National School Nutrition Policy

DRAFT VERSION AUGUST 2023 i DRAFT VERSION AUGUST 2023 ii National School Nutrition Policy and Standards © Ministry of Education and Youth and Ministry of Health and Wellness 2023 First published in 2023 NOT FOR SALE Copyright Notice: All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form, or by any means without the prior permission in writing of the copyright holders. Ministry of Education and Youth School Feeding Unit Caenwood Centre 37 Arnold Road Kingston Jamaica, West Indies Ministry of Health and Wellness Head Office 10-16 Grenada Way Kingston 5 Jamaica, West Indies Developed by the School Feeding Unit, MoEY and MoHW Design and layout by Media Services Unit, MoEY ISBN FOREWORD DRAFT VERSION AUGUST 2023 iii The National School Nutrition Policy is a significant milestone, achieved by the Government of Jamaica through the Ministry of Education and Youth (MoEY) and the Ministry of Health and Wellness (MoHW) and other collaborating Ministries/agencies in guiding the process for the provision of good nutrition coupled with wellness especially for the most vulnerable students in our society. This policy will seek to ensure that children entering educational facilities are exposed to good nutrition and healthy lifestyles. Good nutrition is the lifeblood of any generation. Without proper nutrition and physical activity, we are destroying our present generation, leaving little or no hope for the next. Over the past seven years, Jamaica has seen an alarming increase in the rate of obesity among our school-age population inclusive of both boys and girls. The Ministry of Education and Youth believes that while it is important for us to educate our children, modelling good eating behaviours and practices are as equally beneficial. This policy sets the framework for school administrators to execute or deploy the means and measures in providing healthy and nutritious meals to students as well as to provide the avenue where students can enjoy a holistic wellness programme that involves both nutrition and physical exercise. The National School Feeding Programme in Jamaica is the oldest and largest component of the government’s social protection programmes, dating back to 1939, and is one of the major initiatives that warrant the formulation of a National School Nutrition Policy. Through the MoEY, the National School Feeding programme gradually became a fundamental part of the Ministry’s welfare programme comprising two components: the traditional cooked lunch component and the snacks component. The traditional cooked lunch component of the programme provides meals to over 225,000 students and over 18,732 students are catered for in the snack component. The MoEYnow provides lunches five (5) days per week to students on the school feeding programme and will continue its effort to provide students within our educational system, from early childhood to the secondary level with wholesome nutritious meals. However, despite the longevity of this programme and the efforts made to target not only the most vulnerable, but all school children ages 3-18 in all Jamaican schools there has been an ‘unevenness’ in the approach to implementation of the National School Feeding Programme that has over the years, raised concerns about whether the programme is satisfying the imperative of quality nutrition in all the targeted schools, with respect to the most recent guidelines relating to the provision of meals in schools. Additionally, the Ministry of Education and Youth has been challenged in its capacity to provide adequate resources to support and monitor the programme in a manner to ensure that all children are given at least one nutritious meal per day and that the programme is void of stigma and discrimination. These perennial issues which have plagued the School Feeding Programme could arguably be linked to the fact that the programme is not rooted DRAFT VERSION AUGUST 2023 iv in or driven by a clear policy that ensures standardisation and regularisation in meeting the physical and social needs of Jamaican school children. The Government of Jamaica’s vision is to sustain a school feeding programme free from stigma and discrimination which upholds the dignity and rights of each child and his/her family. This National School Nutrition Policy provides the enabling environment and has set the premise for this vision to become a reality as we seek to provide a robust school feeding programme that promotes the mental, emotional, social and physical welfare of all our students and bolster their ability to attain high academic standards. The Draft Policy Document was circulated to stakeholders prior to consultations with the groups. These were:  Students  Parents  Vendors  Global Health Advocacy Incubator (GHAI)  Experts in various MDAs  Manufacturers and Importers Association All Stakeholders agreed with the need for the Policy and with the objectives. Some concerns/comments were raised in relation to areas for further review or inclusion. These were included and others, mainly relating to funding and legislation are being further reviewed for clarification. DRAFT VERSION AUGUST 2023 v ACRONYMNS/ABBREVIATIONS DPAS Global Strategy for Diet, Physical Activity and Health ECC Early Childhood Commission FAO Food and Agriculture Organisation of the United Nations FGD Focus Group Discussion GOJ Government of Jamaica HPS Health Promoting Schools JADEP Jamaica Drugs for the Elderly Programme M & E Monitoring and Evaluation MAF Ministry of Agriculture and Fisheries MICAF Ministry of Industry, Commerce, Agriculture and Fisheries (formerly) MOHW Ministry of Health and Wellness MoEY Ministry of Education and Youth NCDs Non-Communicable Diseases NFITF National Food Industry Task Force NHF National Health Fund NSFP National School Feeding Programme NSNP National School Nutrition Policy PAHO Pan American Health Organisation PATH Programme for Advancement Through Health and Education PE Physical Education RADA Rural Agricultural Development Authority DRAFT VERSION AUGUST 2023 vi UN United Nations UNICEF United Nations International Children's Emergency Fund WHO World Health Organisation GLOSSARY DRAFT VERSION AUGUST 2023 vii Beneficiaries Students who are provided with a meal through the National School Feeding Programme; the cost of which is borne by the Government of Jamaica. Curriculum The lesson and academic content taught in a school or in a specific course or programme. Food Services Environment The food services environment in schools consists of food offered in school canteens, school Tuck Shops, and by vendors operating from or within 200 metres of the school gate. Food Security Food Security exist when all people at all times, have physical, social and economic access to sufficient, safe and nutrient dense foods which meets their dietary needs and food preferences for an active and healthy life (World Food Summit, 1996). Local Produce Food groups include: fruits, vegetables, staple foods, legumes, food from animals, fats and oils produced locally. Malnutrition Malnutrition can be defined as inadequate dietary intake relative to the dietary needs, and it can manifest in different forms: undernutrition, micronutrient deficiencies, and overweight and obesity (FAO, 2018; WHO, 2021b) Micronutrient deficiencies Lack of vitamins and minerals that are essential for body functions such as producing enzymes, hormones and other substances needed for growth and development (WHO, 2021b) Marketing Marketing refers to any form of commercial communication or message that is designed to, or has the effect of increasing the recognition, appeal and/or consumption of particular products and services. It comprises anything that acts to advertise or otherwise promote a product or service (WHO, 2010). Non-communicable Diseases Non-communicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors. They are not contagious. Nutrition The process of providing or obtaining the food necessary for health and growth. Nutritional Status The condition of the body influenced by diet. DRAFT VERSION AUGUST 2023 viii Obesity/Overweight Abnormal or excessive fat accumulation that may impair health. Physical Activity Any bodily movement produced by skeletal muscles that requires energy expenditure. Recommended Daily Allowance The estimated amount of nutrient or calories per day considered sufficient for 97.5% of healthy individuals of a particular age range or sex. School vendors School vendors refer to persons in proximity to the school compound who sell their goods to members of the school community. Stunting Height below that which is recommended as normal for a particular age, as assessed using approved growth standards. DRAFT VERSION AUGUST 2023 ix TABLE OF CONTENT 1. Forward iii 2. Acronyms and Abbreviations v 3. Glossary vii 4 Executive Summary 1 5. Rationale 3 6. Situational Analysis 6 7. Nutritional Status of Jamaican Children 7 8. Improving the Nutritional Status using the School Environment 8 9. Linkages with other Policies and Programmes 10 10. Guiding Principles 11 11. The National School Nutrition Policy: - Vision 13 - Mission 13 - Policy Goal 13 - Policy Objectives 13 12. Policy Areas: - Food Service Environment 14 - Provision of Meals 15 - Physical Activities Environment 16 - Health Promotion 17 - Curriculum Development 19 13. The Development of Regulations to Monitor Vendors in the Vicinity 20 of the School 14. Legislative Framework 20 15. Gender 29 16. Rural Versus Urban Areas 30 17 Key Stakeholders - Roles and Responsibilities 31 18. Policy Implementation Mechanisms 33 19. Human Resources Requirement 33 DRAFT VERSION AUGUST 2023 x 20. Monitoring and Evaluation 34 21. Financial Resources 35 22. Risk to Policy Implementation 37 23. Implementation Plan 37 24. Policy Review 37 25. Conclusion 36 26. Risk Matrix 38 27. Bibliography 39 28. Appendix 45  School Nutrition Standards for Jamaica DRAFT VERSION AUGUST 2023 Page 1 of 84 EXECUTIVE SUMMARY The Government of Jamaica through the Ministry of Education and Youth (MoEY) developed a draft National School Feeding Policy in 2015, through the assistance of the Inter-American Development Bank (IDB). Subsequently, the MoEY has seen the need to integrate this policy into a National School Nutrition Policy (NSNP) which is closely linked with the School Nutrition Standards developed by the Ministry of Health and Wellness and which are attached as an Appendix. This in keeping with the policy directives of the MoEY in addressing and establishing a National framework for the nutritional standards and physical wellness of our students within the school- aged population of our education facilities. This is in alignment with the Sustainable Development Goals and Vision 2030 Jamaica – National Development Plan. Purpose and Scope In keeping with the Sustainable Development Goals 2030, the main purpose of the NSNP is to provide a national framework that promotes and facilitates healthy eating habits and a physically active lifestyle among students in Jamaica. This will foster the physical, social and cognitive development of children and contribute to the reduction in malnutrition in all its forms. The Policy targets students particularly those between the ages of 3 to 18 years. Additionally, the policy aims to reduce the increasing rates of obesity by increasing physical activity and balanced eating among the student population by 2030 and also seeks to address undernourishment and micronutrient deficiencies in children. This Policy will encompass the school environment and vendors within 200m of the school perimeter. The policy encompasses, but is not limited to: - 1. The development of standards and guidelines for the provision of safe and nutritionally adequate meals to the school-age population. 2. Providing measures that will help to improve the nutritional status of all school children and support the alleviation of short-term hunger, with special focus on poor and vulnerable Jamaican students. 3. Establishing partnerships with local producers and small farmers to provide a sustainable source of locally produced foods to support the School Feeding Programme (SFP). 4. Encouraging schools to develop school gardens that help to support the National School Feeding programme. 5. Promoting the principles of food security, nutritional health and equity through the provision of free, subsidised or full-cost meals for all children according to assessed needs. 6. Facilitating improvements in the management and monitoring of the School Feeding Programme (SFP). 7. Contributing to improvements in the nutritional knowledge of children and their families. DRAFT VERSION AUGUST 2023 Page 2 of 84 The policy focuses on five overarching priority areas, which together cover the key aspects of nutrition and wellness in the school environment. These areas are: 1. The Food Services Environment and Education 2. Provision of Meals to meet Nutrition Standards 3. The Physical Activity Environment 4. Health Promotion and Lifestyle Habits Development 5. Curriculum Development The policy components are guided by experience and evidence from PAHO/WHO and other agencies relating to effective policy and programme interventions in school settings. Research from both developed and developing countries point to key areas that contribute to successful implementation of School Nutrition Policies: • Curriculum on diet and physical activity and taught by trained teachers • Supportive school environment policies • Physical activity programmes • Family component • Availability of healthy food options Nutrition training should be at all levels to encompass the principals/teachers at the highest level and cooks/food providers who implement and control food provision. Partnership will be established with key Government Ministries, Departments and Agencies (MDAs) and other stakeholders for the successful implementation and administration of the policy. The legislative framework is to be fully developed and implemented. The monitoring and evaluation techniques will be reenergized and strengthened to ensure the viability and sustainability of the policy. The policy will be reviewed after five years of implementation. DRAFT VERSION AUGUST 2023 Page 3 of 84 RATIONALE The United Nations (UN) Sustainable Development Goal (SDG) Goal 2 seeks to End hunger, achieve food security and improved nutrition and promote sustainable agriculture and by 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round. By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons (p26). Led by WHO and the Food and Agriculture Organization of the United Nations (FAO), the UN Decade of Action on Nutrition calls for policy action to build safe and supportive environments for nutrition at all ages. The Vision 2030 Jamaica - National Development Plan states “Jamaica, the place of choice to live work, raise families and do business” (chap1. p.15). Goal #1 of the National Development Plan speaks to Jamaicans being empowered to achieve their fullest potential which can be realised through a healthy and stable population (chap 2. p.19). The MoEY has been given the mandate to ensure that proper nutrition is established within the School Feeding Programme. The World Health Organisation (WHO) has identified four main behavioural risk factors associated with most of the major Non-communicable Diseases (NCDs). These are unhealthy diet, physical inactivity, harmful use of alcohol and tobacco. These risks which account for 74% of deaths worldwide (WHO, 2022) are considered modifiable risks. In Jamaica, it is reported that 79% of all deaths are due to non-communicable diseases (WHO, 2014a) and high expenditure to treat NCDs pose a direct economic burden on the health system. Additionally, NCDs impose significant indirect costs on the national economy resulting from loss of productivity (UNIAFT, UNDP, and PAHO, 2018). The cost of treatment of NCDs can drain household resources and or divert resources from other household needs such as food and education (UNIAFT, UNDP, and PAHO, 2018). The most practical way in controlling this epidemic is by taking precautionary measures in reducing them. Obesity, overweight and high cholesterol have been identified as major outcomes of unhealthy diets and physical inactivity, and are biological risk factors for NCDs globally. NCD risk factors often begin early in life and continue through adulthood. Obesity and overweight rates in children have increased significantly in the last thirty years (WHO). In fact, since 1980 the rate of obesity has reportedly more than doubled globally. The WHO has classified obesity as one of the most dire public health issues affecting children in the 21st Century. The WHO revealed that, in 2020, a total of 39 million children under the age of 5 were either obese or overweight. In 2016, greater than 1.9 billion adults from the age of eighteen and above were reported to be overweight. Of this amount, a total of 650 million people were obese (WHO 2021). Among the targets established to DRAFT VERSION AUGUST 2023 Page 4 of 84 be achieved by 2030 by the WHO for infant and young child nutrition, is a “halt in the level of childhood overweight globally” (WHO, 2018). This target is achievable by implementing restrictions concerning the marketing of foods and beverages in the school environment which are considered high in sugar, salt and fats. It is widely accepted that good nutrition practices in schools can improve cognitive and academic performance, depending on the type of food provided, the size of food rations and the programme duration (Adelman, Gilligan & Lehrer 2008). It is also acknowledged that in order to improve children’s nutritional status, regular meals that significantly address the nutritional deficiencies in children’s diets must be addressed. As noted in the National Operational Action Plan for the Prevention and Control of Obesity in Children (MOH, 2016): “…childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. In addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects” (WHO 2015, p2). The narrative of the plan goes on to caution that, ‘the high prevalence of overweight and obesity among children should therefore be a cause of concern to policy makers and health professionals as it has implications for the health care system and the economic productivity of the countries affected’ (ibid). Citing studies done in the Caribbean, the Plan points out that treating the co- morbidities of obesity will be a huge economic cost for the region, and will become unsustainable. According to Dobbs & Manyika, 2015, obesity accounts for 2-7% of health cost globally. This policy is a part of a national response to improving the nutritional status of children in Jamaica. The Government of Jamaica has taken significant policy and programmatic steps to address the threats faced by Jamaicans as a result of unhealthy diet and physical inactivity. These include inter alia: 1. The School Feeding Programme since 1939. 2. The National Food and Nutrition Policy (Ministry of Agriculture). 3. The National Food Industry Task Force (NFITF) established by the MoHW in 2016 to develop and implement strategies to improve the nutritional status of Jamaicans and reduce the economic burden of NCDs. The formation of the Task Force supports the Ministry of Health and Wellness’ National Strategic and Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) 2013-2018, which was developed in response to the high mortality rates linked to NCDs in Jamaica, and the growing socio-economic burdens of treating a rapidly growing unhealthy population. Jamaica Moves in Schools, a collaborative effort between Ministry of Education and Youth and the Ministry of Health and Wellness is the latest initiative that focuses on physical activity, healthy eating and age appropriate health checks. DRAFT VERSION AUGUST 2023 Page 5 of 84 4. The Food and Agriculture Organisation of the United Nations (FAO) with the permission of the MoEY piloted the Sustainable School Gardening Project in selected schools, designed to strengthen the link between the School Feeding Programme and the Agricultural Sector, especially farmers in the school community. 5. The MoHW developed and implemented the Interim Guidelines for beverages in schools, effective January 2019, which restricts the sale of certain sugary drinks in schools. As of January 2023, the approved level sugary drinks in schools is 2.5gm sugar/100ml. The MoHW launched the Food Based Dietary Guidelines in 2015 to promote healthy nutrition habits in the population through social marketing and health promotion activities. 6. The launch of the National Infant and Young Child Feeding Network (NIYCFN) in 2019, in keeping with the National Infant and Young Child Feeding Policy. 7. The establishment of the National NCD Committee in 2021, by the Ministry of Health, and as associated sub-committees to provide guidance on NCD prevention in Jamaica. DRAFT VERSION AUGUST 2023 Page 6 of 84 SITUATIONAL ANALYSIS It is well established that nutritional factors affect the cognitive development of children and their school achievement (Lawson, 2012). Some of these effects of impaired cognitive development are absenteeism, low motivation and cognitive function, lack of concentration and tardiness. Children with impaired cognitive development perform less in school, are more likely to drop out and have higher rates of absenteeism than other children (Del Rosso, 1999). While more pronounced in children who are chronically hungry and malnourished, these effects are also seen in children who suffer short-term hunger, as they have difficulty concentrating and performing complex tasks. Additionally, clinical trials show a critical link between learning and school children’s health and nutrition, suggesting a substantial gain in educational effectiveness from improving children’s nutrition and health (Del Rosso, 1999). Globally in 2020, 149 million children under five years (5yr) were estimated to be stunted (too short for age), 45 million were estimated to be wasted (too thin for height), and 38.9 million were overweight or obese (WHO, 2021b). The WHO reported that, “overweight in children is reaching alarming proportions in many countries and poses an urgent and serious challenge. The prevalence of overweight among children is rapidly increasing even in many low- and middle-income countries. Jamaican children face a double burden of malnutrition with short-term hunger, under-nutrition and micronutrient deficiency co-existing with overweight/ obesity. Almost 9 per cent of children under age 5 years are overweight. The Global School-based Student Health Survey (GSHS), 2017 report on students in Jamaica revealed that 23.3 per cent of students aged 13-17 years were overweight and 9.2 per cent were obese. It also found that over two-thirds (69.1%) of students had at least one carbonated beverage each day (WHO, 2017a). The level of physical activity among adolescents 13-17 years was low. Fewer than one in four (23.2%) students were engaged in some type of physical activity for at least 60 minutes each day, while 56.4 per cent spent three or more hours in sedentary activities such as watching television and playing computer games each day. According to the World Health Organisation (WHO), “Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily”. However, in many schools in Jamaica, mandatory participation in Physical Education ends at age 14 for schools that have such a programme. The then Ministry of Health conducted a Health Promoting School Survey in 2011, which concluded that the school was the primary source of lunches and snacks for children. More than three-quarters of the students get their lunch from the school (canteen, tuckshop, vendors), while less than twenty-five percent take lunch from home (MOH 2011, p23). NCDs have been the leading cause of deaths in Jamaica for over 50 years. The projected total losses associated with NCDs and mental health conditions over the period 2015-2030 is US$18.45 Billion for Jamaica. (Bloom et al, 2018, p4). It is estimated that the Government of Jamaica (GOJ), spends annually, more than US $170 million to treat NCDs. It has been projected that, by 2060, the economic costs of overweight and obesity will be US $1.5 billion USD and will exceed 5% of DRAFT VERSION AUGUST 2023 Page 7 of 84 Jamaica’s GDP and represents a predicted 3.5-fold increase in total costs between 2019 and 2060 (World Obesity Federation, 2022) The GOJ recognizes that changes in long established dietary and physical activity patterns require the partnership of multiple sectors including health, agriculture, transportation, education, sports and entertainment among others, such as food retail and processing, and urban planning. Poor dietary practices and inadequate physical activity among the general populace are noted as the underlying causes for growing obesity and overweight rates. In fact, obesity and overweight have been identified as the main causes of NCDs and deaths in Jamaica (National NCD Plan, 2013-2018/Cabinet approved) and are recognized as the primary public health threats impacting and costing Jamaicans. It is now imperative that greater effort in promoting good nutritional practices be made in our schools to achieve our national goal. This will require a “whole of Government” approach, for effective and sustainable achievement. NUTRITIONAL STATUS OF JAMAICAN CHILDREN Inappropriate child feeding practices are identified as one of the main contributing factors to poor nutritional habits in Jamaica. These practices, it is noted, begin in children from infancy and carry over into adulthood. Indeed, eating practices during pregnancy and before birth can affect brain development during the critical period of growth up to two (2) years and this determines learning capacity for life. Research has even shown that the effects of poor eating habits can be passed from one generation to the next as epi-genetic pre-disposition and contribute to the child’s potential for chronic disorders. A high percentage of the country’s population is classified as obese/overweight; and between 2008 and 2016, the percentage of adults identified as obese increased by 33 percent (Pan American Health Organisation, 2016) and the most recent Jamaica Health and Lifestyle Survey 2016-17 showed that 54 percent of adults were classified as overweight/obese (MoHW, 2018) Information available on the health and nutrition status and lifestyle behaviours of school children in Jamaica, points to the following as areas of concern: i. Between 25 per cent and 33 per cent of the school age population in Jamaica arrives at school hungry or without having eaten anything on a given school day (Fox & Gordon- Strachan, 2007). ii. Short-term hunger (understood as lack of food intake before arriving to school on any given day) co-exists with poor eating habits, such as an overconsumption of high sugar drinks and snacks of low nutrient density critical for growth, in the school age population (Walker, Chang & Grantham-McGregor, 1996; Powell, Walker & Chang, 1998; Fox & Gordon- Strachan, 2007). iii. Overweight and obesity are twice as common as underweight in the school age population and overweight and obesity increase rapidly with age during the school years; (FAO 2003; DRAFT VERSION AUGUST 2023 Page 8 of 84 CFNI 1997; Fox & Gordon-Strachan, 2007). Of note however, is that previously malnourished and underweight children, poorly fed, are more likely to develop obesity in adulthood than normal weight, properly fed children. iv. Iron Deficiency anaemia is a serious nutritional problem among the school age population (Walker, Powell, Hutchinson, Chang & Grantham-McGregor, 1997; FAO 2003), especially in adolescence and young females. One in four (25%) women and girls aged 15 and older are anaemic (MOHW, 2018). The COVID-19 pandemic exacerbated food security, nutrition and health challenges among children and adolescents. A UNICEF/CAPRI Study on the socioeconomic impact of COVID-19 (UNICEF, CAPRI, 2020) found that 44 percent of households experienced food shortages. In tandem with this, there were increases in children’s level of overeating (57 percent) as an emotional reaction to COVID-19 restrictions. UNICEF’s Situational Analysis of Children 2021 noted that the combination of household income loss and the temporary suspension of the school feeding programme due to school closures may have led to increased risk of malnutrition and consumption of cheaper processed foods with higher fat and sugar content (UNICEF, 2021). The Regional Overview of Food Security and Nutrition in Latin America and the Caribbean, 2022 has noted that two-thirds of Jamaica’s population cannot afford a healthy diet. (FAO, IFAD, PAHO, UNICEF, WFP, 2023) IMPROVING NUTRITIONAL STATUS USING THE SCHOOL ENVIRONMENT The WHO and FAO have long advocated for the use of the school environment to promote healthy eating habits and lifestyles. The appeal to tackle nutritional status through schools lies in the fact that schools provide a ready environment for reaching large groups of children and the school community. According to WHO, scientific evidence has long established the effectiveness of school-based interventions to changing eating behaviour and preventing overweight and obesity (PAHO, 2014). In 2004, the World Health Assembly adopted the “Global Strategy on Diet, Physical Activity and Health (DPAS). The DPAS was one of the first comprehensive strategies that advocated for countries to develop and implement school policies and programmes that promote healthy diets and increased levels of physical activity, as part of global efforts to curb obesity. The strategy recognised schools as conducive environments to tackle issues related to childhood obesity, due to the length of time children spend daily in this setting. In 2008, the WHO developed the DPAS School Policy Framework as a guide for policy-makers to develop and implement “policies that promote healthy eating and physical activity in the school setting through changes in environment, behaviour and education.” DRAFT VERSION AUGUST 2023 Page 9 of 84 Since 2008, several countries have taken steps to develop school nutritional policies based on the Framework of the WHO. According to the 2021 Global Survey of School Meal Programs, 24 countries in the Americas have implemented school meals programmes to varying degrees. There are, however, a few countries, e.g. Canada, that initiated the development and implementation of nutritional school policies, a few years prior to the publishing of the DPAS School Policy Framework. In Canada, where policies have been in place since 2005, the decline in childhood obesity rates over a 10-year period suggests nutritional policies may be having the intended effect. A rapid review of their School Nutritional Policies shows that equal emphasis is placed on the food environment, physical activities and the curriculum to support improved nutritional status. Brazil’s National School Feeding Program, implemented in 2009, restricts schools from procuring certain unhealthy foods and excessively sweetened drinks and requires schools to offer unprocessed and minimally processed foods in partnership with family farmers. In 2020, the legislation was updated to increase the minimum quantity of fruits and vegetables offered, in compliance with the Brazilian Dietary Guidelines, and to impose stricter limits on the availability of ultra-processed foods. Barbados’ National School Nutrition Policy, was approved in May, 2022, launched February 15, 2023, and is being introduced to all schools in a phased approach during the 2022–2023 academic year. It aims to create healthy school environments that enhance student learning and are conducive to the development of healthy lifelong eating and activity behaviours through a multisectoral and integrated approach. The policy applies to all public and private schools and educational institutions from preschool to tertiary level covering the food services environment, curriculum, health promotion, school recognition, physical activity, school health and nutrition services. (UNC, 2023). The implementation process for this Policy will provide useful feedback for Jamaica as it embarks on our National School Nutrition Policy. The World Health Organization School Policy Framework (2008) has been used as the main guide to develop the National School Nutrition Policy for Jamaica. The framework guides countries on how to develop and implement school policies and programmes that promote healthy diets and increased level of physical activity. Additionally, the preparation of the National School Nutrition Policy for Jamaica was guided by the established rules for policy development, including the Consultation Code, which have been set by the Cabinet Office. These rules recognise that an effective policy framework must have the inputs of the multiple stakeholders who are positioned to contribute to its implementation. This includes public sector organisations, as well as civil society organisations that may be able to provide nutrition and physical activity services to supplement those offered by the GOJ. In keeping with these principles, policy makers, school leaders, parent organisations, nutrition professionals, and students provided inputs into the policy. When implemented, the Policy will support the aims and objectives of the National Operational Action Plan for The Prevention and Control of Obesity in Children and Adolescents 2016-2020. It will also complement the strategies to reduce the prevalence of NCDs, which are outlined in the National Strategic and Action Plan for the Control of Non-Communicable Diseases, which targets DRAFT VERSION AUGUST 2023 Page 10 of 84 the general population. Although covering a wider range of issues related to nutrition in the school environment, this policy is aligned to the goals and objectives of the draft National School Feeding Policy. LINKAGES WITH OTHER POLICIES AND PROGRAMMES The National School Nutrition Policy has linkages across multiple sectors. In addition to the impact on health, wellness and education, discussed above, it is understood that once implemented, the National School Nutrition Policy will both complement, as well as be supportive of, various national policies, programmes and plans that influence or affect food and beverage consumption in Jamaica. This includes in the areas of agriculture, food processing and manufacturing, and poverty reduction. Key elements of the policy framework are provided below and discussed as appropriate. (a) Vision 2030 Jamaica – National Development Plan Goal #1 of the National Development Plan speaks to Jamaicans being empowered to achieve their fullest potential which can be realised through a healthy and stable population. (b) National Food and Nutrition Security Policy (MICAF & MoHW, 2013): The Nutrition Security Policy provides the guiding framework within which Jamaica’s agriculture and food systems can deliver adequate quality and nutritionally appropriate quantities of food and food imports to increase the availability of good quality-nutritious foods in Jamaica. The National School Nutrition Policy both reinforces and is supported by the Nutrition Security Policy, creating an enabling environment for the mutual and beneficial pursuit of the respective goals and objectives. (c) National Food Safety Plan 2012-17 (MICAF): The Food Safety Policy aims to implement programmes that promote high standards of food hygiene and maintain systems of surveillance and control to ensure compliance with those standards and is complimentary to the goals and objectives of the National School Nutrition Policy and its focus on the food service environment. (d) Jamaica National Health Policy (MoHW, 2006-2015) (e) National Infant and Young Child Feed Policy (MoHW, 2018) (f) National Food Based Dietary Guidelines or Jamaica (MoHW, 2015) (g) National Operational Action Plan for the Prevention and Control of Obesity in Children and Adolescents in Jamaica (MoHW) 2016-220 (h) National Strategic and Action Plan for the Prevention and Control of Non- Communicable Diseases (MoHW) 2013-2018 (i) “Jamaica moves in Schools” (MoHW, MoEY): a collaborative effort focussing on physical activity, healthy eating and age appropriate health checks. (j) The School Feeding Programme DRAFT VERSION AUGUST 2023 Page 11 of 84 (k) Sustainable School Feed Project (Food and Agriculture Organisation “FOA”, MoEY) The FAO with the permission of the Ministry piloted the Sustainable School Feeding Project in selected schools, which is designed to strengthen the link between the School Feeding Programme and the Agricultural Sector, especially farmers in the school community (l) The Operations and Procedures Manual for the School Feeding Programme (MoEY, 2017) (m) Jamaica Nutritional Guidelines for Children and Youth (MoEY) (n) Standard Bidding Documents for Canteen Concessionaries (MoEY) (o) Guidelines for the Engagement of Canteen Concessionaries (MoEY) (p) Food Based Dietary Guidelines for Jamaica (MoHW) (q) Interim Guidelines for Beverages in Schools (MoHW) (r) The National Strategic Plan For Preadolescent And Adolescent Health (MoHW) (s) The National Policy on Poverty and the Social Protection Strategy. GUIDING PRINCIPLES The successful implementation of the National School Nutrition Policy will be guided by the following principles: 1. The Rights of the Child: This policy is rooted in the Child Rights perspective and is focused at all times on the fair treatment and best interest of the child in accordance with Articles 2 and 3 of the Convention on the Rights of the Child (CRC). It also responds to CRC Article 4, in which the GOJ committed to taking all available measures to safeguard the rights of children, including assessing our social services and funding for these services to ensure that children are protected, and Article 5, which gives governments the responsibility to assist parents in fulfilling their role as nurturers. More specifically, the Convention (Article 24) provides children with the right to nutritious foods and information to help them stay healthy as part of the right to health and health care. These rights have been reiterated by the 2013 General Comments of the Committee for Rights of the Child (CRC, 2013) which calls on governments to put in place policies and programmes that address the underlying determinants of child health, nutrition being one such ‘underlying determinant’. The Committee requires that special attention be paid to children in disadvantaged circumstances and underserved areas and notes that school feeding is desirable to ensure all pupils have access to a full meal every day, as this can enhance children’s attention for learning and increase school enrolment. The Committee further recommends that this be combined with nutrition and health education, including DRAFT VERSION AUGUST 2023 Page 12 of 84 setting up school gardens and training teachers, food providers and parents/caregivers to improve children’s nutrition and healthy eating habits (para. 46). 2. Right to good nutrition: The Government of Jamaica (GOJ) considers the protection of the health and nutrition of all children as integral to its overall responsibility to safeguard the life of Jamaican children. It recognizes that health and nutrition are integral to the positive development of children and important to their cognitive and psychosocial development. 3. Equality and Equity: The policy requires that every vulnerable child in Jamaica should have equal access to the school feeding provisions regardless of location, gender, type of school attended and age. 4. Good Governance: To provide an environment of transparency and accountability. 5. Multi-Sectoral and Community Empowerment: The implementation and sustainability of this policy will require partnership and coordination primarily among the Ministries of Education and Youth, Health and Wellness, Agriculture and Fisheries, their Departments and Agencies, Local Government and Rural Development, Municipal Corporations and other relevant stakeholders in the service and delivery of nutritional guidance and support. The Policy will facilitate the implementation of school based health initiative such as ‘Jamaica Moves in Schools”. DRAFT VERSION AUGUST 2023 Page 13 of 84 ABOUT THE NATIONAL SCHOOL NUTRITION POLICY Good Nutrition! Physical Wellness! Healthy Living! VISION STATEMENT An equitable, adequate, and sustainable nutrition and wellness programme that upholds the dignity and rights of each child. MISSION STATEMENT To promote quality and cost-effective nutritional and wellness goods and services to all children in our educational facilities in order to improve learning and well-being. POLICY GOAL To provide a national framework that promotes and facilitates healthy eating habits and a physically active lifestyle among students in Jamaica in keeping in keeping with national and global commitments. POLICY OBJECTIVES The policy aims to: - 1. Provide and implement nutritional standards and guidelines. 2. Optimize the nutritional status of children in order to improve and sustain the physical, social and mental well-being of children in Jamaica. 3. Create an environment in schools in which a variety of healthy food options from the six food groups are available and promoted. 4. Increase to 85 per cent by 2030, the number of schools that provide dietary choices to complement meals in order to meet the nutritional needs of students. 5. Increase to 85 per cent by 2030, the number of schools which provide mandatory opportunities for physical activity to students at all grade levels. DRAFT VERSION AUGUST 2023 Page 14 of 84 THE POLICY AREAS The policy focuses on five overarching priority areas, which together cover the key aspects of nutrition and wellness in the school environment. These areas are: 1. The Food Services Environment and Education 2. Provision of Meals to meet Nutrition Standards 3. The Physical Activity Environment 4. Health Promotion and Lifestyle Habits Development 5. Curriculum Development FOOD SERVICES ENVIRONMENT Policy statement: The Government of Jamaica through the MoEY in collaboration with other Ministries, Departments and or Agencies shall provide an adequate, safe and healthy food service environment to support the growth and development of children in Jamaican schools. Food Service Environment Descriptors: - i. The food services environment consists of canteens, tuck shops, canteen concessionaires and vendors at the school gate, or within 200 metres of the school gate (premises). This environment will be governed by the standards, regulations and policy guidelines of the feeding programme. ii. Food establishments and community shops outside of the immediate vicinity of the school do not fall within the scope of this Policy. This will be accomplished using the following strategies: 1) The development of regulations to guide the operations of school vendors in the vicinity of the school. 2) The provision and utilization of an appropriate institutional framework including training to support the implementation of the nutrition standards. 3) Increasing the use of locally grown produce and minimizing the amount of processed foods and snacks offered by schools. Most Jamaican students buy meals and snacks at school during the school day, and only a small percentage of students take their lunches and snacks to school from home. Observance of the Nutritional School Nutrition Standards, which accompany this Policy (Appendix I), is therefore expected to support increased consumption of meals and snacks with appropriate nutritional value DRAFT VERSION AUGUST 2023 Page 15 of 84 in schools, and at the same time provide guidance on items that should be restricted/controlled. The proposed plan is to employ a team of nutritionists to serve each region including a Head Nutritionist to provide the required support and training at different levels within the educational system. It is expected that the Ministry of Health will also provide technical assistance in this component. There will also be ongoing discussions with all stakeholders prior to and during the implementation stages. Implementation of the policy will be done on a phased basis. PROVISION OF MEALS Policy statement: The Government of Jamaica shall ensure the provision/availability, and accessibility of healthy and nutritious meals to all students. This will be accomplished using the following strategies: i. The promulgation of Food Based Dietary Guidelines and the National School Nutrition Standards for Jamaica to regulate the provision and consumption of food by students in schools. ii. The provision of at least one nutritious meal per day providing ¼ to ⅓ of daily nutritional requirements to the beneficiaries on the School Feeding Programme (SFP) from early childhood to the secondary level. iii. The utilization and compliance with the use of manuals with menus and recipes standardized for different levels from early childhood, primary and secondary schools, which incorporate the use of local produce. iv. Enhancement and expansion of school gardens, where feasible to provide food for meal preparation within schools. v. Increase in the variety and volume of locally grown fruits available in schools. vi. Increase in the linkages between the agricultural sector and the schools for locally produced foods to be made available in schools. vii. Regulate the marketing of unhealthy foods and beverages in and around the school environment. viii. Limit students’ access to “empty calorie” snacks and beverages. The School Nutrition Standards in the Appendix provides more detailed information and guidance on the food items/descriptions mentioned here and will used as a reference and guidance in implanting the policies relating to the Food Service Environment. DRAFT VERSION AUGUST 2023 Page 16 of 84 School Feeding Programme The list of students benefiting from the School Feeding Programme (SFP) is provided by the Ministry of Labour and Social Security Programme of Advancement Through Health and Education (PATH) while other welfare programmes are initiated by schools. This policy is premised on the understanding that the school nutrition and feeding interventions play important roles in supporting the local agricultural sector. At least 10 per cent of raw materials for the School Feeding Programme (SFP) should be produced by and sourced from school gardens/farms and local producers in the agricultural sector. The SFP is designed to enhance student’s growth and development, to maximize learning and bolster human capacity while contributing to national development through the use of locally produced inputs. Meals provided under this programme will also be adjusted to meet the nutrition standards. PHYSICAL ACTIVITY ENVIRONMENT Physical activity and health education in schools have been recognized as important strategies in addressing obesity in children and youth. Physical Activity and Physical Education/Health Education policies, programmes and initiatives are generally combined with food and beverage focused policies to promote overall health and wellness. This policy seeks to increase opportunities for students to be engaged in physical activities. The school environment should have safe and age-appropriate facilities and equipment that will contribute to the growth and development of the students. Policy Statement: The Government of Jamaica through the Ministry of Education and Youth shall provide a school environment with safe age-appropriate facilities and equipment and provide opportunities for sufficient physical activity that will contribute to the growth and development of the students. This will be accomplished using the following guidance and strategies: i. Physical activities programmes for children from early childhood to Grade 13. ii. Three five-minute physical activity breaks per day iii. A minimum of one hour of physical activity per week iv. Physical education in schools as guided by the curriculum. v. A safe, secure and suitable play area for all students. HEALTH PROMOTION Policy Statement: DRAFT VERSION AUGUST 2023 Page 17 of 84 The Government of Jamaica through the MoEY and the MoHW shall promote the benefits of good nutrition, physical activity and their relationship to the growth and development of children in educational facilities. This will be accomplished using the following strategies: 1. Encourage and promote food and drink appropriate to the target group in order to enhance and sustain their physical, social and mental well-being.  Nutrition, health and education manuals and practices standardized at all levels of the school system.  Providing services to assess Recommended Dietary Allowance (RDA) for students.  Promote the consumption of local agricultural produce.  Promote intake of water and fresh fruit days. 2. Promote food safety principles to ensure the provision of food that has been stored, prepared and served in a safe and hygienic manner. Ensure:  Adequate supply of clean and safe water is available at all schools.  Appropriate and sanitary health facilities are available.  Promote proper handwashing principles and encourage proper hygiene before handling food or eating.  Ensure food handling staff are adequately trained and possess the requisite certification. 3. Promote and maintain the health status of students through the initiation of effective health promoting activities o The MoEY and/MoHW will ensure that there is regular medical examination and age-appropriate nutrition assessments and a referral system in place for all schools. o Nutritional Guidance and nutrition counselling services available and accessible to all students Guidance and social/emotional counselling services available and accessible to all students. o Increase the level of physical activity at the pre-primary to secondary levels. 3. Improve collaboration with other Ministries, Departments and Agencies in the planning and implementation of NSNP interventions to include: -  Jamaica Moves in Schools’ initiative.  National School Nutrition Standards DRAFT VERSION AUGUST 2023 Page 18 of 84  Increasing the use of local produce in school meal programmes 5. Provide health and nutrition education and promotion of activities up to the secondary level of the education system. The MoEY will: o Ensure the delivery of health education at the early childhood, primary and secondary levels through the Health and Family Life Education curriculum. o Promote the integration of wellness and nutrition concepts into all school activities. o Promote and sustain a safe and healthy learning environment. o Ensure capacity building among stakeholders. o Provide appropriate guidelines for nutritional standards to tuckshops and vendors in and around the school environment, coupled with ongoing monitoring and evaluation. o Educate all persons at all levels of the food chain from ‘farm to fork’ including local farmers about menus and products to be utilized in the School Feeding Programme. o Ensure that all schools provide opportunities for physical activity to students at all grade levels. Additionally, the MoEY will: - i. Promote and implement health awareness activities through the Health and Family Life Education Programme (HFLE). ii. Encourage schools to incorporate/integrate healthy lifestyle practices in various lessons and out of class activities. iii. Develop and disseminate educational materials to schools and parents. iv. Develop a culture of healthy lifestyle practices through public education and engagements v. Introduce healthy lifestyle competitions and provide incentives. The MoHW in collaboration with the MoEY will commit to health promotion such as: i. Develop and coordinate educational seminars on nutrition and physical activity in conjunction with the National Parenting Support Commission. DRAFT VERSION AUGUST 2023 Page 19 of 84 ii. Provide access to information, education and communication (IEC) materials on nutrition and physical activity through Parent Teachers’ Associations, the NPSC, Parents Places, schools, faith based and community based organisations, Non- Governmental Organizations (NGOs), as well as other civil society groupings across the island. iii. Engage the media to help disseminate approved nutrition and physical activity related information to parents and caregivers. iv. Encourage private schools to adopt the standards developed for the NSNP. v. Partner with private sector, International Development Partners and civil society to fund a variety of educational opportunities for nutrition and physical activity using materials approved by the MoEY and the MoHW. vi. Encourage and support the formation of active groups in schools, which are geared towards the promotion of healthy eating and physical activity e.g. healthy lifestyle clubs and 4H clubs. vii. Provide opportunities for schools to participate in National, Regional or parish level health-based events and special days. A key strategic action to be pursued under this policy is the promotion of nutrition and physical activity among children and their families through collaboration with relevant agencies and ministries. School nutrition and physical activity programmes are most effective when they form part of a comprehensive package of interventions, which support the main objectives of the programme. This policy recognises that the school environment is only one of the environments in which students access food and engage in physical activity. Students and school administration should be empowered to advocate for healthy lifestyles in schools. This would assist in promoting healthy lifestyles at home. CURRICULUM DEVELOPMENT Policy Statement: The Government of Jamaica through the MoEY shall promulgate in the curriculum, information on nutrition and wellness that will inform students in making healthy choices. This will be accomplished using the following strategies: i. Coordinate the communication and dissemination of nutrition education to students from early childhood to secondary level using the Health and Family Life Education (HFLE) curriculum. Furthermore, ensure that curriculum content already covered in the other DRAFT VERSION AUGUST 2023 Page 20 of 84 subject areas complement each other such as physical education and home economics, as well as: a. Foster an awareness of healthy eating habits and encourage physical activity through practical learning experiences. b. Encourage children to participate in “hands on” food preparation activities. c. Increase the awareness of non-communicable diseases and their impact on a healthy lifestyle. d. Provide opportunities for students to practice healthy eating, physical activity and food safety principles to improve their health and well-being. e. Providing the tools and resources in methodology delivery for effective integration of nutrition and healthy lifestyle information by teachers into broad curricula areas and within and across subject areas involving nutrition education. This includes developing exemplar lessons plans, and appropriate teaching materials to guide teachers on effective methods of including nutrition education in their teaching. ii. Providing training in updated concepts for teachers at each level of the education system to improve their own eating behaviours and act as role models. Integrating nutrition and wellness concepts into the curriculum from the pre-primary to the secondary level will give students a better understanding of the tools and benefits from good nutrition and wellness practices. THE DEVELOPMENT OF REGULATIONS TO MONITOR VENDORS IN THE VICINITY OF THE SCHOOL Street vendors and the food they offer for sale in the school environment forms an integral part of the school nutrition support in Jamaica. The activities of these vendors must therefore align with the policy goals of the Government of Jamaica. To ensure this, options will be explored with the Ministry of Local Government and Rural Development and the Municipal Corporations for the monitoring and regulation of vendors and vending areas in the proximity of the school. LEGISLATIVE FRAMEWORK The policy is consistent with existing legal, procedural and policy frameworks at the national and international levels as outlined in the table below. It is also recognised that to ensure enhanced compliance, amendments and alignment to other legislation might be advisable. DRAFT VERSION AUGUST 2023 Page 21 of 84 Table Showing Existing Legal, Procedural and Policy Frameworks at the National and International Levels Category 1: Sector Law Examples Education Act and Education Regulations, 1980  paragraph (g) of subsection (1) of section 4 (1) empowers the Minister, subject to such conditions as may be prescribed, to render assistance to students to enable them to take full advantage of the education facilities available to them.  paragraphs (a), (b) (c) and (d) of subsection (1) of section 43 empowers the Minister to make regulations concerning, respectively, the management and conduct of public educational institutions; the powers and duties of boards of management of public educational institutions; the standards to which the premises of educational institutions shall conform; and the purposes for which the premises may be used. The Early Childhood Act, 2007 and Early Childhood Commission Act, 2003  subsection (2) of section 23 of the Early Childhood Act empowers the Minister, subject to affirmative resolution, to make regulations prescribing the guidelines for the nutrition programmes to be implemented in early childhood institutions. These include basic schools and day care centres. Child Care and Protection Act (CCPA), 2004  subsection (1) of section 28 mandates that every person having custody, charge, or care of a child between the ages of 4 and 16 years has a duty to ensure that the child is enrolled and attends school.  paragraph (a) of subsection (1) of section 40 imposes a duty on the owner or operator of an establishment that sells or serves intoxicating liquor to ensure that no intoxicating liquor is sold or served by the establishment to any child. Category 2: National Law Examples Hawkers and Peddlers Act, 1867  This Act makes provision for the licensing of persons who go from place to place to sell goods. Licenses on Trades and Business, 1908  subsection (1) of section 3 provides that every person carrying on a trade or business specified in the relevant schedule shall take out a licence. This includes the business of a retailer, as that term is defined by the Act, with an annual turnover of at least $5000. Under section 2, the definition of “retailer” includes any person occupying a “fixed stand” who buys and sells in small quantities by retail to those who consume the goods. The DRAFT VERSION AUGUST 2023 Page 22 of 84 requirement for licensing does not apply to someone who operates their stall in a market The Processed Foods Act  under paragraph (c) of subsection (1) of section 13, the Minister may prescribe grades or standards of purity, composition, quality, quantity, weight or other property in respect of any food (including drink) manufactured, prepared or processed for export or for sale, known as “prescribed food” for the purposes of the Act.  under section 7, it is prohibited to label or pack a prescribed food or its container in a manner that is false, misleading or deceptive as to its character, contents, value, composition, merit etc, or its compliance with any relevant standard.  paragraph (b) of subsection (1) of section 13 empowers the Minister to make regulations, concerning a prescribed food, in respect of the use of any substance as an ingredient in that food, the specification of containers of that food and the labelling and advertising of that food, “to prevent the consumer or purchaser thereof from being deceived or misled as to the character, contents, value, quality, weight, composition, grade, merit or purity” of any prescribed food; or to “prevent injury to the health of the consumer or purchaser thereof”. A consultative approach is mandated for the development of such regulations, for instance, under subsection (2) of section 13; and subsection (1) of section 14.  The Processed Food (General Regulations), 1959; the Processed Food (Grades and Standards) Regulations, 1964; and the Processed Food (Prepared Syrups) Regulations 1974 are made under the authority of this Act. The Standards Act, 1974  subsection (1) of section 7 confers on the Bureau of Standards (“BOS”) the responsibility to formulate specification for commodities (i.e. any article, product, or thing the subject of trade or commerce) etc. as requested by the Minister. Under subsection (2) of section 7, subject to the Minister’s consent, the Bureau may declare the specification developed to be a standard specification. Subsection (3) provides that where another enactment (law) prescribes the grade, standard or other characteristic of a commodity etc., before the Minister can give consent for the declaration of Page 4 of 8 a standard specification for that commodity etc., he must first obtain the approval of the Minister with portfolio responsibility for administering the relevant enactment. DRAFT VERSION AUGUST 2023 Page 23 of 84 Under subsection (7) of section 7, where it appears to the Minister to be necessary or desirable in the public interest, the Minister may by order declare a standard specification to be a compulsory standard specification.  paragraph (d) of subsection (1) of section 11 empowers the Minister to make regulations with respect to the packaging, labelling, description and advertising of any commodity for which a standard specification has been declared.  under the Standards (Labelling of Processed Food) Regulations, 1974, regulation 3, it is a requirement for every container into which processed food is packed to bear a label that complies with the regulations. This includes the listing of all ingredients in decreasing order of proportion; however, provision of nutritional information is optional. There is also the Compulsory Standard Specification (Labelling of Commodities) (General) Order, 1971, among other orders. The Public Health Act, 1985  subsection (1) of section 14 confers the power on the Minister to make regulations in relation to “the importation, preparation and distribution of food and drink intended for human consumption, in so far as it concerns public health”.  under regulation 2 of the Public Health (Food Handling) Regulations, 1998, a ‘food-handling establishment’ is defined to mean a place where food is prepared or sold for human consumption and includes the categories of retail and food service premises set in in the relevant schedule to the Act, viz. “food service operations within institutions” including schools and “itinerant vendors, snack shops and food shops”. By virtue of regulation 3 (1), every person who is desirous of operating a food- handling establishment shall apply to the Medical Officer (Health) in the parish for a licence (valid for 1 year) to operate such establishment. Before granting the application, the Medical Officer must determine whether certain minimum requirements are met. Local Governance Act, 2016  section 51 (2), and (3) (m), (vi) and (x), of the Local Governance Act confers powers on a Council of a Municipal Corporation or City Corporation, to the extent not governed by any other enactment, to make regulations governing respectively, prohibiting or removing encroachments and nuisances in any thoroughfare or public place; and prohibiting or DRAFT VERSION AUGUST 2023 Page 24 of 84 regulating the exposing of goods for sale in any thoroughfare or public place. Category 3: International Law Examples Conventions on the Rights of the Child, 1989  The Policy is rooted in the Child Rights perspective and is focused at all times on the fair treatment and best interest of the child in accordance with Articles 2 and 3 of the Convention on the Rights of the Child (CRC). It also responds to CRC Article 4, in which the GOJ committed to taking all Page 5 of 8 available measures to safeguard the rights of children, including assessing our social services and funding for these services to ensure that children are protected, and Article 5, which gives governments the responsibility to assist parents in fulfilling their role as nurturers. More specifically, the Convention (Article 24) provides children with the right to nutritious foods and information to help them stay healthy as part of the right to health and health care. Assessing the Adequacy of the Current Framework Jamaica’s public-school system is characterized by a decentralized model of school management, which may sometimes create challenges to the implementation and monitoring of national policies in the absence of local ownership by school communities. It is recalled that every public educational institution is administered by a Board of Management (“Board”) (s. 9 of the Education Act) comprised of nominated or elected representatives of the school community responsible for “the conduct, supervision and efficient operation of the institution” (Education Regulations 1980, r. 89 (1) (a)). There are approximately 950 public educational institutions in Jamaica, with as many Boards. The Education Regulations, 1980 stipulates that during school hours, the premises of a public educational institution shall only be used for the purposes of the institution, and thereafter only for purposes as may be approved by the Board (regulation 15 (1)). The principal and teachers of a public educational institution are employed to the Board (not the Ministry). The principal is responsible as professional head and chief executive officer of the Board to inter alia, “plan and administer the day-to-day educational programme and support services of the institution and to carry out such policy decisions as the Board may delegate for the efficient and orderly conduct of the day-to-day administration of the institution” (Education Regulations 1980, r. 43, 44, Schedule D, paragraph 4). From the foregoing, the cooperation of school leadership is essential to ensure uptake by school communities. Legislation to compel adherence to policy guidelines remains an available option for influencing the necessary behaviour change. DRAFT VERSION AUGUST 2023 Page 25 of 84 Under section 17 of the Education Act, it is provided inter alia, that every public educational institution shall be conducted in accordance with regulations made in respect thereto (see s. 17 (1) (a) and (d)). The power conferred on the Minister to make regulations, subject to negative resolution, is contained in section 43 of the Education Act and extends to such matters as the management and conduct of public educational institution; the powers and duties of boards of public educational institutions; the standards to which the premises of an educational institution should conform; and the purposes for Page 6 of 8 which the premises of an educational institution may be used. The principal is also required to undertake additional duties and responsibilities as may be prescribed by the Minister. To ensure enhanced compliance with the Policy, amendments and alignment to other legislation is advisable. It is noted that some countries have opted to enact new or amending legislation to deal with the issue of nutrition in schools. Examples include:  France: In 2005, a controversial law was introduced prohibiting vending machines in schools.  United States: The Healthy, Hunger-Free Kids Act, 2010 authorized funding and set policy for the United States Department of Agriculture's core child nutrition programs including the National School Lunch Program and the School Breakfast Program creating the opportunity to make real reforms to the school lunch and breakfast programs by improving the critical nutrition and hunger safety net for millions of children.  Canada: The Healthy Food for Healthy Schools Act, 2008 addresses healthy eating in schools, including dropping trans-fat from food and beverages sold in schools and establishing mandatory nutrition standards for food and beverages sold in schools. The Act serves to amend the Education Act to introduce requirements on school boards to conform to the relevant standards and is supported by a School Food and Beverage Policy and Trans Fat Regulations. Other countries, such as New Zealand, opted to introduce non-statutory guidance to schools. The Heathy Food and Drink Guidance to Schools (Ministry of Health and Wellness, 2019) “helps schools develop a policy to promote and provide healthy food and drink” and is intended to provide “a consistent message that the whole school practices nutrition education that is part of the curriculum” and helps to create “supportive environments for children where healthy choices are easy”. The Guidelines exclude food and drink brought to school by children and staff to eat. The policy uses a simple, colour-coded classification system (green, amber, red) to identify “healthy” and “less healthy” food and beverage choices. It discourages association by schools with products and brands that belong in the “red” category that are high in saturated fat, sugars, and salt with poor nutritional values. Toolkits are provided to support schools to use the information in the Guidance to adopt and implement their own policies. Complimentary to the guidelines is a Health Star Rating Page 7 of 8 (one-half stars to five stars) which is a front-of-pack labelling system that DRAFT VERSION AUGUST 2023 Page 26 of 84 rates nutritional profile of packaged foods within food groups. Additionally, a two-year pilot programme is under way to offer free, nutritious school lunches to all students funded by the Ministry of Education and Youth but managed at the school level. DRAFT VERSION AUGUST 2023 Page 27 of 84 Recommendations for the enactment of new and amending legislation POLICY STRATEGY LEGISLATIVE GAP RECOMMENDATION FOOD SERVICE ENVIRONMENT The development of regulations to guide the operations of school vendors in the vicinity of the school (food service environment defined to include canteens, tuck shops, canteen concessionaries, venders at the school gate or within 200 meters of the school gate). A school, like any other property owner or occupier, may regulate the food service environment on its premises but has no jurisdiction to do so beyond its boundary. The legislative authority to regulate vending in any thoroughfare or public place resides with local government subject to any public health requirements. New regulations to be developed under the Education Act to govern vending on school premises. New regulations proposed to be developed under the Local Governance Act in respect of vending within 200 m of any educational institution. PROVISION OF MEALS The Promulgation of Food Based Dietary Guidelines and the National School Nutrition Standards for Jamaica to regulate the provision and consumption of food by students in schools. The Minister may make regulations prescribing the guidelines for the nutrition programme in Early Childhood Institutions. In contrast, there is no express power under the Education Act to make regulations governing the food and drink sold on school premises, although the power could be implied. To avoid leaving the matter to interpretation, express provisions could be enacted. The technical input for formulating such guidelines and standards should come from the Ministry of Health and Wellness. It is noted that the absence of a requirement to include nutritional information on the labels for processed foods will negatively impact the Enactment of legislation to amend the Education Act to empower the Minister to make regulations governing the nutritional requirements of food and drink provided or sold on school premises; and new regulations made pursuant to that power. New regulations under the Early Childhood Act to prescribe the guidelines for the nutrition programme in Early Childhood Institutions. New regulations to require inclusion of nutritional information on labels for (some) processed food and drink made under legislation administered by the Ministry of Industry, Investment and Commerce, and its agencies. DRAFT VERSION AUGUST 2023 Page 28 of 84 POLICY STRATEGY LEGISLATIVE GAP RECOMMENDATION ability to implement the Policy. The provision of at least one nutritious meal per day providing one quarter to one third daily nutritional requirements according to the beneficiaries on the School Feeding Programme from early childhood to the secondary level. The Minister may prescribe conditions in respect of any assistance provided to students under the Education Act. This would include the School Feeding Programmes at the pre-primary, primary and secondary schools. There is also power to make regulations prescribing the guidelines for the nutrition programme of an early childhood institution under the Early Childhood Act. New regulations to be made under the Early Childhood Act and Education Act prescribing the guidelines for the government funded School Feeding Programme in pre-primary, primary and secondary schools. Regulate the marketing of foods and beverages in and around the school environment. It is within the purview of the Board to grant access to the school for the purpose of food and beverage marketing campaigns. Given limited resources, schools often rely on commercial sponsors to host school extracurricular and sporting events, or personal development programmes for students. If a standardized approach to such matter is required, regulations could be developed within the scope of the existing Education Act. However, the legislative authority for regulating advertising outside the boundaries of a school is vested in local government New regulations proposed under the Education Act to govern the duty of the school board in respect of sponsorship, advertising, and marketing on school premises, or for/at school events and activities. Limit students’ access to ‘empty calorie’ snacks and beverages. Whereas regulations may govern what a school sells or provides, it is unlikely that mandatory requirements could be made to apply to food and drink brought from home by students unless same Students and staff should be encouraged to adopt healthy eating practices; supported by restrictions on what the school sells, provides and promotes. DRAFT VERSION AUGUST 2023 Page 29 of 84 POLICY STRATEGY LEGISLATIVE GAP RECOMMENDATION was in breach of a public health enactment. GENDER CONSIDERATIONS The eating habits and proper nutrition requirements of both males and females in the school system were taken into consideration in the development of the Policy. These areas will be adequately addressed through the use of the National School Nutrition Standards (MoHW 2022) Operations and Procedures Manual for the School Feeding Programme (2017) and the School Feeding Programme Recipe Manual (2015) which have been developed to streamline the requirements for the dietary needs of each distinct group of students. The Ministry will engage the services of nutritionists to provide guidance to schools in meeting the daily dietary needs of the students. The Caribbean Food and Nutrition Institute (CFNI) Recommended Dietary Allowances (1994) for the Caribbean was also used to determine the dietary provisions for girls versus boys as depicted in the table below: Students participating in various agricultural or home management exercises could be discriminated against due to their gender. This could adversely affect student’s participating in agricultural science as home grown gardens could be seen as male dominated while home management could be viewed as female dominated. The teaching of agricultural science and home management should be infused in the curriculum from Grade 1 making it mandatory for both males and females to participate in these activities up to the secondary level. Efforts should be made to remove the stigma associated with tasks that are DRAFT VERSION AUGUST 2023 Page 30 of 84 considered male or female dominated. This should be supported through HFLE classes, curriculum support and practical experience in the school environment by both male and female students. RURAL VERUS URBAN AREAS The Government of Jamaica is cognizant of the possible challenges that schools encounter with accessing provisions for healthy meals due to their location. Schools in the rural areas may be better able to receive ground provisions readily due to their close proximity to farming communities and markets at a reduced cost, while this may not necessarily be the case for those in the urban areas. The Government of Jamaica through the MoEY will seek to ensure that "no school is left behind”. Consequently, fixed term contracts with farmers to ensure the availability and sustainability of locally grown produce to the feeding programme will be executed and measures put in place to account for deficiencies in the short, medium and long term. Some schools, primarily those in the rural areas are at a greater advantage than those in the urban areas due to several factors. These schools have adequate land space, exposure to the farming communities and consequently benefit from established school gardens and are producing more than required. The Ministry will seek to implement a sustainable school garden programme to allow these schools in the rural areas to supply excess produce to other schools particularly those in the urban areas at a reduced cost. Schools in rural areas are also more privileged as they are able to purchase agricultural provisions at a reduced cost since most of these schools are in the farming communities. For those in the urban areas, schools will be encouraged to use the limited land space to promote school gardens and as far as possible greenhouse farming through the assistance of the Ministry of Agriculture and Fisheries, RADA and the Jamaica 4H Clubs. A Memorandum of Understanding was signed in 2016 between the Rural Agriculture Development Authority (RADA) and the MoEY as the Ministry seeks to promote the establishment of new school gardens, resuscitate dormant ones and improve on those existing hence cultivating in the minds of the students the need to grow the food they eat. This initiative will continue in association with the Jamaica 4H Clubs. The Ministry of Agriculture and Fisheries (MAF) will play a dominant role in partnership with the MoEY in ensuring that agricultural provisions are made available to the schools whether in the rural or urban areas and will work with key stakeholders to this end as the MoEY seeks to promote Jamaica’s mantra, “eat what we grow and grow what we eat”. Instilling these values in the students at this level is of utmost importance. Whether rural or urban all students will be treated with equity and will be provided with the proper nutrition as set out in the National School Nutrition Standards developed by the MoHW (2023). The need for these students to be engaged in physical activity is also important, however, the MoEY is aware of the issues faced by some schools due to the limited space which is available for physical activities especially those in the urban areas. The MoEY will work closely with the DRAFT VERSION AUGUST 2023 Page 31 of 84 various stakeholders in ensuring that students are afforded the opportunity to engage in physical activities. KEY STAKEHOLDERS ROLES AND RESPONSIBILITIES The MoEY shall have primary responsibility for governance of the National School Nutrition Policy, however, a number of Ministries and Department/Agencies (MDAs) are critical to its successful implementation. The following stakeholders shall be involved in the implementation of the policy: The Government of Jamaica through the MoEY shall: 1. Implement and monitor nutritional standards, in conjunction with the MoHW, for all meals provided by or through schools. These standards will apply to all meals provided to children in schools, whether or not wholly or partially financed by the Government of Jamaica. 2. Implement measures to ensure improvement in the nutritional status of all school children 3. Facilitates the development of standards and guidelines for the provision of safe and nutritionally adequate meals to the school age population. 4. Facilitate the preparation, formulation and management of menus from local foods. 5. Establish Home Grown School Feeding Programme which will ensure a sustainable market for locally produced food. 6. Develop educational programmes for incorporating nutrition education in the curriculum 7. Support the development/strengthening of curricula at the pre-school, primary and secondary levels to include nutrition in science and Family Life Education (HFLE). The development and implementation, in collaboration with the relevant Ministries, Departments and Agencies, of a behavioural change modification programme aimed at shifting eating patterns to healthier and preferably, locally produced foods, including fruits and vegetables. The School Feeding Unit The School Feeding Unit within MoEY, will monitor and evaluate the Policy within the institutions to ensure that standards are being met and menus utilized. The Ministry of Health and Wellness The MOHW will:  Facilitate the development and implementation of standards and guidelines to ensure that dietary requirements of school-aged children are met.  Provide guidance and build capacity in the monitoring of Standards. DRAFT VERSION AUGUST 2023 Page 32 of 84  Provide technical support to critical FNS activities related to nutrition and physical activity.  Collaborate in the development of a national social marketing campaign to encourage nutritious food choices in schools.  Encourage and support an environment conducive to increased physical activity in schools in compliance with national guidelines.  Promote foods in line with the Food Based Dietary Guidelines for Jamaica. The Ministry of Agriculture and Fisheries (MAF) will:  Facilitate the provision of local produce for school meals production parameters to satisfy volume of produce required.  Provide technical assistance in areas related to production and marketing-related initiatives of School Feeding Programme.  Develop and support mechanisms for smaller holder farmers to participate in school feeding public purchases. The Ministry of Local Government and Rural Development will:  Facilitate meeting with representatives of the Municipal Corporation and the MoEY to discuss vending in and around schools  Assist in the development of a framework to guide the operations Additionally:  Jamaica Association of Professionals in Nutrition and Dietetics (JAPINAD) – Support services including health/nutrition promotion  National Parenting Support Commission and the National Parent-Teachers Association of Jamaica – partnership in the quest for good eating habits and practices, and increased parental involvement in achieving the goals and objectives of this policy.  Jamaica Teachers’ Association – endorsement of the government initiative to improve nutrition and physical activity in schools.  Jamaica Association of Principals of Secondary Schools/Association of Principals and Vice Principals - leadership of the government initiative to improve nutrition and physical activity at the school level.  National School Nurse Association – assist with assessment of students and the completion of assessment reports (e.g. BMI reports)  The National Secondary Students’ Council/Jamaica Prefect Association – mobilize student population to practice and promote health and wellness.  School Vendors/Concessionaires – partnership in supporting the initiatives of the government and complying with policies, regulations and guidelines. DRAFT VERSION AUGUST 2023 Page 33 of 84  Private Sector - Partnership and support in keeping with the required health related standards, policies and regulations.  Non-Governmental Organisations - partnership and support.  International development agencies – partnerships, support, systems strengthening POLICY IMPLEMENTATION MECHANISMS The MoEY has direct responsibility for the implementation of the National School Nutrition Policy. Improvements in the school nutrition environment must take place within the context of broad, national school reform programmes. Though aligned to education policy, the provision of nutritious food in schools is an integral part of the country’s social protection system and, therefore, its success is contingent on the involvement of several stakeholders. Key stakeholders which will play an integral role in the execution and sustainability of the policy include: i. Public Sector Organisations: The MoEY will collaborate with other public sector organisations to provide the necessary resources to effect the successful implementation and sustainability of the NSNP. ii. Families: The families will promote and reinforce healthy lifestyle practices and continue the nutritional fortification provided in schools through ongoing parental support and engagements with the National Parenting Support Commission (NPSC). The Community: The community including vendors should support the school and family in sustaining the practices established in this National School Nutrition Policy (NSNP) via public engagement and support. iii. The Private Sector: This sector should adhere to the standards and regulations stipulated by the Government in the marketing and production of their products for sale to the public school system. HUMAN RESOURCES REQUIREMENT For the policy to be fully implemented the human resource requirement will be critical to its successful implementation. An assessment was conducted under the Modernization of the School Feeding Programme which identified a staff deficiency in the School Feeding Unit. As implementation of the Policy and Standards proceed there will be the need for additional staff in the area of Nutrition and Dietetics. The policy is therefore proposing to address this need through the engagement of additional staffing in these areas. DRAFT VERSION AUGUST 2023 Page 34 of 84 It is expected that the Ministry will continue to collaborate as implementation proceeds The engagement of consultancy services will also serve as an effective tool in providing training of canteen staff, and assessing the progress of the NSNP and Policy implementation as a whole. MONITORING AND EVALUATION (M&E) The design of an implementation plan will specify details of targets to be reached in the short, medium and long terms and evaluation tools will specify quantitative and qualitative indicators with time frames, which will assist in tracking progress on the achievement of the policy objectives. The implementing partners will use these tools in their internal monitoring and evaluation process. Emphasis will be on assessing relevance, performance, challenges, successes and the impact of various recommended policy actions. The Government of Jamaica (GOJ), will reactivate and strengthen the School Health Enhancement Committee (SHEC) which was established to guide the Health Promoting Schools Programme. This Committee, will monitor the implementation of the NSNP to provide oversight for the efforts to improve nutrition in the school environment and supported by the Programme Monitoring and Evaluation Unit in the Planning and Development Division of the MoEY. The leadership of the SHEC will be rotated every 3 years. The school feeding administrative mechanism will serve as the Sub-Committee Secretariat, and have responsibility for the engagement and coordination of Committee activities. The Educational Services Division of the MOEY will oversee the work of the Secretariat. Key stakeholders should be fully responsive to the requirements pertaining to the implementation of the agreed policy actions. Roles should be clarified and defined to ensure that they complement each other and reduce duplication and inefficient ways of working across sectors. The Sub-Committee membership should at a minimum include representatives from:  The Ministry of Education and Youth  The Ministry of Health and Wellness  The Ministry of Agriculture and Fisheries  The Ministry of Local Government and Rural Development  Jamaica Association of Professionals in Nutrition and Dietetics  National Parent Teachers’ Association of Jamaica  National Parenting Support Commission  Early Childhood Commission.  Jamaica Teachers’ Association  Jamaica Association of Principals of Secondary Schools/Association of Principals and Vice Principals  National School Nurse Association DRAFT VERSION AUGUST 2023 Page 35 of 84  The National Secondary Students Council/Jamaica Prefect Association  Jamaica 4H Clubs The details including timeframe for implementation will be elaborated in the Plan of Action upon adoption of this policy. The implementation of the Plan of Action will be administered by the Monitoring and Evaluation Committee once appointed. The buy-in of schools is pivotal to the success of this policy. Schools operate in a variety of contexts, and the GOJ recognises that resources vary among schools. Implementation of this policy should reflect the social and resource context within which the schools operate. Successful M&E requires that capacity be built to execute it meaningfully. The M&E team must move to have this deficiency addressed. This involves government making the appropriate allocations, enlisting the required skilled human resources and taking action to ensure appropriate institutional enablement. Monitoring and evaluation of the NSNP will be guided by the National Monitoring and Evaluation Framework. FINANCIAL RESOURCES It will cost the government approximately $3.6B to implement the National School Nutrition Policy over 5 years. AREAS OF EXPENDITURE TOTAL REQUIRED ($) Amount required for 2023-2024 for Policy Implementation (Short Term) 543,091,500 The Food Service Environment and the Provision of Meals 377,385,750 Health Promotions 52,920,000 Physical Activity Environment 45,202,500 Curriculum Development 62,842,500 Administrative Support 4,740,750 DRAFT VERSION AUGUST 2023 Page 36 of 84 Medium Term (2024 – 2026) Requirement 2,122,533,000 The Food Service Environment and the Provision of Meals 1,444,826,250 Health Promotions 179,707,500 Physical Activity Environment 48,730,500 Curriculum Development 291,611,250 Administrative Support 157,657,500 Long Term (2026 – 2028) Requirement 954,985,500 The Food Service Environment and the Provision of Meals 625,889,250 Health Promotions 88,200,000 Physical Activity Environment 12,127,500 Curriculum Development 90,405,000 Administrative Support 138,363,750 Grand Total 3,620,610,000 DRAFT VERSION AUGUST 2023 Page 37 of 84 RISK TO POLICY IMPLEMENTATION The main risks to the successful implementation of the policy are: i. Economic constraints: Financial constraints by the Government could derail implementation. ii. Increase in poverty: Increase in the number of beneficiaries on the programme due to poverty will require more students in need of nutritional support. This could hamper the ability of the programme to provide for all identified children. iii. Internal Organisational Weaknesses: This poses a risk to the successful execution of the policy. Strengthening of this capacity is of utmost importance. iv. Lack of Coordination between the policymaking and the programme implementation arms of school feeding pose a significant risk to the policy’s effectiveness. To this effect, the MoEY along with the MoHW will continue to engage the direct stakeholders to mitigate against any risks of collaboration. v. Vagaries of agriculture sector output: The policy requires that at least 10% of meal inputs be from locally produced items. This may be threatened when there are downturns in local agriculture production. This target may also be compromised if the distribution channels for produce are underdeveloped, resulting in inconsistencies in the availability of local inputs. IMPLEMENTATION PLAN The Policy will be implemented on a phased basis. It will take approximately five (5) years for the policy to be fully implemented. POLICY REVIEW The Policy shall be reviewed after five (5) years. The Schools Operations and Schools Improvement Units of the MoEY with support from the Planning and Development Division, and the School Feeding Unit along with other key stakeholders will be responsible for the review of the Policy. CONCLUSION The overarching goal of the National School Nutrition Policy is to improve the health and wellness of children in our educational facilities. Notwithstanding the risks stated before, with the implementation of effective monitoring and coordinating systems, allocation of appropriate human resources and consolidation of available financial and technical resources, the policy can be successfully implemented. The successful implementation of the policy is dependent on the commitment of the schools and other key stakeholders. When all the necessary measures are implemented, Jamaica will see an improvement in the nutritional status of our children towards Vision 2030 Outcome # 1 of a healthy and stable population DRAFT VERSION AUGUST 2023 Page 38 of 84 MINISTRY OF EDUCATION AND YOUTH RISK MANAGEMENT MATRIX FOR THE NATIONAL SCHOOL NUTRITION POLICY 2023-2028 KEY: Highdiu m Medium Low PROBABILITY: 1-5, with 5 being the highest. 1-2 not likely; 3-4 likely; 5 most likely POLICY FOCUS RISKS IMPACT PROBABILITY MITIGATING MEASURES DESCRIPTION OF MITIGATING MEASURES/ RESPONSIBILITIES ECONOMIC CONSTRAINTS 5 International Donors Seek funding from donors INCREASE IN POVERTY 4 Reduction in allocation Cut some areas in approved estimates to offset shortfall INTERNAL ORGANISATIONAL WEAKNESSES 3 Strengthening of internal capacity Training of staff INFRASTRUCTURE DEVELOPMENT 4 None LACK OF COORDINATION AMONG KEY STAKEHOLDERS 3 MoUs Stakeholders consultations sessions  Establishment of intersectoral committees with key Government Ministries/Departments and Agencies.  Memorandum of Understanding between key stakeholders such as; MICAF, MOHW and FAO. VAGARIES OF ARGRICULTURE SECTOR OUTPUT 3 Substitute Allow for the substitution of alternative produce during period of shortages. DRAFT VERSION AUGUST 2023 Page 39 of 84 BIBLIOGRAPHY Adelman, S., Alderman, H,. Gilligan, D. O., & Lehrer, K (2008). The Impact of Alternative Food for Education Programs on Learning Achievement and Cognitive Development in Northern Uganda. Accessed 2018. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.558.7838&rep=rep1&type=pdf Accessed 2018. Blake-Scarlet et. al. (2013). Jamaica: Prevalence of Overweight and Obesity among Children Six to Ten Years of Age in the North Health Region of Jamaica, West I. Med. I 62 (3):171-6. Accessed 2018. Retrieved from https://westindies.scielo.org/scielo.php?pid=S0043- 31442013000300002&script=sci arttext&tlng=es Bloom, D.E., Chen S. and McGovern M.E. (2017). The Economic Burden of Non- Communicable Diseases and Mental Health Conditions: Results for Costa Rica, Jamaica and Peru. Accessed: Retrieved from https://cdn1.sph.harvard.edu/wp- content/uploads/sites/1288/2018/03/PGDA WP 144 Economic-Burden-NCD- MentalHealth-Conditions-CostaRica-Jamaica-Peru.pdf Caribbean Food and Nutrition Institute (1994). Recommended Dietary Allowances for the Caribbean. CFNI, Mona, Jamaica. Accessed February 2020. Retrieved from http://nutritioncentre.health.gov.bb/public/uploaded files/GNHFSAug2015.pdf?fbclid=I wAR1SND4IZYf BDGTYGu2tVu-xkooD7FiUdtmiu2nT9cmAMAU28lffuIK6N0 Chin, D., & McFarlane L.N. (2013). Health Promoting Schools Survey 2011, Final Report. Ministry of Health Epidemiology Research and Data Analysis Unit. Accessed 2018 https://www.moh.gov.jm/wp-content/uploads/2015/05/Health-Promoting-School-Survey- 2011-Report.pdf Del Rosso J.M. : (1999) School Feeding Programs: Improving Effectiveness and Increasing the Benefit to Education, A Guide for Program Managers. The Partnership for Child Development. Accessed 2018: Retrieved from https://www.academia.edu/29899509/School Feeding Programs Improving effectivene ss and increasing the benefit to education. Dobbs, R., & Manyika, J (2015) The Obesity Crisis. McKinsey Global Institute. Accessed 2019. Retrieved from https://www.mckinsey.com/mgi/overview/in-the-news/the-obesity-crisis Elmslie, K. (2015). “Against the Growing Burden of Disease.” Centre for Chronic Disease Prevention, Canada. Accessed 2019. Retrieved from http://www.ccgh- csih.ca/assets/Elmslie.pdf Global Nutrition Monitoring Framework, Operational Guidance for Tracking Progress in http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.558.7838&rep=rep1&type=pdf%20 https://westindies.scielo.org/scielo.php?pid=S0043-31442013000300002&script=sci arttext&tlng=es https://westindies.scielo.org/scielo.php?pid=S0043-31442013000300002&script=sci arttext&tlng=es https://cdn1.sph.harvard.edu/wp-%20content/uploads/sites/1288/2018/03/PGDA WP 144 Economic-Burden-NCD-MentalHealth-Conditions-CostaRica-Jamaica-Peru.pdf https://cdn1.sph.harvard.edu/wp-%20content/uploads/sites/1288/2018/03/PGDA WP 144 Economic-Burden-NCD-MentalHealth-Conditions-CostaRica-Jamaica-Peru.pdf https://cdn1.sph.harvard.edu/wp-%20content/uploads/sites/1288/2018/03/PGDA WP 144 Economic-Burden-NCD-MentalHealth-Conditions-CostaRica-Jamaica-Peru.pdf http://nutritioncentre.health.gov.bb/public/uploaded files/GNHFSAug2015.pdf?fbclid=IwAR1SND4IZYf BDGTYGu2tVu-xkooD7FiUdtmiu2nT9cmAMAU28lffuIK6N0 http://nutritioncentre.health.gov.bb/public/uploaded files/GNHFSAug2015.pdf?fbclid=IwAR1SND4IZYf BDGTYGu2tVu-xkooD7FiUdtmiu2nT9cmAMAU28lffuIK6N0 https://www.moh.gov.jm/wp-content/uploads/2015/05/Health-Promoting-School-Survey-2011-Report.pdf https://www.moh.gov.jm/wp-content/uploads/2015/05/Health-Promoting-School-Survey-2011-Report.pdf https://www.academia.edu/29899509/School Feeding Programs Improving effectiveness and increasing the benefit to education. https://www.academia.edu/29899509/School Feeding Programs Improving effectiveness and increasing the benefit to education. https://www.mckinsey.com/mgi/overview/in-the-news/the-obesity-crisis http://www.ccgh-csih.ca/assets/Elmslie.pdf http://www.ccgh-csih.ca/assets/Elmslie.pdf DRAFT VERSION AUGUST 2023 Page 40 of 84 Meeting. Accessed: December 2017. Accessed 2019. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/259904/9789241513609- eng.pdf;jsessionid=D6B3AF342DE860B3A3C45D00CD15FD48?sequence=1 FAO, IFAD, PAHO, UNICEF and WFP (2023). Regional Overview of Food Security and Nutrition – Latin America and the Caribbean 2022: towards improving affordability of healthy diets. Global Child Nutrition Foundation (GCNF). 2022. School Meal Programs Around the World: Results from the 2021 Global Survey of School Meal Programs. Accessed 2023. Retrieved from Global-Survey-report-V1-1.12.pdf (gcnf.org) Henry, F (2016). Childhood Obesity in the Caribbean: Weighty Challenges and Opportunities. Accessed 2018. Retrieved from https://symbiosisonlinepublishing.com/obesity-control-therapies/obesity-control- therapies22.php Hibbert, K. (2017, March 28). Obese Nation. Jamaica Observer. Accessed 2018. Retrieved from http://www.jamaicaobserver.com/news/Obese-nation 93943 Jamaica Health and Lifestyle Survey 2007-8. Accessed 2018. Retrieved from https://www.moh.gov.jm/wp-content/uploads/2015/05/Jamaica-Health-and-Lifestyle- Survey-2007-8.pdf Jamaica. National Development Goals: Accessed 2018. Retrieved from http://www.vision2030.gov.jm/National-Development-Plan. Internet Article. Accessed 2019 JIS. (2012) Gov’t Tackling Non-Communicable Diseases. Health & Wellness May 14, 2012 Jamaica: Government. Accessed 2018. Retrieved from https://jis.gov.jm/govt-tackling-non-communicable-diseases/ Kaufmann R and Pontet-Ubal N. The challenge of tackling the obesity economic burden: The case of Uruguay [version 1; peer review: awaiting peer review] Emerald Open Research 2019, 1:11 (https://doi.org/10.12688/emeraldopenres.12869.1) First published: 17 Apr 2019, 1:11. Accessed 2019. Retrieved from (https://doi.org/10.12688/emeraldopenres.12869.1) Lawson, Ty M. (2012) Impact of School Feeding Programs on Educational, Nutritional, and Agricultural Development Goals: A Systematic Review of Literature. (No. 1097-2016- 88667). Accessed 2018. Retrieved from https://ageconsearch.umn.edu/record/142466?ln=en . Martorell, H. (2017). Canadian Policy Interventions Supporting Healthy Eating in Schools. Canada http://apps.who.int/iris/bitstream/handle/10665/259904/9789241513609-eng.pdf;jsessionid=D6B3AF342DE860B3A3C45D00CD15FD48?sequence=1 http://apps.who.int/iris/bitstream/handle/10665/259904/9789241513609-eng.pdf;jsessionid=D6B3AF342DE860B3A3C45D00CD15FD48?sequence=1 https://gcnf.org/wp-content/uploads/2023/02/Global-Survey-report-V1-1.12.pdf https://symbiosisonlinepublishing.com/obesity-control-therapies/obesity-control-therapies22.php https://symbiosisonlinepublishing.com/obesity-control-therapies/obesity-control-therapies22.php http://www.jamaicaobserver.com/news/Obese-nation 93943 https://www.moh.gov.jm/wp-content/uploads/2015/05/Jamaica-Health-and-Lifestyle-Survey-2007-8.pdf https://www.moh.gov.jm/wp-content/uploads/2015/05/Jamaica-Health-and-Lifestyle-Survey-2007-8.pdf http://www.vision2030.gov.jm/National-Development-Plan https://jis.gov.jm/govt-tackling-non-communicable-diseases/ https://doi.org/10.12688/emeraldopenres.12869.1 https://ageconsearch.umn.edu/record/142466?ln=en DRAFT VERSION AUGUST 2023 Page 41 of 84 McKenna, M.L. (2010). Policy Options to Support Healthy Eating in Schools. Canadian Journal of Public Health, 101(2). Ministry of Health and Wellness. 2005. National Health Policy 2006–2015 and Strategic Plan 2006-2010 Final Report. Accessed 2019. Retrieved from https://www.healthresearchweb.org/files/National Health Policies-Jamaica 2006- 2015.pdf Ministry of Health and Wellness. 2011-2012. Health Promoting School Survey 2011. Accessed 2019. Retrieved from https://moh.gov.jm/wp-content/uploads/2015/05/Health-Promoting-School-Survey-2011- Report.pdf Ministry of Health and Wellness. (2013). National Strategic and Action Plan for the Prevention and Control Non-Communicable Diseases (NCDs) 2013-2018. Kingston, Jamaica. Accessed 2019. Retrieved from https://www.moh.gov.jm/wp-content/uploads/2015/05/National-Strategic-and-Action- Plan-for-the-Prevention-and-Control-Non-Communicable-Diseases-NCDS-in-Jamaica- 2013-2018.pdf Ministry of Health and Wellness. (2018) Jamaica Health and Lifestyle Survey III (2016-2017) Preliminary Key findings. Retrieved from https://www.moh.gov.jm/jamaica-health-and- lifestyle-survey-iii-2016-2017/ Ministry of Health and Wellness. Dietary Guidelines for Jamaica. Accessed 2019. Retrieved from https://www.moh.gov.jm/edu-resources/food-based-dietary-guidelines-for-jamaica/ Ministry of Health and Wellness (June 2019) National School Nutrition Standards Ministry of Agriculture and Fisheries and Ministry of Health and Wellness. (2013). Food and Nutrition Security Policy. Jamaica. Accessed 2019. Retrieved from http://www.moa.gov.jm/AboutUs/departments/Food and Nutrition Security Policy.pdf Mullally, et al. (2010). A Province-wide School Nutrition Policy and Food Consumption in Elementary School Children in Prince Edward Island. Canadian Public Health Journal, Volume 101(1):40-43. Planning Institute. Jamaica. (2009). Vision 2030 Jamaica. National Development Plan. Planning for a Secure and Prosperous Future. Accessed 2019. Retrieved from http://www.vision2030.gov.jm/National-Development-Plan Sorhaindo, Annik, Feinstein. (2006) What is the relationship between child nutrition and school outcomes. Accessed 2019. Retrieved from https://pdfs.semanticscholar.org/ba7a/2310072fc6af65fae3d321c8b059ab7208a4.pdf https://www.healthresearchweb.org/files/National Health Policies-Jamaica 2006-%20%20%20%20%20%20%202015.pdf https://www.healthresearchweb.org/files/National Health Policies-Jamaica 2006-%20%20%20%20%20%20%202015.pdf https://moh.gov.jm/wp-content/uploads/2015/05/Health-Promoting-School-Survey-2011-Report.pdf https://moh.gov.jm/wp-content/uploads/2015/05/Health-Promoting-School-Survey-2011-Report.pdf https://www.moh.gov.jm/wp-content/uploads/2015/05/National-Strategic-and-Action-Plan-for-the-Prevention-and-Control-Non-Communicable-Diseases-NCDS-in-Jamaica-2013-2018.pdf https://www.moh.gov.jm/wp-content/uploads/2015/05/National-Strategic-and-Action-Plan-for-the-Prevention-and-Control-Non-Communicable-Diseases-NCDS-in-Jamaica-2013-2018.pdf https://www.moh.gov.jm/wp-content/uploads/2015/05/National-Strategic-and-Action-Plan-for-the-Prevention-and-Control-Non-Communicable-Diseases-NCDS-in-Jamaica-2013-2018.pdf https://www.moh.gov.jm/jamaica-health-and-lifestyle-survey-iii-2016-2017/ https://www.moh.gov.jm/jamaica-health-and-lifestyle-survey-iii-2016-2017/ https://www.moh.gov.jm/edu-resources/food-based-dietary-guidelines-for-jamaica/ http://www.moa.gov.jm/AboutUs/departments/Food and Nutrition Security Policy.pdf http://www.vision2030.gov.jm/National-Development-Plan https://pdfs.semanticscholar.org/ba7a/2310072fc6af65fae3d321c8b059ab7208a4.pdf DRAFT VERSION AUGUST 2023 Page 42 of 84 Smith-Edwards, A. (2012). Gov’t Tackling Non-Communicable Diseases. Accessed 2018. Retrieved from https://jis.gov.jm/govt-tackling-non-communicable-diseases/ S M Grantham-McGregor, S Chang, S P Walker, Evaluation of school feeding programs: some Jamaican examples, The American Journal of Clinical Nutrition, Volume 67, Issue 4, April 1998, Pages 785S–789S. Accessed 2018. Retrieved from: https://doi.org/10.1093/ajcn/67.4.785S Standing Senate Committee on Social Affairs, Science and Technology- SOCI (2016). Obesity in Canada- A Whole-of-Society Approach for a Healthier Canada. Ottawa, Canada. Statistics Canada (2015). Community Health Measures Survey. Ottawa, Canada Taylor, J. P., McKenna, M. L., & Butler, G. P. (2010). Monitoring and Evaluating School Nutrition and Physical Activity Policies. Canadian Journal of Public Health/Revue Canadienne de Sante'e Publique, S24-S27. Accessed 2019. Retrieved from https://pdfs.semanticscholar.org/7b99/e62236c4c217fa1b28c87c6455a2db7747d2.pdf University of North Carolina. (2023). Global Food Research Program. School Food Environments. Accessed 2023. Retrieved from https://www.globalfoodresearchprogram.org/policy-research/school-food-environments/ University of Technology (2018) Journal of Arts Science and Technology. Fiscal Measures to prevent obesity/NCDs in Jamaica: Focus on Sugar-Sweetened Beverages. Accessed 2019. Retrieved from http://www.utech.edu.jm/academics/sgsre/publications-1/journal-of-arts-science-and- technology-jast-vol-11-special-issue-1-2018 United Nations Children’s Fund (UNICEF) (2021). Situational Analysis of Children 2021 United Nations Children’s Fund (UNICEF) Jamaica Caribbean Policy Research Institute (CAPRI) Kingston, Jamaica (2020). Lasting impact: Educational, social and psychological effects of the COVID-19 pandemic on children. Accessed 2023. Retrieved from https://www.unicef.org/jamaica/media/3241/file/Lasting%20impact.pdf UNIAFT, UNDP, and PAHO (2018). The Case for Investment in Prevention and Control of Noncommunicable Diseases in Jamaica: Evaluating the return on investment of selected tobacco, alcohol, diabetes, and cardiovascular disease interventions. Washington, D.C. Accessed 2023. Retrieved from https://iris.paho.org/bitstream/handle/10665.2/49693/9789275120545 eng.pdf?sequence= 5&isAllowed=y Valaitis, R (2015). Implementation of Ontario’s School Food and Beverage Policy (P/PM 150) in https://jis.gov.jm/govt-tackling-non-communicable-diseases/ https://jis.gov.jm/govt-tackling-non-communicable-diseases/ https://doi.org/10.1093/ajcn/67.4.785S https://pdfs.semanticscholar.org/7b99/e62236c4c217fa1b28c87c6455a2db7747d2.pdf http://www.utech.edu.jm/academics/sgsre/publications-1/journal-of-arts-science-and-technology-jast-vol-11-special-issue-1-2018 http://www.utech.edu.jm/academics/sgsre/publications-1/journal-of-arts-science-and-technology-jast-vol-11-special-issue-1-2018 https://www.unicef.org/jamaica/media/3241/file/Lasting%20impact.pdf DRAFT VERSION AUGUST 2023 Page 43 of 84 Peel Region: A Qualitative Evaluation. University of Waterloo, Waterloo, Ontario, Canada. World Health Organization (2000). Obesity: preventing and managing the global epidemic. Report of the WHO consultation. Geneva: WHO; (WHO Technical Report Series, No. 894). Accessed 2018: Retrieved from: http://apps.who.int/iris/bitstream/10665/42330/1/WHO TRS 894.pdf?ua=1&ua=1. World Health Organization (2010). Global Recommendations on Physical Activity for Health. Geneva: Accessed 2018. Retrieved from http://apps.who.int/iris/bitstream/10665/44399/1/9789241599979 eng.pdf. WHO 2014 Global Status Report on Non-Communicable Diseases. Accessed 2019. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854 eng.pdf?sequen ce=1. World Health Organization (2014). Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition. Geneva: WHO. World Health Organization (2009) Interventions on diet and physical activity: what works: summary report.World Health Organization. ISBN 978 92 4 159824 8 World Health Organization. (2017). Tackling NCDs: 'best buys' and other recommended interventions for the prevention and control of noncommunicable diseases. World Health Organization. https://apps.who.int/iris/handle/10665/259232. License: CC BY-NC-SA 3.0 IGO" https://apps.who.int/iris/handle/10665/259232# WHO. Media centre: Obesity and Overweight, Fact Sheet 2015. Accessed 2019. Retrieved from http://wedocs.unep.org/bitstream/handle/20.500.11822/18767/WHO Obesity and overw eight.pdf World Health Organization. (2017a). Global School-based Student Health Survey. Retrieved from https://www.who.int/ncds/surveillance/gshs/Jamaica 2017 GSHS FS.pdf?ua=1&ua=1 World Health Organization (2008). Global Strategy on Diet, Physical Activity and Health. Retrieved from https://www.who.int/dietphysicalactivity/factsheet young people/en/ World Health Organisation (2022). Non Communicable Diseases. Retrieved from http://www.who.int/mediacentre/factsheets/fs355/en/ WHO (2021). Obesity and Overweight. Key Facts. Retrieved from http://apps.who.int/iris/bitstream/10665/42330/1/WHO TRS 894.pdf?ua=1&ua=1 http://apps.who.int/iris/bitstream/10665/44399/1/9789241599979 eng.pdf https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854 eng.pdf?sequence=1 https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854 eng.pdf?sequence=1 https://apps.who.int/iris/handle/10665/259232. https://apps.who.int/iris/handle/10665/259232#: http://wedocs.unep.org/bitstream/handle/20.500.11822/18767/WHO Obesity and overweight.pdf http://wedocs.unep.org/bitstream/handle/20.500.11822/18767/WHO Obesity and overweight.pdf https://www.who.int/ncds/surveillance/gshs/Jamaica 2017 GSHS FS.pdf?ua=1&ua=1 https://www.who.int/dietphysicalactivity/factsheet young people/en/ http://www.who.int/mediacentre/factsheets/fs355/en/ DRAFT VERSION AUGUST 2023 Page 44 of 84 https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight WHO (2021b). Malnutrition. Key Facts Retrieved from https://www.who.int/news-room/fact-sheets/detail/malnutrition World Obesity Federation (2022). The Economic Impact of Overweight & Obesity in 2020 and 2060. Retrieved from https://data.worldobesity.org/publications/ Wilks, R. et al. (2007-2008). National Health Fund. Jamaica Health and Lifestyle Survey. Technical Report. Accessed 2019. Retrieved from https://www.moh.gov.jm/wp-content/uploads/2015/05/Jamaica-Health-and-Lifestyle- Survey-2007-8.pdf Wilks, R., Younger, N., Tulloch-Reid, M., McFarlane, S., & Francis, D. (2008). Jamaica health and lifestyle survey 2007-8. Kingston: Tropical Medicine Research Institute, University of the West Indies, Mona. Accessed 2018. Retrieved from http://www.jamaicabicentenary.org.jm/reports/health/JHLSII final may09.pdf FAO, IFAD, PAHO, UNICEF and WFP. 2023. Regional Overview of Food Security and Nutrition – Latin America and the Caribbean 2022: towards improving affordability of healthy diets. https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight https://www.who.int/news-room/fact-sheets/detail/malnutrition https://www.moh.gov.jm/wp-content/uploads/2015/05/Jamaica-Health-and-Lifestyle-Survey-2007-8.pdf https://www.moh.gov.jm/wp-content/uploads/2015/05/Jamaica-Health-and-Lifestyle-Survey-2007-8.pdf http://www.jamaicabicentenary.org.jm/reports/health/JHLSII final may09.pdf DRAFT VERSION AUGUST 2023 Page 45 of 84 APPENDIX NATIONAL SCHOOL NUTRITION STANDARDS NATIONAL SCHOOL NUTRITION STANDARDS DRAFT VERSION AUGUST 2023 Page 46 of 84 Contents Introduction and Background ....................................................................................................... 48 Objectives of School Nutrition Standards ..................................................................................... 49 Scope of the Standards .................................................................................................................. 49 Exemptions to the Standards ......................................................................................................... 49 Standards for Cooked meals ......................................................................................................... 50 Summarised Meal Standard for Breakfast .................................................................................... 51 Nutrition Standard for Lunch and Dinner ..................................................................................... 52 Summarised Meal Standard for Cooked Lunches ........................................................................ 52 Summarised Meal Standards for Cooked Dinner (Evening Meal) ............................................... 52 Catering for special needs or Other Considerations ..................................................................... 53 Standards for Processed and/ or Ultra-Processed Pre-Packaged Foods and Snacks .......... 53 Standards for Beverages ............................................................................................................... 54 Reference Documents for the Preparation and service of Cooked Meals in Schools ................... 56 The Food Service Environment .................................................................................................... 56 Marketing Standards ..................................................................................................................... 57 APPENDIX 1 ................................................................................................................................ 59 Guidelines for Procurement/Purchasing ....................................................................................... 59 Guidelines for Receiving foods .................................................................................................... 59 Food Safety Guidelines for Receiving .......................................................................................... 59 Guidelines for Storage of Foods ................................................................................................... 60 Dry Storage ................................................................................................................................... 61 Cold Storage .................................................................................................................................. 61 Guidelines for Ordering and Issuing ............................................................................................. 62 Ordering ........................................................................................................................................ 62 Issuing ........................................................................................................................................... 62 Production of Meals ...................................................................................................................... 63 Guidelines for Pre-Preparation ..................................................................................................... 63 Guidelines for cooking the meal ................................................................................................... 63 Food Safety Guidelines for Pre- preparation & Cooking ............................................................. 64 Meal service .................................................................................................................................. 65 Guidelines ..................................................................................................................................... 65 DRAFT VERSION AUGUST 2023 Page 47 of 84 Food Safety Guidelines for Service .............................................................................................. 66 Recommended Guidelines for Record Keeping ........................................................................... 67 Inventory management .................................................................................................................. 67 Stock record .................................................................................................................................. 67 Ordering and Issuing ..................................................................................................................... 67 Menu record .................................................................................................................................. 67 Personal Hygiene (staff/employees) ............................................................................................. 68 Proper Hand Washing Procedures ................................................................................................ 69 Other Personnel Hygiene Factors ................................................................................................. 69 Pest Control ................................................................................................................................... 69 Garbage Disposal .......................................................................................................................... 70 Manual Ware Washing ................................................................................................................. 70 Floor & Equipment Cleaning and Sanitizing ................................................................................ 71 Cleaning Schedule ........................................................................................................................ 72 References ..................................................................................................................................... 74 DRAFT VERSION AUGUST 2023 Page 48 of 84  Introduction and Background The development of school nutrition standards in Jamaica was conducted in the context of rising levels of overweight and obesity in Jamaican children coupled with evidence of unhealthy diets and inadequate physical activity (1,2).These trends have prompted a range of policy and programme interventions in Jamaica aimed at addressing the main contributory factors while at the same time providing the framework for developing supportive school environments that will support long term behaviour change in school-aged children. The World Health Organization has been at the forefront of reviewing and documenting evidence relating to the linkages between lifestyle and the risk for the development of Non-Communicable Diseases (NCDs) in adults and children and has published strong evidence to support the connection between the consumption of unhealthy diets (high in fat, sugar and salt and low in fibre, fruits and vegetable) as well as low levels of physical activity, and the increased risk for NCDs. Excess alcohol consumption and smoking have also been identified as strong risk factors for NCDS. Policies and programmes designed and implemented within the context of comprehensive School- based diet and physical exercise policies have been shown to be effective in supporting the adoption of healthy diets and physical activity habits. This is partly due to the fact that the school environment is regulated and can therefore, through appropriate policy implementation exert a positive influence on the lifestyle choices in the areas of diet and exercise of most children. The evidence suggests that multi-component school-based interventions that include inter alia changes in curriculum as well as supportive school environment policies, availability of healthy food options and structured physical activity programmes can form the basis for the inculcation and eventual adoption of healthy lifestyle behaviours. (3) The Government of Jamaica has embarked on a comprehensive programme to address the negative nutrition and lifestyle-related trends that are being manifested in school-aged children, including a comprehensive health promotion initiative aimed at sensitizing the population at large about the importance of healthy lifestyle choices and ultimately targeting appropriate behaviour change with respect to food choices and physical activity. The development of a National School Nutrition Policy was spearheaded by the Ministry of Education and Youth and includes School Nutrition Standards and is one such intervention aimed at reducing the prevalence of Non-Communicable Diseases in Jamaica. Development of the National School Nutrition Standards which will support the implementation of the School Nutrition Policy was led by the Ministry of Health and Wellness using a consultative process. These standards are based on the Food Based Dietary Guidelines for Jamaica and evidence-based recommendations from regional and international health agencies and will provide guidance on the nutritional profiles of healthy meals, snacks and beverages i.e. Meals, snacks and beverages that are:  In keeping with the Food Based Dietary Guidelines for Jamaica  Low in salt/sodium DRAFT VERSION AUGUST 2023 Page 49 of 84  Low in added sugar and sweeteners  Free from industrially produced trans fats  Inclusive of fresh or minimally processed fruits and vegetables  Inclusive of peas, beans and nuts  Appropriate with respect to fat content All standards contained herein will be in addition to all existing legislation governing the production, labelling, sale and distribution of foods and beverages in Jamaica.  Objectives of School Nutrition Standards 1. To define the types of foods and beverages which are restricted, in order to replace food high in fat, sugar and salt with more nutritious food and drinks. 2. To ensure nourishing food is served more frequently. 3. To ensure improvement in the nutrient quality of school meals, allowing time for the more detailed process of developing meals that meet the new nutrient-based standards. 4. To help children to develop healthy dietary habits  Scope of the Standards The standards will be applicable as follows. Where: Public Early Childhood Institutions, primary and secondary institutions -Including:  The school compound  The immediate vicinity of the school – within 200 meters of the school perimeter  Sporting events and competitions at schools  School fundraisers  School recreational activities e.g. concerts, fairs, barbecues etc. held on the school premises Who: All providers of meals and non-meal items (snacks and beverages) – canteens, concessionaires, vendors including parents/ guardians, teachers and school administration, and students who may provide food items for sale in schools. Boundaries of the school environment: Immediate vicinity of the school i.e. against the school boundary When: School days (Mondays- Fridays), during school hours and special school activities, and on weekends (Saturday and Sunday) for schools which provide meals for residential students, e.g. boarding schools, weekend camps etc. What: all food items within the specified boundary, for children aged 4 to 18 years  Exemptions to the Standards Food and drink brought by students from home for their own consumption will be exempt. This will accommodate students with special dietary requirements. Exceptions to Nutrient Standards DRAFT VERSION AUGUST 2023 Page 50 of 84 Possible exemptions may include Cultural days (e.g. Jamaica Day) where specific foods by their nature and or recipe content, breach the nutrient guidelines. Sports drinks (electrolyte and or glucose replacement drinks) are permitted for use, but only by athletes during training and competition. Provision of specially formulated meals or beverages which fall outside the meal and nutrient standards outlined herein must only be carried out under the advice of a qualified medical professional (e.g. medical doctor, nutritionist, dietitian) and after nutrition assessment. Extended use must be accompanied by routine follow-up assessments.  Standards for Cooked meals The Standards are food-based and are provided for each meal type. The standards will apply to all food and drink items available to children within the school environment whether prepared on or offsite. Below are the proposed nutrient and meal standards which will be applicable in schools by age group. There will be three meal sizes as follows:  Small for age group 4 – 8 yrs  Medium for age 9-13 years  Large for age group 14- 18 Meals are planned to provide roughly 30% of the Recommended Daily Allowance (RDA). This is based on the Population Nutrient Intake Goals for the Caribbean which has been used as the reference document. (4) This indicates the following for daily intake: 4-8 years 9-13 years 14-18 years Calories (kcal) 1500 2000 2400 Vitamin C (mg) 30 40 40 Iron (mg) 6.3 14.3 25.8 Carbohydrates 49% 50% 52% Proteins 18% 18% 16% Fat 33% 32% 32% The recommended daily distribution of food groups is show below. # of Servings according to age group 4-8 years 9-13 years 14-18 years Milk 2 3 3 Fruit 2 2 3 Starchy Vegetables 1 1 1 Other Vegetables 2 2 2 Added Sugar 6 6 6 Staples 7 10 14 DRAFT VERSION AUGUST 2023 Page 51 of 84 Foods from animals 6 8 8 Fats and Oils 3.5 5 6.5 ● Meals should provide 50% Vitamin C and Iron to combat the prevalent and persistent problem of anaemia. (4) ● An iron-rich food should be included at least 3 times each week. ● Plant-based proteins such as peas and beans should be promoted and included as an option at least Two (2) times per week. ● Other vegetable include raw or steamed vegetables served in meals. These exclude the starchy vegetables. Dark Green leafy vegetables should be provided at least three (3) times per week. ● Safe water should be made available for consumption at meal times, as well as throughout the day to facilitate adequate fluid intake  Summarised Meal Standard for Breakfast Breakfast should contain foods from the following food groups, at minimum:  Staples  Foods from animals or  Legumes (or other based protein sources) Breakfast for students should include one serving of fruit. A variety of fruit should be offered. This may be as:  Fresh fruit,  Canned fruit in its own juice or  Unsweetened fruit juice, not more than 6oz. Summarised Meal Standard for Breakfast It is recommended that breakfast be constituted as follows: 4yrs to 8 yrs (Small) 9 yrs to 13 yrs (Medium) 14 yrs to 18 yrs (Large) Milk 2 3 3 Fruit 1 1 1 Starchy Vegetables - - - “Free” Vegetables - - - Sugar 2 2 2 Staples 2 3 4 Foods from Animals 1 2 2 Fats and oils 1 1 2 DRAFT VERSION AUGUST 2023 Page 52 of 84 A breakfast cycle menu should be included in the supporting Recipe Manual. Nutrition Standard for Lunch and Dinner Lunch and dinner should contain foods from the following food groups at minimum:  Staples  Foods from Animals or  Legumes  Vegetables Evening meals for residential students should include one serving of fruit. Processed meat or chicken products and fried foods, should not be provided more than once per week, if at all (for example bacon, ham, sausages, chicken nuggets and similar products). These foods should be assessed as processed and ultra-processed foods- See “Standards for Processed and/ or Ultra-Processed Pre-Packaged Foods and Beverages” Meals containing lean red meat should be offered two to three times a week. A lunch cycle menu and dinner cycle menu should be included in the supporting Recipe Manual. Summarised Meal Standard for Cooked Lunches 4yrs to 8 yrs (Small) 9 yrs to 13 yrs (Medium) 14 yrs to 18 yrs (Large) Milk - - - Fruit - 1 1 Starchy Vegetables 1 1 1 “Free” Vegetables 1 1 1 Added Sugar 2 2 2 Staples 3 3 5 Foods from Animals 2 3 3 Fats and oils 1 2 2.5 A variety of fruit should be offered. This may be as:  Fresh fruit,  Canned fruit in its own juice or  Unsweetened fruit juice, not more than 6oz. Summarised Meal Standards for Cooked Dinner (Evening Meal) 4yrs to 8 yrs (Small) 9 yrs to 13 yrs (Medium) 14 yrs to 18 yrs (Large) Milk - - - Fruit 1 - 1 Starchy Vegetables - - - “Free” Vegetables 1 1 1 Added Sugar - 2 2 DRAFT VERSION AUGUST 2023 Page 53 of 84 Staples 2 4 5 Foods from Animals 3 3 3 Fats and oils 1.5 2 2 A variety of fruit should be offered. This may be as:  Fresh fruit,  Canned fruit in its own juice or  Unsweetened fruit juice, not more than 6oz.  Catering for special needs or Other Considerations For persons with allergies or intolerances, considerations should be made to provide foods that exclude common allergens or irritants such as dairy, nuts and seeds. A vegetarian cycle menu should be included in the supporting Recipe Manual.  Standards for Processed and/ or Ultra-Processed Pre-Packaged Foods and Snacks The PAHO Nutrient Profile model (3) forms the basis for the definition of standards for non-meal offerings in schools. The Nutrient Profile Model classifies processed and ultra-processed food and drink products that are in excess of nutrients such as sugars, salt, total fat, saturated fat and trans- fatty acids. The rationale for the focus on these nutrients is based on a review of evidence linking the nutrients to detrimental public health trends. The profile recommends maximum acceptable levels of nutrient content developed after analysis of evidence which links nutrient intake to public health outcomes. Other sweeteners are also included in the model because evidence suggests that regular use of other sweeteners predisposes children to increased consumption of foods and drinks with high sugar content. This category does not include fruit juices, honey or other food ingredients that can be used as a sweetener. The summary of the critical nutrients included in the Profile and which will be included in the Jamaica School Nutrition Standards are set out below in Table 1 abstracted from the PAHO Profile. Table 1 Nutrient standards for snacks and non-meal foods (adapted from the PAHO Nutrient Profile Model) Sodium Free sugars Other sweeteners Total fat Saturated fat Trans fat ≤1 mg of sodium per 1 kcal ≤10% of total energy from free sugars Any amount of other sweeteners ≤30% of total energy from total fat ≤10% of total energy from saturated fat ≤1% of total energy from trans fat DRAFT VERSION AUGUST 2023 Page 54 of 84 Examples of the relevant foods are provided in the Model and include inter alia: “Processed products: fruits in sugars and candied fruits; canned sardine and tuna; breads and baked products (in general). Ultra-processed products: Sweet or salty packaged snacks, biscuits (cookies), ice cream, and candies and confectionery (in general); sweetened breakfast cereals; cakes and cake mixes and cereal bars; sweetened and flavoured yoghurts; canned, packaged, dehydrated, and other “instant” soups, noodles, pre-prepared meat, fish, vegetables, pizza and, burgers, hot dogs, sausages, poultry and fish “nuggets” and “sticks”, and other products made from animal byproducts”. (3) Foods that are not included in the restrictions above include fruits and vegetables that occur in their natural states, or that have undergone minimal processing as well as freshly prepared dishes and culinary ingredients.  Standards for Beverages The main objective of these standards is to limit the amount of total sugar in sweetened beverages, which are available or served in schools. The implementation schedule is set out below: Sugar Content Implementation Date Maximum 6g/100ml effective Jan 1, 2019 Maximum 5g/100ml effective Jan 1, 2020 Maximum 4g/100ml effective Jan 1, 2021 Maximum 2.5g/100ml effective Jan 1, 2023 Prohibited Beverages In line with the implementation schedule, beverages that are prohibited are as follows: 1. Sweetened beverages that are in excess of the prescribed sugar limit, including but not limited to:  carbonated beverages (such as regular soda), that are in excess of the prescribed sugar limit  fruit flavoured drinks, that are in excess of the prescribed sugar limit  coffee and tea beverages that are in excess of the prescribed sugar limit  sweetened waters, that are in excess of the prescribed sugar limit 2. Energy drinks and other beverages with caffeine content of more than 40mg caffeine per serving 3. Beverages containing artificial sweeteners. The use of artificial sweeteners is not DRAFT VERSION AUGUST 2023 Page 55 of 84 recommended for prolonged consumption by children Permitted Beverages  Plain water  Unsweetened flavoured and infused water  Unsweetened juices  Unsweetened coconut water  Unsweetened milk or milk products  Unsweetened milk substitutes and milk substitute products  Sweetened beverages (including flavoured and infused water) below the prescribed sugar limit  Sports drinks (Electrolyte and glucose replacement drinks) – reserved only for athletes during training and competition. These guidelines for beverages will be implemented within the context of appropriate labelling of products based on the relevant Food and Drug Regulations 1975 and its relevant amendments and guidance on the use of Artificial sweeteners. Additional recommendations (based on USDA guidance for children less than 18 years) also include: 1. Caffeine content: Recommended - <10mg per serving. 2. Package size: Recommended - <12 ounces for all beverages except water Therapeutic and Meal Replacement Beverages The beverage standards do not apply to therapeutic beverages, and liquid meal replacements. Therapeutic beverages and liquid meal replacements should not be sold to the general school population. If supplied by the school, it should be based on the recommendation of a qualified medical professional after a nutritional assessment. The use of the product should also be accompanied by routine monitoring of the health status of the consumers. This also applies to any supplementary feeding programme, for example, athletic or student welfare. DRAFT VERSION AUGUST 2023 Page 56 of 84  Reference Documents for the Preparation and service of Cooked Meals in Schools Standardized Recipes are available in the Recipe Manual - School Feeding Pilot Region 1, Ministry of Education, January 2014. This manual provides guidance on producing standardized meals for children in infant, primary and secondary schools. It details recipes for a three-week cycle menu of five days per week. A ten-day vegetarian menu and a five-day emergency menu are also included. The manual must be reviewed and updated prior to implementation of the standard, and on a periodic basis, upon recommendation from the competent authority. Review and update should include:  Review and updating/ preparation of menus for all meal times i.e. breakfast, lunch and dinner, in accordance with the Nutrition Standards  Review and updating of recipes in accordance with the Nutrition Standards  Guidance for portioning the foods according to the meal sizes (small, medium and large), in accordance with the Standards It is also recommended that the standards be revised on a periodic basis to incorporate any new and relevant evidence based recommendations.  The Food Service Environment School nutrition standards are closely linked with the quality of the overall food service environment in schools. Guidelines/assessment instruments related to the standards for the food service environment are set out in Appendix 1 and cover the areas set out below. ● Guidelines for Procurement/Purchasing ● Guidelines for Receiving foods ● Guidelines for Storage of Foods ● Guidelines for Ordering and Issuing ● Guidelines for the Production and Service of Meals ● Food Safety Guidelines for Service ● Guidelines for Record Keeping ● Sanitation DRAFT VERSION AUGUST 2023 Page 57 of 84 ● Personal Hygiene (staff/employees) ● Pest Control ● Garbage Disposal ● Floor & Equipment Cleaning and Sanitizing  Marketing Standards In order to protect the health of the children, it is well documented that a critical element in facilitating appropriate changes in food consumption habits in school-aged children is the development of standards relating to the marketing of food in the school environment. The school environment includes: 1. The school compound 2. The immediate vicinity of the school 3. Events where school-aged children gather a. Sporting events and competitions for schools b. School fundraisers c. School recreational activities e.g. concerts, fairs, barbecues etc. Marketing efforts which should be prohibited in the school environment include: 1. Promotion of brands associated with products which are high in salt, fat or sugar including: a. Mascots b. Sales/ special sale promotions c. Giveaways d. Branding on posters e. Branding on textbooks, exercise books and other school supplies 2. Sponsorship (by brands associated with products which are high in salt, fat or sugar) of a. Equipment and materials including learning/ teaching aids b. Teams, uniforms and other apparel c. Events, competitions d. Buildings, rooms, facilities DRAFT VERSION AUGUST 2023 Page 58 of 84 e. Services 3. Philanthropic activities tied to brands associated with products which are high in salt, fat or sugar a. Health and wellness campaigns b. Scholarships/ funds/ grants for schools or students c. Food or feeding programmes DRAFT VERSION AUGUST 2023 Page 59 of 84 APPENDIX 1  Guidelines for Procurement/Purchasing ● Purchase foods in keeping with the written menu. ● Compile food items into a commodities list or form. ● Adjust recipes to determine the total quantity of each food item to be purchased ● Use guidelines provided to determine how often a particular food item must be purchased.  Guidelines for Receiving foods It is recommended that a senior teacher or the School Feeding Coordinator should be the person responsible for this aspect. They should ensure that foods are fresh and safe when they enter the foodservice operation and accept only the products that meet specifications, quality standards, and sanitation requirements. Foods should be transferred to proper storage as quickly as possible. ● Organize the physical space used for receiving. Have available: ● A clean basket, cart or hand truck for transporting goods from the receiving area to storage. ● A copy of purchase order ready when the delivery is scheduled. ● A product specification list. ● Inspect goods received against purchase order, invoice and purchasing record form ● Verify weights and counts on both the purchase order and invoice. ● Examine foods for colour, texture, odour, presence of cuts, bites, tears/rips, dents, bulges and expiration dates. ● Certify that the quantity of goods was received and in good condition. ● Refuse goods/supplies in poor condition, or if the items were not ordered, price was not what was quoted or the goods/supplies were not received on a timely basis. ● Place goods in respective storage area immediately using the first in first out (FIFO) system.  Food Safety Guidelines for Receiving ● Keep the receiving area well lit and clean to discourage pests. DRAFT VERSION AUGUST 2023 Page 60 of 84 ● Mark all items for storage with the date of arrival or the “use-by” date. ● Check to be sure shelf dates have not expired and will not expire before use. Check expiration dates of milk, and other perishable goods. ● Make sure frozen foods are in airtight, moisture-proof wrappings. Reject foods that have been thawed and refrozen. Signs of thawing and refreezing include large ice crystals, solid areas of ice, or excessive ice in containers. ● Reject cans that have any of the following signs of deterioration: swollen sides or ends, flawed seals or seams, dents, or rust. ● If available use a food thermometer to check the temperature of refrigerated and frozen foods including dairy products, fresh meat, fish, and poultry products. ● Examine packaging for content damage and insect infestations. ● Remove empty containers and packing material immediately to a separate trash or recycling area.  Guidelines for Storage of Foods Space should be available for the storage of perishable and non-perishable foods and supplies. While this space may be shared with another department, a location reasonably close to the kitchen and service areas reduces transportation time and must allow for seclusion of food items. Storage activities and access to storage must be assigned to one specific individual to ensure control over the goods in storage. ● Good ventilation is essential to retard growth of various bacteria and molds, prevent mildew and rusting of metal containers, and minimize caking of ground or powdered foods. Water heaters, compressors, motors, or other heat-producing equipment should not be located in the storeroom. ● To prevent access by rodents and insects, floors, walls, and ceilings should be smooth, moisture-proof, and free from cracks. ● Ensure adequate space - At least 6 inches from walls and floors and in-between shelves for good housekeeping and inventory control. ● Install a security sash, screen, or bar on windows in storerooms located at ground level. DRAFT VERSION AUGUST 2023 Page 61 of 84 ● Provide a separate storage area for: cleaning supplies; chemicals; paper goods and other non-food materials  Dry Storage ● Arrange goods according to the First in, First out (FIFO) method of issuing (stock rotation). ● Store goods such as flour, rice and sugar in bins with tightly fitted lids on pallets. These bins must be replaced as necessary. ● Store canned items and food items in small containers on shelves (not wood) at least 6 inches from the ground and 6 inches away from the wall. ● Check goods periodically for signs of spoilage such as bulging or leaking cans. ● DO NOT store cleaning supplies and paper in dry storage area with food items.  Cold Storage ● Store all perishable foods either in refrigerator or in frozen storage immediately upon receipt and keep under these conditions until ready for use. ● Refrigerator storage temperature must be less than 4°C (40°F) to be suitable for storage of fruits, vegetables, and most other perishable products. ● Remove heavy wrapping paper from foods that are to be refrigerated to allow cold air to circulate through the food. ● Store/arrange foods using the First-in First-out (FIFO) method. ● Refrigerators MUST NOT BE overcrowded but must allow space between items to allow for cold air to circulate. ● Raw and cooked foods MUST BE stored separately if possible, or store cooked foods above raw foods in the same refrigerator. ● Milk, meat and drinks must be stored separately. ● All food items such as canned foods MUST NOT BE stored in their containers after being opened. ● Shelves and interiors of refrigerators MUST BE clean and free from debris and excess moisture. ● Hot foods must be cooled rapidly in an ice water bath (container with ice and water) before storing in refrigerator or freezer. DRAFT VERSION AUGUST 2023 Page 62 of 84 ● Refrigerator doors MUST BE kept closed except when removing or putting in foods. ● Freezer storage temperature -18°C (0°F). Foods for storage in freezers are meat seafood and poultry. ● Frozen foods MUST BE securely packaged to prevent freezer burns. ● Foods slated for freezers MUST BE labeled and dated prior to storage ● The temperature of the refrigerators should be monitored twice daily at the beginning of the work day and at the end of the work day and recorded.  Guidelines for Ordering and Issuing The number of meals to be prepared and the quantity of food items required for preparation should be based on a count of the number of students that will be requiring meals on a daily basis.  Ordering Set out below are recommended procedures for implementing a system for the ordering of lunches. Please refer to the Guidelines for Using and Administering the PATH Nutritional Subsidy for further guidance on the recommended procedures and practices in this area especially as it relates to the maintenance of records for PATH beneficiaries. ● Post weekly menu in the classroom or canteen on Friday after lunch. ● Inform students each day of the menu for the following day. ● Document the number of children requiring meal for each class in the meal register. This should be collated the evening before and sent to the canteen. ● Confirm the number of students for meals each day. ● The total number of students requiring meals each day should be collated from the daily request form. ● Adjust recipes based on orders received ● Order the requested amount of each food item based on the adjusted recipes  Issuing ● Issuing must be done based on the menu requirement ● The quantity issued must be based on the number of meals ordered. ● Issuing must be done at least a day ahead to allow for pre-preparation DRAFT VERSION AUGUST 2023 Page 63 of 84 ● The First In First Out (FIFO) method of issuing must be used to ensure the quality of foods being used for each menu item  Production of Meals In order to maintain nutrient standards, the recipe manual should be used for the preparation of all menu items.  Guidelines for Pre-Preparation ● Pre-preparation must be done ahead of scheduled preparation based on number of students having lunch. ● Review menu ● Gather and read all recipes ● Requisition foods from stores based on diet scale ahead of preparation time ● Assemble all ingredients for each recipe as per menu ● Thaw meat in refrigerator or under cold running water ● Start pre-preparation by cleaning, trimming and cutting food item into appropriate portion size ● Season meat and other food item appropriately ● Store prepared ingredients in appropriate containers, label and refrigerate.  Guidelines for cooking the meal ● Use recipes provided for each menu item being prepared. This is to ensure that nutrient standards are being maintained. ● Proper measurements must be done to ensure accuracy. For example, level instead of heaped. ● Read scale and cups appropriately. ● Use the correct utensil example, liquid cup for liquid measures only; dry cups for dry measures. ● Review the cooking methods specified in the recipes and follow instructions carefully. ● Follow the cooking method as it will affect the quality and quantity of the meal. ● Begin the cooking process starting with food items which will take longest time to prepare. ● Cook vegetables as close to serving time as possible. DRAFT VERSION AUGUST 2023 Page 64 of 84 ● Serve meals on the same day within an hour of cooking or completion.  Food Safety Guidelines for Pre- preparation & Cooking There are several cautions for food handlers because pre-preparation usually takes place at room temperature. This stage is one of the most common points of contamination and cross- contamination:  Pre Preparation ● Wash hands correctly before beginning preparation. ● Prepare foods no further in advance than necessary. ● Prepare foods in small batches and place in cold storage immediately. This will prevent holding food too long in the temperature danger zone. ● Always hold prepared cold foods at or below 4 C (40ºF). ● Wash fresh fruits and vegetables with cold, running drinkable water to remove surface pesticide residues and other impurities, such as soil particles; wash regardless of whether the produce will be served whole, peeled, or cooked. ● Use a brush to scrub thick-skinned produce. ● Avoid cross-contamination. ● Keep raw products separate from ready-to-serve foods. ● After each contact with a food, wash, rinse, and sanitize cutting boards, knives, equipment, and all other food contact surfaces. Wash hands. ● Follow equipment manufacturer’s directions and standardized recipes to avoid overloading baking pans.  Cooking ● Stir foods cooked in deep pots frequently to ensure even distribution of heat and thorough cooking. ● Avoid overloading fryers. Allow the oil temperature to return to the required level between batches. ● Regulate size and thickness of each portion to make cooking time predictable and uniform. Cook similar sized portions together. DRAFT VERSION AUGUST 2023 Page 65 of 84 ● Never interrupt the cooking process. Partially cooking poultry or meat, for example, may produce conditions that encourage bacterial growth. ● It is best to use a thermometer to monitor the accuracy of heating equipment. ● If available also use a food thermometer to check that food reaches the required safe internal temperature during cooking. Check food temperature in several places, especially in the thickest parts, to make sure the food is thoroughly cooked. To avoid getting a false reading, be careful not to touch the pan or bone with the food thermometer. ● Always cook food to the required safe internal temperature and appropriate time. ● Use a serving utensil or single-use glove to avoid cross-contamination. ● Taste foods correctly to avoid cross-contamination. Place a small amount of food from the food container into a small bowl, step away from the food container, and taste the food with a teaspoon. Remove the used bowl and teaspoon to the sink for washing. Never reuse a bowl or spoon already used for tasting. Wash hands after tasting. ● A small portion of all menu items served daily should be collected in individual sterile containers, labelled, dated, and refrigerated for at least three (3) days, for possible testing in the event of food borne illness. These containers ARE NOT reusable.  Meal service The completed dishes/menu items for the school feeding programme should be served with the food items appropriately arranged in the plate or serving container and attractively garnished if necessary. Guidelines ● A Service and distribution area should be identified at each school. This area must be made ready prior to meal service each day. ● Set up service area before the food is removed from the cooking range, oven or refrigerator. ● Clean and sanitize all serving areas. ● Ensure adequate serving utensils. ● Ensure that all eating areas are clean ● Equipment should be arranged prior to the start of service these include: o Holding equipment/area for meals DRAFT VERSION AUGUST 2023 Page 66 of 84 o Standard portioning equipment o Trays and tray covers o Regular eating ware or disposable boxes, forks and/or spoons ● Ensure correct and consistent size for each portion of each menu item. ● Review the lunch register for number of meals to be served. Make special notation of the ● number of small and large meal sizes required. ● Encourage children to clear refuse from plates before stacking plates. ● Soils from table and emptying must be done promptly. ● Where disposables are used, a lined leak proof bin/drum must be placed in areas to receive disposables. Prompt clearing of bin/drum must be done to prevent over flow. Food Safety Guidelines for Service ● The food being served should not come in contact with: o Hand o Body o Clothes o Surrounding e.g. counters, floors o Other utensils o Raw or other unprepared foods ● Always keep HOT foods in hot holding equipment at or above 60 C (140°F); and ● Always keep COLD foods in a refrigeration unit or surrounded by ice at or below 4 C (40°F). ● Stir foods at reasonable intervals to ensure even heating or cooling. ● Do not add partially cooked food items to containers containing fully cooked foods awaiting service. ● Leftovers should not be stored and used in the feeding programme. Each day a new menu is prepared to ensure the provision of a variety of nutrient sources to students. ● Always wash hands and arms up to the elbow with soap and water before serving food. ● Use cleaned and sanitized long-handled ladles and spoons so bare hands do not touch food. ● Avoid touching the parts of plates, glasses, food trays, or flatware that will come into contact with food or the customer’s mouth. DRAFT VERSION AUGUST 2023 Page 67 of 84 ● Use lids/food covers to protect prepared food from contamination. ● Always clean and sanitize food preparation areas and equipment between food preparation tasks. For example, do not reuse a serving pan used to hold raw chicken to serve the same chicken after it has been cooked unless the pan has been thoroughly cleaned and sanitized. ● Throw away garnishes used on pans on the service line after each meal.  Recommended Guidelines for Record Keeping  Inventory management An inventory of all commodities received from the Ministry of Education, companies or bought from vendors must be recorded using records/forms specified by the Ministry of Education for this purpose. Stock record ● Stock records should be maintained. These records should give details of the movement of the major commodities in storage. It should show: o Stock received o Stock issued o Spoilage o Stock balance Ordering and Issuing ● A meal or lunch register should be used to record the information on the meals ordered by students. ● The meal register should have the students’ name and the day of the week. A mark (✓) will indicate students having meal and (X) will indicate students not having meal. ● At the end of each day an inventory of stock on hand must be carried out using the appropriate inventory form Menu record This record should give details of the meal/s provided on a daily basis. It should also state the quantities of the various commodities used, the number of lunches served detailing the number of DRAFT VERSION AUGUST 2023 Page 68 of 84 students who had paid, the number of free lunches given to needy students as well as the members of staff who had purchased lunches. Production of Meals In addition to the menu items prepared for the day’s meal, the number of meals prepared and the quantity of food items used should be recorded daily for each meal. Refer to the Ministry of Education Guidelines for the Operations of Tuck Shops and Canteens in Public Educational Institutions for sample forms that should be used in the above areas Sanitation A schedule must be developed in accordance with the Public Health Inspector for random spot checks of all facilities each term. A schedule must be established for the cleaning and sanitizing of the facility and equipment. Personal Hygiene (staff/employees) ● All persons involved in food production and distribution must have valid food handler’s certificates prior to employment and a system must be developed for annual re- certification. ● Employees must wear clean clothes and aprons or smock daily. Clothing should be made from cotton material. Armpits should be covered, flat shoes must be worn, and no slippers or open toe shoes should be worn in the foodservice establishment. ● Hair restraint must be worn to effectively cover head. Facial hair must also be covered with appropriate restraint. ● Jewelry must not be worn while on the job as they are havens for bacteria and can contaminate food. ● Fingernails must be trimmed, short and free from nail polish. ● Hands must be kept away from face, hair, mouth and nose. ● Smoking is not allowed in the foodservice establishment. ● Hands must be washed before beginning work or before returning to work, following a break and after carrying out the following activities: o After defecating, urinating, scratching or other contact with the body, body fluids DRAFT VERSION AUGUST 2023 Page 69 of 84 o or discharges. After coughing, sneezing using a handkerchief or disposable tissue. o After smoking, using tobacco, eating or drinking. o After handling soiled equipment or utensils. o Immediately before preparation, such as working with food, clean equipment or supplies. o When switching from working with raw food to cooked food.  Proper Hand Washing Procedures 1. Wet hands with water; soap properly; soap back of hands, between fingers and up to elbows. 2. Scrub properly using a brush reserved for nails. Rinse. 3. Soap and rinse the pipe tap 4. Re-soap hands up to elbow and rub, for about 20 seconds. 5. Rinse properly under running water or fresh clean water in a clean basin. 6. Dry hands, using disposable towel.  Other Personnel Hygiene Factors ● All food handlers must have a valid food handlers certificate ● No unauthorized persons should be allowed in the food preparation area. ● All cuts and abrasions must be covered with water proof bandage ● Cuts on hands must be covered with water proof bandages and a water tight disposable glove ● Employees with any symptoms of vomiting, diarrhoea, fever, cold or sore throat must not be allowed to handle food. ● Employers should receive a written confirmation from a doctor that employee is fit for work after a period of illness.  Pest Control ● An ongoing pest control programme must be in place to prevent infestation from insects DRAFT VERSION AUGUST 2023 Page 70 of 84 and rodents. Pest control activities should be done in keeping with national regulations (e.g. by certified individuals, use of approved pesticides etc.) ● The building must be free from cracks ● Fly screens must be in place at windows and on doors ● Inspect all deliveries and reject any package found to contain evidence of pests ● Clean up spills promptly ● Inspect for signs of infestation  Garbage Disposal ● Adequate numbers of garbage containers should be strategically placed throughout the main production and eating areas. ● Garbage containers must be leak proof, water tight, easily cleanable, pest-proof and durable. ● These containers should be made of metal or approved hard plastic ● Containers must have tightly fitted lids and must be kept covered ● There must be sufficient number of containers to hold the amount of garbage that is created daily. ● Garbage must not be allowed to accumulate anywhere except in garbage containers ● Garbage must be removed from food preparation area as soon as possible and must be disposed of at intervals to prevent odour formation and attraction of pests. ● Garbage containers must be scrubbed, rinsed and sanitized daily.  Manual Ware Washing ● Prepare equipment, cleaning agents and tools to be used in manual ware washing. ● Ensure that 3 compartment sink (or 3 separate containers) is clean and filled with water. ● Use approved sanitizer and detergent diluted and mixed according to manufacturer's instructions. ● Prepare and empty drying racks. ● Ensure that water is at the correct temperature. ● Scrape and pre rinse dishes. A brush or cloth may be used to remove any remaining soil. Pre-soaking may be used when food particles are not easily removed DRAFT VERSION AUGUST 2023 Page 71 of 84 ● Wash in the first compartment: each piece of utensil must be washed separately in hot water 43–49°C (110–120°F). ● Rinse in the second compartment: using clear hot water temperature 49°C (120°F). ● Sanitize in third compartment: immerse in hot water 77°C (170°F) for 30 seconds or immerse in an approved sanitizing solution, that is, as directed by manufacturer’s guidelines. ● Place to drain and allow to air dry. Do not towel dry as this may re-contaminate utensils. Do not touch food contact surfaces of sanitized utensils. ● Inspect and store utensils in a clean dust free enclosed area away from toilets, sewer lines, leaking pipes and other sources of contamination.  Floor & Equipment Cleaning and Sanitizing ● Use cleaning schedule to carry out cleaning and sanitizing. ● Spills must be wiped up promptly. ● Floors must be swept, scrubbed and wiped. ● Walls must be cleaned to remove grease, water and food particles. ● Counter areas must be cleaned before and after each meal. ● Storage areas must be kept in sanitary condition at all times. DRAFT VERSION AUGUST 2023 Page 72 of 84 The following tables below detail appropriate sanitation schedule and procedures for selected facility and equipment.  Cleaning Schedule AREAS When to clean HOW TO CLEAN After use Daily Weekly Monthly Bathroom ✔ Basins must be scoured, bowls brushed daily and sanitized. A deodorizer should be in place. Wall ✔ Food contact areas and walls near to preparation and cooking area should be washed, rinsed and sanitized daily. Ceiling Lights, Fans ✔ Use either wet or dry cleaning method, unplug power before cleaning fixtures. Floors ✔ Remove soils, wash with hot soapy water, rinse, and sanitize. Spills should be wiped immediately. Clean and sanitize prior to closing for the day. Dining Area Floor Table Chairs ✔ ✔ ✔ ✔ Sweep after each meal. Wipe after each meal. Legs of chairs must be wiped as well. Drains ✔ Use spray hose to flush, pour drain cleaner, scrub with brush and rinse with hot water. Pour spray sanitizer into drain. [Last to be cleaned daily] Use degreaser on schedule. Cleaning Tools and Supplies Wash mops, turn mop head up in the janitorial room. Scour mop wringer weekly. All washcloths should be properly washed, sanitized and put to dry. DRAFT VERSION AUGUST 2023 Page 73 of 84 DRAFT VERSION AUGUST 2023 Page 74 of 84 References 1. Global School-based Student Health Survey, 2010 2. Global School-based Student Health Survey, 2017 3. WHO Global action plan for the prevention and control of Non-Communicable Diseases 2013-2020. 4. Recommended Nutrient Intakes and Population Nutrient Intake Goals for the Caribbean, Washington, D.C.: Pan American Health Organization; 2020. License: CC BY-NC-SA 3.0 IGO. 5. Pan American Health Organization (2016). Nutrient Profile Model. Washington, DC: PAHO, 2016. 6. WHO Set of recommendations on the marketing of foods and non-alcoholic beverages to children 2010. 7. The Recipe Manual - School Feeding Pilot Region 1, Ministry of Education, January 2014 8. Operations and Procedures Manual for the Pilot Testing of School Meal Options in Region 1, Ministry of Education, 2013