Planning and coordinating food-based strategies
In response to the ICN, the World Summit for Children and other international conferences which have highlighted the problem of micronutrient malnutrition, many countries have established mechanisms to plan and implement strategies to address the issue. The planning process will benefit from reviewing health, education and agriculture policies that affect micronutrient status.
Planners must consider the micronutrient needs not only of the general population but also of vulnerable groups which may have special dietary problems and nutritional needs. Vulnerable groups include women of childbearing age, especially when pregnant or lactating, young children and refugees and famine-affected populations. Measures to ensure adequate micronutrient availability and consumption by the population as a whole may be insufficient to meet the needs of these groups. Deficiencies of multiple micronutrients have occurred in epidemic proportions among refugee populations subsisting for long periods of time on limited rations.
Governments should be encouraged to adopt policies that promote the availability of micronutrient-rich foods. For example, horticultural programmes and extension networks can emphasize the production, distribution and marketing of fruits and vegetables. Increasing the capacity to preserve and store surplus micronutrient-rich foods produced during peak seasons encourages increased and improved year-round availability. Parallel to the effort, identification of foods that could be fortified at a central point should be undertaken.
Planners must also take into account the resources available to address food-based strategies. The term "resources" should be interpreted broadly to include laws, policies, and agriculture, health, education, and communication programmes and personnel at both national and community levels. Fortification programmes would involve food industry participation and the development of fortification standards, regulations and monitoring systems. Last but not least, planners need to understand the dietary habits of the target population and the factors that influence people's food choices. Compiling this broad array of information is a crucial step in selecting an appropriate food-based strategy.
The most successful approach is likely to be a combined multisectoral strategy that addresses both increased production (supply) and increased consumption (demand) of micronutrient-rich foods and that also meets the needs of special groups such as children and women of child-bearing age. Nutrition education is essential to enable increased production to lead to increased consumption among vulnerable groups.
The three major micronutrient deficiencies have many causes and potential solutions. However, opportunities exist to coordinate strategies and reduce duplication and costs. Coordination of advocacy efforts can increase the likelihood of reaching policy makers with effective messages. Some assessment and surveillance components can be coordinated. Programmes targeting different deficiencies can hold joint training sessions. There may also be opportunities for combined and intersectoral information, education and communication activities.
At the national level, many types of expertise are required to develop and implement a broad-based strategy to eliminate micronutrient deficiencies. The involvement of many different organizations, all of which share responsibility for a programme, can significantly slow the pace of development and implementation. Inter-sectoral committees under the leadership of the appropriate governmental agency can speed the process.
Representatives of key authorities in the health, agriculture, food industry and education sectors should be permanent members of national micronutrient committees. Representation from the food industry and possibly mining (for salt) authorities should be sought when fortification is discussed. Authorities dealing with laws and food regulations may need to be involved to ensure compliance with food fortification regulations. Authorities responsible for vulnerable groups should also be involved. NGOs can provide valuable practical advice regarding, for example, community participation.
The success of food-based strategies greatly depends on advocacy to obtain both community acceptance and the support of political leaders. When communities are directly involved in assessment, analysis and action decisions, they will tend to accept a strategy which they perceive to be aimed at solving a problem, even if it adds to their workload. Political decision makers need evidence of effectiveness and of community concern for the problem to sustain their own support for programmes