PART 4
I. FOOD AND NUTRITION INTERVENTIONS TO IMPROVE NUTRITIONAL STATUS, FOOD QUALITY, HYGIENE AND SAFETY
1. Universal nutrition education
1.1. Universal nutrition training
- Training of nutrition network staff (on nutrition knowledge, planning, management and communication skills) in order to help the local health workers in setting up and implementing their local nutrition plans.
- Appropriate nutrition training for different targeted groups (female adolescents, mothers, reproductive-age women, husbands, elderly, teachers, students,...).
- Introduction of nutrition contents in school curricula in collaboration with the MOET.
- Counseling on proper nutrition for different targeted groups emphasizing in appropriate nutrition, food hygiene and food safety, clinical nutrition, maternal and child nutrition, nutrition and aging, etc. Organizing the nutrition activities (forum for exchange between nutritionist and public)
1.2. Nutrition education and communication
- Mass education: Nutrition messages are to be delivered through the mass Target groups an entire population (both for women and men). Leaders, members of mass organizations, teachers and students are additional important target groups.
- Movements to involve the participation of the whole society, such as Micro-nutrient Days, Nutrition and Development Week, Maternal Care and Malnutrition Control Days, Breast-feeding Promotion Week, Clubs of communes with malnutrition prevalence under 30%, Food Hygiene and Safety Month, Universal Salt Iodization Days..... are to be promoted.
- Through direct nutrition education, nutrition information is to be provided directly to families by local staff using standardized guidelines on contents and procedures.
- Organization of a proper family meal consisting of 4 dishes: staple food (rice), vegetables, protein rich foods (tofu, nuts, meat, fish and eggs...) and soup. Special attention should be paid to promotion of traditional nutritive dishes and diversified foods in the diet.
- Different targeted groups, occupation and age groups are to be given guidance on proper nutrition. More attention should be paid for those who eat in public or school canteens. A program so-called “School Meal” should be established and implemented in order to improve students’ physical health.
- Education materials and communication means for local (commune and hamlet) levels are to be designed and provided. The existing "Nutrition and Development Newsletter" and other information will also be regularly sent to communes.
1.3. Staff training and research
- There is a need for the training and re-training of nutritionists with appropriate patterns. In the coming years, the nutritionists at all levels will be trained on planning master, implementation, monitoring and evaluation of nutrition programs. The training in community nutrition for district level is also important to be considered. The national and international Masters and Ph.D. training in nutrition should be continued.
- Research on food and nutrition should be expanded, particularly on food quality and food safety during food processing, preservation and distribution; on functional foods, dietary therapy and preventive medicinal foods; on the relation between nutrition, diseases and health status; and on nutrition problems in the transition period.
2. Ensured household food security
This is a very important approach, mainly for the regions prone to food shortages, poor areas and low-income populations. Based on specific situation, VAC development should be introduced and promoted so that every family will have their own VAC system, providing an available food source. The production and consumption of nutritive foods such as beans, peanuts, sesame and soybeans should be promoted. Providing loans to poor households is also needed in order to create more jobs to improve their income. Agricultural services need to be improved, e.g. providing new seeds and seedlings with higher yield, minimizing the use of chemical fertilizers and increasing the use of organic or microbiological fertilizers, improving local food processing and preservation at community and household level, finding or creating new markets, etc. Ensuring equal access to food for every household members is also a key intervention.
1. Control of protein energy malnutrition among children and mothers
- Control of PEM is one of the objectives of the health sector, financially supported by the Government; it needs to be implemented at a nation-wide scale.
- Access to child care at household level is also a key issue in the line of prevention of child malnutrition. Nutrition messages should be delivered teenage girls. The outcome of these activities will eventually improve child care and feeding practice. Priority should be given to children from 0 to 24 months of age. The care strategy should include the following key actions: improvement of breast-feeding practices (especially exclusive breast-feeding in the first 4 months), appropriate complementary feeding practice, food processing and preparation at local and household levels, hygienic practices, increased time allocation for child care together with improvement of the nutritional status of mothers themselves during the prenatal and post natal period, as well as improvement of care practice for every household members. Child care and feeding practices plus regular growth monitoring and maternal care should be conducted effectively and consistently.
- It is critical to identify prioritized activities in different localities. As the food security status has been improved in most rural areas, activities should be focused on child care activities, feeding practices and prevention of infectious diseases. In the remote, disadvantaged areas, rehabilitation activities should be highlighted. Families will know how to rehabilitate their malnourished children, based on their own resources by developing a “nutrition square” and family VAC system. These activities should be introduced to the household members so that the people themselves can properly practice them.
- To improve nutritional status of mothers, it is necessary to have better health services, to eliminate micro-nutrient deficiencies, to transfer nutritional and feeding skills to mothers, to release heavy workload for pregnant and lactating women, to develop and implement policies for protection of mothers, promotion of breast-feeding, better prenatal care, and women empowerment within their families and in their communities.
2. Control of micro-nutrient deficiencies
Control of vitamin A deficiency: In long-term, Vitamin A deficiency should be resolved by diversifying diets to increase Vitamin A rich foods. Vitamin A capsules distribution for children from 6 to 24 months of age and for mothers right after delivery should be continued nationwide. From 2006 onward, mass vitamin A distribution will be focused in the most disadvantaged areas and to continue supplementation to the sick children. Research is to be continued in order to produce food fortified with Vitamin A, together with diet diversification (promoting production and consumption of in vitamin A rich food from the household VAC).
Control of nutritional anemia: Supplementation of iron tablets and folic acid to prevent anemia in women aged 15 to 35, and in pregnant and lactating women should be expanded nation-wide. The aim is to produce an iron syrup for malnourished children. It is necessary to have practical guidelines and education for communities to approach different types of iron and folic acid sources in the market. More attention should be paid to iron fortification and diversification of the diet as long-term strategy. In rural areas, where the rate of hook worm infection is high, it is urgent to conduct regular deworming combined with improved environmental sanitation. Control of nutritional anemia should be implemented in the whole country.
Control of IDD: This is an independent national program. Its implementation goes together with the solutions of mobilizing the population to consume iodized salt and of improving the monitoring/supervision activities of the salt production, distribution and consumption stage.
3. Prevention of non-communicable nutrition-related chronic diseases
- Development of a surveillance system for better assessment of the actual situation and trends of these diseases, including obesity, cardio-vascular disease, hypertension, diabetes, cancer, etc.
- Development of guidelines for proper nutrition for Vietnamese at all ages 2001-2010.
- Strengthening dietary therapy departments in the hospital system.
- Research in production and consumption of functional food.
6. Integration of nutrition activities into Primary Health Care
Along with the implementation of the Expanded Program of Immunization, the prevention of infectious diseases (ARI and diarrhea), the promotion of exclusive breast-feeding in the first 4 months and improved complementary feeding practices thereafter, the Integrated Management of Childhood Illnesses (IMCI) be strengthened. The implementation of Reproductive Health Care has to go hand in hand with nutrition and healthy lifestyle education, especially for vulnerable groups.
7. Ensuring Food quality and food safety
Food safety is an important aspect supported by the Government in a separated program. There is a close relation between food hygiene and safety, and nutrition. The main proposed approaches focus on the following points:
- Food legislation and regulations system should be set up and followed. Food quality and safety standards should be developed based on regulations of the Codex Alimentarius adjusted to Vietnam’s conditions. Ad-hoc Laboratories will be set up to monitor the food quality and safety at the central and provincial Preventive Health Centers. Control of quality and hygiene of exported and imported foods, as well as street foods should be carried out. Guidance in the application of Hazard Analysis of Critical Control Point (HACCP) and Good Manufacturing Practices (GMP) should be given to food producers, processors and handlers.
- Implementing safe food production, keeping sanitary environment and clean water are very important issues. Control of the trade, distribution and utilization of chemicals used in agriculture production must be carried out in cooperation with the MARD. Control of quality and hygiene of products in food shops and markets should also be strengthened.
- Giving basic knowledge on food hygiene and food safety to the consumers and food handlers, as well as training of food inspectors will also required.
- All of the above activities must be implemented in multi-sectoral manner. Particularly, the nutrition activities and food quality/safety interventions should be implemented in a coordinated way.
8. Monitoring, evaluation and surveillance of nutrition
- The system of nutrition surveillance, monitoring of activities and evaluation of the nutritional status of the population has to be considered. A nutrition data bank needs to be set up in cooperation with the GSO. The provinces themselves will have to carry out annual surveys in order to have up-to-date data on the nutritional status of their people.
- National nutrition surveys will be carried out in 2005 and in 2010. Data in poor rural areas are needed for the proposal of specific approaches. A national food balance sheet should be set up in cooperation with MARD and the GSO.
9. Piloting of Nutrition Models
- A model of "sustainable nutrition improvement” will be developed, with a comprehensive intervention approach called “life security”. It will be a combination of relevant security determinants, such as health, nutrition, economy, culture, family, education, society, environment and infrastructure. This model will be implemented at several pilot districts.
- Models of nutritional improvement for some special occupational groups, high-risk groups, manufacturing establishments, hospitals and disadvantaged localities will be demonstrated.
II. NUTRITION-RELATED AREAS
1. Ensuring National Food Security
The Government needs to have appropriate policies and solutions to diversify agriculture production, increase productivity and decrease manufacturing price. Proper farming patterns should adjust to actual situations of different areas to meet their food demand. Production plans need to be based on actual requirements to ensure food security in parallel with the regulation given by the market and reasonable price policies. Investments in processing and storage of agricultural products and the promotion of safe food production should be paid more attention.
2. Promotion of Hunger Eradication and Poverty Alleviation
This is one of the important policies of the party and government affecting nutrition. It is considered necessary to give prioritized support to the infrastructure of food production in the areas at risk of food insecurity, with high prevalence of malnutrition. For urban areas, support is given to employment in order to increase income, which will result in increased food accessibility for the poor and high-risk groups. Nutrition objectives should be incorporated into the program’s objectives.
3. Improved infrastructure and basic service for maternal and child care.
- Safe water supply and environmental sanitation. They are essential determinants related to nutrition care. Making access to safe water for extended population and to good sanitation in key areas is the important issue.
- Kindergartens system. Proper and feasible solutions need to be worked out to maintain and to improve the quantity and quality of kindergarten and day care system in rural areas with the support of both the Government and the community.
- Improvement of CHC in disadvantaged communes will be the core factor for the effective integration between PHC and nutrition care in community.
1. Incorporation of nutritional objectives into local socio-economic development plans
Nutrition indicators are representatives of socio-economic development achievement. These should be used to measure the attainment of these objectives set by the Party and the authorities. The nutrition strategy should become the legislative document of local governments. Every commune, district and province should integrate these activities into their annual plans to reduce maternal and child malnutrition, to alleviate food shortages and to ensure food safety. Each locality should have its specific plans and approaches to achieve the set goals.
2. Policies to support better nutrition outcomes
- Regulations will be needed to support pre and post-natal maternal leaves, as well as to assist pregnant and lactating mothers in an effort to promote better breast-feeding and infant care.
- It is necessary to implement, amend and complete the policies on care and protection of children and women, on health and nutrition care for the poor and on social welfare.
- Laws and regulations to enforce food fortification to control micro-nutrient deficiencies will be needed.
- Laws and regulations to enforce food quality and safety control will also be needed.
- A policy to explicitly support nutrition staff at grass-roots level will be needed.
3. Community participation nutrition activities
Community participation in nutrition activities needs to be considered the strategic multi-sectoral approach with the involvement of various social groups. Nutrition activities must be supported firstly by the local authorities. Multi-sectoral collaboration is a key for community participation in nutrition. In order to have an effective collaboration, the Government needs to assign specific responsibilities to each sector, as well as each sector should consider the objectives of improving the nutritional status in implementation of their plans. Local authorities at different levels must consistently support nutrition plans and the mobilize all social groups involve. Each family and each citizen should be aware of nutrition actions and become actively involved.
1. Government investments
The Government will provide funds for nutrition activities of the proposed Plan from the annual state budget. Funding for existing programs (PEM, IDD, IDA, food safety, etc) will continued. The state budget will be the key source; and prioritized to be allocated for disadvantage areas.
2. Mobilization of internal resources and community mobilization
Mobilizing contribution from other resources, such as relevant sectors, local governments, mass organizations and enterprise for implementation of this nutrition strategy will be necessary. Communities and households are mobilized to more actively participate in nutrition and food safety activities. For the greater effectiveness, more efforts are needed to raise the awareness about nutrition and food hygiene and safety.
3. International cooperation in the field of nutrition
Bilaterally and multilaterally international cooperation for nutrition is expanded with governments, international organizations and international NGOs. These resources need to be used more efficiently to complement the local investments.
1. Organization
- The MOH is the executing institution for the NNS in cooperation with other ministries, government branches, mass organizations, and international agencies. They will develop, implement and evaluate the Strategy’s progress.
- The NIN is appointed as the national focal point of the NNS and as the institution in charge of assisting Ministry of Health in all technical aspects of the NNS. The NIN will be responsible for regular evaluating, monitoring and supervision of the NNS.
- The steering committees for nutrition strategy will be established at different administrative levels. The Minister will chair the central steering committee, while in localities, it will be headed by the vice chairperson of the people’s committee in charge of socio-cultural services with the members from difference sector such as the health representative (as the secretary of the committee), the planning-investment, finance, education and agriculture, CPCC, Women’s Union and other related sectors and social agencies.
2. Responsibilities of relevant sectors
The Ministry of Health (MOH)
As the steering institution, the MOH is responsible for the development and implementation of the Nutrition Strategy and related Plans and Programs/ Projects to be proposed to the Government for approval. The MOH is also the executive institution to make annual plans, to coordinate the implementation of the activities, and to evaluate the NNS’s impact.
The Ministry of Planning and Investment (MPI)
The MPI is responsible for incorporating nutrition strategies into National Plans, coordinating international support, as well as monitoring and supervising the NNS implementation.
The Ministry of Agriculture and Rural Development (MARD)
Based on the recommended dietary allowances (RDA), MARD is responsible for development of agricultural plans and measures to ensure both national and household food security. The MARD will also give guidance and instruction for local food processing, support the development of household VAC Eco-system and provide IEC support on food security for different regions. The MARD is also involved in the program for safe water supply in rural areas. Additionally, the MARD is responsible for safe food production, and development of regulations and supervision for the use of chemicals.
The Ministry of Education and Training (MOET)
The MOET will develop nutrition education to be put in curricula at all levels of education from kindergarten to university. Particular attention should be given to improvement of pre-school system (especially in rural areas) and school canteens.
The Committee for Protection and Care of Children (CPCC)
The CPCC will collaborate with the MOH and related sectors in development of the strategy. It will assist in developing policies and plans to stimulate the achievement of nutrition objectives in general and child nutrition in particular. It will give guidance to the local CPCCs to coordinate with other sectors for the implementation and monitoring of nutrition plans.
The Ministry of Finance (MOF)
The MOF allocates financial resources for the approved nutrition programs, and monitors and supervises the expenditures.
The Ministry of Justice (MOJ)
This ministry coordinates with other related branches to develop the legal framework and regulations needed for this Strategy. Supportive policies in nutrition and food safety need to be built up.
The Women’s Union (WU)
The Women’s Union disseminates nutrition knowledge, creates greater nutrition awareness among its members and other mothers and mobilizes community to participate in nutrition activities. In close cooperation with the health sector, the WU implements primary health care and nutrition activities, especially practical activities for improving nutritional status of children.
The Ministry of Labor, Invalids and Social Affairs (MOLISA)
The MOLISA implements the National Plan of Action for Hunger Eradication and Poverty Alleviation. Special attention should be paid to its effective impact on improvement of nutritional status and food security. Policies to support the poor, disadvantaged areas and emergency aids are to be set up.
The Ministry of Trade (MOT)
This ministry is in charge of food management, transfer, distribution, import and export to assure food and nutrition security, as well as micro-nutrient sufficiency. It also regulates food export and import, thus ensuring national food security.
The Ministry of Culture and Information (MOCI)
This ministry disseminates appropriate nutrition knowledge/understanding through the IEC channels. It also offers priority for non-commercial nutrition advertising.
The Ministry of Science, Technology and Environment (MOSTE)
MOSTE supports relevant researches on nutrition and food safety.
The National Committee for Population and Family Planning (NCPFP)
The NCPFP implements family planning programs to improve population quality. In family planning, nutrition is a key component. NCPFP gives guidance to the collaborators on population and family planning to incorporate nutrition activities in reproductive health.
Other social agencies and mass organizations (Trade Unions, Farmer’s Association, VACVINA, Youth’s Unions, etc.)
All these organizations disseminate nutrition knowledge to their members in close coordination with the health sector to promote community participation in nutrition.
3. Responsibilities of local authorities
The chairperson of the People’s Committees of provinces/cities is responsible for implementing this nutrition strategy in their own localities.
4. Mechanism of coordination
- Based on the national objectives of this strategy, each of the different sectors, social agencies and mass organizations needs to develop practical and specific implementation plans to achieve both their own specific objectives as well as the objectives of this nutrition strategy.
- Quarterly review meetings will be called by the MOH to review the implementation of this strategy with the participation of related ministries/branches.
- Semi-annual reports from all provinces/major cities must be sent to the MOH, who will be responsible for reporting the progress to the Prime Minister.
- A multidisciplinary approach should be strengthened at all levels. Local and central steering committees need to closely communicate.
5. Plan of Implementation
- Period 1 (2001 – 2005): During this period, implementation will concentrate on improving the nutritional status of the population, especially focusing on nutrition education, training, human resource development and the amendment of nutrition supportive policies.
- The implementation of the targets-focused programs will be continued.
- Period 2 (2006-2010): Activities will be continued on institutionalization of the Government’s official guidance in nutrition work as well as sustainable maintain and comprehensive evaluation of the NNS implementation.
Link download:
Full text: National Nutrition Strategy period 2001-2010
Full text: Decision of the Prime Minister on the ratification of the National nutrition strategy 2001-2010