FOOD SECURITY Concepts, Basic Facts,and Measurement Issues June 26 to July 7, 2011 Dhaka, Bangladesh
Kazal 4d:Issues in Nutrition and Policies for Its Promotion in BangladeshLearning: The goal is to identify andunderstand links between food andnutrition, and available and potential policyinstruments and institutional arrangements.Focus on policy documents related tonutrition aimed at expanding andstrengthening nutritional support.
Brief Contents• food and nutrition plans and policies• conceptual framework in designing food & nutrition security interventions• linkages between food security and nutrition• National Nutrition Services• important issues of nutrition and malnutrition situation in Bangladesh• institutional arrangements and nutrition interventions of MH&FW
Food and nutrition plans and policiesWhat is food and nutrition policy?“The Food and Nutrition Policy encompasses the collectiveefforts of the government and other stakeholders to influence thedecision-making environment of food producers, food consumersand food marketing agents in order to improve the nutritionalstatus of the population.”
Food and nutrition plans and policiesKey elements for developing the food andnutrition policySustainable food production, processing, distribution and consumptionEnsure optimal food quality and safetyCollective/multi-sectoral efforts for sustainable food and nutrition securityAchieve and maintain nutrition well-being and healthy lifestyle of the population
Food and nutrition plans and policiesKey stakeholders for developing Steps involved in developing thefood and nutrition policy food and nutrition policy Government Understanding the need for a policy; Review the current food and nutrition status of UN agencies the population; Review the existing the policies (if any) and International organizations identify the lacunae; Nongovernmental organizations Develop appropriate food and nutrition policy using: (national and international) − Direct policy instruments; and Industry − Indirect policy instruments; Develop plans of action for implementation; Professional bodies Evolve an effective and strong monitoring and Academia/researchers evaluation mechanism; and Consumers Establish a nutrition surveillance system to facilitate programme appraisal and follow-up Mass Media action.
The evolution of Food and Nutrition Security concerns
Conceptual framework in designing food & nutrition security interventions(Source: adapted from Metz, 2000)
A Conceptual Framework – Food and Nutrition security
Figure: Conceptual framework of the nutritional status at household level
The Food and Nutrition Security Conceptual FrameworkThe household food security conceptual framework adopted by EFSAs considers foodavailability, food access and food utilization as core determinants of food security, and linksthese to households’ asset endowments, livelihood strategies, and political, social,institutional and economic environment. Figure : The Food and Nutrition Security Conceptual Framework
Linkage between nutrition, poverty alleviation, employment generation and gender
Linkages between food security and nutrition Gender of the head of the household and nutritional status of children and women Relationship between household food consumption pattern and nutritional status of children and women and young child-feeding practices Relationship between food consumption score and nutritional status of children and women Relationship between food consumption score and young child-feeding practices Relationship between household food consumption groups and nutritional status of children and women Relationship between Coping Strategy Index and nutritional status of children and women Relationship between Coping Strategy Index and nutritional status of children and women by area and by division Relationship between most affected livelihoods and nutritional status of children and women
Linkages between food security and nutrition Relationship between percentage of food expenditures and nutritional status of children and women Relationship between wealth status and nutritional status of children and women Relationship between households without enough food in the past 12 months and nutritional status of children and women Relationship between decrease in health expenditures in the past 12 months and nutritional status of children and women Relationship between monthly income per household and nutritional status of children Relationship between “informal borrowing” and nutritional status of children
Linkages between food security and nutritionFigure : Food consumption score and nutritional statusof children and women
Linkages between food security and nutritionFigure: Average CSI at household level amongst acutelymalnourished children by division, by area, and nationality inBangladesh
National Nutrition ServicesImportant Nutrition Projects in Bangladesh • Bangladesh Integrated Nutrition Project (BINP) • National Nutrition Project (NNP) • Expanded Program on Immunization (EPI) • Nutritional Surveillance Project (NSP) • The National Immunization Days (NIDs) • National Vitamin A Plus Campaign (NVAC) • The Integrated Horticulture and Nutrition Development Project
National Nutrition ServicesPolicy and Programmatic Responses to Malnutrition The Government of Bangladesh (GoB) finalized and endorsed the National Plan of Action for Nutrition (NPAN) in 1995. NPAN was a cross Ministerial Action Plan, but could be adequately implemented and monitored Nutrition needs to be firmly highlighted on the national development agenda, articulating the roles of the various Ministries. NFP and the NFP PoA and NNS are recent policy and programmatic actions towards strategic nutrition improvement
Important issues of nutrition and malnutrition situation in BangladeshKey statistics of child and maternal nutrition in Bangladesh Nutrition % of the population Malnutrition, in children (birth to 59 months) Wasting (weight-for-height) 17.4 Stunting (height-for-age) 43.2 Underweight (weight-for-age) 41 Low birth-weight 36 Exclusive breastfeeding (birth to 6 months) 43 Anemia, in children (6-23 months) 64 Chronic energy deficiency, in mothers 32 Night blindness (Vitamin A deficiency), in children 0.04 (18-59 months) Iodine deficiency, in children (6-12 years) 33.8Source: UNICEF, April 2009
Nutrition and malnutrition situation in BangladeshNutrition situation in Bangladesh Dietary pattern Childhood Under-nutrition Maternal malnutrition Micronutrient Deficiencies
Nutrition and malnutrition situation in BangladeshThe underlying causes include (i) household food insecurity resulting from inability to grow or purchase a nutritionally adequate amount and variety of food; (ii) lack of dietary diversity; (iii) inadequate maternal and child care due to inappropriate hygiene, health and nutrition; (iv) low rates of exclusive breast feeding; (v) inadequate access to quality health services; (vi) poor environmental hygiene and sanitation along with low levels of income and maternal formal education.Malnutrition early in life has long-lasting and negative effects onoverall growth, morbidity, cognitive development, educationalattainment and adult productivity.
Institutional arrangements and nutrition interventions of MH&FWINSTITUTE OF PUBLIC HEALTH NUTRITION (IPHN) IPHN is implementing quite a good number of important work intended for the improvement of the nutritional status of the people particularly for the under 5 children and mothers.IPHN Activities:A. Vitamin A Plus Campaign :• Children under 1 year - High potency vitamin A capsule (1 lack I.U) Supplementation during measles vaccination at EPI site.• Children 1 to 5 years-High potency vitamin A capsule (2 lack I.U) supplementation through national events 2 times (4-6 month Intervals) a year.• Children 2 to 5 years- Supplementation of Albendazole through national events 2 times (4-6 month Intervals) a year.• Mother - High potency vitamin A capsule (2 lakh i.u.) supplementation during postpartum period. (With in 6 wks of delivery).
IPHN ActivitiesB. Reduction in the incidence of iodine deficiency diseases (IDD) • Iodized salt monitoring • Awareness creation activities • Training of field workers of health and family planning on control of iodine deficiency disorder (CIDD) • Training for testing Iodized salt • Surveillance of salt for iodizationC. Reduction of incidence of Anemia: • Awareness creation activities to control anemia • Parasitic disease control • Strategy implementation address the major causes of the malnutrition and anemia including iron-foliate supplementation, longtime food fortification & implementation.
IPHN ActivitiesD. Reduction of Protein Energy Malnutrition (PEM) by training program • Awareness program for PEM control. • Growth monitoring of 1-3 years old children • Communication on weaningE. Infant and Young Child Feeding (IYCF) • Strategy implementation. • Promotion and protection of Breast feeding through proper implementation of BMS code and proper child weaning PracticeF. To strengthen laboratory activities: • To develop the effective laboratory facilities of food and biochemical aspects of nutrition. • Serological tests for Nutrition related diseasesG. Guideline for the “Management of Severe Malnutrition of Children in Bangladesh”
IPHN ActivitiesH.Nutritional survey. • To evaluate nutrition related situation at present in selected districts • To assess rapidly the impact of price hike on household food security, food quality and nutritional status among poor women and children in Bangladesh • Recently a survey prepared from 164 family in Bangalypoor union, Sayidpur Upazila, Nilphamary districtI. Strengthening Nutrition & Food Safety Education WHO supported Program • Training for nutrition Sector. • Training for nutrition vulnerable population. • Development of Radio & Television spot on Nutrition awareness creation. • Research on nutrition.J. Strengthening of Child Nutrition Unit: • Identification of malnourished children under 1-3 years of age through growth monitoring • Orientation and education program for mother
Institutional arrangements and nutrition interventions of MH&FWCurrently few nutrition services are delivered as part of core health service delivery.These are Iron Folic Acid (IFA) supplementation is a part of antenatal care for pregnancy, but only about 50% of women make one visit to a health facility Zinc Supplementation: Zinc supplementation during treatment of childhood diarrhea has recently gained importance under the leadership of ICDDR,B and MOHFW. De-worming and distribution of Vitamin A capsules. IPHN also manages the program to combat iodine deficiency disorder The National Nutrition Program has prime responsibility for implementing the area based community nutrition (ABCN) program. The core components of ABCN include: Behavior change and communication (BCC) activities; Growth Monitoring and Promotion (GMP); Food supplementation to children under 2 years of age and pregnant women from ultra poor households; Micronutrient supplementation (vitamin A and iron-foliate); deworming. Additionally it is responsible for promoting infant and young child feeding, particularly breast feeding.
A Multi-sectoral Approach of National Food and Nutrition Policy in BangladeshA draft national food and nutrition policy (FNP) was prepared and approved by the Bangladesh National Nutrition Council (BNNC) and the Council of Ministers (Cabinet).The strategy for effective implementation of the FNP is divided into fourmajor sectors:(a) Food, agriculture, fisheries, livestock, and forestry for increased production, proper distribution, and food security;(b) Health, family welfare, and environment for primary health care, caring practices, disease control, sanitation, and hygiene; (c) Nutrition education and communication for the creation of awareness at different levels with formal and non-formal education; and (d) Community development and social welfare for poverty alleviation, income generation, and economic growth. To implement the various provisions of the FNP, a national plan ofaction for nutrition has been approved.