Global forum on food security and nutrition

Jane Sherman, FAO, Italy

Dear FSN Forum,

Below are my comments on the workplan, together with tracking comments on the text itself (which are much the same).

Best regards,

Jane Sherman

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Most of the following comments fall under Question 2 of the suggested areas for comment: What are your general comments to help strengthen the presented elements of the first draft work programme of the UN Decade of Action on Nutrition?
General points

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  In several action areas (e.g. paras 22, 23, 30) the problems are laid out but no program of action is indicated.
  
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  Throughout, the document should emphasize the critical importance of M&E in guiding the choice of interventions and ensuring their success, and the essential criteria of (a) cost-effectiveness, and (b)  sustainability of impact, especially in interventions which depend on establishing practices and attitudes.
  
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  In this light, a really useful document would be a guide for governments, NGOs and aid organizations on how to choose between, or mix, interventions to get the best long-term results at the lowest cost. It could link to an accumulating database of
  
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    models of working interventions (preferably institutionalized),
    
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    tools and instruments, policy outlines, regulatory measures, etc.,
    
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    evidence for effectiveness and cost-effectiveness
    
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    protocols for program design
    
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    existing training materials
    

Points on specific paragraphs
Para 13.  Full support for inclusiveness and for making use of existing skills and expertise in the population, but can we also ask that nutrition education pay due attention to

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  people’s/consumers’ existing understanding, practices, attitudes and motivations, resources, capacities and influences
  
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  building consumer capacity, maintenance and resilience with regard to diet and food practices and the professional capacity to promote them
  
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  the choice, mix and balance of strategies adopted, on the criteria of cost, durability/long-term impact, evidence of success, context, history and country capacity
  

Para 16.2    Does “essential nutrition actions” refer to the ENAs (i.e. for infant and young child feeding), or does it mean essential nutrition actions in general, for all the population?

Paras 16 and 28.  In line with the framework of action developed by ICN2, nutrition education cannot be simply included with social protection in point 3.  Nutrition education (which includes behavior change interventions)  is integrated across the sectors in nutrition-sensitive interventions, and has shown impact at scale in several of them, in particular in home gardening and maternal and infant feeding as well as social protection.  It has also shown impact in income generation schemes and is recommended at all levels of school education by the ICN2.  It should therefore be seen as an intervention cutting across all sectors. There is also a great need for capacity in the field of nutrition education (quite distinct from expertise in nutrition), for understanding at all social and political levels, and for expression in national policy and programming.   It is suggested therefore that nutrition education should stand a 7th action area headed “Food and nutrition education and professional training at all levels and in all sectors”.

Para 18.  Add “including civil society organizations and consumer movements” after “other potential actors”, to balance the top-down emphasis. 

Para 19.   “A food system approach – from production to processing, storage, transportation, marketing, retailing and consumption – is thus important to promote healthy, sustainable diets and improve nutrition as isolated interventions have a limited impact.”  If “consumption” includes “acquisition”, well and good.  If not, “acquisition” needs to appear, otherwise the consumer has no role except to eat and the food system is presented as entirely supply-side.

Paras 20 and 21  need more attention to consumer demand:  there are suggested tracking changes in the text.  The paragraphs should also insist on the importance of implementing food-based dietary guidelines and evaluating impact as well as developing them.

Para 22.  The description of food safety problems should be extended with suggestions on what to do about them, especially in the light of the high cost of refrigeration/regulation/inspection in low-income countries.

Paras 24-16 on health services.  The emphasis here is mainly technical.  The strength of  health systems is not only determined by what they treat, or the evidence base for the treatments, but by the quality of the service in terms of (e.g.) training, numbers, presence, accessibility (is this the same as access?), consumer service (including respectful handling, follow-up and education) and accountability  to communities.  There is a body of action  and expertise in these areas, and also on low-cost strategies for improving health services, which could be acknowledged here.

Para 27  Suggest expanding the role of the health services in nutrition education with a new para,  e.g. “Health ministries are usually responsible for national campaigns to promote better nutrition and food practices, for advising the education and food security sectors on food and nutrition.  They therefore need expertise in direct nutrition education, in training frontline workers in nutrition education, and in integrating nutrition and nutrition education into interventions in other sectors.

Paras 30 and 32   “Knowledge” and “education” appear to be treated as distinct.  Does education not include knowledge?  If “education” here does not mean “learning” by whatever means, perhaps its meaning can be defined.  Alternatively, in some cases “education and knowledge” could be replaced by e.g. ““learning about food and  how to improve diet”.

Para 30.  The program for nutrition education, again in line with the recommendations of ICN2, needs to be expanded, for example by adding the following words:

“It (NE) also maximizes the impact of nutrition-sensitive interventions in food security, health, social protection, which may all need some element of FNE/SBC.  Achieving such results requires specialist capacities in the relevant services, beyond technical knowledge of nutrition, health or agriculture, which should be recognized in training curricula for educators, agriculture and health professionals.  FNE/SBC requires an enabling physical and institutional environments, and hence calls for action at several levels of society, including policy and programming.  It is also enabled by a supportive social environment and a general climate of interest in food and health, hence the importance of an extensive action-oriented school curriculum, well-publicised government actions (e.g. labeling, subsidies, taxes), and ongoing media attention.   In all cases where FNE/SBC is an important arm of a program, allowance should be made for some form of impact evaluation.” 

Para 37 should be followed with some recommendations on (a) the information and communication environment, e.g.  the control of deceptive information/advertising, food advertising to children,  free access to information on good diet and the role of the media and (b) the food environment – guidance for institutions, workplaces etc on how to create nutrition-friendly environments

38.  Is a multi-sectoral umbrella committee essential?  Have we any evidence of success with such committees or of the demands they pose (e.g. costs, time, transport),  the necessary level and quality of communications, and the time-span (e.g. for collaborative training, curriculum change)?  Outside projects can do this, but in the end the praxis has to be institutionalized . The answer would seem to be to do things bit by bit, but I have not seen this recommended anywhere.  When giving counsel of perfection, there should be some attention to the challenges.

Jane Sherman 11.02.17

Attachment:

http://www.fao.org/fsnforum/sites/default/files/discussions/contributions/Tracking%20comments%20on%20the%20text_JSherman.docx