Capacity Development in Nutrition in Central and Eastern Europe Mirjana Pavlovic, Fre Pepping, Arne Oshaug and the participants from CEE countries Joint meeting of SCN Working Groups on

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Capacity Development in Nutrition in Central and
Eastern EuropeMirjana Pavlovic, Fre Pepping,
Arne Oshaug andthe participants from CEE
countries Joint meeting of SCN Working Groups
onCapacity Development and Nutrition, Ethics
and Human Rights 15th March 2006Geneva ,
Switzerland

• Report from the inaugural meeting of the Network
  on Capacity Development nutrition in CEE
  countries

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Background

• Regional networks already exist in Asia, Latin
  America, the Middle East and Southern Africa.
• Thus the network in Central and Eastern Europe is
  the newest network facilitated by the UNU Food
  and Nutrition Programme and by SCN.
• The inaugural meeting took place in Budapest on
  the13-14 February 2006, at the FAO SEUR Office.

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Participating countries

• The meeting was attended by participants from 10
  countries
• Bosnia and Herzegovina, Bulgaria, Czech Republic,
  FYR Macedonia, Hungary, The Netherlands, Norway,
  Romania, Serbia and Montenegro and Slovakia.

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Participants

• Lajos Biro, HU
• Katarina Chudikova, SK
• Zlatka Dimitrovska, MK
• Veselka Duleva, BG
• Aida Filipovic, BIH

• Mirjana Pavlovic, SCG
• Jana Parizkova, CZ
• Camelia Parvan, RO
• Facilitators
• Fre Pepping, NL
• Arne Oshaug, NO

FAO provided support staff and engaged somewhat
in the discussion
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Objectives

• The objectives of the meeting were to
• Formally initiate the Network on Capacity
  Development for the CEE countries within the
  capacity development initiatives of SCN, UNU and
  other European research and training institution.
• Present and discuss the profile of challenges
  identified by participants.
• Identify follow-up activities in order to
  facilitate the initiatives of the Network in the
  field of capacity development in the CEE region.
• Identify strategic elements to meet the capacity
  development plans of institutions and individuals
  in the region.
• Prepare a presentation of needs and strategies to
  be presented at the 33rd session of SCN in
  Geneva, March 2006.

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Some results
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The main characteristics of nutrition and life
style in CEE countries

• Foods and meal pattern
• Irregular meal pattern
• Low intake of certain food groups - particularly
  fruits and vegetable, milk products and fish
• High intake of total fat (in particular
  saturated), sugar, and salt
• Low intake of vitamins folate/folic acid, and
  minerals e.g. calcium, iron, iodine (except in
  countries having programmes on salt iodisation)
  (Relevant for some countries)
• High level of alcohol intake in some countries
• Low breastfeeding rates.

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The main characteristics of nutrition and life
style in CEE countries (cont.)

• Nutritional and life style related public health
  problems
• High prevalence of NCD hypertension,
  atherosclerosis, CHD, CVI, certain cancers,
  diabetes mellitus, etc.
• High level of overweight and obesity.
• Dyslipidaemia.
• Low level of Haemoglobin, although some data are
  lacking.
• Generally low level physical activity, in
  particular in urban areas.
• Increasing osteoporosis in both genders, in
  particular with increased age.
• Eating disorders in certain groups may increase,
  in particular in younger girls.
• Consumption mega doses of minerals and vitamins
  lack of information about risk of mega doses.
• High level of smoking.

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Overview of challenges in CEE countries

• National nutrition action plans
• Food based dietary guidelines
• RDA
• National food database
• Nutrition information center
• Training of professionals on academic level
• Education and promotion (for the public)

• Bulgaria 2005, Macedonia 2004, Bosnia (draft
  waiting approving), Hungary 2004, Slovak Republic
  1999, Rumania (draft waiting approving), Czech
  Republic (approved), Serbia Montenegro (none).
• Bulgaria, Macedonia, Bosnia, Hungary, Slovak
  Republic, Czech Republic.
• Bulgaria, Macedonia, Hungary, Slovak Republic,
  Rumania, Czech Republic.
• Bulgaria, Hungary , Slovak Republic, Rumania,
  Czech Republic, Serbia Montenegro.
• Not formalized.
• Modest in many countries, few countries have
  special education of nutritionists.
• Mostly part of national action plans for food and
  nutrition.

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Is it adequate nutrition education and training
of professionals in CEE countries?

• The gap in capacity in nutrition education is
  major challenge. Those challenges included
• inadequate/insufficient
• knowledge of nutrition among medical specialists.
  
• international training in modern nutritional
  epidemiology.
• international training in modern clinical
  nutrition.
• training of nutrition in schools and
  universities.
• knowledge of nutrition in the population.
• education and curricula of nutrition in medical
  faculties e.g. incorporated in hygiene. Nutrition
  is now considered to be a part of specialization
  in hygiene.
• knowledge of nutrition among health professionals
  working with the population.
• Nutrition is only a part of other trainings
  (mentioned earlier).
• Lack of pure nutrition education at academic
  level.
• Lack of in-service training of nutrition.
• Lack of methodological approaches and software
  for data collection, assessment and analyses.

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Political dimensions-Governmental level
(resistance or neglect of addressing nutrition
issues)

• Engagement of ministries and public agencies in
  food, dietary and nutrition related issues is
  lacking due to lack of funds (official
  explanation).
• Lack of a national nutrition strategy, or action
  plan (e.g. based on WHO Global Strategy on Diet
  and Physical Activity, or Food and Nutrition
  Action Plan for Europe), except Hungary and
  Bulgaria.
• Lack of contact and collaboration between
  responsible ministries (e.g. Ministry of Health,
  Agriculture, Education, and Research) and
  institutions working in the field of nutrition
  (except for Bulgaria and Hungary).
• Lack of coordinated activities at national and
  regional level in nutrition and nutritional
  status monitoring (except Bulgaria and
  Macedonia).

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Possible elements of a common strategy for the
network and possible actions for improvement of
capacity development in CEE countries

• Continue/start developing national food and
  nutrition policies and action plans
• Standardize education and training programs in
  nutrition for medical professionals
  (undergraduate and postgraduate studies)
• Need common training courses for relevant
  professionals within health, food and nutrition
  in CEE countries
• Need mass media in nutrition, health and
  lifestyle modification
• Need promotion of food and nutrition at all
  levels (including incorporate nutrition in the
  curricula of elementary and high schools)
• Stimulate school canteens to improve nutrition
  quality of school meals
• Standardisation and collaboration on recommended
  dietary allowances (RDA) in Europe

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Possible elements of a common strategy for the
network and possible actions for improvement of
capacity development in CEE countries (cont.)

• Harmonize research, evaluation and monitoring of
  the nutrition situation in the region
• Develop dietary guidelines for different
  population groups
• Collaborate with the food industry to produce
  healthier products
• Conduct specific programs to prevent obesity,
  non-communicable diseases and micronutrient
  deficiencies
• Get support from the UN, such as the UNU, FAO,
  UNICEF and WHO to the network
• Establish relevant internet web pages/modules for
  exchange and collaboration between countries in
  the CEE.
• One example is the Food and Nutrition Agro Web
  Network in CEE Countries (http//agrowebcee.net)

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Framework for analyzing actors and
responsibilities in nutrition in CEE
Main responsibility
Levels
Actors
Governmental Primarily MoH, and MoA, MoT(E),
MoST, MoE, MoWSA, MoLD.Policy makers/civil
servants, Parliament, local level authorities

• Policy development (food security,
• nutrition, health, training), decision
• making, legislation for protecting and
• supporting the human right to adequate food
• National plans of actions
• Funding
• Monitoring and evaluation

1
Institutional Health and research institutions
(including statistical), clinics (medical
doctors, public health specialists, dietitians,
nurses, food controllers), agriculture
extension, hygiene

• Implement policies
• Providing expertise and advisory function
• Evidence base (research) in nutr.
• Maintain and develop staffs capacity
• Adapt strategies to local needs
• Monitoring and evaluation
• Provide feedback to ministries
• International collaboration/networking

2
Educational Universities, faculties, scientific
academies, institutions/ departments, scientists,
researchers, professors, primary and secondary,
school teachers, kindergarten personnel, catering
staff

• Implement policies on education
• Provide and support staff development
• Base education/training on local needs
• Evaluate education/training
• Provide feedback to ministries
• Engage in international collaboration
• Publishing education material

3
Community Farmers, cooperatives,
industry/business Mass media (public and
private) NGOs, professional associations
Families, individuals

• Production of safe healthy foods, responsible
• marketing
• Promotion of healthy nutrition
• Positive role models in healthy eating
• patterns and life style
• Making informed choices
• Promotion of consumers rights
• Availability of desirable food at acceptable
  prices
• Compliances to legislation

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Framework for capacity development in nutrition
in CEE
Levels
Needs
Strategies/activities

• Political commitment
• Food and nutrition policies
• Develop nutritional action plan
• Reinforcing scientific evidence for increased
  awareness
• Strengthen capacity building
• Support for capacity development

• Lobby for political support for needs of
• nutrition policy and national action plan
• Lobby for funding of national capacity
  development
• Monitor for government accountability
• Information/education of politicians/parliamentari
  ans
• Requesting increased communication between line
• ministries

1

• Adequate human resources (including knowledge)
• Most recent equipment, methodology and relevant
  standards
• Adequate facilities and organizational structure
• Transforming national policies to needs of
  various groups
• Updated/approximation of legislation on food and
  nutrition

• Terms of reference/job description - updates
• Promote staff development by academic education
  and training in nutr./health (incl. in-service)
• Monitoring dietary intake/nutritional health
  status
• Exchange of experience (national/international)
• Communication and dissemination of scientific
  results on nutritional health
• Establishing and using food database (software)

2

• Adequate institutional capacity (human resources)
  
• Research equipment, apply recognized
  methodologies and standards
• Adequate facilities and organizational structures
• Take account of relevant national policies
• Updated/approximation of legislation on food and
  nutrition
• Establish academic institution for nutrition
  training
• Develop curricula at each level of education
• Accreditation and certification of higher
  training activities
• Conformity of catering serviced to nutrition
  demands

• Harmonization/approximation of EU requirements of
• the educational system according to the Bologna
  Process
• Preparing nutrition training and education
  material
• Establish training courses for professionals with
  
• international collaboration
• Promote/update a web-based food and nutrition
  network
• Disseminate research results to users
• Research to support FNAP
• Develop food database

3

• Scientific based information for food selection
• Food based dietary guidelines
• Sustainable and adequate food supply
• Information for informed individual choice for
  diets (use of labeling)
• Application of legislation for food labeling

• Nutrition promotion and education
• Collaborate with industry/business on responsible
  marketing
• Specific programmes targeting certain population
  groups
• Contribute articles on nutrition to media

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Planning guidelines for capacity development in
nutrition in CEE
Challenges/ Problem areas
Food security (WFS 1996)
Nutrition
3. Educational
2. Institutional
1. Governmental
4. Community
Levels
Lobby/advocacy for food and nutrition action
plans

• Engage in monitoring/
• evaluation activities
• Promote staff development
• Argue for funding food database
• Apply intern. accepted
• methodologies
• Develop project proposals
• for EU

• Develop project proposals for EU
• Engage in food database develop.
• Initiate the support the FNAP
• Disseminate res. results to users
• Raise awareness of EUFIC on the
• needs for training materials in
• CEE languages
• Update a web-based food and
• nutrition network

• Nutrition promotion
• (including media)
• Popularize scientific
• findings adapted to
• local challenges
• and food habits

Prioritized Strategies/activities
For all Fund raising/networking/communication
material
Continuous
Medium/long term
Short term
Duration
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Some plans

• 3rd meeting of core countries (plus 2-3
  universities), November 2006
• Presentation of two specific themes, one
  suggested the human right to food
• preparation of 1 or 2 proposals for funding of
  the Network activities. Goal to finalise Socrates
  application to be submitted March 2007
• Involvement in new EC-programmes, such as
• EuroFIR
• Harmony, depends on go/no-go
• NuGO
• European Federation of the Associations of
  Dieticians (EFAD)
• Increase participation in existing post graduate
  courses, for example food databases (VELAG),
  epidemiology (Florence), the right to adequate
  food (Norway)
• 4th meeting of the core countries and
  universities would be considered for the second
  half of 2007 depending on go/no-go for Socrates
  programme(s) for 2006/2007. VLAG can offer
• Regulation of food intake (10 13 April 2006)
• Management of food safety issues (18 22
  September 2006)
• Nutrition and lifestyle epidemiology (June 2007)

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Thank you for the attention!