PUBLIC HEALTH NUTRITION

STEPS IN FOOD AND NUTRITION PROGRAM PLANNING

MANAGEMENT

1. ASSESSING THE SITUATION AND DEFINING THE PROBLEM

2. GOALS AND OBJECTIVES SETTING
3. SELECTING STRATEGIES AND INTERVENTIONS
4. FORMULATING A FOOD AND NUTRITION PROGRAM PLAN
5. PROGRAM IMPLEMENTATION AND MANAGEMENT
6. MONITORING AND EVALUATION

1. ASSESSING THE SITUATION AND DEFINING THE PROBLEM

□ Despite considerable progress in recent decades, the world still falls far short of the
goal of adequate food and nutrition for all. Over 780 million people, mainly in Africa,
South Asia and Latin America, do not have enough food to meet their basic daily needs
for energy and protein. More than two billion people subsist on diets that lack the
essential vitamins and minerals required for normal growth and development and for
the prevention of premature death and disabilities such as blindness and mental
retardation. At the same time hundreds of millions suffer from diseases caused or
exacerbated by excessive or unbalanced dietary intakes or by the consumption of
unsafe food and water.

□ Eradicating hunger and malnutrition is within the reach of humankind. Political will and
well-conceived policies and concerted actions at national and international levels can
have a dramatic impact on these nutrition problems. Many countries, including some of
the poorest, have adopted and taken measures to strengthen food, nutrition,
agriculture, education and health and family welfare program, which have dramatically
reduced hunger and malnutrition. The current challenge is to build upon and accelerate
the progress already made.

□ Coherent(Consistent/coordinated) and effective action at local, national and

international levels to achieve nutritional well-being is imperative(obligatory/act of
duty). However, resources, needs and problems vary between and within countries and
regions of the world. Therefore, the situation in each country and region needs to be
assessed in order to set priorities for formulating specific national and regional plans of
action, giving tangible expression to policy-level commitments to improve the
nutritional well-being of the population. This should entail considering nutritional
impacts of overall development plans and of all relevant sectoral development policies
 and plans. These plans should identify short- and long-term priority areas for action;
specify goals, which should be quantified where feasible, to be achieved within
specified time frames, define the roles of relevant government ministries, local
communities and private institutions, and, as appropriate, include estimates of
resources that are required. The plans should take into account the goals set forth in
the World Declaration on Nutrition and be formulated by governments with the active
participation of academic and local communities, NGOs and the private sector.

2. GOALS AND OBJECTIVES SETTING

□ The goals of a program are usually stated in broad terms and should be translated into
specific and operational objectives expected to be achieved by component activities of
projects.

□ Precise definition of objectives allows for systematic analysis and facilitated

formulation of projects under a program. Thus, in defining project objectives, the
following should be indicated:
o Time frame or duration of project activity
o Short-term and long-term objectives
o Measureable targets (number of beneficiaries, extent of nutrition improvement)

□ Ensuring continued access by all people to sufficient supplies of safe foods for a
nutritionally adequate diet
o To achieve satisfactory nutritional status, it is essential to ensure continued
access to sufficient supplies of a variety of safe foods at affordable prices and of
safe drinking-water so that all people, especially the poor and vulnerable
groups, can have nutritionally adequate and safe diets. This is an issue of
supreme importance to the many millions of people worldwide who currently
suffer from persistent hunger, malnutrition and micronutrient deficiency
diseases and to those others who are at risk of suffering in the future.

□ Achieving and maintaining health and nutritional well-being of all people

o Good nutritional status is dependent upon each person having appropriate
intakes of macronutrients and micronutrients, combined with adequate health
and care and access to safe drinking-water. Nutritional status also depends on
the availability of sufficient knowledge about appropriate diets, taking into
account local food habits to prevent problems of undernutrition and of diet-
related non-communicable diseases. Healthy and properly nourished people are
both the result of successful development and contributors to it. Nutritional
well-being should be adopted as a key objective in human development and
must be at the center of development strategies, plans and priorities.
□ Achieving environmentally sound and socially sustainable development to contribute to
improved nutrition and health
o Development policies and program in developed and developing countries
should be sustainable and environmentally sound and lead to improved
nutrition and health for both present and future generations. Equally important
is the implementation of agricultural, food, health, family welfare, population,
education and development policies that will achieve and maintain a balanced
relationship between population needs and available resources as well as
between rural and urban areas.

□ Eliminating famines and famine deaths

o Food emergencies that deteriorate into famines are, in many cases, an
indication of a lack of emergency preparedness. While the development of
national early warning systems and the existence of emergency food reserves
can help to avoid famines, other factors, such as open political environments at
local and central levels and a free press, are crucial.

3. SELECTING STRATEGIES AND INTERVENTIONS

□ The basic goal of protecting and promoting nutritional well-being for all will be
achieved only through a combination of policies involving various sectors at various
levels of responsibility. Based on the worldwide consultations held in preparation for
the actions to be considered by governments in their efforts to improve nutrition are
presented below. These are grouped under nine action-oriented themes, allowing each
sector and actor to determine how it can best address nutritional problems, taking into
account the specific needs and conditions in each country.

□ Incorporating nutritional objectives, considerations and components into development

policies and program
o Significant improvements in nutrition can result from the incorporation of
nutritional considerations into the broader policies of economic growth and
development, structural adjustment, food and agricultural production,
processing, storage and marketing of food, health care, education and social
development. Such policies have an impact on nutrition through food
availability and prices, incomes, environmental conditions and health status,
care and feeding practices and other socio-economic factors. Development
policies and program can also have varying impacts on the nutritional well-being
of different population groups.

□ Improving household food security

o Food security is defined in its most basic form as access by all people at all times
to the food needed for a healthy life. Achieving food security has three
dimensions. First, it is necessary to ensure a safe and nutritionally adequate
food supply both at the national level and at the household level. Second, it is
 necessary to have a reasonable degree of stability in the supply of food both
from one year to the other and during the year. Third, and most critical, is the
need to ensure that each household has physical, social and economic access to
enough food to meet its needs. This means that each household must have the
knowledge and the ability to produce or procure the food that it needs on a
sustainable basis. In this context, properly balanced diets that supply all
necessary nutrients and energy without leading to over-consumption or waste
should be encouraged, It is also important to encourage the proper distribution
of food within the household, among all its members.

□ Protecting consumers through improved food quality and safety

o A safe food and water supply of adequate quality is essential for proper
nutrition. The food supply must have an appropriate nutrient content and it
must be available in sufficient variety and quantity. It must not endanger
consumer health through chemical, biological and other contaminants and it
must be presented honestly. Food safety and quality control ensures that the
desirable characteristics of food are retained throughout the production,
handling, and processing, packaging, distribution and preparation stages. This
promotes healthy diets, reduces food losses and encourages domestic and
international food trade. Food quality encompasses the basic composition of
foods and aspects concerning food safety. Consumers have the right to a good
quality and safe food supply, and government and food industry actions are
needed to ensure this. Effective food quality and safety control program are
essential and may comprise a variety of measures, such as laws, regulations and
standards, together with systems for effective inspection and compliance
monitoring including laboratory analysis. Where appropriate, governments, in
close collaboration with other interested parties.

□ Preventing and managing infectious diseases

o The interaction of infection and malnutrition has an overwhelming impact on
health status, particularly in lower socio-economic groups. It is a major cause of
death, sickness and disability in infants and young children and an important
contributor to women's ill health and reproductive problems. Preventing,
controlling and correctly managing infections improves nutritional well-being
and markedly enhances the productivity of the adult population. Governments,
in cooperation with all concerned parties

□ Promoting breast-feeding
o Breast-feeding provides infants and young children with the ideal nutrition.
Together with its many beneficial effects, such as those on child spacing and the
prevention of disease, it is the most inexpensive form of infant feeding. All
women should be enabled to breast-feed their babies exclusively for the first
four to six months, and, while giving appropriate supplementary food, to
 continue breast-feeding for up to two years or more. In order to do so, the
international community needs to create awareness and provide maximum
support to women to breast-feed, and governments and concerned parties of
the private sector.

□ Caring for the socio-economically deprived and nutritionally vulnerable

o Care refers to the provision in the household and community of time, attention,
support and skills to meet the physical, mental and social needs of socio-
economically deprived and nutritionally vulnerable groups. Among these groups
the growing child is the most vulnerable, but others include women, the elderly
and the mentally, physically and sensory disabled. Among the socio-
economically deprived are refugees, displaced persons, some indigenous
peoples, those in isolated communities, the landless, the unemployed, recent
immigrants, orphans and children in difficult circumstances. Individuals most at
risk of malnutrition are those who are both physiologically vulnerable and socio-
economically deprived, Countries should recognize that the skills and abilities of
the care giver, who is usually the mother, are crucial to the quality of care,
particularly the selection and preparation of food for the family, including the
mother herself, the children and other dependents.

□ Preventing and controlling specific micronutrient deficiencies

o Micronutrient deficiencies are a matter of major public health concern. They are
widespread, although the prevalence of a particular deficiency can vary
considerably within and between countries Deficiencies of vitamin A (including
beta-carotene), iodine and iron are especially important because of their serious
health consequences, wide geographic distribution and the existing global
commitment to their control.

□ Promoting appropriate diets and healthy lifestyles

o Non-communicable diseases related to unhealthy lifestyles and inappropriate
diets are becoming increasingly prevalent in many countries. With greater
affluence and urbanization, diets tend to become richer on average in energy
and fat, especially saturated fat, have less fiber and complex carbohydrates and
more alcohol, refined carbohydrates and salt. In urban settings exercise and
energy expenditure frequently decrease, while levels of smoking and stress tend
to increase. These and other risk factors, as well as increased life expectancy,
are associated with the increased prevalence of obesity, hypertension,
cardiovascular diseases, diabetes mellitus, osteoporosis and some cancers, with
immense social and health care costs. Dental caries is also an important diet-
related condition in some regions.

□ Assessing, analyzing and monitoring nutrition situations

o Information on the nature, extent, magnitude and severity of different types of
nutritional problems, as well as their causes, resources and how they are
 changing over time, is essential for the development, implementation,
monitoring and evaluation of effective policies and program to improve
nutrition. Information is also needed to provide early warning of impending
nutritional emergencies and for ongoing program management. The basic aim
should be to provide relevant and accurate information that can be utilized
efficiently. Therefore, information must be timely, relevant to the decision-
makers and communicated effectively at the appropriate levels. These levels
range from the individual and household level, through the community and
national levels, to the international level. Open access to information regarding
the nutritional situation must be ensured for all interested parties. Utilization of
information may be facilitated by the establishment or strengthening of specific
bodies or mechanisms. Data collection and analysis have costs that must be
balanced against the overall resources available for the program. Governments,
in close cooperation with all parties concerned,

4. FORMULATING A FOOD AND NUTRITION PROGRAM PLAN

□ Principles and Concepts Useful in Food and Nutrition Program Planning and
Management
1. Malnutrition is not merely a health or social problem but a development
problem linked to poverty, illiteracy, inequality, deprivation, and certain
environmental factors.
2. Being a development problem, eliminating malnutrition calls for nutrition-
oriented development strategies and approaches to be planned and
implemented with the active participation of the people
3. Integration of nutrition considerations into the development planning process
considers nutrition improvement as an objective, a tool, a consequence, and an
indicator of development. Nutrition consideration must be infused in all phases
of program planning, implementation, monitoring, and evaluation.
4. Recognizing that many factors affect nutritional well-being, it is important to
have clear and precise definition of existing food and nutrition problems.
5. The causes of malnutrition are interrelated and interdependent. Sustainable
socio-economic programs for the poor families can lead to the long-term
solution of malnutrition.
 The cycle of Malnutrition and Underweight

6. The solutions that consider existing resources and constraints in the community
and family should address the root causes of the problem
7. Malnutrition can be only solved through the integrated and coordinated efforts
of the public and private sectors, the political leaders, and the people at-risk
8. The functionaries involved in the nutrition-oriented development planning
should have a common understanding of the malnutrition problem. These
functionaries are:
 Heads of sectoral departments
 Executives of the government (national and local)
 National and lower level legislators (provincial/municipal/barangay
councils)
 Development councils
 Program/project planners and implementers
 Development workers (BNS, BHWs, etc.)

□ The Food and Nutrition Program Planner/Manager

1. Identify/define nutrition problems and analyze causes
2. Provide information on social/economic costs of malnutrition needed for
establishing criteria for selection of priorities
3. Define needed “intervention” programs and scope within the context of
development
4. Monitor nutritional status and implementation of intervention programs
5. Evaluate outputs/benefits relative to cost
6. Provide leadership in implementation of nutrition intervention and
development programs
7. A person who develops a plan and manage program activities to improve
nutritional status of the community/country as part of the total development
plan
8. Discharges managerial functions: planning, staffing, directing, coordinating,
budgeting and evaluating plan/programs

□ Requisites of a Food and Nutrition Program Planner

 1. Must have the skills, intelligence, objectivity, vision and ability to forecast
2. Must be creative realistic and practical

5. PROGRAM IMPLEMENTATION AND MANAGEMENT(PG. 92-99)

□ The Food and Nutrition Program Planning and Management Cycle
□ Steps in Food and Nutrition Planning and Management

□ Management of Food and Nutrition Programs(PG. 114-125)

□ Functions of Management in Program/Project Implementation
6. MONITORING AND EVALUATION(pg. 81-89)
□ Nutrition Surveillance
 □ Monitoring and evaluation(pg. 109-114)
o Three basic types of evaluation
o Construction of the Hypothetical Input-Process-Output-Outcome
(HIPPOPOC) Table
o Dynamic

Analysis of the elements needed for ensuring sustainability such as administrative capability at
various operational levels and management processes involved in the implementation of
LAKASS show that there is sufficient evidence to conclude that the programme has a good if
not excellent chance of sustainability.

Management resources (social mobilization, training, leadership, implementing structure and

support) and management processes (planning, implementation, monitoring, and evaluation)
are all embedded in the programme’s features and strategies. The regular feedback or
monitoring and evaluation which is a feature of LAKASS allows programmatic adjustments
from time to time or troubleshooting to address weaknesses and constraints in programme
implementation.

The implementing structure of LAKASS closely adheres to the decentralized, and

organizational framework of the national food and nutrition programme making it more
workable. With a largely democratic and consultative leadership coupled with clear delineation
of roles and responsibilities of various line sectoral agencies, integration and coordination is
achieved through a shared view of the goals and objectives of LAKASS. Moreover, while most
municipal and barangay governments are unable to provide funding for loans, they have
provided counterpart funds for the salaries of employees or incentives for overseers of the
LAKASS programme.