2.1 Review of ICN Goals and Commitments
2.2 Efforts to Turn Commitment into Action
6. At the International Conference on Nutrition member governments pledged to work, in active cooperation with multilateral, bilateral and non-governmental organizations, the private sector, communities and individuals, to eliminate before the end of this decade:
- famine and famine-related deaths;- starvation and nutritional deficiency diseases in communities affected by natural and manmade disasters;
- iodine and vitamin A deficiencies.
Governments also pledged to substantially reduce within the decade:
- starvation and widespread chronic hunger;
- undernutrition, especially among children, women and the aged;
- other important micronutrient deficiencies including iron;
- diet-related communicable and non-communicable diseases;
- social and other impediments to optimal breastfeeding;
- inadequate sanitation and poor hygiene, including unsafe drinking-water.
7. The ICN called upon governments to translate this global commitment into country level activities through development and implementation of national plans of action built on the principles and strategies enunciated in the World Declaration and Plan of Action for Nutrition. It was suggested that national plans be based on an analysis of the country situation and be representative of the needs of all people, with particular emphasis on the most vulnerable groups. Governments were urged to promote community-wide participation and establish coordinated intersectoral mechanisms to develop, implement and monitor execution of these plans, encouraging participation of all relevant ministries, local governments and communities, non-governmental and research organizations and the private sector.
8. The conference stressed that to turn plans into action, allocation and mobilization by government of adequate financial and human resources would be imperative. Recognizing that many countries were lacking needed capacity, it was recommended to give high priority to efforts aimed at strengthening human and institutional resources. The international community was called upon to provide, to the extent their mandates and resources allowed, increased technical and financial support for preparation and implementation of national plans of action. Development agencies were urged to strengthen collaborative mechanisms to fully participate at all levels in the achievement of the goals of the global Plan of Action.
Intersectoral consultation
National plans of action and other mechanisms to achieve ICN goals
Increased commitment for activities to improve nutrition
Support from development agencies for ICN follow-up activities
9. A primary achievement of the International Conference on Nutrition has been the attainment of a global consensus on the extent, magnitude and causes of malnutrition and on various policies and strategies to bring about long-lasting improvements in nutrition. Apart from its function as an international forum, the conference has also given rise to a widespread mobilization of people at local, national and international levels, to raise awareness, generate ideas and initiate action from a wide range of perspectives to improve the nutritional well-being of all people. It has also provided a unique opportunity to tap on resources, both human and financial, available within various sectors and at several levels of society.
10. The global dialogue initiated at the ICN has become a framework for drawing country and regional action plans, with the ultimate aim of turning commitment into action. In order to arrive at coherent, transparent and, above all, realistic plans of action, many countries are using an intersectoral consultation process. This has often involved establishment of a multisectoral task force, lead by a line ministry, such as health, agriculture or planning, or by a research center or university. Of those reporting to WHO, 101 countries and 1 territory indicated that they have established or institutionalized national intersectoral mechanisms to implement, monitor and evaluate their agreed policies and national plans of action for nutrition. Participants in this consultation process include government ministries and organizations, research institutions, universities, non-governmental organizations, development organizations and the private sector.
11. In many countries, national plans are prepared through a process of alternating sectoral and intersectoral consultations. In addition to establishment of a multisectoral task force, this frequently requires creation of ad-hoc sectoral or thematic working groups and organization of national workshops or seminars. In many countries, national seminars or workshops have been held to coordinate and consolidate the efforts of various government sectors as well as international agencies and nongovernmental organizations. Coordinating mechanisms among international agencies working to achieve nutritional well-being were reported by 77 countries; while collaboration is good in many countries, it needs to be strengthened in some. This approach is maximizing input from key sectors such as agriculture, health, trade and industries and strengthens linkages between those sectors. To maintain and strengthen intersectoral bonds, several countries are reinforcing or proposing to institutionalize their framework for development, implementation and follow-up of food and nutrition plans and programmes in order to continue dialogue on topical food and nutrition issues on a more permanent and formal basis.
12. In many countries such as Burkina Faso, Benin, Ecuador, Peru and Fiji, ICN follow-up is providing a unique opportunity for non-governmental organizations, academia and the private sector to participate in national planning. Their participation is enhancing community participation in national planning and enabling planners to adopt more need-oriented and target-group based approaches. Exchange of information and joint planning is reinforcing momentum of both public and private sector programmes. In some countries, increased people's participation is being pursued through development of district and local level plans of action often using local food and nutrition committees. In only a small minority of countries, development of a national plan has been a central planning exercise, with only minimal involvement of non-governmental organizations and the private sector. In general, participation of industry in preparation of national plans of action has been limited.
13. At present, 139 countries world-wide are preparing or have completed national plans of action for nutrition; 72 countries report having finalized a national plan, 26 are in the stage of revising a draft plan and 41 are still in a process of their preparation. In the last group, plan formulation has been hampered by various causes, including lack of local capacity, inadequate institutional arrangements, lack of resources or political turmoil (see Table 1).
14. In a number of countries (e.g. Kenya, the Philippines, Dominican Republic, Vet Am, Zaire) national plans of action for nutrition are being adopted by the highest Government authorities and have become truly national plans. In other countries, plans are being adopted by one or several line ministries without further referral to higher political levels. Indonesia, for example, has made a conscious decision not to develop a national plan, but is rather addressing nutrition problems through other national development planning exercises. In several other countries such as Seychelles, Ireland, Singapore and France, where food supplies and access to food are considered to be generally adequate, nutrition is being addressed primarily through existing health plans. In these countries, national plans may still be needed to address problems of food insecurity among ethnic minorities and other vulnerable groups.
15. Many countries, in addition to preparing national plans of action for nutrition, are using other mechanisms to achieve ICN goals. These include existing national food and nutrition policies (e.g. Western Samoa, Chile, Mexico, Uganda, Solomon Islands), five-year development plans (e.g. Indonesia, Iran, Pakistan, Cambodia, Ghana, Namibia), national programmes of action for children (e.g. Lesotho, Mauritania, Uganda, China, Namibia) or a national hunger campaign such as the one in Brazil. However, despite the wide array of planning processes employed in developing countries, impact of existing programmes is often curtailed by lack of local capacity, resources and coordination. Countries report that insufficient awareness and understanding of nutrition problems among policy makers and planners is resulting in inadequate resource allocations to food and nutrition programmes and neglect of strengthening local capacity and intersectoral coordination.
16. Development of national plans relies heavily on information gathered and analyses made in the course of the ICN process. In particular, preparation of country papers and organization of national seminars have allowed planners in the formal and informal sectors to review existing food and nutrition programmes, assess their impact in the light of efforts and investments made and re-prioritize issues and select appropriate strategies in the broadened nutrition context created by the ICN. Many countries propose to further develop and expand the information generated through the ICN and increase accessibility to potential users. As an immediate output, country reviews and analyses are resulting in increased recognition and understanding of the complementarity between various sectoral programmes. This is clearly reflected in the many national plans of action that consolidate sectoral efforts into comprehensive plans with increased visibility and leading to greater efficiency and impact. However, country experience shows that to turn national plans of action into useful programme guides, they need to be integrated at some stage in regular national and sectoral planning and budgeting cycles.
17. The ICN continues to yield important levels of commitment to intensify efforts to protect and promote nutritional well-being. This is clearly reflected in the number of people being mobilized, the amount of time and resources spent and the level of technical and financial support provided by various ministries, institutions, agencies and non-governmental organizations. Seventy-two countries and 1 territory have indicated successful efforts made to allocate or mobilize additional financial and human resources as a result of the Declaration and Plan of Action. Of these, 49 countries and 1 territory have been able to mobilize these resources nationally, for example, by allocating additional funds for nutrition-related activities and/or creating a multisectoral food and nutrition task force; 56 countries and 1 territory reported that they had received financial and technical support from international agencies including WHO, UNICEF, FAO and the World Bank. In addition, 24 countries have reported success in obtaining additional resources from bilateral agencies.
18. Collaboration with nongovernmental organizations to mobilize additional financial and human resources for implementing national plans of action for nutrition has been mentioned by 37 governments. In several countries commitment is not only being translated into development of national plans of action, but is also resulting in a redirection of activities of concerned line ministries (e.g. Ghana, Laos, Iran) or even establishment of new institutions or ministries to address food and nutrition issues (e.g. Indonesia). Many non-governmental organizations are also taking up their responsibility through the integration of nutrition considerations and components into their programmes and projects.
19. In a majority of countries, the ICN continues to have a multiplier effect on efforts to involve communities and the people themselves in activities to improve nutritional status. Some governments envisage to develop provincial or district plans of action for nutrition (e.g. Cuba, Burkina Faso, Argentina, Kenya, Uganda), while others, such as Cambodia, are enhancing people's participation in programme implementation through establishment of committees for intersectoral cooperation and rural development at these or even lower levels
20. Country experience further shows that there is a synergetic effect between efforts to raise public awareness and actions to generate necessary political commitment. In the Philippines, for example, where the ICN is resulting in increased activities to improve nutrition, the National Nutrition Council has received authority from the President and is supported by a network of organizations and institutions allowing broad community and institutional participation in both assessment and planning. This is resulting in an equally broad involvement in implementation and follow-up of the national plan of action.
21. The ICN has encouraged and enhanced partnerships among development agencies to work collaboratively towards common goals, and particularly so at the country level. Considering the overlapping mandates of many development partners, greater attention is needed to seek out opportunities to support countries in developing complementary approaches to address food and nutrition problems in a sustainable manner, while avoiding duplication of effort. While FAO and WHO have strengthened their areas of collaborative work, increased coordination among development partners needs to be encouraged, particularly among UN agencies, to support their unique role in building national capacity to address food and nutrition problems.
22. FAO and WHO continue to provide considerable support to national and regional efforts to implement the ICN goals. Both organizations are providing technical and financial support for development of national plans of action and are actively promoting intersectoral consultation in favour of nutrition. To facilitate implementation of national plans, FAO and WHO are also making serious efforts to increase local capacity to turn plans into operational proposals. FAO has provided assistance to over 100 countries world-wide through support to national consultants and workshops and technical assistance from headquarters and regional offices. In total, FAO along with UNDP has provided over 3.0 million dollars to countries to support ICN follow-up activities (see Table 2).
23. WHO has intensified its technical and financial support to countries, particularly to those least developed. A major proportion of its time, energy and financial resources has been spent in providing support to countries for developing, strengthening and implementing their national plans of action for nutrition in line with their commitment to the World Declaration and Plan of Action. WHO'S technical support to countries for implementing the World Declaration and Plan of Action has been provided through its active network at country, regional and global levels. This includes both programme support activities and normative work. As of 30 November 1995, technical and financial support was provided to a number of countries (see table 3). It should be noted that FAO, WHO and UNICEF regional offices are playing a key role in identifying and organizing the support needed by countries in order to develop more comprehensive nutrition-oriented policies and programmes, particularly at country level.
24. At regional and sub-regional levels FAO, WHO and UNICEF are working together to strengthen technical cooperation, identify constraints and share experiences in implementation of ICN recommendations. To this end, the agencies have organized or supported a number of inter-country meetings and workshops (see table 4). These meetings were held to stimulate and review country progress towards the finalization of national plans of action for nutrition, to share information and experience, and to provide assistance to those countries needing help in finalizing their national plans of action. At some of these meetings, operationalization and budgeting of national plans of action was also discussed. Countries are explicitly requesting increased regional and sub-regional cooperation and clearly defined programmes, based on regional issues emerging from national plans.
25. Countries are indicating that resource mobilization for plan implementation can best be achieved through national and inter-agency coordinating bodies. National efforts to promote intersectoral coordination and mobilize resources are resulting in an increased demand from ministries and agencies for strengthened inter-agency cooperation. This is expected to result in substantial savings and increased budget allocations for nutrition by aligning programmes and increasing visibility of nutrition in the overall development framework. In the past, UN and other agencies have participated in national task forces, intersectoral committees and other national food and nutrition coordinating mechanisms. At present, many countries, such as Ghana, Lesotho, and Syria, are establishing a schedule for regular inter-agency consultations and as a result collaboration between FAO, WHO, UNICEF and other development organizations in the area of food and nutrition has increased substantially. In some countries (Lesotho, Namibia and Sudan), nutrition has become a key issue in the development of a Country Strategy Note prepared by UNDP.
26. FAO and WHO continue to play a major catalytic role in sustaining the ICN follow-up process. As countries now reach the stage where plans need to be implemented, it becomes increasingly important to support these country initiatives through an intensification of relevant normative and operational activities. FAO is, therefore, intensifying its assistance to member countries to improve food security, fight micronutrient deficiencies and improve food quality and safety through concrete actions in the areas of food, agriculture, forestry, fisheries and sustainable development. The organization is actively promoting and pursuing integration of nutrition components and considerations throughout its programmes. FAO is further providing food and nutrition monitoring, evaluation and information services and policy advice to member countries and concerned agencies. Through participation in numerous international, regional and national fora, the organization is actively advocating development and application of food and agriculture based approaches to alleviate poverty and malnutrition.
27. WHO has strengthened its capacity to respond to its Member States by drawing up a strategy for supporting the implementation of the World Declaration and Plan of Action for Nutrition at all levels and by establishing a new Division of Food and Nutrition at headquarters, comprising the previously separate units of Food Aid programme, Food Safety and Nutrition. A series of working groups have also been established to consider each of the nine strategy areas of the World Declaration and Plan of Action for Nutrition. The Nutrition Task Force continues to serve as a means by which collaboration with and support by the Division of Food and Nutrition can be facilitated. It also acts as a forum for reporting, sharing and harmonizing the working groups activities, thereby promoting a complete and integrated nutrition output for WHO.
28. In addition, FAO and WHO have continued their critical normative work, particularly at global level, reviewing the latest scientific data and developing norms, criteria and guidelines covering a broad spectrum of nutrition issues. In view of the enormous burden of malnutrition, FAO and WHO continue to accord high priority to their normative functions, on behalf of the Member States. Much joint FAO and WHO work combines the food and agriculture strengths of FAO to the outstanding WHO health expertise to produce joint normative expert reports and work on food quality and safety. In other cases, more specific areas of food, agriculture or health are treated separately by FAO or WHO so that a complete range of normative advice is available to member countries.
29. Normative work is carried out by FAO and WHO in the following areas: assessing, preventing and managing protein-energy malnutrition; overcoming micronutrient and trace element deficiencies; promoting infant, young child and maternal nutrition; preventing diet-related noncommunicable diseases; preventing food-borne diseases; training in preparedness and management for nutrition emergencies and promoting research and training in nutrition. FAO and WHO'S normative work is achieved in three main ways: by holding scientific meetings; by producing technical documentation; and by assessing the worldwide prevalence of the major forms of malnutrition and monitoring their trends through a series of data banks (on protein-energy malnutrition, iodine deficiency disorders, vitamin A deficiency, anaemia in women, anaemia in children, and prevalence and duration of breast-feeding). In addition, databases on food and nutrition policies are available for the European and Western Pacific Regions, and a database on food composition of regional foods is managed by the Regional Office for the Americas. FAO and WHO technical documentation, which incorporates the outcomes of interagency consultations, workshops and other meetings, provides technical, programmatic and managerial guidance to decision-makers and others responsible for implementing national nutrition activities.
30. Other UN agencies and development organizations are also providing considerable support to implement the ICN goals. In many countries, UNICEF has taken an active role in assisting in the formulation of national plans of action for nutrition and other nutrition programmes. A good example of FAO - UNICEF cooperation can be seen in Malawi, where each agency has provided technical assistance to strengthen national capacity to develop the national plan of action and related programmes. As poverty alleviation and nutrition improvement are core objectives of IFAD's programme, the organization assists countries through various regular programme activities. The organization reports that it has developed a strategy for improving nutrition through rural investment projects and operational methodologies for project design and monitoring to strengthen household food security and nutrition in poverty alleviation projects.
31. The World Bank reports that since the ICN it has provided substantial loans for projects on nutrition or with major nutrition components (in the areas of education, population and health, agriculture, and infrastructure). While the impetus within the Bank for promoting nutrition programmes may not have arisen from the ICN, clearly the enthusiasm on the part of recipient countries to address nutrition has been greatly influenced by their involvement in the ICN process. IAEA indicates that nutrition is considered as a high priority in the Agency's medium term plan for the period 1995-2000 and it has increased resource allocations for implementing national plans of action for nutrition and strengthened its technical capacity in nutrition. In collaboration with WHO, IAEA is also supporting research on nutrition and micronutrients and technical cooperation projects on dietary diversification and traditional foods. UNU is giving increased attention to research on prevention of iron deficiency and supplementation strategies. It is focusing on improved food composition information and supporting a worldwide network of regional institutions and data bases to enhance quality and availability of food composition data in developing countries. UNU and FAO have strengthened their collaboration in this area.
32. UNEP is contributing to increased food security through programmes on integrated pest management. In collaboration with FAO, it is assisting countries to prevent and control contamination of food with mycotoxin through training and other capacity building programmes. Much attention is given to exchange of information on contamination levels to increase foreign exchange earnings by preventing rejection of foods for export. WFP reports that its country programmes are being guided by national plans of action and increased attention is being given to building food security safety nets. Micronutrient components are being included in food aid and school feeding programmes. In several countries such as Myanmar, Laos and Paraguay, UNDP is coordinating assistance provided by UN agencies in the preparation of national plans of action, while in Bangladesh, Indonesia, Nepal and Eritrea, it has provided support through its TSS-1 programme.
33. To reinforce country activities, some bilateral agencies have brought their national development assistance plans in line with the ICN recommendations and have responded to requests to strengthen country programmes for ICN follow-up. For example, Canada and the USA are providing assistance in the development of strategies and programmes to reduce vitamin A, iron and iodine deficiencies. Denmark reports that its development agency is integrating nutrition considerations into sectoral development assistance programmes including health, fisheries, forestry and agriculture. Belgium indicates that it is contributing through existing national programmes for development assistance, including international agricultural research and training in agriculture, food science and nutrition. Japan is providing support in strengthening and implementing national plans of action for nutrition, developing strategies for caring for the vulnerable, preventing diet-related noncommunicable diseases and preventing food-borne diseases through improved surveillance systems and better coordination between international agencies. Other countries, such as France, the Netherlands, Norway, the United Kingdom and the USA, have provided technical assistance through the APO programme.
34. It is important to note that a large number of countries, through their national plans of action and other mechanisms, are requesting organizations and agencies to bring their development programmes in line with the goals and strategies of the World Declaration and Plan of Action for Nutrition. For example, Burkina Faso, Mauritania, Pakistan, Bangladesh and Zambia have obtained World Bank funding for implementing specific activities of their national plan of action.
