9. Nutrition Integration

1)  Define a reasonable time-frame where reasonable target could be achieved. For example adapting the strategic outcomes in line with the deep understanding of underlying factors and how to sequence and synchronize the targets from different programme perspectives. we should not  expect same outcomes or same programme approach to address similar issues with a varying context...=> deep localized context analysis.

        a) In country A , children are born stunted, early pregnancy before 18 associated with all the risk factors is as high as 40 percent. WFP targets in this context should be  staged for at least half a generation to see real impact on the main outcomes of interest. However clearly process indicators and intermediate results can be achieved reasonably every few years we should see milestones.=> managing expectations and defining achievable targets

        b) from the above are several actions that WFP can integrate from pre adolescence to next-generation generation of adolescence to cover the whole cycle with a package of support at each stage to attenuate existing deficiencies and prevent occurrences on the new generation. => defining time-frame and integration/synergy/complementarity of a continuum of intervention package ( we can propose at next steps of the discussion)

2) Listening more to the people we serve, applying in extenso the concept of AAP. People need to be involved and to know why we are here, what we are trying to address and involve them in identifying the solutions. => provide feedback on assessment discuss the problem with the communities and mutually agree on the solutions and implementation models

a) we need patience and time to engage with local governments / communities and beneficiaries since unfortutaley the three level have obviously different objectives but needs to be mutually comprehensive=> Consultation/time

b) be flexible and less prescriptive. Be more consultative , promote horizontal learning. Build the model from the ground with community and people participation and respecting they reasonable choices.=> empathy

Tanimoune,

You raise very pertinent points in your 2 comments. On number 1), addressing adolescent needs is important as adolescence is a unique and critical period of life and a bridge between childhood and adulthood. Investing in adolescents is key to preventing the vicious intergenerational cycle of malnutrition, as malnourished girls are more likely to deliver nutritionally impaired babies and are themselves at increased risk of maternal death. In addition, investing in adolescents provides an opportunity to establish healthy behaviour such as proper eating habits and physical exercise. The Fill the Nutrient Gap Analyses also highlight the importance of nutrition for adolescent (and particularly the girl child) and how to address these. The FNG (https://www.wfp.org/publications/2020-fill-nutrient-gap) analyses the nutrition situation in a country and identifies the barriers faced by the most vulnerable to accessing and consuming healthy and nutritious foods.

Anticipating the needs for adolescents in our programming is important. Ongoing WFP work on resilience under the Resilience Building Block Project can also be useful particularly around the various resilience capacities (anticipatory, absorptive, adaptive, transformative) and can be leveraged to enhance nutritional and other outcomes for adolescents. To ensure that needs for adolescents are considered, the following have to be taken into account.

i) strengthen internal and external capacities; ii) Improve WFP’s data systems to better capture and report activities and services targeting this age group; iii) Engage more with adolescents, including them in the design, implementation, monitoring and review of multi-sectoral programming that it responsive to their needs, communication (SBC initiatives); and iv) strengthen partnerships for adolescents.

On number 2), the time factor is indeed critical. Nutrition integration is a process and we need to acknowledge the time factor as well as the importance of engagement. Accountability to affected populations (AAP) is important for WFP because of our strong field presence and direct implementation. The context within each area will strongly determine what our approach will and the various capacities of the stakeholders will need to be taken into account/strengthened for quality programming of nutrition integrated interventions. To this end, the Country Capacity Strengthening (CCS) approach alongside other capacity initiatives (both internal and external) are necessary.

Dear John,

Thank you very much for your insight looking forward contributing to this important agenda.

Best

Tanimoune

Whilst it is important to come up with good nutritious foods and relevant policies, the example of rice fortification shows that without supply chain and especially procurement involvement it will be impossible to implement nutrition policies, procure, deliver and distribute nutritious foods. It will be also crucial to discuss availability and production capacity of the specific food commodities with procurement and logistical corridors and delivery options, storage conditions etc. with logistics. 

With my supply chain lens, in a middle-income country like Kenya, our objective is to facilitate efficient food markets and supply chains to promote access to affordable, nutritious, quality, and safe foods.

To achieve this Nutrition, Programme and Supply Chain shall collaborate in a seamless manner to:

• work with Governments at Central and County level to support crops that resistant to climate change and that can address the nutrition deficit.
• Promote of nutrition-sensitive value chains, in collaboration with Academia and Private sector, to find scalable and sustainable models beyond WFP assistance.
• Reduce post-harvest losses through use of innovative, sustainable, and low-cost technologies to maintain fresh foods, fruits, meat, fish etc … longer.
• Ride on WFP expertise on food safety and quality to support Governments, at central and county level, in their food safety and quality regulatory, surveillance, technology and best practice efforts. The objective is to ensure the food production and food in the markets complies with standards.
• Increase the fortification capabilities at industrial, small, and medium enterprise and at home level.
• Building on the capacity of private sector in country to produce nutritious products (SC+, RUSF) for WFP’s demand, collaborate with them to develop and produce locally affordable nutritious foods, that are meeting the consumer’s taste.
• Food safety and quality messages and campaigns coupled with storage practices to preserve food at home and food preparation and cooking recipes to make attractable high nutrient foods.
• Create and strengthen private partnerships and linkages to draw on industry trends and innovations to enable improvement if food safety and operational capacity to improve local production of affordable and nutrition;
• Partnerships with regulatory bodies like Ministry of Health, County Governments to influence in their food safety policies and monitoring systems. 
• Creating monitoring and incentive systems to ensure children, adolescents and pregnant and lactating woman are consuming diverse and nutritious foods.
• Work with Ministries of Education, to include nutrition education in the school meal programme and training curriculum, explicitly and through provision of the diverse meal.
• Functioning markets are a prerequisite for cash assistance and sustainable livelihoods to contribute to improved nutrition outcomes. Market assessments should be undertaken to better understand the market functionality and supply chain mapping of nutritious foods.
• Programming to focus on supply chains and retail of specific nutritious foods to reduce inefficiencies, increase supply, decrease costs, and stimulate demand. Specific key areas include strengthening market linkages, improving infrastructure and local low costs cold storage, provision of inputs for nutritious crops, establishment of farmer organizations, promotion of value-adding activities, and veterinary surveillance for disease-free livestock markets. Monitoring is essential to track and evaluate the impact of interventions on dietary quality and nutrition outcomes.

How can WFP beneficiaries be part of the malnutrition sustainable solution?

Hint:

• Education of nutrition (perception of healthy food)
• Identifying the nutritious content of local food source
• Using local and common food types to promote healthy diet.

Thanks.

Thank you, George, Josefa and Elvis for the valuable insights you are contributing here.

George Gegelia  rice fortification is indeed a concrete example of how important WFP nutrition policies should be supported by multiple functional areas in WFP such as supply chain and logistics to ensure quality foods reach our beneficiaries. Supply chain lens shared by Josefa Zueco further capture the areas of the needed internal and external collaboration. Josefa, you highlighted the depth of WFP’s operational engagement requiring various angles of multi-sector partnerships involving governments, NGOs, academe, private sector and many more.

George Gegelia and Josefa Zueco what do you think are top 3 ways to strengthen the linkages of nutrition, supply chain and logistics?

Elvis NJABE you mentioned sustainable solutions through education and knowledge of locally available foods that can promote healthy diets. We know that nutrition education has been in existence for several years and certainly cannot be a standalone intervention to show impact. A couple of years ago, Social Behavioral Chance activities have been introduced to WFP programming and more needs to be done to build skills, motivation, and knowledge for healthy decisions.

Thanks to all for the fruitful discussion and in my point view, the critical long-term and future policy and programme shifts are the need for more focus on beneficiaries and quality care. In fact, and many of emergency settings, there are predominant focus on the product more than the beneficiary. Approaches to address malnutrition have tended to focus predominantly on targeted and blanket supplementary feeding, although both approaches have limitations. Both forms of supplementary feeding are product focused and do not always take into consideration the underlying causes of malnutrition, nor do they always pay adequate attention to institutional and system capacity-building or to the training and education needed for professionals as well as for care givers of wasted children. Beneficiaries of these programmes often return to the same conditions which caused them to become malnourished in the first instance, and so are at risk of relapse. Additionally, there is the issue of low coverage for the treatment programme and the lack of attention to nutrition programmes that’s mainly attributed to the fact that the current methods in managing MAM include products with a high unit cost, programmes that often have low coverage, a focus on generalized prevalence rates rather than season-specific incidence rates, and frequent high defaulting. Thus, human resource development, professionalization of programming, and adequate investment in awareness-raising and behaviour change as part of both facility and community-based interventions are essential key taken for the new strategy.

Here is below some thoughts for the future:

(1) Upgrading Nutrition Unit to Nutrition Programme at each Country Office level. While there is a good success with having a nutrition division at HQ level, yet there is a critical need to upgrade nutrition unit to nutrition programme at each Country Office Level to make it linked directly to DCD Operation. This would enhance better enabling and delivering of nutrition service to save and change lives.

(2) Promote links between nutrition-specific and nutrition-sensitive interventions that address underlying causes not only of wasting, but of stunting and micronutrient deficiencies too, should be an integral part of the strategy. This would include integration of nutrition service including nutrition counselling and education (nutrition SBCC) and Supplementary Feedings (TSFP/BSFP) within other WFP assistance programmes including livelihoods and resilience programme, School Meal, and General Food Assistance programme.

(3) Link nutrition service to research and operational studies, translating research into policies and practices. It is important to link nutrition strategy to research and operational research through establishing research/learning centre focused on operational studies (implementation) at impacts, product, beneficiaries, operations (challenges and effectiveness) and national curriculums. this would include opening master and higher phd degrees for staff to carry operational research at field and share the best practice, knowledge, and skills across all operational sites.

(4) Integrate nutrition counselling and education for improved feeding practices and nutrition status within nutrition programme. It is important to ensure the most effective means of delivery of SBCC in ways that are appropriate, relevant and realistic within diverse contexts.

(5) Breaking the intergenerational cycle of malnutrition through link wasting, stunting and micronutrient deficiencies into integrated WFP nutrition strategy. Improve PLWG nutrition service through continued food fortification activity, promoting out-reach activities and integration of the service at community and Health Facilities levels as well as link nutrition strategy to PLWG improved incomes.

(6) Institutional and professional capacity-building are essential, and the integration of nutrition programme within national systems and protocols is essential. In this regard, it is important to promote establishment of MAM unit within Ministry of Health and integrate South to South Cooperation within nutrition programmes.

(7) Creation of coordination platforms and common information systems.

(8) Integrate nutrition programmes to climatic shock. Apply a climatic changes and shock on all nutrition activities.

Hi Salem Muftah. Thank you for the elaborate discussion of the important inputs from your technical and operational perspective. Among your points, let me highlight that evidence-based programming should merit attention - linking research as one of the sources of knowledge to reform, adjust or create nutrition policies and programmes.