IV. CLOSURE OF THE CONSULTATION

Appendix I

Technical Meeting of the Asia-Pacific Network for
Food and Nutrition on Nutrition Interventions for Food Security –
can they work effectively in isolation?

22 – 24 July 2008, Bangkok, Thailand

LIST OF PARTICIPANTS

Appendix II

OPENING ADDRESS

By

He Changchui
Assistant Director-General and
Regional Representative for Asia and the Pacific

Delivered at the

Technical Meeting of the Asia-Pacific Network for Food and Nutrition
on Nutrition Interventions for Food Security – can they work effectively in isolation?

Bangkok, Thailand
22 – 24 July 2008

Distinguished participants,
Colleagues,
Ladies and gentlemen,

It gives me great pleasure to welcome you all, on behalf of FAO Director-General, Jacques Diouf, and on my own behalf to the Technical Meeting of the Asia-Pacific Network for Food and Nutrition on “Nutrition Interventions for Food Security – can they work effectively in isolation?”

I find that this year’s topic is quite interesting and important, amid the current issues of soaring food prices and their impact on our efforts for poverty and hunger reduction, as well as worldwide responses by governments and international communities.

While stressing food shortages and emphasizing the need and actions for increasing agricultural productivity and market supply, it is also important to recognize the critical role of the agriculture sector in addressing other aspects of the problems of malnutrition.

Agriculture and nutrition are linked in many ways. Food security is one of the three pillars of good nutrition, along with good care and good health. Some of the key nutrition problems that the countries in the region are confronted with include undernutrition of mothers and children (associated with low birthweight), stunted growth in childhood, iron deficiency anaemia, iodine deficiency and vitamin A deficiency. Multidimensional nutrition interventions can potentially address most of these problems. However, food-based approaches need to be pursued vigorously so that they become a larger part of longer term global strategies.

In order to ensure that the conceptual understanding of food security and nutrition goes beyond food production, governments need to better understand the crucial role, function and impact of the agricultural sector not only on food production, but also on poverty and malnutrition. If agriculture can increase and better demonstrate its antipoverty and nutrition benefits, the sector is likely to generate more support for many important public goods that are associated with agricultural development.

It is therefore important to appreciate the interfaces between agriculture, nutrition and food science. Interactions need to be strengthened right at the productive stage so that cropping systems can be designed to achieve nutrition goals. Balanced nutrition should come from farms, not from pharmacies! Due consideration need also to be given to post-harvest phases so that losses are minimized. Such a strategy would have duel benefits -- it not only adds value to processed food products but also enhance the quantities available for consumption. Improved post-harvest technology, therefore, will maximize yields and minimize quantitative and qualitative losses. By seeking closer collaboration with the nutrition sector, agriculture can gain new insights into the needs of its primary end-users -- the consumers, whether poor or rich – and offer a more comprehensive national food basket that is the product of sound agriculture policies, including the fisheries and livestock sub-sectors.

Distinguish participants,
Ladies and gentlemen,

During the 1996 World Food Summit, food security was defined as “Food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.”

This definition presents a comprehensive guidance for increased collaboration between agriculture and nutrition, in particular as it focuses on the needs of consumers across different dimensions: cultural (preferences), health (nutritionally adequate diet and safe food), utilization and sustainability.

As people’s incomes go up, their demand for foodstuffs other than cereals – namely fruits, vegetables, and animal products – increases dramatically. This rise in demand is due to a combination of income growth and shifts in taste preferences and increased urbanization. Increased intake of these products, which are rich in micronutrients, is consistent with improved nutrition status. Deficiencies in various minerals and vitamins, such as iron, iodine, folic acid, and vitamins A and D, are widespread in many developing countries, and the consequences of these deficits are especially serious for infants, children and women. The nutrition community should thus be seen as an ally of agriculture in indirectly stimulating demand for variety in the diet by directly stimulating the demand for micronutrient-rich foods.

With increased incomes, however, high consumption of fat, sugar and salt turns into an important risk factor associated with noncommunicable diseases such as coronary heart disease, diabetes, hypertension, and some forms of cancer. So these are the other forms of malnutrition. The nutrition community should act as a leading advocate by suggesting appropriate dietary preferences so as to combat the emerging problem of malnutrition in developing countries. I believe that national food based strategies and agriculture/nutrition policy instruments have a tremendous role to play in this context.

Consumers may have preferences for some locally produced foods. This preference is often explained not by economics, but by culture. The agriculture community must be aware of these preferences if it is to maximize its connection to consumers and its profits. The nutrition community has longstanding expertise in identifying the diversity of available indigenous foods, and the agriculture community should develop partnerships to tap into that expertise.

It is important to recognize that serious consideration needs to be given on the type of action or combination of actions that are most appropriate for combating problems of undernutrition under varying situations. The choice will depend on the actual nature and distribution of the malnutrition problem and its causes. Can any single intervention be prescribed in isolation? I understand this is the exercise you are challenged to undertake in the meeting and to come up with recommendations for future actions. I trust your focus will be towards the agricultural sector.

Although nutrition cuts across sectors, it is often placed in a line ministry – typically the Ministry of Health. In the absence of a strong motivation to develop cross-ministerial policies and programmemes for food and nutrition security, sector-specific homes for nutrition ends up favouring one sector at the expense of the others. This tendency to “departmentalize” nutrition should be totally discouraged. There is therefore a strong need for most institutions to internalize the latest generation of conceptual frameworks for addressing the issues of nutrition.

National level food and nutrition apex bodies that bring together line ministries, such as the ministries of agriculture, health, social affairs and finance have been successful in a few instances, typically under a very specific set of circumstances. We call for more countries to experiment with innovative arrangements and apply state-of-the art conceptual models of food security and nutrition.

Increased attention to nutrition can enable the agriculture sector to better meet its own needs in many ways. It can enhance the antipoverty and nutrition impacts of agriculture and ensure greater support for a broad range of important public goods that are associated with agricultural development, as mentioned earlier. Clearly, what is essential is a common goal or conceptual vision to guide both agriculture and nutrition in policymaking, strategy development and institutional innovation so that those commonalities can be realized for the benefit of people including in particular the large number of small farmers.

Distinguished participants,

With soaring cereal prices, in particular record high prices of major staple foods such as rice and wheat, there is a threat that more people are going hungry in the developing world. The increase in prices not only makes overall food less available and accessible, but reduces the variety and choices because poor people can only afford cheaper or low cost staples which lack in essential vitamins and minerals needed to maintain good health. As a result, millions are left at-risk for not only severe malnutrition, but also micronutrient deficiencies. The High-Level Conference on World Food Security held by FAO in Rome from 3 to 5 June 2008 was attended by 180 countries and the European Community. More than 40 Heads of State and Government pledged to ease the current food crisis. UN Secretary-General Ban Ki-moon emphasized the essential need to work collectively to address the root causes of food insecurity and poverty. There was a general recognition of the priority need for making more food available at reasonable prices, and to pay special attention to nutrition of children and women in communities at risk.

Transboundary animal diseases such as avian influenza, the 2004 Indian Ocean tsunami and the recent floods in Bangladesh and cyclone Nargis in Myanmar, are but few examples of how natural disasters that can ultimately affect livelihoods of poor people and their nutritional status. You may therefore, wish to address these issues in your deliberations.

I am confident that with your rich experience in the field you will be in a position to put forward your recommendation so as to have a better community outreach by imparting education and training on nutrition, health and hygiene, aimed at increasing awareness of the relationship between a balanced diet and disease prevention, and improving the overall health and nutritional status of communities in need. In doing so, I suggest that your prime consideration should be the agricultural sector with a definite focus on specific malnutrition problems.

Before I conclude, I should mention and extend my appreciation to the Asia-Pacific Network for Food and Nutrition which provides a coordinating forum for such technical meetings. I trust you enjoy attending this yearly meeting at RAP.

I now declare the Technical Meeting of Asia-Pacific Network for Food and Nutrition on “Nutrition Interventions for Food Security – can they work effectively in isolation?” open.

I thank you all and wish you a pleasant stay in Bangkok.

Appendix III

Technical Meeting of the Asia-Pacific Network for
Food and Nutrition on Nutrition Interventions for Food Security –
can they work effectively in isolation?

22 – 24 July 2008, Bangkok, Thailand

Timetable

0830 hrs    Registration

Appendix IV (a)

Agenda 1 and 2
List of Nutrition Interventions, Constraints and Opportunities

Group 1 Outputs

Below is an inventory of different interventions, direct and indirect, which have been implemented and an assessment of their limitations and opportunities based on experiences and documented evidence.

Appendix IV (b)

AGENDA 1
CURRENTLY NUTRITION INTERVENTIONS

GROUP 2

1. Hardinsyah (Indonesia)
2. Jai Singh (India)
3. Patenee (Thailand)
4. Truong Son (Vietnam)

1. Food Production, including home gardening
2. Food quality & safety
3. Complementary feeding & supplementary feeding
4. School feeding
5. Food buffer stock, food storage & distribution
6. Food fortification (mandatory: iodized salt in all countries, wheat flour with iron+zinc+folate in Indonesia, Voluntary: ghee with vitA+D in India, fish souses with iron in Vietnam, toned milk with vitA in India)
7. Food and nutrition education
8. IEC on nutrition materials
9. Micronutrient supplementation (iron tablet, multi-micronutrients; Vit A capsule/drops; iodine capsule)
10. Portable drinking water
11. Environmental sanitation & personal hygiene
12. Small scale food industry
13. De-worming

AGENDA 2
CONTRAINTS & OPPORTUNITIES OF MULTISECTORAL NUTRITION PROGRAMME

GROUP 2

1. Hardinsyah (Indonesia)
2. Jai Singh (India)
3. Patanee (Thailand)
4. Truong Son (Vietnam)

Constraints:

Opportunities:

Suggestions:

1. Nutrition should be part of national nutrition policy
2. The Agriculture should be responsible for Food & Nutrition security
3. The Inter-sectoral Coordination Committee on Nutrition under Agriculture headed by Prime Minister/ President of the country.
4. Strengthening food quality and safety Food fortification as mid-term intervention.
5. Storing and distribution of food in planned manner on area specific basis.
6. Enhance horticulture, animal food and dairy product production.
7. Farmer policy in the country to focusing on economic and nutrition well-being.
8. Food and nutrition security basket should be enlarged to include nutritious millets or nutritious local foods.
9. Nutrition Education should be implemented as a long term sustainable dietary behavioural change programme.

Appendix V

Technical Meeting of the Asia-Pacific Network for
Food and Nutrition on Nutrition Interventions for Food Security –
can they work effectively in isolation?

22 – 24 July 2008, Bangkok, Thailand

Group Work

COUNTRY QUESTIONNAIRE

Questionnaire to be used and discussed during the up-coming technical meeting

Participants are requested to prepare this information
as input for presentation and discussion

1. What are the ongoing nutrition interventions in your country? List them and indicate the intervention(s) you are associated with.
2. Which are the sectors that are involved in implementing food and nutrition programmemes in your country?
3. Is Ministry of Agriculture/Food implementing any nutrition programmeme in your country? If yes, list them.
4. Develop a project proposal for nutrition interventions to be implemented by the Ministry of Agriculture or Ministry of Food to address any two important nutrition programmemes in your country. The proposal should be brief and focused as per the following outlines:
• Title of the project
• Background and rationale
• Overall objectives
• Specific objectives
• Activities against objectives
• Outputs against activities
• Outcomes against outputs
5. How will you promote nutrition interventions if you are posted in the Ministry of Agriculture? Describe your thoughts in only ten bullet points.

Appendix VI (a)

Agenda 3
Presented by Group 1
Bangladesh, Philippines, Sri Lanka and Thailand

2008 Lancet

• Document presented new insights on global prevalence and impact of maternal and child undernutrition (short as well as long term)
• Presented a review of different nutrition interventions however, mostly health based
• Very limited discussion on food based strategies except those that deal with food insecurity and food subsidy (mentioned only in passing)
• While it is recognized that nutrition and health interventions are important yet they do not cover the entire spectrum of causality of malnutrition;
• While the document identified the lasting impact of poor dietary intake in childhood yet there was no mention of the importance of food production to address this factor as well as in addressing micronutrient deficiencies like iron, Vit A and zinc

Lancet

• Root causes like poverty are not dealt with adequately so the solution may not be sustainable
• Nutrition interventions also require high investments and so scaling up can be a problem
• It is likely that the researchers had little information on impact of agriculture based interventions hence the proposal to undertake research that would examine the impact of agricultural development and microcredit programmemes

1983 FAO Manual

• Basically the document proposes a methodology for selecting and prioritizing interventions (which could have been used in the Lancet document)
• Recognizes the multifactorial nature of malnutrition hence a wide array of interventions, agricultural, health, nutrition, socio-economic and even political are included

FAO Manual

The use of the methodology emphasizes the need for data for deciding on criteria

The manual continues to be a very relevant and useful material that provides guidance for programme planning and management

Highlights also key requisites of programme implementation like community participation

Can agricultural or nutrition interventions as stand alone programmes work effectively?

• No !!!
• There is a need for an integrated, holistic and systems perspective for a more sustainable strategy
• Why? Because malnutrition as a problem is multifaceted and the solution does not lie with one sector alone
• Promotion of intersectoral involvement as well as horizontal integration is needed from planning to M&E
• Food and Nutrition system analytical framework needs to be used (i.e farm to table or cell to society ) and identify the blocks in each stage of the system
• Integration of nutrition means:

Include nutrition objectives
Include nutrition indicators for M&E
Include nutrition component
Targeting of nutritionally vulnerable groups

Examples of Successful Programmes which have integrated nutrition

• Philippines:
  Integration nutrition into agricultural and rural development programmes resulted to transfer of the National Nutrition Council to DA
  Although now with DOH, its biggest programme is the Accelerated Hunger Mitigation using FIVIMS data for targeting

Population Education, Environment and Nutrition –brought the Agriculture, Environment and Population sectors together

Bangladesh

Integration of nutrition topics in primary, secondary and diploma agricultural curriculum
Nutrition-oriented training for different stakeholders

Sri Lanka:

Samurdhi – poverty alleviation programme includes food production
integration of nutrition and food science in rural finance

Thailand:

School milk programmeàbenefit to farmers and students

Agriculture-school lunchà student knowledge, better nutrition lunch

Constraints to effective integration

• Agriculture has no appreciation for importance of nutrition
• Primarily concerned with production and economic returns
• Nutritionists do not speak the language of agriculturists and economists; not practical
• Programmes depend on personalities rather than needs
• Turfism/isolationism or narrow perspective of agency mandate
• Lack of knowledge on how to integrate
• Turnover of personnel ; those trained no longer work and there is no system for transfer of knowledge
• No built in mechanism for an integrated M&E

WHAT WILL BE MY KEY MESSAGES IF I AM TO CONVINCE THE AGRICULTURE OFFICIALS TO INTEGRATE NUTRITION?

• Man is a vital resource of any nation esp. in the agriculture sector
• Good nutrition results to improved mental performance and increased productivity
• Ensuring food and nutrition security should be the priority of any sector for sustainable human, social and economic development
• Malnutrition imposes heavy social and economic burden to society
• An integrated, multisectoral approach at all levels is therefore necessary
• Goals of the agriculture sector should be realigned/consistent with nutrition goals

Appendix VI (b)

AGENDA 3
Group 2

NUTRITION IN AGRICULTURE

Why Nutrition Should be the part of Agriculture?

Nutrition is the science of food and its relationship to health. Good Nutrition is the fundamental basic requirement for positive health, functional efficiency, &productivity

As the production and supply of food items is directly related to agriculture, therefore nutrition should be the prime responsibility of agriculture

What is undernutrition?

• Outcome of insufficient dietary intake and repeated infectious diseases
• Underlying causes include inadequate caring practices, lack of access to
• household food security
• hygienic environment
• health and child care services

NUTRITION IN AGRICULTURE/ FOOD

1. Nutrition may not stand alone in any sector because it is a multi-faceted problems
2. However certain sector have to play the lead role in improving the nutritional wellbeing of the people, includes:
   1. Agriculture/food
   2. Women development
   3. Education
   4. Health
   5. Economic and cooperative
   6. Rural/development/infrastructure
   7. Social welfare

HOW TO INTEGRATE NUTRITION INTO AGRICULTURE/ FOOD SECTOR

Policies and Actions:

1. Nutritional orientation of agriculture policy.
2. Ensure food and nutrition security. From national level to household and individual levels.
3. Promote nutrition oriented horticulture production
4. Enhance the production of fisheries livestock diary and their products
5. National farmer policy focusing to the economic and nutritional wellbeing of farmers and their family
6. Strengthening of agriculture, food and nutrition extension and education framework and activities
7. Address the gender issues in farming and food processing right from harvesting to storage by incorporating the women empowerment tin the policy.
8. Enhance food security basket (food items required for food security) by including nutritious millets (locally grown nutritious cereals).
9. Integrate Food subsidy/ stamp and feeding programme intro agriculture policy and programme for better nutrition wellbeing of vulnerable group.
10. Minimize the post heaviest losses both in quantity and quality, and improve the safety.
11. Food for work in special circumstances in agriculture
12. Enhance food and nutrition security through bio-fortification (naturally selected or properly certified GMF)
13. Horticulture produced rich in nutrients Strong marketing support in case of local food production
14. Strong research back up to provide better varieties of food stuffs
15. link the nutrition with agriculture research and extension activities
16. Nutrition subject should be incorporated in the course curriculum of agriculture educations, training and orientation

Key messages to the agriculture sector

1. The important of agriculture in the national development, include for nutrition wellbeing.
2. The important of Nutrition for National development (social-economy, health, education, industry, security and political development).
3. International commitments: ICN/ WFS/MDGs.
   (Food, agriculture & environment for reducing poverty & hunger)

MDGs Commitments (3 out of 8 points related directly to role of Agriculture Development):

1. Eradicate Extreme Poverty and Hunger.
2. Promote Gender Equality and Empower Women.
3. Ensure Environmental Sustainability.

ICN Commitments (6 out of 9 points related directly to role of Agriculture Development):

• Incorporating nutritional objectives, consideration, and components into development policies and programmes
• Improving household food security
• Protecting consumers through improved food quality and safety
• Caring for the socio-economically deprived and nutritionally vulnerable
• Preventing and controlling specific macronutrient deficiencies
• Promoting appropriate diets and healthy lifestyles

Comments on Lancet article:

• Detailed analysis of consequences of maternal and child undernutrition and its effect on health in the later life.
• The suggested of Lancet series focus on health sector, while malnutrition also concern of agriculture/ food sector.
• The document rightly emphasized the lack of political commitment, financial investment, man power and institutional capacity to deal with the problems of malnutrition

Comments on FAO Document:

• A complete documents to deal with the problems of malnutrition during 1980s and 1990s
• Provide comprehensive and samples on criteria for selecting interventions for nutritional improvement
• However emphasize has not been given to food fortification, bio-fortification, research, extension and education, and institutional building on nutrition

Appendix VII (a)

Group I- Proposed Programme to showcase the importance of nutrition

• Title: Promotion of home gardens and small livestock production: a sustainable strategy for improving maternal and child nutrition.

General objective:

• To reduce maternal and child undernutrition through improving access to adequate, safe and nutritious foods

Specific Objectives

• To improve nutrient intake of vulnerable mothers and children particularly of Vitamin A and iron;
• To improve infant and child feeding practices using home grown foods;
• To increase purchasing power of households to meet other nutrient needs (energy, protein etc) ; and
• To improve knowledge and acquire skills on appropriate food preparation, preservation and storage.

Project Components

• Establishment of home gardens and small livestock production
• Nutrition information, communication and education for dietary diversification and infant and young child feeding
• Training on food preparation, preservation and storage
• Establishment of cooperative organizations for marketing of excess products

Expected Outputs

• Home gardens and small livestock production units established
• Mothers trained on proper food preparation, preservation and storage
• Improved knowledge on maternal and child nutrient needs and feeding
• Cooperatives established
• Increased incomes
• Improved diets

Expected Outcomes

• Improved nutrient intakes
• Improved nutritional status of mothers and children
• Reduction of prevalence of maternal and child undernutrition
• Reduced maternal and infant morbidity and mortality

Appendix VII (b)

Group 2 Output

Addressing the food and nutrition needs of rural women in poorer areas of South and South East Asia countries

1. Background

Food and nutrition security is important for human development, especially of children and women. It has direct impact on national development. Inadequate food affects the nutritional status, productivity and health, which in turn affects the infant, child and maternal mortality.

More than 65 % of the total women population live in rural areas, and about 25-60 % of them are suffering from anemia, and 20- 45 % women are suffering from CED. More than 3.5 million mothers and children <5yr die due to underlying causes of under-nutrition (Lancet, 2008) and most of them are from developing countries

Inadequate food and malnutrition is not the result of a single cause but is in fact a multifaceted problem caused by factors like poverty, purchasing power, health care, ignorance and even the national policies relating to food, agriculture distribution are therefore necessary.

2. Rationale

As mentioned above the problem of malnutrition among women in rural SE and SEA is more serious and has inter-generational effects. Therefore, to eradicate the problem of malnutrition, the project will focus on women, especially rural women.

The project will be started on a pilot basis. At least one district for each country for the first year will be selected using FIVIMS data for selection.

A new model for improving food and nutrition status of rural women is being proposed where outputs, outcomes and impact will be determined This project is proposed in addition to the on going development programmes in those areas.

No such project proposal addressing the food and nutrition status of rural women in depressed areas has been taken. This project uses a food based approach to improve the nutritional status of rural women, mostly involved in agriculture sector. Moreover, the first and the third MDGs, namely eradicate extreme poverty and hunger, and gender equality and empower women, fall within the FAO mandate. Therefore, funds from FAO are solicited.

3.Project Framework

Objectives

1. To improve the food intake of rural women to address nutrient deficiency
2. To improve the nutritional status of rural women which directly affect agricultural production

4. Activities:

Selected activities to achieve the above objectives are as follows:

1. Workshop on empowering rural women
2. Training of field functionaries for empowering rural women
3. Food and nutrition awareness
4. Integrated home gardening for small and medium land owners
5. Production of fish, eggs, chicken, milk and horticulture products
6. Promotion of consumption of fruit, vegetable and animal products
7. Introduction of appropriate rural based technology for food processing and preservation
8. Production of low cost nutrition complementary foods for children
9. Food and Agriculture infrastructure development in rural areas
10. Integration of gender concern, that is 25-30% of the various major schemes/programmes and development intervention at village level may be allotted to women groups

Appendix VIII

Technical Meeting of the Asia-Pacific Network for
Food and Nutrition on Nutrition Interventions for Food Security –
can they work effectively in isolation?

22 – 24 July 2008, Bangkok, Thailand

RESOLUTION

“Integrating Nutrition into Agriculture and other Development Policies and Programmemes”

Whereas, believing that people are the country’s key human resource capital and their quality determines to an immeasurable extent the state of a nation’s economic, social and political development;

Whereas, nutrition impacts heavily on the physical and mental performance, and consequently productivity in agriculture sector;

Whereas, recognizing malnutrition in all its forms is usually complex and multi- faceted requiring commitment and sustained efforts from various sectors;

Whereas, realizing also that political commitment needs to be translated into firm national policies supported by relevant plans and programmemes backed up by resources, an effective organizational structure and efficient management system that includes research, monitoring and evaluation;

Whereas, understanding and appreciating the key role of households and communities in addressing food and nutrition issues leading to achieving food and nutrition security;

Do hereby resolve to advocate for:

1. Integration of nutrition in agriculture and other development policies, programmes and projects to ensure convergence of basic nutrition, health, agriculture and other related interventions;
2. (Re)Formulation of relevant policies particularly agriculture to ensure that nutrition becomes a deliberate objective, with suitable indicators for monitoring and evaluating nutrition outcomes;
3. Improved planning process anchored on functional and effective management information systems to facilitate the identification, location and quantification of targets like the use of FIVIMS data
4. Creation of an effective organizational structure and efficient management system which will include among its functions resource generation, capacity-building of all stakeholders and monitoring and evaluation of national as well as global efforts for increased efficiency and accountability; and
5. Community empowerment for shared ownership of problems as well as solutions enhancing their capacity for food and nutrition improvement and to be able to respond to situational changes due to extreme climate, natural calamities and disasters besides economic crises.

Signed this 24^th day of July 2008 at FAO-RAP Office in Bangkok, Thailand.

Kraisid Tontisirin   A.F.M Saiful Islam Jai Singh   Hardinsyah   Maria Antonia G. Tuazon Chandrani L. Piyasena   Visith Chavasit Pattanee Winichagoon Truong Hong Son