Global Forum on Food Security and Nutrition (FSN Forum)

Author of submission 

Dragana Stojisavljević, MD, PhD, Public Health Institute of Republic of Srpska, University of Banja Luka, Medical Faculty

Slađana Šiljak, , MD, PhD, Public Health Institute of Republic of Srpska,

Amela Lolić, MD, Deputy Minister of Health and Social Welfare, Ministry of Health and Social Welfare of Republic of Srpska,

Ljiljana Stanivuk, MD, MSc in Nutrition, Public Health Institute of Republic of Srpska, University of Banja Luka, Medical Faculty

Jelena Niškanović, PhD psychologist,  Public Health Institute of Republic of Srpska,

Jelena Đaković Dević, MD, Senior Officer for Public Health, Department for Public Health, International Relations and European Integration, Ministry of Health and Social Welfare of Republika Srpska

Nataša Cvijanović, PhD, Head of Department for Preschool Education, Ministry of Education and Culture of Republic of Srpska

Radmila Kocić, Deputy Minister of of Education and Culture of Republic of Srpska, Ministry of Education and Culture of Republic of Srpska

Title of your example

Implementation of Nutrition Friendly School/Preschool Initiative in Republic of Srpska

Theme

School/Preschool food and nutrition programs

Date, location and geographic scope of your example

Nutrition friendly school/pre-school initiative (NFSPI) in Republic of Srpska was established during the 2014 year by the team of Public Health Institute of Republic of Srpska in five pilot pre-schools across five regions in Republic of Srpska. We started with the implementation of the NFSPI in five pilot pre-schools. We used all NFSPI Guidelines and Tools prepared by the World Health Organization, which we have adapted before implementation.

Main responsible entity(ies) for the implementation of your example

Nutrition friendly school/pre-school initiative (NFSPI) is supported by the Ministry of Health and Social Welfare in the Government of Republic of Srpska and Ministry of Education and Culture in the Government of Republic of Srpska and UNICEF Office in Bosnia and Herzegovina.

On the proposal of Ministry of Health and Social Welfare the Government of  Republic of Srpska in May 2011 adopted the Policy for Improving Early Childhood Development in the Republic of Srpska. The Policy’s goal is creation of optimal conditions for children’s adequate growth and development, striving towards the highest community standards, in order to ensure that each child, regardless of his/her background and individual abilities,  can have conditions for a healthy start in life and so that it can reach its  full potential. The basic conditions for adequate growth and development of children imply a well balanced nutrition, prevention of nutritional deficiencies and control of food-related diseases.

On the proposal of Ministry of Health and Social Welfare in the 2012 year the Government of  Republic of Srpska adopted the Policy for Improvement of Nutrition of Children under the Age of Five in Republic of Srpska

Key objectives and implementation approach of your example

One of the main objectives of the overall development of Republic of Srpska is improvement of the position of children. One of the priorities of Republic of Srpska is investment in children and promotion of their rights in line with the principles and provisions of the Convention on the Rights of a Child.

The aim of the Health promotion program "Nutrition friendly schools/preschool institutions" (NFSPI) was to create a network of institutions (pre-school, school, high school) that encourage the improvement of nutrition and physical activity among children, parents and professional staff (educators, teachers, cooks) and perform activities to prevent obesity and improve healthy lifestyles in preschool and school environments.

Some specific objectives of the Health promotion program "Nutrition friendly schools/preschool institutions" are:

1. To train pre-school staff for developing food and nutrition policies in pre-schools in order to to ensure the sustainable implementation of general and specific goals of this program,
2. Improve eating habits and the level of physical activity among children in pre-schools; nutrition, adequate selection and preparation of foods among food preparation staff to prepare meals in accordance with the guidelines, standards and norms for preschool children.
3. Improve parents' knowledge and habits regarding the importance of proper nutrition and physical activity and their impact on child development;
4. Improve knowledge and habits among professional staff vs. educators and teachers in the area of ​​nutrition and  physical activity in order to further educate children and young people about the healthy lifestyles;
5. Improve knowledge and habits in the area of ​​nutrition, adequate selection and preparation of foods among food preparation staff to prepare meals in accordance with the guidelines, standards and norms for preschool children.

Steps for first phase of implementation were: self-assessment of pre-schools diet, physical activity and hygiene; developing nutrition policies in preschools and implementation of activities written in action plans. During the first year of implementation we prepared health promotion material and provided equipment for teacher, parents, cockers and children, and organized more than 30 workshops for all target groups in the pre-schools in Republic of Srpska.

At the second phase we developed Nutrition Standards with seasonal cookbooks and tools for monitoring and evaluation of NFSPI and established Government body for evaluation (GBE) which is responsible for certification of pre-schools.

During the third phase all pilot pre-schools were evaluated by the GBE and nominated for certification. Also, in this phase we included four new pre-schools. In the fourth phase we are going to evaluate and certificate four pre-schools from previous phase.

Funding and technical assistance of your example

Financial support for the implementation of the NFSPI was provided by the UNICEF Office in Bosnia and Herzegovina during all four phases of the implementation of the NFSPI.

Technical and professional support was provided by the staff of the Ministry of Health and Social Welfare in the Government of Republic of Srpska, the Ministry of Education and Culture in the Government of Republic of Srpska, the Institute of Public Health of Republic of Srpska  and preschool institutions involved in the NFSPI.

Key stakeholders involved. Describe the cross-sectoral coordination mechanism of your example, if any

The Ministry of Health and Social Welfare in the Government of Republic of Srpska,

The Ministry of Education and Culture in the Government of Republic of Srpska,

The Institute of Public Health of Republic of Srpska 

The Government of the Republic of Srpska in September 2012 adopted Policy for improvement of health of the population in the Republic of Srpska by the year 2020. Policy for Improvement of Health of the Population in the Republic of Srpska by the year 2020 enables designing and implementing activities required for improvement of health in the forthcoming period, with coordination, cooperation and partnerships of competent institutions, governmental, non-governmental and philanthropic organizations, private foundations and community. One of priority courses of action was promoting and adopting “health in all policies” approach which included:

• advocacy leading to accepting the fact that health is concern and responsibility of not just the health care sector, but all other sectors, and that investing in health should not be considered as an expenditure but an investment in development of a society,
• implementing multi-sectoral activities which improve health and health equality, by addressing social determinants of health (improving education, promoting social cohesion, reducing poverty, enhancing early growth and development of children),
• building partnerships for health between competent institutions, governmental, non-governmental and philanthropic organizations, private foundations and community,
• building capacities for evaluation of effects of all sectoral policies, strategies, programs and projects on health of the population and making improvement of health as one of the priorities in all sectoral policies, strategies, programs and projects, and
• promoting health and health equality in all policies, so that all sectors understand and accept their responsibility for health and act within the framework of this responsibility.

During the implementation of the NFSPI, we used all of these priority courses of action.

In the period of implementation of NFSPI we also prepared Nutrition Standards with seasonal cookbooks. The Nutrition Standards were prepared by the working group composed of representatives from Ministry of Health and Social Welfare in the Government of Republic of Srpska, Ministry of Education and Culture in the Government of Republic of Srpska, Institute of Public Health of Republic of Srpska. In that period we also established the Government body for evaluation (GBE) which is responsible for certification of pre-schools.

How your example addresses food security and nutrition challenges. Describe linkages to social protection policies / school food programs / sustainable food systems

Implementation of the NFSPI resulted in adoption of Regulation on Conditions and Methods of Providing Nutrition, Care, Preventive Health Care and Social Protection of children in pre-schools. Main activities of NFSPI are now regular activities for most of preschools in public and private sectors in Republic of Srpska.

What are the elements needed for the practice to be institutionally, socially, economically and environmentally resilient and/or sustainable?

The elements needed for the practice to be institutionally, socially, economically and environmentally resilient and/or sustainable included development of legal framework in the field of nutrition in preschools.

During the implementation of NFSPI The Assembly of Republic of Srpska adopted a new Law on pre-school education, Official Gazette of Republic of Srpska, 79/15. After that The Government of Republic of Srpska in 2016 adopted the Regulation on Conditions and Methods of Providing Nutrition, Care, Preventive Health Care and Social Protection of Children in Preschool Institutions, Official Gazette of Republic of Srpska, 88/16.

Also during the implementation of the NFSPI we developed promotional materials for children and their parents:

Book and poster "Choose right, grow healthy “.

For Preschools institutions we developed Nutrition Standards with with seasonal cookbooks (a Four Seasons) and the Guide “How to Become a Nutrition Friendly School/Pre-school institutions” that enables them to implement the NFSPI easier and make NFSPI  sustainable.

The impact of your example on national policies and people’s lives. What indicators have been used to measure it?

During the process of implementation of the NFSPI, we have used the WHO tools to develop materials that include indicators to monitor the achievement of the goals defined by pre-school nutrition policies.

Pre-school institutions used developed materials to monitor the implementation of the defined goals and carry out self-evaluation.

Multi-sectoral body for monitoring and evaluation of progress in preschool institutions also used those tools to perform external monitoring and evaluation.

In relation to the objective of the Policy for Improvement of Nutrition of Children under the Age of Five in Republic of Srpska, we can conclude that our example is involved in all activities that will help reach the goal of Policy: Improvement of diet and prevention of diseases associated with the diet of children under the age of five through: 1. development of healthy lifestyles among children under the age of five through improvement of diet and physical activities; 2. prevention of mass non-communicable diseases among children; 3. prevention of micro-deficiencies; 4. prevention of food-related diseases; 5. adoption of WHO growth monitoring standards for children under the age of five to ensure consistent practices in monitoring and reporting in  Republic of Srpska and to WHO.

Key lessons (positive and negative) that can be learned from your example and how gaps, obstacles and any other adverse conditions were addressed

Based on the experience and lessons learned from pilot-testing it can be concluded that the NFSPI has the potential to mobilize pre–schools, schools and communities to act towards improvement of nutrition and health in Republic of Srpska.

Sources and/ or additional background material