II. CONCLUSIONS AND RECOMMENDATIONS FROM THE PAPERS DISCUSSED

Agenda item 1: Overview on implementation of food based dietary guidelines (FBDGs) - FAO perspective and initiative

14. The consultation adopted the provisional agenda and the timetable (Appendices III and IV) as proposed by Biplab K. Nandi.

15. Biplab K. Nandi presented an overview on the implementation of FBDGs from the FAO perspective, emphasizing the main agenda items as (i) examining country initiatives on the status of implementation of FBDGs at various levels (ii) issues for consideration as regards promoting implementation of FBDGs and identification of future actions and (iii) linking implementation of FBDGs to NPANs as part of ICN and WFS follow up activities.

16. He recalled some of the key components of FBDGs in terms of the context for addressing FBDGS, consideration of general and specific issues to promote healthy eating, challenges to implementation and ways of intensifying the involvement of multi-sectors.

17. He also put forth the consideration for developing the quantitative components of FBDGs and identifying projections that will make it possible to consolidate these efforts for efficient and effective implementation.

18. Testing the feasibility of FBDGs through phased field testings would need to be carried out, as appropriate. Systematic approaches would need to be adopted using change agents at various levels through appropriate multi sectoral collaboration.

19. FBDGs need to be integrated into food and agricultural policies with the objective of providing adequate safe and nutritious foods for all. Food, agricultural, health, educational and rural development policies along with the National Nutrition Policy would need to be harmonized to support the implementation of FBDGs. A core department/ministry would need to be designated and be responsible for co-ordinating the FBDG implementation. As far as possible, related departments/agencies would have to support the strategies and be closely involved in monitoring and evaluation of the programmes. In essence, FBDGs should serve as a valuable tool in translating National Plans of Action on Nutrition (NPANs) and as a strategy for their effective implementation.

20. The Consultation was informed that the deliberation was to focus on reviewing implementation of national food based dietary guidelines, update on implementation of ICN/WFS/NPAN follow - up activities and explore possibilities for implementing FAO’s nutrition education modules on Feeding minds, Fighting Hunger” in countries of the region.

Agenda item II: Forging agricultural links with and nutrition links in the implementation of FBDGs

Presented by Barbara Schneeman

21. Barbara Schneeman, informed the consultation that food-based dietary guidelines (FBDG) are an integral component of nutrition policy and provide a mechanism to link policies related to food, nutrition and health promotion. As an educational tool for the public, FBDGs express nutrition principles in terms of food and dietary patterns that are central to public health strategies. As a policy tool, they provide a means to coordinate nutrition-related programmes as well as evaluate the adequacy of the food supply in meeting the nutritional needs of the population.

22. In linking agricultural production to human nutrition, she pointed out that development of agriculture in relation to nutrition has occurred in three phases namely: improving yield to provide adequate energy from food, improving efficiency of production to diversify the sources of nutrients in the food supply, and targeting efforts to improve nutritional profile of foods that will help lower the risk of diseases and promote health.

23. FBDGs would need to be country specific taking into consideration the public health issues, dietary problems and socio-economic conditions. She recognized that national overviews are dynamic and therefore, issue of both agriculture and nutrition must evolve together. In identifying the association between diet and health, one has to identify foods and the components of foods that are bioactive, build up analytical methods, determine the essential components and monitor intake. This knowledge can be used to improve food supply as well as to developing supplementation and fortification strategies. The nutrition knowledge is also incorporated into relevant policies, programmes, health management, recommended dietary allowances, and monitoring and evaluation issues.

24. Drawing upon an FAO consultation in 2000^[1] on experiences from Thailand and the Philippines, Ms Schneeman, emphasised the lessons learnt, which included: the importance of a research and science based process, involvement of multidisciplinary expertise in the process of development of FBDGs, the value of having FBDGs relevant to the public health needs of their population, and the motivation to extend its use to multi-sectors. The process is valuable for building consensus among various sectors for appropriate food based strategies.

25. Inclusion of self-evaluation/frequently asked questions (FAQs) was also an important feature promoting implementation. For example, the Thai guidelines included a self-evaluation which guides an individual through the key messages and enables one to assess what changes are needed to follow the guidelines. In the Nutritional Guidelines for Filipinos (NGF), it had sections with FAQs and an action plan. Both approaches are particularly useful in making the guidelines more practical and to stimulate action.

26. Ms Schneeman observed that the food-based approach raises the importance of agricultural policies that address the food needs of the population. In most countries, several government agencies have responsibility for nutrition. While it is a challenge to coordinate among multiple agencies with such responsibility, the FBDGs process itself creates a format for coordination and consensus building around the most important public health issues related to nutrition.

27. The consultation in 2000 reported that both Thailand and the Philippines developed nutrition expertise during the past 20 years. This capacity-building is most evident at the Institute of Nutrition of Mahidol University (INMU) Salaya in Thailand and at the University of the Philippines, Los Baños, although in both countries capacity building extends beyond these two institutions. This capacity building has strengthened the ability of these countries to develop science-based approaches for the development and implementation of FBDGs.

28. The FBDGs would also need to respond to the needs of the low income groups, where it is likely to be perceived as being useful for the well - to-do and that the recommendations at times could be too expensive for many at-risk, low-income individuals to follow. This was expressed in both Thailand and the Philippines. This calls for concrete efforts to ensure that all groups are able to use the guidelines effectively to improve nutritional status.

29. Ms Schneeman concluded that the ability of countries to share their experience in implementing a process is one of the best ways to expand and improve upon the recommendations from the Cyprus Expert Meeting.^[2]

30. The consultation raised important issues and concerns which included the debate over the medical/health professionals on the promotion of diet supplements as a quick fix to solve problems of malnutrition versus the use of food based dietary guidelines; use of foods/food groups and dietary patterns that are misleading to some consumers and thus hampering sustainability of nutrition education campaigns.

31. The example of the Five-a-day Campaign for increased consumption of fruits and vegetables in the US was cited which served to promote dietary improvement among the population groups and also to support the food production initiatives among farmers.

32. The consultation agreed that these issues and concerns emerged as challenges to improving research, communications and strategies for both health and nutrition professionals to make a difference in the win-win situation for the government and private sector in its collaborative efforts in contributing to consumers’ health and nutrition improvement.

Agenda item III: Country status with regard to implementation of FBDGs and identification of future actions

Bangladesh: presented by Mirza Altaf Hossain and Mohammad Mannan

33. The consultation noted that the FBDGs for Bangladesh developed by Bangladesh National Nutrition Council (BNNC) in 1997 are being implemented through different sectors in general, and health and agriculture sectors in particular. Specifically, the health and agriculture sectors have integrated the FBDGs in different training programmes. The guidelines are disseminated at various levels during the observance of National Nutrition Week. The FBDGs are also being implemented at the community level in 59 Upazillas/sub-districts by the Bangladesh Integrated Nutrition Project (BINP) and 13 Upazillas/sub-districts by the Bangladesh Institute of Research and Training on Applied Nutrition (BIRTAN).

34. The tri-media (radio, television, prints) is employed in popularizing the messages of the FBDGs. Non-governmental organizations (NGOs), boy scouts and girls guides are also involved in its dissemination.

35. The National Steering Committee at the Ministry of Health and Family Welfare represented by the Focal Points for Nutrition from different concerned ministries, departments and bureaus are responsible for monitoring the implementation of FBDGs. These stake holders have ownership and responsibility for formulation and implementation of the dietary guidelines which strengthen implementation of FBDGs.

36. It was suggested that initiatives for monitoring and evaluation of FBDGs taken up by the countries of the region would need to be facilitated by FAO. FAO (RAP) could facilitate in formulating some common indicators for use in the region.

China: prepared by Yang Xiaoguang

37. As the representative from China could not attend the consultation, the summary was read out by the chairperson. The Dietary Guidelines for Chinese Residents are founded on principles of nutritional science and the present nutrition situation of China. They provide guidance to the Chinese people for consuming balanced diets so as to achieve and maintain good nutrition and health. The Guidelines have been prepared by a Commission of experts from the Chinese Nutrition Society and the Institute of Nutrition and Food Hygiene affiliated with The Chinese Academy of Preventive Medicine. This Academy has proposed having a policy for the development of soy bean and its by-products, and rational utilization of soybean resources. A “Milk Action Plan” has been developed along with the development of milk products and milk processing. There is also a regulation in the consumption of meat.

38. In keeping with the ICN, the Chinese Plan of Action (PAN) is making efforts towards ensuring food supply and implementation of appropriate interventions to alleviate hunger and food shortage, reduce the incidence of PEM and prevent, control and eliminate micronutrient deficiencies. Through proper guidance for food consumption behavior, it is promoting improvement of dietary patterns and promotion of healthy lifestyles, general nutritional status and the prevention of nutrition-related chronic diseases.

39. Results of a survey on nutrition knowledge, attitude and behaviour of 5145 persons from five cities in four provinces (Shandong, Guangdong, Sichuan and Heilongjiang) between 1998 and 2000 showed that the Nutrition Education Project namely, “Dietary Guidelines” had been effectively conducted. Obvious propaganda effects had been achieved among its residents, middle and primary school students and older persons.

40. The nutrition knowledge scores showed that people developed a good attitude towards learning nutrition concepts and that some dietary behaviours and lifestyles of people have been modified.

India: presented by Kamala Krishnaswamy

41. Kamala Krishnaswamy briefly indicated the multi sectoral expertise used in the development and formulation of FBDGs in India, and highlighted the nation-wide efforts to ensure that FBDGs messages reach the core community. NGOs and mass media are seen to be playing predominant roles. The various steps undertaken for popularization of the guidelines and promotion of their acceptance, include wide publicity through mass media and interpersonal communication approaches through professional societies among others.

42. In view of the diversity of food habits, cultures and socio-economic situations in India, FBDGs need to be modified and adapted to local conditions. The Indian Guidelines emphasize the liberal consumption of fruits and vegetables, adequate consumption of cereals and pulses and moderate comsumption of oil, meat and sugar especially for those who might overeat. FBDGs cover all aspects related to undernutrition and overnutrition and food safety. Household measures have been included to make the quantitative FBDGs explicit.

43. Implementation includes sensitization of the policy makers and local opinion leaders to issues related to FBDGs and identification of a central nodal agency for implementing the national nutrition policy and promoting FBDGs. She opined that FBDGs must become an education tool to be built within related agencies in their development plans. She emphasised that with the adoption of the national nutrition policy by the Government of India, the FBDGs approach would need to be dovetailed to the general nutrition policy utilizing appropriate communication strategies for promoting positive behavioural changes. Centre-state co-ordination in the existing federal governmental set-up and participation of local food industry are important in this regard.

44. Implementation, monitoring and periodic evaluation are critical components to the success of food based dietary guidelines for which the process of evaluation should be dynamic and provide necessary feed back for a continuous updating of FBDGs. Media inputs, frequency of messages being displayed, frequency of purchase, national food production data, national availability of data, food consumption data which is easy to collect are important components herein. Mapping of nutrition problems is being done through ICDS at national levels, and in this regard FBDGs can serve to provide dietary and nutrition related information. Further, nurition surveillance systems which is being developed in all stages based on the Triple A approach must build in FBDGs

45. In promoting the practical use of FBDGs, Dr Krishnaswamy informed the Consultation that translation into various regional languages has been done. Implementation now calls for a nation - wide launch of FBDGs. Women are the primary target groups and publicity programmes serve as important means to promote implementation. Secondary audiences such as teachers, youth, students in schools, and elderly also need to be mobilized if FBDGs have to reach out more effectively.

46. Production of food grains and other commodities in India shows that grain banks are overflowing but pulses and millets have decreased, which have implications for PEM. Egg and milk production and consumption have gone up, while production of fruits and vegetables has not gone up, which is important in view of the problems of micronutrient malnutrition. India is second in vegetable and fruit production in the world but almost a third is lost due to post harvest losses. She expressed the need to address this issue and encourage more rural preservation, packaging and value addition in FBDGs and build in an economic angle to promote incentives to the farmers and food producers.

47. Recent retrograde steps undertaken with regard to salt iodization largely due to political factors at the central level were not encouraging. However, certain states have not withdrawn the sale of iodized salt, which is gratifying and she felt that the mass media and NGOs need to be aware of such issues to raise community awareness.

48. Priorities for research have been planned, which include strategies to promote and link up agriculture and rural centred technolgies, food fortification and production of complementary foods. Simple evaluations need to be built into the programme to get necessary feedback in updating FBDGs.

Indonesia: presented by Arum Atmawikarta

49. Arum Atmawikarta elaborated on the review of FBDGs in Indonesia. Primary efforts were undertaken to raise awareness among policy makers through dissemination of information on the Indonesian Nutrition Guidelines (ING). Advocacy has been undertaken for decision makers in related sectors at formal levels of administration and in non-formal institutions such as the community and groups such as religious leaders.

50. Specific approaches are also carried out through control on food and beverage advertisements against the non-conformity with existing ethical codes and rules; inclusion of ING into school curriculum; promoting local food that meets nutrition requirements through an “I Love Indonesian Food”, and Keluarga Sadar Gizi or Nutrition - Awareness Family Movement; mainstreaming ING in a coordination forum at various levels, and through publication of a book of 13 Basic Messages.

51. This book is designed to be used by decision makers at various levels and consists of a brief description about the basic messages in the form of an easy language guide. However, there are some messages which are not very clear and this needs to be addressed.

52. Indonesia also employs the empowerment approach where several activities to build capacities of institutions through training for related health personnel and NGOs are undertaken.

53. As part of strengthening, involvement of national and local government, NGOs and related partners, concerted support from related institutions and the community are being elicited. Efforts undertaken include an agreement among all prospective groups in disseminating the messages of ING to utilize and activate all prospective personnel in an innovative and effective manner to gain support in disseminating the FBDGs.

54. Among the processes that are found effective in the dissemination of FBDGs are inter-programme and inter-sectoral workshops, symposia, TOT (Training of Trainers), campaigns through public and commercial radios and TV channels. Due to some difficulty in understanding the ING, its review and modification have been undertaken. An additional guidebook that provides simple information will be also be developed

Malaysia: presented by Ismail Noor

55. Ismail Noor updated the consultation about the Malaysian FBDGs which consist of healthy eating messages developed by a Technical Working Group (TWG) established in 1997 under the auspices of National Core Council for Food and Nutrition (NCCFN) chaired by the Ministry of Health. The Malaysian Food Pyramid presents the kinds of foods to be taken everyday along with the number of servings. Examples of typical foods and food preparations are suggested along with an indication of the nutrient source of the suggested food. The FBDGs were first published in December 1999 and was launched by the Minister of Health in July 2000.

56. As an educational tool, the guidelines have been incorporated into training modules for health care professionals and the food pyramid has been adopted by several professional societies in their website and are printed as posters and pamphlets for wider distribution. More recently, the messages and food pyramid were adopted for use in a “Bright Start Nutrition” project for children 2-6 years old. On-going activities include drafting dietary guidelines for infants with plans to monitor and evaluate the usefulness of the dietary guidelines in the near future.

57. The challenge ahead is to encourage the larger sections of the population to use FBDGs. This requires continuous support and commitment of both the Government and the Private sectors that are involved in food, nutrition and health programmes to educate and motivate to public in recognizing the vital role nutrition plays in promoting health and well being. Central to this would be the need to make individuals and communities to play their parts and make the necessary changes to achieve the desired goal.

Nepal: presented by Yogesh Vaidya

58. The consultation was informed by Mr Vaidya that Nepal had yet to develop FBDGs for the general public. He remarked that the task of developing national FBDGs can be initiated and guided by the National Nutrition Coordination Committee (NNCC) of the National Planning Commission (NPC) and that a national working group to formulate FBDGs. The scientific basis for this should consider a systematic approach obtaining and using baseline information and eliciting the involvement of multi sectors. FBDGs would also need to take into account the ethnic differences, difficult geographical terrain and related factors.

59. As NPAN was adopted in the current Ninth Plan and has been implemented by His Majesty’s Government, Mr Vidya solicited FAO’s assistance in working out details for implementation of the ICN themes on “Promotion of Appropriate Diet and Healthy Lifestyles” which has been incorporated along with other themes for the Nepal NPAN. This could serve to build in the FBDGs.

60. An advocacy for policy makers, planners and programme executors will help raise concern for initiating actions on formulation, development and implementation of FBDGs considering multisectoral and multidisciplinary involvement.

Philippines: presented by Elsa M. Bayani

61 The consultation noted that FBDGs are not new to the Philippines, the country having developed dietary guidelines in the 1980s. However, the recently adopted Nutritional Guidelines for Filipinos (NGF) marked a new beginning for the intensification of nutrition education. In its efforts to evoke public attention, the 2000 and 2001 celebrations of the Nutrition Month (NM) in July focused on the NGF, first with a call to know and practice good nutrition, and then with a call to also spread and promote the NGF messages.

62. A mix of communication channels is used through tri media and interpersonal communications. These include production and airing of nutrition plugs, publication of supplements, production and distribution of various collateral materials, and organising seminars and special events. Other nutrition education and related activities which focus on one or more of the NGF messages have included the Child Growth Project (CGP), Garantisadong Pambata (NM) or Preschoolers Health Programme, and the Integrated Multimedia Campaign on Fruits and Vegetables (INMCFV).

63. Mobilization of influencers (food manufacturers, media, and various organizational associations) to participate actively in promoting the NGF needs to be undertaken. It is envisaged that participation can range from being role models to investing in the various components of the National Institution Education Programme (NNEP), which is being formulated.

64. Ms Bayani positively noted that for the past few years, there has been a growing involvement of the private sector, particularly food manufacturers in bringing nutrition messages to the attention of each Filipino. At the local level, FBDGs are being promoted through the Nutrition Month (NM) Celebrations which include promotion of nutrition messages during the Monday Flag raising ceremonies in July. Nutrition parades, cooking contests and distribution of posters and streamers are activities implemented.

65. Presently NNEP is being integrated, rationalized and harmonized with the other on-going programmes of the Government and the NGF remains the basis for promoting nutrition behaviour at all levels. Sustained promotion of the Philippine FBDGs will be carried out through the NNEP, 2002-2004.

66. Recognizing that interpersonal communication will be used as a major strategy to promote the NGF, it is critical to train professionals and community level workers particularly in terms of skills to translate nutrition knowledge into action that is practical and more attuned to the needs and circumstances of the target audience.

67. The NNEP shall include components such as capacity building on effective nutrition education, mobilization of influencers to help promote NGF, carrying out research to evaluate the effectiveness of the programme and complementing them with other impact programmes.

Sri Lanka: prepared by Gamage Dhanawardana

68. Since the participant from Sri Lanka was unable to attend the consultation, the summary of the paper was read out by the chairperson. The various activities that are linked with promotion of food based dietary improvements in Sri Lanka as part of the implementation process of FBDGs were pointed out.

69. Almost all programmes dealing with nutritional problems in Sri Lanka tend to start with advocacy programmes aimed at creating awareness among the policy makers. Advocacy programmes deal with prevalence of the specific nutrition problems, concepts and the approach used in intervention programmes to overcome them. Illustrative examples include the Participatory Nutrition Improvement Project (PNIP), Micronutrient deficiency control project (MDCP) and Nutrition Education Project (NEP). Annually Ministry of Health launches a national nutrition week to educate the public on themes related to nutrition.

70. The Nutrition Division, Department of Health Services of the Ministry of Health in 2000 compiled a “Nutrition Guide”. It provides nutrition education not only in terms of FBDGs, but also in quantitative principles, minerals and vitamins for each food group.

Thailand: presented by Songsak Srianujata

71. Songsak Srianujata highlighted a food and nutrition cycle concept that was used in Thailand. This concept, influenced by several food, agriculture and health variables, guides national food and nutrition policy decisions and actions and signifies a holistic approach towards food security and nutritional adequacy. The Thai FBDGs have been developed and implemented in the NPAN within the 8^th National Economic Social Development Plan (NESD) during the year 1996-2001.

72. A number of challenges face the implementation of Thai FBDGs, particularly with regard to communication. While the revision of up-to-date scientific evidence provided the basis for establishing healthy eating through the current Thai FBDGs, these guidelines need to be more easily understood by the public if they are to be translated into practice. Key factors ranging from consumer awareness to inequities in health and nutrition, to literacy levels within target populations, and to the quality of the food supply have been recognized as challenges in meeting the goals of FBDGs.

73. Comprehensive and coordinated efforts such as development of National Food and Nutrition Policies and Plan, closer collaboration and coordination among government, industry and non-governmental partners, and academia, appropriate legislative and policy change, nutrition research, surveillance and monitoring systems to detect behavioral changes and health consequences were therefore to be undertaken.

74. He pointed out that the communication and implementation of the Thai FBDGs depends on commitment and partnerships at many levels. Responsibility for and commitment to the FBDGs as well as their communication and implementation, rests with all of the stakeholders.

75. The official release of the FBDGs booklet by the Prime Minister has provided sound advocacy support and evoked a high sense of importance to the FBDG initiative. Other activities that have reinforced widespread dissemination of information on the Thai FBDGs include round table discussion, nationwide radio broadcast, weekly television programme on FBDGs, luncheon talks with senior persons of the mass media and participation from the food industry and non-food public organizations

76. Educational tools and kits produced by Ministry of Public Health depicting the food guides, as well as national campaigns on “clean food, good taste,” for food producers, “health promoting schools”, “health promoting hospitals and healthy workplace” have been developed and undertaken through several formal and informal channels. Formal and informal training programmes on healthy eating have also been carried out through peer education, religious leaders and other target groups.

77. For future actions, Thailand will review its FBDGs and the communication/implementation strategies in collaboration with the Advisory Committee. Monitoring and evaluation of changes in eating patterns of specific groups through the collaborative efforts of relevant organizations and actively disseminating research results and implications as they relate to the implementation of the Thai FBDGs will continue to be undertaken. Research efforts will include learning more about the target audience, their environment and what motivates their decisions on changing their food habits. The nation wide evaluation of Food Consumption Survey is planned for 2002-2003.

Viet Nam: presented by Ha Huy Khoi

78. The consultation was informed that there was commendable progress in the current status of FBDGs in relation to its applications on the nutrition policy in Viet Nam. In particular, the FBDGs have been used as official document of NPAN.

79. With the approval of the National Plan of Action for Nutrition for the period 1995 - 2000 from the Prime Minister, ten nutrition recommendations have been elaborated and used as a tool for educating the public. FBDGs have been introduced in all training courses, and nutrition education messages appear regularly in newspapers and mass media programmes. Recommendations include how to reduce PEM which is prevalent in Vietnam and the promotion of healthy lifestyles and appropriate food choices.

80. On 22 February 2001, the Government ratified the National Nutrition Strategy for the period 2001-2010. Reviewing and preparing new FBDGs relevant to the actual nutrition situation is timely and necessary.

81. As nutrition education is the main strategy of NNS during the period 2001 - 2010, FBDGs are seen to play a very important role in NNS implementation. In this regard, FBDG would need to be relevant to the actual diet pattern and disease pattern in order to reach the NNS goals and objectives. FBDGs should provide for expanding the quantitative components, be applicable and in conformity with traditional food habits. Viet Nam is also in a period of nutrition transition with the double burden of under and overnutrition. FBDGs need to contribute towards addressing these problems.

82. Due to Viet Nam’s nutrition education efforts, the awareness of the policy makers and people on nutrition issues has improved remarkably. In keeping with its NPAN goals, reduction of child malnutrition is noted at the national level, provinces, districts and communes.

Progress and review of FBDGs from the Secretariat of the Pacific Community (SPC): Presented by Wendy Snowdon

83. Snowdon emphasized that changes in traditional lifestyle and diet in the Pacific Islands have led to increases in rates of non-communicable diseases (NCDs), and noted that in many countries Vitamin A deficiency and anaemia are still high. Concern about unhealthy diets has led to a need for developing a food guide for the Pacific, which could depict a food based system of ensuring a healthy balanced diet for the general population.

84. Recognising the lack of capacity amongst many of its member countries to develop their own specific food guide and in response to demand from its member countries, SPC agreed to work on developing a Pacific Food Based Guide for its member countries. The initial development phase has now been completed, and the next stage is to disseminate this across the region and to colleagues and to support them in its appropriate use locally.

85. In taking responsibility for this initiative, SPC’s Lifestyle Health Section has reviewed the food grouping system and also developed a food based guide for the region. The food group system has been widely disseminated regionally and incorporated into local teaching and resources. While there is general awareness concerning the three food groups across the region, the overall understanding of the way to construct a healthy balanced diet is limited.

86. There is a region-wide tendency to consume excess body-building foods and have small amounts of the protective foods or none at all. The high intakes of fat and sugar based foods are also of concern, particularly in light of the increasing rates of NCDs in the region. Ms. Snowdon pointed out that there is a need to move on from the concept of ‘eating from the three food groups’, to ‘eating the correct relative amounts of the three food groups’. During the development process it was suggested that information on other lifestyle issues such as exercise, smoking and drinking be included, as a healthy diet should not be separated from other key lifestyle risk factors.

87. It is hoped that these posters and their concepts will form the basis of training and education around healthy lifestyles in the region. The development process included consultation with member countries and partner agencies, along with piloting in selected sites.

88. As part of regional dissemination, following the final printing of these posters at the end of 2001, training is planned across the region. As the food guide is a new development for the region, it is essential that this be incorporated into all training programmes regionally. It is hoped that member countries will seek support for the translation of these resources into local languages along with any other minor modifications required.

Fiji: presented by Nirmala Nand

89. Ms Nand informed the consultation that Fiji has produced its dietary guidelines over ten years ago in collaboration with the Ministry of Health. The guidelines aim to help the population to follow a set of nutrition and health principles in order to achieve and maintain good health and nutritional status, with a focus on addressing the prevention and control of the prevalent health and nutrition problems that the country faces such as anemia, diabetes, hypertension, coronary heart disease, obesity, cancer and gout. These conditions, she pointed out, are known to be prevented and controlled by eating the right kind of foods in the right amounts. The National Food and Nutrition Centre (NFNC) is vigorously pursuing the revision of FBDGs and will commence its dissemination and distribution to all levels through multi media channels and a number of IEC materials such as posters, pamphlets, calendars, brochures, etc.

90. Implementation of guidelines in Fiji is undertaken by the Ministry of Health, Agriculture, Education, Women and Culture, National Food and Nutrition Centre, National Centre for Health Promotion and various non-governmental organizations. More concerted effort for converging various multi sectoral actions in the effective implementation of FBDGs is needed. A national campaign on FBDG is also being planned for 2002 to sensitize the population. Specifically, for nutrition to become a visible part of national campaigns, there is urgent need for advocacy at the higher levels and for entrenching nutrition into the national policy. The NFNC plans to take a lead role in revising and revitalizing and relaunching the new FBDGs.

91. Among the constraints identified that hinder implementation of the FBDGs, inadequate budgetary allocations, lack of qualified and skilled professionals, poor clarity of objectives and guidelines for programmes emerge as important.

Vanuatu: presented by Emily Kulsukau

92. Ms Kalsakau shared with the consultation that due to the dietary habits in Vanuatu, problems of non - communicable diseases (NCDs) are of great concern. Micronutrient deficiency is another problem that has been addressed and is slowly being improved. In spite of the country’s abundant production and supply of wild fruits, vegetables and root crops, the locals especially in the urban areas, choose to consume imports such as rice, canned meat/fish and bread.

93. Implementation of programmes to address nutrition and diet related issues poses problems, and constraints include lack of networking between necessary organizations, inadequate staffing capacity to carry out the necessary tasks and budget constraints.

94. The National Food and Nutrition Committee has contributed to the development of the Vanuatu Plan of Action for Food and Nutrition (VPAFN) in the late 1990s. However, due to lack of co-operation and co-ordination amongst necessary government sectors, nutrition improvements have not been realized. The health department, however, has played a major role in providing awareness to the public at large, which has led to several nutritional improvements.

95. Vanuatu’s implementation plans include recommendations to revise the existing dietary guidelines with a clear focus to support nutrition education initiatives of the National Food and Nutrition Committee.

96. Posters have been used in a variety of effective ways to encourage people to change for a better lifestyle, wherein Ms. Kalsakau, highlighted a popular poster used to educate locals is the “Three Food Group” which paints a picture to make sure that poeple eat balanced meals everyday. A noteworthy point of the posters is that it depicts the actual food products that are available and mostly eaten in Vanuatu.

97. The National Food and Nutrition Policy has responsibilities designated to various government sectors and groups. For instance, the department of Agriculture would look into issues related to food security, while the Environmental Health and Food Centre would deal with issues related to food safety, with the notion of viewing it in an integrated perspective.

98. Monitoring and evaluation initiatives have included nutrition surveys and evaluating the survey outcomes to check whether any nutrition improvements have been made. Apart from local adaptation of the posters, the use of popular theatre groups to act out real life situations has served as an effective way of disseminating information.

99. In improving the implementation of action plans, there is a need to strengthen ties between the necessary government sectors to implement the tasks outlined in the action plans. Commitment and motivation are urgently needed to carry out the tasks of the action plan. Vanuatu is awaiting the regional FBDGs being formulated by SPC to use as a guide to prepare a national one.

Working group sessions

100. The countries were divided into two working groups. Group 1 consisted of participants from Bangladesh, Fiji, Indonesia, India, Malaysia and Nepal, Thailand and Group II included participants from Bangladesh, the Philippines, Thailand, Vanuatu and Viet Nam.

101. The terms of reference (TOR) for Working Group I were to: (a) identify the process and enabling factors in strengthening implementation of the FBDGs process; (b) highlight key components to be considered while expressing foods and food groups in household amounts, identifying methodological issues (c) point out action-oriented participatory and community based to be included in the FBDG implementation process (d) provide follow up suggestions and actions to initiate/strengthen implementation of FBDGs. The TORs for Working Group II included: (a) drawing up the process for monitoring and evaluating implementation of FBDGs (b) providing suggestions for self evaluation of FBDGs (c) developing a protocol for assessing practical use of FBDGs and (d) developing improved working mechanisms for enabling monitoring and evaluation of FBDGs.

102. Both groups outlined action plans for implementation of FBDGs based on the progress made by the respective countries and identified possibilities for FAO technical support with regard to strengthening implementation of the FBDGs. The summaries of the Working Group outputs are listed in Appendices V, VI and VII.

103. Based on the working group outputs, the consultation provided the following recommendations for strengthening implementation of FBDGs.

For country action:

1. Incorporation of FBDG considerations into relevant national policies such as agriculture, food, health, nutrition education, social welfare and into national plans for development. Identification of the focal points and co-focal points in each country for FBDG implementation and work towards building strong collaborating mechanisms for strenthening the process for implementation of FBDGs within the context of NPAN and WFS activities. The plans for food and nutritional security should include and embrace the objectives of FBDGs.

2. Developing working mechanisms for eliciting multi sectoral involvement for effective implementation of FBDGs and ensuring co-ordination by identifying roles for key stakeholders from related ministries, universities, research institutes, professional organizations, NGOs, and the private sector whose partnership can be evoked for promoting the implementation of FBDGs.

3. Undertaking advocacy/sensitization activities involving decision makers/key stake holders for generating political support for promoting use of FBDGs.

4. Undertaking efforts towards institutionalizing the FBDG objectives so that efforts are sustainable, once donor funding is no longer available. This would require creating a functional structural system for implementation. In many cases, this might be a coordinating committee that engages the stakeholders in regular meetings with an agenda to review proposed actions and develop specific plans for FBDG implementation.

5. Expanding nutrition capacity across agencies through cross-training of personnel, hiring and promoting of nutrition experts. Countries were urged to promote employment opportunities for nutritionists in multi-sectoral fields and enhance their visible roles in developmental programme. This expanded capacity becomes increasingly important as countries must be prepared to address the problems associated with diet related chronic diseases and overnutrition.

6. Developing and promoting small scale and medium scale food based activities/projects which strengthen traditional food processing and preparation techniques as well as cooking practices along with income generation, as appropriate for community groups.

7. Recognizing the importance of monitoring and evaluation in the FBGDs process and investments required for research and research capability building.

For FAO action:

1. Provide leadership for advocacy and promotion for achieving food and nutritional security through:

• Building country capacity

• Sensitizing key leaders at country level

• Exploring/strengthening possibilities for partnership with bilateral agencies, NGOs and the private sector

2. Extend technical assistance in

• Formulation and implementation of FBDGs (for countries which have not developed FBDGs)

• Monitoring and evaluation of FBDGs (for countries who have developed and implemented FBDGs) in terms of developing specific monitoring and evaluation tools, establishing nutrient databases and content analysis of FBDGs in addressing behaviour change

• Enhancing country capacity building through appropriate education and training programmes and workshops and regional networking.

Agenda item V: Implementation of ICN/WFS follow up and NPAN related activities

Bangladesh: presented by Mirza Altaf Hossain

104. Mr. Hossain emphasized that the goal of the NPAN is to improve the nutritional status of the people of Bangladesh to the extent that malnutrition would no longer be a public health problem by the year 2010.

105. In this undertaking the NPAN actions, Bangladesh National Nutrition Council (BNNC) has been reorganized, inter-sectoral Steering Committee and Working Groups are formed, and Focal Points for nutrition in all concerned sectors have been nominated. Orientation of the Focal Points on the contents of NPAN and their responsibilities has also been assigned.

106. Human resource development, advocacy meetings by the agriculture sector, horticulture and nutrition projects are some of the major initiatives undertaken to address poverty alleviation, food insecurity and malnutrition. Legislation for universal salt iodization has been passed. Recently, the Bangladesh Applied Nutrition and Human Resource Development Board has been established to undertake and coordinate different food and nutrition programmes in the country.

107. The National Nutrition Project (NNP), financed by World Bank and other development partners, has given due consideration to NPAN related activities. The government and the development partners, particularly FAO and WHO’s assistance are important, since they have been key partners in facilitating countries in the development of NPANs.

108. Future programmes include, organising mid level courses on Food and Nutrition Programme Planning and Management, integration of nutrition into the curriculum of agricultural education and establishing nutrition data banks through nutrition mapping integrated in the FIVIMS process.

Fiji Plan of Action on Nutrition (FPAN): presented by Nirmala Nand

109. Following the ICN, Fiji produced a draft FPAN which was endorsed by the Cabinet in 1998 for implementation by line ministries and non governmental organizations. The implementing agencies include the Ministries of Health, Agriculture, Education, Women and Culture, Social Welfare, Regional Development, Labor, Consumer Council and Red Cross.

110. Under the nine priority themes, several projects are undertaken each focusing on overall improvement of nutrition and health. Implementing strategies by various organizations include use of innovative information education and communications techniques including that of multi media.

111. There is need to create a demand in the community and involve them in the process of developing nutrition relevant projects with officials playing a facilitating role. As the FPAN is being revised, it is envisaged that upon its completion, it would be launched with media publicity and evoking the partnership of relevant stakeholders in its implementation.

112. Incorporating some monitoring and evaluation procedures to establish a system of continuous feedback from the implementers to the coordinators for data banking and report keeping would be integral to the efforts undertaken.

India: presented by Kamala Krishnaswamy

113. India adopted its National nutrition policy in 1993 and set up its NPANs which are multi sectoral. The Department of Women and Child Development (DWCD) under the Human Resource Ministry serves as the nodal agency. The National Integrated Child Development Services (ICDS) serves as the core infrastructure which provides a package of services for improving nutrition of children and pregnant women.

114. Several achievements have been accomplished as a result of the NPANs. These include establishing of district level diet and nutrition data, control and prevention of micronutrient deficiency, establishment of the nutrition surveillance system, on going initiatives related to food safety, women’s health and food fortification. Most impressively, horticultural initiatives have been strengthened Other developments include FBDG development and updating of the RDA. Decline in the prevalence of several nutrition disorders have been observed.

115. Future Plans include nutrition mission approach, targeting 0-2 year old children in programmes, strengthening complementary feeding, promoting adolescent nutrition expansion of nutrition and diet survey to all states, institutionalization of nutrition surveillance system based on triple A approach, and giving more attention to diet related disorders and expanding tribal nutrition survey initiatives.

Indonesia: presented by Arum Atmawikarta

116. Since 2001, Indonesia has adopted a decentralized governmental system, in which a more visible role is seen for the local government in setting its own development strategies for the community. The National Plan of Action for Food and Nutrition (NPAFN) provides guidance to all levels of the government to integrate food and nutrition into its developmental programmes.

117. To the NPAFN, institutional development and strengthening are planned which span a five year ten point programme action plan. These include, development of institutions, man power development, strengthening food security, strengthening food and nutrition surveillance system, handling and prevention of malnutrition and overnutrition, handling and prevention of micro-nutrient deficiency, strengthening family nutrition awareness, institutional nutrition services, development of food quality and safety, and research and development.

Malaysia: presented by Mohd Ismail Noor

118. Activities of the NPAN are carried out by three technical working groups (TWG) namely; Research, Training and Nutritional Guidelines. A national survey of KAP on nutrition involving 5 groups, namely primary school children, adolescents, adult, elderly and the food vendors. The results are being collated by the Institute for Medical Research. The first National Nutrition Survey is currently being planned and coordinated by Ministry of Health (MOH). The TWG on Training has published several training modules and organized several workshops to educate health care provides on nutrition. These activities are coordinated by Universiti Putra Malaysia. A Fourth TWG was established recently and has prepared a draft for the first National Nutrition Policy which is being studied by the MOH.

119. As part of the future plans and efforts, a National Nutrition Council to be chaired by the Minister of Health will be established with its membership comprising high-ranking officials of relevant ministries. The establishment of a National Food Safety Council, under the MOH is also in process.

Nepal: presented by Yogesh Vaidya

120. The Nepal National Plan of Action for Nutrition has been adopted by the government in 1998 and incorporated in the present Ninth Plan. In the present Ninth Plan (1998-2002), nutrition has been considered as a priority concern for human resource development.

121. Mr Vaidya pointed out that Nepal has significantly controlled IDD and VAD, but the control of anemia continues to remain a major challenge. The rigorous promotion of iodised salt among consumers, and the distribution of vitamin A capsules through mass campaigns, are measures pursued by His Majesty’s Government. As for PEM, in 25 years there been no significant positive change in the prevalence of stunting which is 50.1% as indicated by the Family Health Survey of 2001.

122. It is gratifying that the agriculture sector has accorded due priority to legumes and pulses which are the main sources of protein in the Nepalese diet. Emphasis has also been given to the production of fresh vegetables and fruits through the promotion of kitchen gardens, home/community orchards, off-season and vegetable farming.

123. To raise nutrition awareness, nutritious food distribution programmes and school feeding are regularly conducted at the district level. Nutrition education features regularly in radio and television programmes of the agriculture and health sectors.

124. The National Nutrition Coordination Committee makes regular progress monitoring through annual review meetings. Food laws and regulations have been enforced in all the 75 districts and food safety and quality control measures are being taken.

The Philippines: presented by Elsa Bayani

125. Elsa M. Bayani informed the Consultation that after ICN, the Philippines Plan of Action for Nutrition (PPAN) has made significant strides along the nine ICN strategies, which include integrating nutrition concerns in the Agricultural and Fisheries Modernization Plan, Health Reform Agenda, and Early Childhood Care and Development Programme. Others include, the establishment of home/school and community gardens, breakfast and milk feeding in school and emergency feeding in disaster stricken areas. Multimedia campaign on consumer rights and responsibilities towards improving food quality and safety have been promoted.

126. Provision of subsidized rice and selected items through government rolling stores in depressed communities and implementation of comprehensive integrated social services to vulnerable groups are being done. Particular progress has been made in the prevention and control of micronutrient malnutrition, through the enacted Food Fortification Act and Salt Iodization Law along with supportive strategies of vitamin A and iron supplementation to infants and pregnant women;

127. Future actions include, continued intensification of advocacy efforts specifically increasing investments for nutrition programme through legislation and partnership with private sector and NGOs; carrying out research to identify cost-effective and cost-effective interventions; strengthening data support systems to assess investments for nutrition, and enhancing capabilities of local governments and national agencies on nutrition programme planning and management.

Thailand: presented by Songsak Srianujata

128. Since the start of the Seventh National Economic and Social Development Plan (NESDP), several programmes and projects in Thailand have been in line with the ICN recommendations. Activities include controlling and eliminating the problem of malnutrition in vulnerable groups; improving household food security; promoting food production, processing, distribution and consumption of nutritious foods for nutritional well being and protecting the rights of the consumers. Effective communication and education campaigns aim at producing behavioral change, protection and support of breast feeding and complementary feeding.

129. Developing more sensitive indicators for nutrition surveillance and monitoring systems along with human resource development and interdisciplinary research in food and nutrition are other strategies being intensified. The current Plan, is the nutritional enrichment of the food supply. This has been used in the community to address micronutrient deficiencies such as vitamin A and iron by promoting appropriate food selection and combinations to enhance the bio availability of nutrients.

130. Consumer protection, food safety and nutrition education are other crucial components of the Plan. Development of Thai Food-Based Dietary Guidelines, Thai Food Guides as well as recommendations for Nutrition Labeling in all food products have been established. Information on Dietary Guidelines and Nutrition Labeling has also been disseminated to the public through several channels.

Viet Nam: presented by Ha Huy Khoi

131. As an outcome of Viet Nam’s VAC (Vuon - gardening; Ao - fish pond; Chuong - animal husbandry) strategy, its achievements in nutrition improvement, include virtually eradication of the clinical signs of VAD. Fortification initiatives for fortification of local foods are also in progress. Every family has developed a typical nutrition square which provides for household food security.

132. Early introduction of complementary foods is another problem in Viet Nam which is being addressed as part of its FBDG initiatives. Now Viet Nam emphasizes the healthy life style concept and is working towards such actions.

NPAN’S in Pacific Island Countries and Territories (PICTs): presented by Wendy Snowdon

133. All the PICT’s recognise importance of NPANs and most countries have an NPAN, though many are still in draft stages, or out-of-date. Implementation is found to vary, and difficulties are faced in getting ownership and ongoing commitment from all necessary partners and agencies.

134. There has been pressure by some donors/agencies to develop action plans addressing specific issues such as NCDs/obesity/diabetes without due consideration of existing NPANs. Consequently, the NPAN can be forgotten.

Vanuatu: presented by Emily Kalsakao

135. Vanuatu attended the WFS but no formal report was formulated. However, a follow-up meeting for the Pacific region on Food Security was held in Apia, Western Samoa (6-9 April 1999).

Agenda item VI: Discussion on Implementation of FAO Nutrition Education Modules in Feeding Minds, Fighting Hunger (FMFH)

136. The ANFN Secretary briefly informed the Consultation about this recent initiative of FAO in its global efforts towards addressing the problem of hunger and malnutrition. The Chairperson invited the participants to express their views on the agenda.

137. Discussion issues included (a) exploring possibilities for the use of FMFH Module (b) identifying potential institutions and target users, (c) adapting the modules according to country contexts, and (d) sharing of ideas with appropriate details with a view to promoting the modules for use in the country.

138. The Consultation commended FAO for developing this novel education module and appreciated this initiative. It expressed the view that the document would be very useful to carry forward the philosophy of addressing the important global issue of hunger and malnutrition and, in particular, to reach out to the unreached and the most vulnerable.

139. On potential institutions and target users, the Consultation suggested exploring avenues for implementation through the Ministry/Department of Education which has a network involving schools, training institutes and other educational institutions to use FMFH as part of educational materials.

140. Other departments (agriculture, health and local governments) which have respective networks of training institutions and organizations can also be tapped to promote and utilize the FMFH modules. Moreover, related institutions/organizations involving women, farmers, youth and local groups may also be involved in this project. Partnership with the private sector as sponsors for such a project may be explored, but this effort should not compromise with the mandate and goals of the concerned country as well as FAO.

141. In adapting the modules, the Consultation recognized (a) the need for strong advocacy to concerned national agencies, NGO, bilateral partners and other stakeholders; and (b) creation of a Task Force/Working Group to brainstorm/review the application of the module in existing programmes or linking up with National Nutrition Education Programme, and similar other initiatives at country level.

Recommendations

1. Viewing FMFH in a comprehensive manner to link it up with issues within the larger developmental context which impacts on hunger and malnutrition.

2. Allowing for wider understanding by various sectors involved in such related initiatives by articulating its connections with NPAN, WFS and related actions at the country level and ensuring that sectors recognize the activity as a long term programme.

3. Solicit involvement of other UN bodies and bilateral partners like ASEAN, South East Asian Research Council for Agriculture (SEARCA) in the FMFH initiative.

4. Participants to undertake brainstorming sessions as appropriate to explore its use. In doing this, adaptation of the modules in local context would need to be considered.

5. Consider use of the FMFH module for capacity building for grass root level functionaries and explore its use in community based programmes.

6. Participants to submit an action project for future country level action providing details as required for possible adoption and adaptation. Specifically, a proposal briefly pointing to the modality of use of this module along with potential partners were to be identified and details of the process and expected outcomes could be submitted to FAO for possible technical assistance.