National Food and Nutrition Policy

II TUVALU'S NATIONAL FOOD AND NUTRITION POLICY National Food and Nutrition Policy \Vorkshop Funafuti, Tuvalu March 1996 II The working draft used at the workshop was compiled by Ben Jonson fellow Masters of Nutrition and Dietetics Human Nutrition and Dietetics University of Sydney , Australia. with input and review from Cecily Dignan, Nutritionist Siliga Kofe. Chief Economist South Pacific Commission Noumea, New Caledonia March, 1994 and key people from all sectors of the Tuvalu Government Funafuti Tuvalu August, 1994 PREFACE A policy is a statement of intent by a government or of what they wish to do about a particular problem(s) The National Food and Nutrition Policy (NFNP) has been developed to combat the problems and enhance the strengths of the food and nutrition situation in Tuvalu. It was developed in conjunction with J'l1e Food and Nutrition Situation in fovalu - 771e Needf<,r a National Food and Nutrition Polic,}' (Johnson, 1994) which provides a background. The development of the NFNP for Tuvalu began in 1988 with Annie Homasi coordinating officers from various sectors in Tuvalu to work in collaboration with Jacqui Badcock, the then SPC Nutritionist. Since then, the Nutrition Information and Training Officer at SPC, Mele'ofa Malolo, has continued the work and communication with Tuvaluan officers. At this National Food and Nutrition Policy workshop in August 1994 the draft presented contained the ideas from the last 6 years of work, in a slightly different format. The working draft at the August workshop has developed by Ben Johnson from the University of Sydney, Australia and Cecily Dignan (Nutritionist) and Siliga Kofe (Chief Economist) from the South Pacific Commission, New Caledonia. This document represents the finally agreed upon policy statement from the August 1994 workshop input. Peggy Maalo coordinated the input. Other contributors are listed on page 30. This NFNP has been set out such that there is an overall goal, ie. an ultimate c:nd, followed by a number of sub-goals and targets. Then follows seven objectives each with target-objectives that will need to be achieved if the goal is to be attained. The Ministries responsible for seeing the fulfilment of each target-objective are then listed along with some possible strategies and programs for achieving the target-objective Various government departments, NGOs and community groups all have a part to play in the development and implementation of the NFNP Other Pacific Island countries have found that good coordination amongst these groups is vital to the successful implementation of the NFNP. A strong National Primary Health Care Advisory Council (NPHCAC), dedicated to ensuring nutrition improvement activities are carried out, is, therefore, essential. CONTENTS Preface 1. The National Food and Nutrition Policy (NFNP) for Tuvalu 1.1 Goal 12 1.3 1.4 Rationale for developing the strategies and activities Objective I· To increase the availability of nutritious food Objective 2: To increase the accessibility of nutritious food PAGE J . 5 Objective 3 • To increase the desire to consume nutritious fiJod 8 1.6 Objective 4 To improve the intra-household food distribution 10 1 . 7 Objective 5: To improve lifestyle factors, environmental and 11 personal hygiene 1.8 Objective 6: To improve the health services for "at risk" groups 13 and people with NCDS II 2 7 1. 9 Objective 7 To evaluate the policy implementation and monitor 14 the food and nutrition situation 2. References 16 3 Appendix l Participants at NFNP Workshop 17 4. Appendix 11 Terms of reference for NFNC 18 5. Appendix 111 Good Health Guidelines 19 "' I. THE NATIONAL FOOD AND NUTRITION POLICY FOR TUVALU 1.1 Goal. To improve the health and nutritional well-being of the total population through the consumption of nutritious foods. It is proposed that the following targets be reached by the year 2000. It would be appropriate to review progress on implementation of the policy in 1997, at the end of the present government's term. Sub-goals and Targets a) To reduce the prevalence of sores, scabies and skin and eye infections in the general population. b) To reduce H'1e incidence of anaemia. In particular, to reduce it in: * school children from 77% to 20% * women of child-bearing age from 23% to 10% c) To improve the dental health of the general population. In particular to reduce the rate of missing or decayed teeth in school children by at least 30% d) To reduce the proportion of the total population that are overweight and obese. In particular, to reduce the proportion of: * overweight and obese women over 29 years from 75% to 40% * overweight and obese men over 29 years from 60% to 30% e) To stabilise and /or reduce the prevalence of non-communkable diseases 111 the general population, in particular * high blood pressure, currently at around in people over 30 years * diabetes, currently at around in people over 30 years. n To maintain the current good nutritional status of babies, infants and school children with respect to growth and development 1.2 Rationale for Developing the Strategies and Activities. For the sub-goals to be achieved, there must be a steady supply of nutritious food which people do consume Activities must be implemented that will ensure there is no obstacle to this from production to consumption (Kofe, 1990). For nutritious food to be accessible, it must first be produced and supplied (ie available) and affordable. Even if nutritious food is accessible, it will not be consumed if people do not have the desire to consume it. This desire comes about by educating the public about the need for nutritious foods and which foods are nutritious. The food that is obtained by a family must then be distributed within it appropriately. Other health and sanitation factors are also important in improving nutritio:ial status. These include: adequate exercise, not smoking, not abusing alcohol, clean, sale water, availability and proper use of toilets and good personal hygiene, including dental hygiene and fl.ill immunisation of children. For even when all people are eating nutritious foods they require, if they are not practising healthy lifestyle, nutritional status will not improve significantly. Many Tuvaluans already have non-communicable diseases such as diabetes and high blood pressure. These diseases can not be cured but they can be controlled by good • management which prevents the development of secondary diseases. Hence the NFNP needs also provide guidelines on improving the management of these diseases. Food and nutrition improvement programs must be watched over to identify and deal with any problems in their running Finally, the food security and consumption patterns and nutritional status of the population must be assessed annually to determine the effectiveness of the policy 2 1.3 Q~j~~t ive l: To ln~ r:t>a~e the Availability of Nutritious Food. i) To increase self-sufficiency in nutritious foods which are being, or can be produced locally. Ministry <?f Natural Resources a. Department <?f Agriculture i) Crop Section: The responsibility of the Department of Agriculture is to encourage food production at a national and household level. Agriculture should be specific on what crops to grow. where, how and for what purpose. It should provide technical advice to farmers on: 1. crops that grow best under atoll conditions and are well liked, such as. pulaka, cassava, taro, sweet potato, pumpkin, pawpaw, bananas, pandanus, breadfruit, lauluu, bele, chaya, drumstick, brazillian spinach. 2. mixed cropping and agroforestry - for diet variety and to improve soil fertility. 3. the use of poultry and pig manure to improve soil fertility. 4. effective pest and disease control. 5. continue to enforce quarantine regulations, including insisting that all planting materials and seeds should only be imported via the Department of Agriculture. Specific Activities 1. Together with Women's and Church groups and the UNICEF recommencing Family Food and Nutrition Project, rt should renew interest in home gardening of nutritious and easily-grown fruit, green leafy vegetables and other vegetables, providing small tools to keen farmers, from its present supply. Institutions (ie schools, the hospital and the prisons etc) should also be encouraged and assisted to renew or continue the development of their gardens. An existing staff position at the hospital should maintain the hospital food garden. These home garden programs should emphasise growing suitable green leafv vegetables and fruits The present estimate is that around 40% of homes in Funafuti grow green leafy vegetables and about 70% have pawpaw and/or bananas growing. By the end of 1997, it is proposed that 80% of households are growing green leafy vegetables and all institutions. This will require an improved efficiency in the multiplication and distribution of planting material 3 2. Through the Atoll Agriculture Project funded by Pacific Regional Agriculture Program (PRAP), the Department of Agriculture is improving the existing pulaka pits to increase pulaka production, but also to allow intercropping on the terraces with a range of crops. After the cessation of PRAP, the Department should continue the project and aim to renovate 50% existing pits by the end of I 997. 3. Farmers should be encouraged to gradually remove older, non-productive breadfruit, pandanus and coconut trees, and re-plant, preferably with a range of varieties. 4. The Department should make use of the ( ilohal Fnvironment Facilities (GEF) program funded by UNDP in Suva to increased the use of composting and re-cycling of waste. ii) Lfre.-.tock: The section should assist interested farmers 011 the outer islands in procuring ducks and provide advice inter rearing, as they are not very derr1nding of labour and the survival rate of ducklings is quite high. Also pigs/poultry should be encouraged as their manure are good source for compost. h. /)eparfment <?f Fisheries Na.ficot: should increasingly exploit Tuvalu's cheap and most abundant fish resource for household consumption by· 1. using data from the USA ID project to increase the exploitation of the deep-slope marme resource. 2. encouraging the speeding-up of the Australian funded project in the Rural Development sector that aims to develop a community fishing centre on each Island. 3. taking advantage of assistance from the Japanese to improve the supply of fish in Funafuti through providing technical training in commercial fishing, fish handling and equipment maintenance, and extending this expertise to interested fishermen. 4 Measures to protect the fish and marine life may need to be taken Tr,;s may be assisted by involvement in the GEF. ii) To improve food distribution in the community. I )epartme111 c!f ( 'ommerce The major constraint facing agriculture production is the irregular transport between the islands, the large distances between production and marketing centres and high transport costs. 4 a. Another boat that is cost effective for moving both produce and people needs to be secured. b. Internal freight rates on foodstuffs and other selected goods needs to be reviewed as soon as possible and a decision about subsidising certain goods should be made and implemented This would lower the cost of foods making them more accessible to the population. Nutritious foods and materials needed for farming should be given preference for subsidising. c. The market for locally produced nutritious food crops and other consumer items needs to be more efficient food distribution system. The Ministry of Commerce should review the operation of the local market to determine what is required for making it more efficient Local co-operative stores, town and island councils and small shop owners should be encouraged and assisted by the government to become outlets for the distribution and marketing of locally produced food crops. Such assistance could include the granting of incentives by the government such as food price subsidies on nutritious local foods which could be covered by a tax on foods of poorer quality. Minisfly <~f Health, Sports and Human Resources Del'e!opment All government institutions and private food providers should be encouraged to use as much local foods in their menus as possible. For this to be possible a regular supply must be available. a. Department <?f Health The Hospital menu should at least include a meal of cooked greens and vegetables once a day to significantly meet the vitamin and mineral requirement of patients in a day A sustainable hospital garden should be able to supply this need. h. Department <?l l~ducation The Motufoua Secondary School meals were also reviewed and found to be slightly low in Vitamin C and very low in Vitamins /\, B-complex, calcium and iron (Maiolo 1990) This needs to be corrected with an increase intake of vitamin and mineral rich foods such as fresh fruit, green leaves and vegetables (in particular fresh toddy. pawpaw. mangoes, bele, lauluu, carrots) and regular use of Vegemite The Marine Training Academy's diet and other institutions should also be review·ed as they represent potential consumers and suppliers of nutritious food 5 nutritional quality could be considered for banning by regulation from entering the country. ii) To provide employment/increase income for those lacking the ability to purchase adequate nutritious food. Minishy <?{ l,ah<mr and Fmph~}went I. The Ministry may wish to emphasise efforts to create more employment for Tuvaluans Income levels rise with an increase in economic activities. Proper targeting of income generating projects, first at people without access to both land and cash income, will reduce the inequity of income distribution leading to sound economic growth with redistribution of wealth. 2. Food preservation activities will provide employment and income generation as well as increase food availability. To ensure food safety and quality it is essential that a blast freezer he purchased in order that foods such as chicken and other freezable local foods will be able to be frozen in a safe manner. /Jepartment <?f Health and Agriculture Departments 3. As a sequel to increased agriculture production there will be need for some food processing i order to increase shelf life. This in turn will create employment. A list of foods suitable for preservation/processing and that have marketing possibilities within Tuvalu, should be made. Note that objectives 1 and 2 will result in an increased food security and thus provide a greater disaster preparedness However, a food distribution plan for use after a disaster is also required. 7 1.5 Objective 3: To increase the Desire to Consume Nutritious Food. i) To increase the level of nutritional awareness in the general public. A.finislly <?f Health, ,~jJorts and Human Resources a. Department<?[ Health I. Culturally appropriate community nutrition education materials based on the many existing regional materials in English should be developed for all sectors of the community. These should be based on the health guidelines mentioned below. 2. Health guidelines for public awareness, which can also be a basis for the food purchasing and pricing policy, should be promoted (see appendix l 11 for suggested guidelines). 3. A continuos and well-planned National Nutrition Education Program covering all islands should be developed with other members of the Health team and relevant NGOs and coordinated by the National Nutritionist. This could include the following (several of which are already occurring): a. a series of radio programs and spots. b translation of the Body Mass Index (BMI) chart, some of the SPC videos and NCD radio programs into the vernacular. c. regular seminars for the general public on various food and nutrition topics. d talks and videos at outpatient clinics and screening and education days for NCD. e. displays at shops, offices and other public places. that encourage nutritious food choices, help in reading food labels and give advice as to how to make your money go further f cooking demonstrations using both local and imported foods to prepare nutritious, affordable meals. g. Nutrition Week which provides great oppotiunities to run community av.rareness and consumer education programs. The fosi should be encouraged to take part in public nutrition education at these times h The Tumlu Ohesity /?.eduction Project should be evaluated If effective, any improvements needed should he made and the program continued ensuring that new SPC BMI charts, accurate weighing scales and medical assistants tramed m we1gt1t monitoring and able to give \veight control advice are available on the outer islands 8 communication techniques and NCO screening and NCD management skills. This could come in the form of regular in-service training programs. h. I )epartment <?l Fducalion 2. Consideration should be given to the appointment of a communication oflicer with expertise in mass communication and development of education materials c. IJepartme11I <!f Agric11/t11re 3. In-service training of extension officers should be encouraged. 4. A food technologist and/or an entrepreneur to develop and popularise methods of food preservation and storage is also needed. 9 I.6 Objective 4. To Improve the Distribution of Food in the Family. i) To promote good nutritional and child care practices in Tuvaluan parents and families. a. Department <?f Health Breastfeeding for as long as possible should continue to be promoted. By 1997 it is proposed that I 00% of four month old babies be exclusively breastfed. and this level be maintained. Mothers should be taught to introduce suitable local foods from four months. b. Department <?f Health and NGOs Should work together to encourage people to practice Family Planning through information, Education and Communication and providing Family Planning services. c. f)epartments <?/Health and f,,dncatio11 Should work towards improving the nutritional quality of foods eaten at primary school by educating the parents on the importance of nutritious foods and strongly encourage parents to make such children bring a nutritious foods at least once a week.. gradually increasing to bringing such foods every day. ii) To improve nutritional knowledge amongst the general public of the food needs of pregnant and lactating women a) J)epartment <?/ Health Education of mothers through the MCH ante and postnatal clinics and the general public through radio and publications on not overfeeding mothers during pregnancy or lactation is needed. iii) To stop the practice of "laulau 'mafa" (/,a11/a11 Toaua) Department <?f Health, litml,1 Fam;~v PlmminR Health Associah011 (Tr IFPHA) and ( '11lt11re neportments N< ;( )s shm1/d educate the local communities to decrease the quantity of "laulau 'mafa" (. The reduction in quantity will avoid food wastage and obesity Women and men should be discouraged from eating left-overs to avoid becoming overweight. 10 l. 7 Objective 5: To improve Lifestyle Factors, Environmental and Personal Hygiene. Minish)' <?I' Health. Sports and Human Resources a. /)epartment <?I' Health I. The Department should promote regular activity levels in the general population but particularly the female population and school children, in order to improve physical fitness. 2. It should strongly discourage smoking and excessive alcohol and excessive alcohol consumption. Aim to reduce the national per capita consumption of alcohol. Smoke­ free zones in public places should be declared. 3. The public should be educated to boil all no-rain or non-chlorinated water as the water table is high and so wells are shallow and often contaminated. 4. Health education on personal hygiene is required to lower the prevalence of hookworm and diarrhoeal diseases. The Department should aim at reducing the incidence of hookworm in school children from 17~,'o to 10% by the end of 1997. 5. Communities need to be mobilised to participate in the SPC AUSAID Sanitahon and Personal H igiene Project which is constructing water-seal, pour-flm~1 latrines. Social attitudes on the use of water-seal latrines needs to be changed. If successfi.tl, this project will reduce diarrhoeal and hookworm diseases in Tuvalu. 6. Legislation on a range of health and security issues (building codes, garbage disposal, etc) is already in place However, they are often not enforced due in most cases to a shortage of funds. The Ministries and Departments responsible for these regulatory activities must enforce these laws as a matter of highest priority Institutions such as schools must close if sanitary facilities do not meet regulatory requirements. 7. The Department needs to consider providing fi.trther education on immunisation. lt should aim at having 90% of babies receiving the Expanded Program of Immunisation rate is 70-80% Hepatitis B immunisation is currently incorporated into the routine EPI schedules. h. /)epartment <?f',\'port 8 Should endeavour to establish proper playing grounds, both outdoor and indoor, for the general public to encourage the involvement of as many people as 11ossible in spo1is. 11 c.. Department (?{ Fducation 9. Dental education in schools and in the community needs to be unproved. This education should focus on the relationship between diet and teeth, especially sugar consumption. All primary school students should receive a monthly lesson on dental hygiene It is recommended that a nurse be given this responsibility. Minist,y qf the Prime Minister f)epartment <?f Rroadcasti11K I 0. This Department should be encouraged to introduce TV transmission. This has the potential to bring useful audiovisual information on NCO and physical fi 1 ness into the homes of the public. A4i11ist1J,' <?f J,ahour and Comm1111ication Department (!/ Puhlic Works l 1. Should make arrangements to provide readily accessible water that is safe for consumption by people at institutions such as primary schools, etc. Private enterprise should be encouraged to carry out this work where PWD is not able to do so. 12 1.8 To Improve the Health Services for· 11 AT Risk" Groups and People with nutrition related diseases called Lifestyle Diseases or NCDs. i) To improve the management of NCDs. l)1;;part111ent (!/ Health I. Protocols for the diagnosis and management of Lifestyle diseases or NCO need to be established. The patients need to be educated in self management eg. medication, dietary and exercise advice. 2. The Department should conduct a screening for NCO, overweight, diabetes and high blood pressure, among adults over 30 on Funafuti every five years in order to obtain an approximate prevalence rate for these diseases. New cases should be registered and followed up 3. Health centres should be supplied with glucometers, glucosstix, blood pressure machines and cuffs, height measures, scales and a BMI wall chart. Health workers should be well trained in their use and consequent counselling. 4. After the screenings mentioned above are carried out, routine screening for NCD should be carried out on all adults over 30 years visiting health centres to pick up new cases. Government and private business employers should be actively encouraged to provide opportunities for their office employees to receive NCO screening. 5 Support should be given to the establishment of NCO clinics on the outer islands such that by the end of 1997, all islands run NCD clinics. Staff running NCO clinics should be trained in the screening and management of NC Os. 6 Registers on the islands of diabetics and people with high blood pressure should be well maintained so that their ongoing management can be monitored. ii) To improve the management of anaemia. 7 Regular screening for anaemia in under five years old, school age children (the same year group each successive year) and pregnant women should be carried out Reliable haemoglobinometers should be obtained and maintained for this purpose 8. Iron supplements and dietary and environmental advice should be given to families concerned and anaemic people should be followed up. iii) To maintain growth monitoring and nutritional surveillance of children under five years old. ':J. l:cnsure ciinics have accurate we1gllmg scales and that statt know !low to monitor growth and provide appropriate advice to mothers. 13 1.9 Objective 7: To Evaluate the Policy Implementation and Monitor the Food and Nutrition Situation. i) To coordinate the implementation, monitoring and evaluation of the Food and Nutrition Policy. I i. Each of Agriculture, Fisheries, Health, Education, Commerce and NGOs needs to designate a representative, preferably from among workshop participants, to form a National Food and Nutrition Committee and be responsible for the coordination of the implementation, monitoring and evaluation of the conduct of their food and nutrition program every three months. They should identify any obstacles, make any changes required for their food or nutrition improvement activities. ii They should be appointed jointly by the Health and Agriculture Minister and be responsible to the Development Coordinating Committee (DCC) The terms of reference and guidelines for the task force are included at appendix ii) To monitor the nation's food security and consumption patterns. 2. Several key indicators have been given in the targets of this NFNP and the "Jhe Food and Nutrition Situation in J'um/11". Further indicators that are not available but should be obtained are given below. The designated representative should be reviewing the indicators relevant to his/her sector. If there is no improvement over a reasonable length of time, their programs and activities may need to be changed appropriately. Minishy <?f Natural Resources & Aiinist1:1· qf Statistics and ('ustoms 3. These should coordinate their efforts in collecting, analysing and disseminating information on local production and imports of certain foods and food consumption patterns. Particulars needed is volumetric measures or food imports (such as kilogram of sugars, white rice and flour, cans of beer and soft drink, and the quantity of spirits. tobacco and mutton flaps). /)epartment <?/ Agriculture 4 Agriculture and Fisheries extension officers quartely and verbal reports should be used to provide quantitative and qualitative data indicating progress on projects ad in some cases production estimates. Annual agriculture reports (written) will supplement this I )epartme11t <?f hade and ( 'omml!rce '.'i The Consumer Price Index (CPI) should be revised bv updating the items in the basket off goods for rhe CPi 14 6. An attempt can be made to assess the status of employment, income levels and income distribution. 7. Statistics should provide information on food consumption patterns from the Household Income and Expenditure Survey to the Food and Nutrition Committee. iii) To improve the nutritional status of the population The main indicators for assessing changes in nutritional status are listed below. Minish}' <?f Health, ,\jmrts and Human Resources Department <?f Health I. Each month, health clinics and the hospital should compile data on: a. the nutritional status of the 0-2 year olds. b. new cases of anaemia by age groups. c. new cases of NCDs. d. new cases of obesity in adults (30) year olds and take appropriate action, eg if problem is serious, where appropriate provide more health education, etc. e. weight for height in primary school children could be assessed on all year 5 or 6 children. Apart from advice to parents of any overweight children, compiling these results could be used to show trends over time in the nutritional status of pre­ teenagers. 9. The annual Health report should be examined to determine nutritional improvement or deterioration in the population 10. Ways to determine the overall success with people's NCO management and prevention of secondary problems need to be developed. 1 I. The annual report will provide data on the rate of decayed and missing teeth in children under twelve if all children up to this age are seen annually, and so will provide data on changes in dental health in this group. 15 2. REFERENCES Annual Health Report, Ministry of Health, Sports and Human Resources, Tu·.·alu, 1991 & 1992. Deo, I. ( 1991 ). An 5/P(' Report 011 Household Food Sec11ri~r in Tuvalu. Agronutridev Consultants. F AO/WHO. ( 1992). lntemational ( 'o,!ference 011 Nutrition. F111al Report<?{ the Cm!f'erence. Rome, Dec. 1992. Johnson. B. (1994). The Food and Nutrition Situatio11 i11 Tuvalu - 77,e 11eed.for a National Nutrition Policy. Kofe, S. ( 1990) Household Food Sernrity in Selected Fac[ftc Island Cou11tries. (A Desk St1ll(i). South Pacific Commission, Noumea, New Caledonia. Maiolo, M. ( 1990). !Juty fral'el Report to fovalu. South Pacific Commission, Noumea, New Caledonia. McConnaghy, G. ( 1986) Foodpath to Health. A Food, Nutrtion, Gardening and Health Manual.for Tuvalu. Save the Children Fund, Westport, Ct. USA National Primary Health Care Advisory Committee. ( 1985). Ji,valu Improved Nutrition Pmgmm. Ministry of Social Services, Government of Tuvalu. Naylor, R. ( 1991 ). J'he Health Status. h?formation Requirements and Health Need\· <l li,valu. South Pacific Commission, Noumea, New Caledonia. Schoeffel, P with Bolabola, C and Ngirmidol, C. ( I g9 I) l11e UNICEF Fami(v Food Production and Nutrition Project. Fvaluation Report. DSIR Social Science, Ilam Research Centre, Christchurch, New Zealand. South Pacific Commission. ( 1991) First Pac{ftc Island\· Enl'ironmmtal Health ( 'onference: A1obilising Resources.for f<ffective fa11fronmental Health Pmgram. Country Statement - Tuvalu. Outline of General Health Concerns. South Pacific Commission, Noumea, New Caledonia Statistics Depai1ment, Tuvalu, personal communication re food import data. 1994 Terrell Perica. S ( 1993) Report of /)11~1· frm·el to lin·alu. South Pacific Commission, Noumea, New Caledonia 16 3. APPENDIX 1 LIST UF PARTICIPANTS TO NATIONAL FOOD & NUTRITION WORKSHOP Afelee Pita, Secretary, MHSHRD Pokia Tihala, Assistant Secretary, ML WC Semu Tafaki, Managing Director ofNAFICOT Maatia Toafa, General Manager, Tuvalu Cooperative Society Penehuro Hauma, Director of Education, MHSHRD David Manuela, Curriculum Officer, MHSHRD Alefaio Semese, Environmental Officer Manuila Tausi, Government Statistician Taai Katalake, Statistical Officer Tavau Teii, Director of Agriculture Itaia Lausaveve, Agriculture Oficer Timoteo Panapa, Agriculture Officer Uatimani Maalo, Youth & Sport Officer, MHSHRD Pula Toafa, Cultural Officer, MHSHRD Esela Natano, M.O. PMH, MHSHRD Filoimanatu Leauma, M.A, MHSHRD Faiatea Latasi, Lab Technician, MHSHRD Moeava Alefaio, Health Education Officer, MHSHRD Galivaka Nauma, Dental Therapist, MHSHRD Emily Ekoepke, Program Officer, TUFPHA Siuila Toloa, Secreatry-General, TuvaluRed Cross Penieli Metia, Private Sector Opened hy: Hon. Otinielu Tausi, Deputy Prime Minister & Minister for Natural Resources ('losed hy: Hon. Faimalaga Luka, Minister of Health, Sports and Human Resources Development Coordinatm·· Peggy Malo, Nutritionist l·t1cilitators: Cecily Dignan, Nutritionist, South Pacific Commission, Noumea Siliga Kote, Chief Economist, South Pacific Commission. Noumea. 17 APPENDIX 11 lerms of Reference for National tood and Nutrition Committee. The National Food and Nutrition Committee (NFNC') is on appointment by the Minister of Natural Resources and the Minister of Health, Sports and Human Resources Department The NFNC members represent a variety of sectors and each sector normally has its own established procedures for planning of its own activities. The implementation of the various sector food and nutrition activities is the responsibility of the relevant sector, and is not normally controlled by the NFNC. It is their role to advice the various sectors. Roles of this NFNC Committee: 1.. Coordination: To facilitate the implementation of the National Food and Nutrition Policy To consistently communicate and network between departments. To coordinate projects and programs that are being implemented by the different sectors. Also the Committee need to coordinate the activities of the various international and regional agencies at the national level. 2. Monitoring & Evaluation: To monitor the implementation of the National Food and Nutrition Policy and feedback to every Ministries and departments for appropriate actions to be taken. To advice and propose relevant recommendations to relevant authorities and sectors, including the private business sector. To control and/or rid practices detrimental to the practice of food safety. To liaise and collaborate with other government sectors and departments, regional and international authorities in the area of nutrition. To produce reports and factsheets to policymakers and decisionmakers 011 its activities and circulate to relevant government and non-government three times a year. The Committee is to meet at least every three months and report to the Minister on its activities. To evaluate past and current activities and programs on the impact and progress of each sector. 18 l. 2. * * * 3. 4. 5. 6. 7. 8. 9. 10. APPENDIX 111 Good Hea1t11 (juidelines for Tuvaluans Achieve and maintain a healthy body through 1·egular exercise and a healthy diet. Walking is a good form of exercise. Eat a variety of food from the 3 food groups every day. Include as much local foods as possible For health and protection have 3-4 pieces of fresh fruits and vegetables every day. For body building and repair have l-2 pieces of lean meat, fish, poultry, shellfish or legumes. For energy have 4 pieces of root crops, bananas or breadfruit, or 1-2 serves of wholemeal or white bread or hard biscuits or rice. Prepare healthy drinks and snacks for children at home and at school. Drink plenty of fresh, clean water ever day. Cut down on sugar and foods containing a lot of sugar. Prepare healthy meals that are low in fat and salt Encourage breastfeeding alone up to 4-6 months and then begin to supplement with other foods. Breastmilk is the best food for babies. Avoid drinking too much alcohol. Don't smoke. Practise good personal hygiene. 19