was expected to yield economic benefits of 8.56 and 5.38
billion VND, respectively. In addition to this, nutrition was also considered
as an effective investment to alleviate poverty. There was still a need to
incorporate nutrition
considerations into food production and related programmes in Viet Nam.
- A multi-sectoral or integrated approach to addressing malnutrition was also
deemed important. This was true for the VAC ecosystem (in Vietnamese Vườn, Ao,
Chuồng and in English vegetables, aquaculture-fish and cage-chickens, ducks) in
rural farms. The VAC was particularly important in improving the micro-nutrient
value of diets of rural farm families. Efforts needed to be directed toward the
cultivation and use of edible, indigenous plants as sources of micro-nutrients.
Presentation by Sudip Kumar
Rakshit
- The Consultation noted the presentation entitled Food Production
Implications – Some Nutrition for Thought and some of the nutrition implications of
food production. Mr. Rakshit started out by saying that, considering the
magnitude, causes and consequences of malnutrition, there was a need for a major
policy framework and obligations for the food production sector to place
emphasis on nutrition. The Consultation recognized that, given the Thailand
experience where agricultural production was one of the key programmes of a
poverty alleviation plan, food production could significantly promote household
food security and income generation.
- The Consultation also noted that most of the strategies that had been
adopted were long routes to improving nutrition. With the adoption, however, of
agricultural biotechnology (which had been rapid) biotech plants with improved
consumer attributes (e.g. functional foods) could now be made available and
accessible to the consumers. Examples of these products were enhanced soybean
protein, new omega-3 products, improved wheat carbohydrates and the golden rice
which was high in beta carotene.
- Other possibilities for improving nutrition through food production were
organic farming bio-farming, minimally processed foods and improvements in the
nutritive value of foods. It was noted that the principles of Good Agricultural
Practices (GAP) took account of food safety and environmental concerns, among
others. This was particularly important in the light of numerous food safety
risks in agriculture and food production like illegal pesticide compounds,
inappropriate use of agrochemicals etc.
- Lastly, the Consultation recognized the importance of functional
foods. Mr Rakshit mentioned also that
there were important issues to address like appropriateness for genotype and
phenotype, emerging market niches, affluence and consumer sophistication,
attribute discovery and food diversity meeting nutritional needs.
- The participants were assigned to
two groups. Group 1, coordinated by Sudip Kumar Rakshit, was to review current
food production as well as nutritional well-being policy framework and major
constraints with regard to its application. Group 2, coordinated by Hardinsyah,
to review on-going food production and nutrition improvement programmes and
projects. Both groups were to come up with recommendations which could improve
policy formulation and programme planning and management. The details of the
working groups, TORs and outputs are given in Appendix 4, 5 and 6, respectively.
