National Nutrition Policy and Plan of Action

. , , NUTRITION POLICY AND PLAN OF ACTION of KIRIBATI . KANAM .: - ---~- --- ---~ A Commitment to all I-Kiribati Table of Contents Executive Sununary . Introduction ,.., 1 Nutrition Situation inKiribati ., . 3 Policy Thrusts '" " , , 6 Goal and Objectives '" . 7 Strategies '" ,... 8 Programmes 9 Support Strategies 12 Linkages With Other Sectors . . 14 Monitoring and Evaluation 17 Organization and Management 18 Budgetary Requirement 20 j EXECUTIVE SUMMARY The Nutrition Policy and Plan ofActionof Kiribati embodies the country's commitment to improve the nutritional well-being ofall l-Kiribati and ameliorate the problem ofmalnutrition in the population. It spells out the policies that the government adopts as a manifestation ofthis commitment, together with the national plan ofaction to carryout thesepolicies. Recognizing that the country is faced withthe doubleedged problem ofundernutrition in cbiJdren and overnutrition in adults, theGovernment will accordhigh priorityto improve the country's food and nutrition situation to enable the population to contributeto thecountry's socio-economic development and improve their quality of life. {\ccordingly the Government will provide the necessary political and economic packingrequired to dealwith the food and nutrition issues facing the nation. For its objective, the Plancallsfor the reductionof undernutrition in children by the end of this decade, virtually eliminate clinical vitamin A deficiency and reducethe incidence of anaemia among children and pregnant women, decrease the incidence of non communicable diseases among adults, increase self-sufficiency in foodand improve environmental sanitation To carry out the Plan, a multisectoralcoordinated approach will be followed. In addition,the strategyof decreasing dependency on imported food and improving household food security, and promoting a healthy blend oftraditionaI and modem practices will beadopted. In order to fulfill these objectives, the Plan prescribes five impactprogrammes: 1)direct nutrition services to those suffering frommalnutrition and ofhighmrtritional risk, 2)nutritioneducation programme in schools and communities, 3)universaI vitamin A supplementation in infants and young children, 4)fiunily food production, and 5)potablewater and environmental sanitation programme. To support these programmes, three support strategieswill be carried out: l)human resourcecapability building, 2)resource generation, and 3)nutrition surveys and research. Recognizing that the problem of malnutrition is not onlymulti-sectoral but multi-faceted, the Planwill fully utilize linkages with all sectors of government and privatesector - from health to natural resources andeducation, from trade and commerce to public works, to employment and homeaffairs. The NGOs will also be conscripted into the programme. To manage this national programme, a National Food and Nutrition Committee will beestablished to serveas the advisory bodyto the Government ofKiribati on all matters related to nutrition. The Committee will havethe primary function ofplanning and coordinating allprogrammes and activities under the Plan, assisted by the National Nutrition Centrewhich will act as the Committee's Secretariat. With the full collaboration ofall sectors, the outlook for SJI0r~~ appears bright, redounding to the benefit of all l-Kiribati, m. D.. •-------- J-l,. 1 Nl=~(.l¥FH:JN~~~Y·~N'OF ACTION OF KIRIBATI Introducti.on Food is man's most basic need. An adequate amount and kind offood is necessary not only for his survival but the fulfillment ofhis full God-given potential as a human being. Proper nutrition insuresall the necessary ingredients for his physical and mental growth and development and maintenance ofhealth. Good nutrition means optimum physical productivity and protection from illness. On the other hand, improper nutrition means poor growth and developmentofboth mind and body, recurrent infections, poor performance and frequent absences in school, and low work productivity in the workplace, in the soil, and in the seas. To a young and developing nation likeKiribati, the food and nutrition situation ofits populationhas seriouseconomic, social and health implications. A healthy and vigorous populationis a necessarycondition to the country's development. A properly nourished populationinsures their maximum contributionto the full economic, social and political lifeof the nation. On the other hand,a poorly nourished population is not able to optimally provide the ingredients for the country's development. Malnutrition saps the energyof thepeople to fully participate in nation building. The problemofmalnutrition is in fact a globalone. Whilecountries may differ in degrees and types ofmalnutrition that plague them,both the developed and developing world sufferfrom various forms ofmalnutrition. Thus in December 1992,leaden of more than a hundred and sixty countries around the world gathered in Romefor the International Conference in Nutrition. The Conferenceresulted in the World Declaration and PlanofAction on Nutritionwhich embodied the commitments of governments to substantially reduce ifnot eradicatehunger and malnutrition fromthe earth by the end ofthis decade. Indeed the objective oferadicatinghanger and malnutrition is within reach. Sufficient knowledge and technologies are now available to attain this objective. However, reaching the goal requires the political will ofgovernments and the full conunitment and concerted actionofeveryone • leadersofgovernment, NGOs. and local communities, as wellas the people themselves. This document embodies the commitment ofthe Government ofKiribati to improve the nutritional well-being ofall J-Kiribati and ameliorate the problem ofmalnutrition in the populationin response to the globalcallmade in Rome. It spells out the policies 1:'..",·,~ that the governmentadopts as a manifestation of this commitment, together with a national planofaction to carryout these policies. Moreover, the document describes the Kiribati National Plan ofAction fur Nutrition (K.NPA~~ for the period 1997 to 200I, including its goals, objectives, strategies and programmes, which will serve as the guide for all instrumentalities ofgovernment as wenas the collaboratingsectors in the national task ofraising the nutritional status of all I-Kiribati. 2 Nutrition Situation in Kiribati NUtritiOd ProbIemJ in Kiribati 1. Genentl malnutrition in children General malnutrition in children generally results from a poor diet lackingin dietary energyand protein. It is also often secondary to infectionssuch as diarrhoeaand respiratory ailments. The conditionaffectsthe child's physical, mentaland intellectual development, and in tum predisposes to more infections. Thus the child who contimJally suffers from malnutrition grows to adulthood unable to fully contributeto the country's socio-economic development. As earlyas the mid-70s, surveys haverevealed a high prevalence ofgeneral malnutrition in children in Kiribati. Anepidemiologic surveycarriedout in four locationsfrom 1976 to 1978revealed a high prevalenceofunderweight in children under fiveyears.(lO.8%· 32.3%). The 1985 NationalNutrition Surveycovering 22% ofhouseholds showed that 100.10 - 15%of children under 5 were underweight. While the growth pattern from birth to 6 months is comparableto Westernstandards; growth faltering occurs after this period probably because ofimproper diet during weaning, exacerbatedby frequent infections. Again in the 1989 survey to assess vitamin deficiency in six islands in Kiribati, mild malnutrition was found in a large percentage ofchildren with or without vitamin A deficiency. More recent data from the health reporting system of the MHFP showedthat whilethe rate bas abated somewhat, cases ofmalnutrition continueto be reported an average of295 cases per year between 1992 and 1996. 2. Vitamin A Deficienq Vitamin A deficiency is a major cause of preventable blindness in children. What is worse, vitamin A deficiency reduces resistance to infection, so that child mortality from common illnesses in communities with high prevalence ofvitamin A deficiency is increased. Studies from late sixties up to the present have made continuing reference to the serious problem ofvitamin A deficiency in children in Kiribati. A study carriedout by the Australian South Pacific Eye Team in 1989 among 300 children under 6 years estimated that 15%ofthe children were vitamin A deficient. The most definitive data came from the 1989 vitamin A deficiency assessment survey carriedout by the MHFP with the assistance ofthe Foundationfor thePeoples ofSouth Pacific, HelenKeller International and Johns Hopkins University. The surveyrevealed a prevalence of 1d. .fO/.. l:tft"onnn "h'l~.-.. ,:. "",,,, l.." ~~ c: •• "-- :- -=- :-,- ~. .!~, .,' •• I ...... , ~ I is much- ~ ~ ~. ------0 .~- 'V.. "" ...~ w •., .v -' J\;QJ;) 111 Mh 1~.uUIU;) ~lUWC;U. t ms I a.e higher than the WHO criteria as a public health problem Apparently the problem has abated to someextent since the programme ofuniversal vitamin A supplementation was started in 1991. Health statisticsnow reveal that while there were 3449 reported cases of clinical vitamin A deficiency in 1989, there were only an average of740 cases P' :. year between 1992 and 19%. This, however, shows that vitamin A deficiency is ~~,~(.~!!I. --------- . still a public healthproblem, causing untold numberofpreventable blindness and lowered resistance to infections. 3. Anaemia in young children and women or child-bearing age The third seriousmalnutrition problemin Kiribati is nutritional anaemia resulting primarily from iron deficiency in the diet aggravatedby intestinal parasitism. Anaemia in pregnancy is often a cause ofmaternal mortality and labour complications; in both adults and children, it limits physical and intellectual performance, thus limiting school and work productivity. In a study of infant weaningpractices in 1983, anaemia was found to be common in Kiribati especially in islands with high rainfall. The 1985 National Nutrition Survey confirmed the highprevalence ofanaemia in preschool children and in womenofchild bearing age particularly pregnant women. 4. Obesity and Diet-Related Non-Communiable Diseases As in other PacificIsland countries, theaduh population ofKin1>ati is prone to obesity and the resultant non-communicable diseases such as diabetes mellitus, hypertension, heart disease and someforms ofcancer. In the Dietary and Cardiovascular Disease survey in Kiribati in 1981, diabetesmellitus even at that time has reached 9.1% in the urban area and 3.00,/0 in the rural in both sexes. Hypertension was as high as 14.7% in theurban area and 10.5% in the rural. The 1985NationalNutrition Survey disclosed the meanweight ofwomen 15-65 years at a high 66 kg. More recent statistics from the MHFP shows that hypertension and diabetes mellitus has apparently been increasing since 1992. For example, while I 18 cases ofdiabeteswere reported in 1992, there were 302 cases reported in 1996. .Factors Aft'ectiRgNutritionIJ Status ill Kiribati A multitudeoffactors is responsible for the above nutritional problems in Kiribati. Foremost ofthese is the economic conditionofmany households whose income is not enough for an adequatediet. Unemployment in the urbanareas aggravates the problem. The scarce natural resources and infertile soil in thecountry is primarily accountablefor the unavailability ofenough food in the household and community, contributing to food insecurity at the household and national levels. Thus a high degree offood importation has to be resorted to. The lack ofleafy greensin the diet ofI Kiribati could be attributed to these geographiclimitations which have constrained a wider variety offood in the diet. Th... h'nh ....+a n~:..~~~~•. ~ .J:=...;u:.;;. ~~: .. ny diarrhoea m chiiidren has alsocontnbuted........., --t!!Y'&. &M~'" v. uU\Jvuvu.t1J W~ U --r---&uu' u.a ••~ UJ.' to malnutrition problem in Kiribati. The poor condition ofenvironmental sanitation and lack ofaccess to potable water supply, not to mention the inaccessibility ofmany areas to health services, haveaU affected the nutritional conditionofthe children. 4-----..... The high rate ofmalnutrition in Kiribati mayalso be attributed to the demographic and social conditions now existing. The high rate ofpopulation growth of2.4% and the largeaveragefamily size of7 limits the available food supply in the household and aggregatelevel. The persistence oferroneous food habitsand practices fallacious cultural beliefs and taboos, coupled with ignorance , low literacyand lackofeducation, makethe introduction ofthe conceptsofgood nutrition difficult. On the other hand, the problem ofovernutrition and dietaryimbalance that is starting to raise concern about obesity and diet-relatednon-communicable diseases is presumably beingbrought about by the changing diet and lifestyle associated with urbanization and higher incomes. The shiftfrom traditional foods to processed imported foods, the inordinate intakeofhigh calorie foods, the increasing prestige value ofnon-nutritious foods, coupledwith less physical, more stressful life style, all are part ofthe social transition that is now occurringin the countryand are contributing to the problemofovernutrition. 5 Policy Thrusts 1. TheGovernment will accord high priority to improve the country's food and nutrition situation and promotebetter health and nutritional well-being ofthe population especially the groups at risk. z. The Government will provide the necessary political and economic backing required to deal with the food and nutrition issuesfacing the nation. 3" The Government further endorses the goals set out in this policy and plan document and urges governmental and non-governmental agencies to direct their effortand resources towards achieving these goals. 4.. The Government also adopts and endorses the programmes and projects mentioned under this Plan ofAction and directsconcerned Ministries and other agencies to include them into their respective sectoral plans and programmes. 5" The Government will take necessary steps to formally establish the National Food andNutrition Committee and empower it to advise, co-ordinate and evaluate the implementation of the food and nutrition policy and plan. Eild-....·'.--~""--"-6 Goal and Obiectives J Goal: For tbe population of Kiribati to attain good nutritional status in order to contribute to tbe country's socio-economicdevelopment and improve their quality of life. Objectives: By the end ofthe Plan period: I. Reduce the incidence ofundemutrition among children by 500.10; '2. Virtually eliminate clinical vitamin A deficiency; 3. Reducethe incidence ofiron deficiency anaemia among pregnant women and children 4+ Decreasethe prevalence ofobesity and the incidence ofNCD among adults 5+ Increase self-sufficiency in food and improve household food security; and 6. Improve environmental sanitation and increase access to safewater supply. 7 Strategi.es 1.. Promotea multisectoral coordinated approach in dealing with nutrition issues; z. Decrease dependency on imported food and improve self-sufficiency with respect to staple and traditional food; 3. Improve household food security and insure adequate supply of leafy greens; 4. Insureproper nutrition in infants, preschool and school children; 5. Prevent and reduce micronutrient deficiencies particularly in vitamin A and iron among mothers andchildren; 6. Preventthe increase in diet-related non-communicable diseases; and 7. Promotea healthy blend oftraditional and modern practices. " ~------·8 Programmes I. Direct nutrition services to the nutritionally at risk The objective ofthe programme ofdirect nutrition services to the nutritionally at risk is to render rehabilitative and supportive servicesto those suffering from primary or secondary malnutrition or those under emergency conditions rendering them nutritionally at risk. These consist of those seen in the clinics, dispensaries, hospitals or in their homessuffering from malnutrition arisingfrom failure ofbreast-feeding, improperweaning or inadequate food intake due to ignorance of healthy food choices, practiceoferroneous food habits, or arising from disasters or other emergencies. Frank: malnutrition cases secondary to infectious diseasesuch as diarrhoeaand acute respiratory infection are also the targets of this programme. Cases suffering from moderate and severe protein-energy malnutrition maybe rehabilitated with supplementary food assistance or maybe admitted in the hospital where they can begiven adequate diet. Cases offrank vitamin A deficiency, i.e., those exhibiting active eye signsofvitamin A deficiency, will be giventherapeutic doses of vitamin A in the form ofretinol palmitate capsules. If resourcesare available, children suffering frommeasles or prolonged diarrhoea will be given preventive doses ofvitamin A capsules. Mothers and children suffering from moderate or severeanaemia will be given iron supplements. Ifnecessary anaemic children harboring intestinal parasites may be dewonned. Cases ofobesityand diet-relatednon-communicable diseases such as diabetes mellitus, hypertension and heart diseasewill be given dietaryadvice and if necessary medical treatment. The programme will be led by the Ministry ofHealth and Family Planning and undertaken by the hospitals, as well as healthcenters and dispensaries spread throughout the islands. Supportivemeasures such as surveillance and reporting of such cases in the communities may also be done by the Division of Social Development of the Department ofEnvironment and SocialDevelopment and the localgovernments under the Ministry ofHome Affairs. '2.. Nutrition Education Programme in Schools and Communities The programme ofnutritioneducationin schoolsand communities will havethe objectiveofdelivering nutritionmessages to the targets, namely, school children, mothers and womenofchild-bearing age in the communities, cormnunity leaders, members of women's clubs, and others. Adult members ofthe community who are at risk ofobesity and diet-related non-communicable diseases will constitute the targets for nutrition messages regarding moderation in food intake. FE "§1M 9 The Ministry ofEducation, Trainingand Technologywillbe the lead agencyfor the nutrition educationprogrammein schools. More specifically, the Ministry will see to the integration ofnutrition in the elementary' and secondary school curriculum as well as the integration ofnutrition and agriculture in the education curriculum. School teachers will be primarily responsiblefor incorporating nutrition in their curricularand extra-curricular activities. The programme ofnutritioneducation in communities will be led by the Ministryof Health and Family Planning. This programmewill pay particular emphasis on the promotion ofbreast feeding and harmfulness ofbottle feeding. and proper weaning practice (e.g., the proper time to start weaning. the proper weaning foods for the growing infant, etc.). The promotion ofleafy green and yellowvegetables and fruits as welt as other nutritious traditional foods willbe emphasized in nutrition campaigns and educationalactivities. In populationswho are prone to overnutritionand diet-related non-communicable diseases, nutrition education messageswill emphasize moderation in food intakeparticularly calorie-densefoods, limitation in the consumption ofoils, saturated fats and cholesterol-rich foods, and liberal intake ofvegetables and fruits. In general, a healthy blendof traditionaland modern practiceswill be promoted. The development ofnutrition information materials such as leafletsand posters will be initiated by the National Nutrition Center. The production, printingand dissemination ofthese materials will be the responsibility ofthe Health Education Division ofthe MHFP. Mass mediaincluding radio and newspaper will be utilized as muchas possible. Other communication strategies such as awareness campaigns, community theatre such as the Teitibwerere, mayalso be used. Aside from the MinistryofEducation, Trainingand Teclmology and the Ministry of Health and Family Planning, other agenciesofthe governmentsuch as the Ministry of Natural Resources, Ministry ofEnvironment and SocialDevelopment, and Ministryof Home Affairs, will also contribute to nutrition promotion through their respective units. The NGOs such the FSP and women's groups will integrate nutritionmessages into their training and outreach activities. ::>. Vitamin A Supplementation Programme While the programme ofvitamin A supplementation is a short term measure against active vitamin A deficiency known as xerophthalmia, the prevalence ofthis deficiency in Kiribati is so high that strong preventive measureshave to be taken if the objective ofvirtua11y eliminating frank vitaminA deficiency is to be achieved by the end of this decade. Thus the programmeofvitamin A supplementation amongall children 6 months to 6 years will be continued for another three to five years. The programme consistsofadministering high-dose vitamin A capsules (100,000 IV for infantsand 200,000 IU of retinol palmitate in oil for older children) to all children in the community every four to six months. The lead agency for the programme will be the Department ofPublicHealth, MHFP. • 4. Family Food Production Programme The objective ofthe programme ofFamily Food Productionis to ensurehousehold food security. More specifically, the programme is meant to contributeto the household supply of vegetables (especially green leafy and yellow vegetables), fruits and small livestock for family consumption. It mayalso contribute to the income of the household ifthe produce is beyondhousehold food needs. The progrannnewill be led by the Ministry ofNatural Resourcesand Development. Demonstration gardens mayneed to be set up in strategic placessuchas schools, churchyards, and public lands. Inputs such as seeds. seedlings and cuttings, as well as training ofhousehold members and connnunities on backyard gardening and livestock raising wiD beprovided. To fully utilize the produce from the garden, the programme willbe accompanied by a strong mrtrition education component to teach households on the nutritional value oftheir produce, together withthe manner ofpreparation, recipes, etc. The other instrumentalities ofthe government suchas the schoolsand local govermnent will play an important role in promoting home gardening in communities, schoolsand homes. The NGOs willalso contribute to the promotion ofthis programme. In support ofthe programme, the Departmentof Agriculture will continue to conduct research on new varieties ofnutritiousvegetables and fruits that can be grownin home gardens. 5. Potable Water and Environmental Sanitation Programme The programme ofPotableWater and Environmental Sanitation is intended to reduce the problem ofdiarrhoea and other infectious diseases which are majorcauses of malnutrition in children. While the necessary infrastructure in the form ofsolar pumps and handpumps will be the responsibility ofthe Water Engineering Unit of the Ministry ofWorks and Energy along with the PUB Waterand SewerageEngineering Unit, a strong educational campaign will haveto be waged to change habits in personal hygiene and waste disposal. Thus the Department ofPublicHealthparticularly the Environmental Health Inspectors in the field together with theMinistry ofEnvironment and Social Development as wellas the Ministry ofHome Affairs will have majorroles. Monitoring the safety of water and food supply will be vigorously pursued by the Department ofPublic Health. .-.." ~r/ ·:;j·tlil- 11 support Strategi.es 1. Buman Resource Capability Building for Nutrition In order to fully support this PIan ofAction for Nutrition ofKiribati, the human resource for such a nationalundertakingwill have to bedeveloped. Thus the strategy ofHurnan Resource Capability Building for Nutrition is meant to build the human infrastructurecapable ofdelivering nutrition servicesand messages to the targets and carryingout the projects and activitiesunder the Plan. The main responsibility for carrying out and coordinatingthis strategy will rest on the National Nutrition Center of the MHFP, with the collaboration ofother Ministries and the NGOs which have responsibilities related to nutrition. Targets for nutrition trainingand orientation are all national and field personnel carrying out nutrition projects and activities. School teachers will especially be targeted. If necessaryan echo-type training strategy will beemployed. Orientation of decision makers, middlelevel managers, community leaders, women's clubs and similar groups will be carried out to generate maximum support for the programme. The staff and volunteers ofNGOs concerned with nutrition activities will also be the subject of trainingand orientation. z. Resource Generation Resource generation will be the responsibility ofall agencies implementing the nutrition programme. This strategy, however, will be led by the National Food and Nutrition Committee with the support of the Ministry ofFinanceand Economic Planning. Additional sources offunds will need to be raised from NGOs and bilateral and international agencies. 3. Nutrition Surveys, Statistics and Research 00--:' Large scale nutrition surveys to determinethe nutritional status ofthe populationhave been carried out at least 8 yearsago. The National Nutrition Survey covering 22% of householdswas done in 1985,while the Vrtamin A Survey was conducted in 1989 in six islands ofKiribati. In fact the Dietary and Cardiovascular Disease Surveywas done in 1981.Without more recent data, it will be difficult to do efficient planning not to mention evaluation ofprogramme impact. Thus it will be highly desirable ifa national nutrition survey can becarried out in 1997 or early 1998. Support for such an activity should be sought from NGOs such as FSP or bilateral and international agencies. Such a survey should be led by the National Nutrition Centre. This will, however, require ~ •• r 1'" ., ,..".... .• cutcr-ccu..atry tlciiiiiiii; VI lnc Ceuu e 5 starr to iean me survey. In addition to the conduct of nutrition surveys, the various Ministries concerned with food and nutrition will endeavor to gather as much relevant statistics as possible from their own reporting systems. Thus health statistics on morbidity and mortalityas well as on health services will come from the MHFP; agriculture statistics on food *,~-~~-- .. -12 .-' production and supply will come from the Ministry ofNatural Resources; economic statistics including Food BalanceSheets will comefrom the Ministry ofFinance and Economic Planning; emnlovment statistics from the Ministrv of Labour ~ Ernnlovrnent ,.... ... #' • J and Co-operatives, etc. The gathering of scientific research information related to food and nutrition will be the responsibility ofthe National Nutrition Centre in collaboration with relevant agencies locally and abroad. Information on composition of local foods, food consumption, food habits and practices, available local foods, and similar data are indispensable in nutrition infonnation and education programmes. 13 Li.nkages wi.th Other Sectors Ministry of Environment ami SosiaJ Development Social,culturaland environmental factors haveconsiderable influences in the health and nutrition situation ofa society. The Ministry ofEnvironrnent and Social Development will have the task ofidentifying the social, cultural as well as environmental problems related to nutrition. In linewith their function, the Ministry will undertakenutrition improvement programmes through community organizations particularly women's groups and NGOs, integrate nutrition into their trainingactivities, and collaboratein the monitoring ofnutrition programme in the community. The Ministry will pay particular concern with food-related behaviour, taboos and other culturalbeliefs and practices. Ministry of Edpcation. T!JIjpipl.nd T«hDgIogy Since the population structure ofKiribati is young and expansive, a largeproportion of the population is in school. Thus the educational systemis an excellent channel for healthand nutrition improvement. Besides leading the programmeofnutrition education in schools particularly in the inclusion ofmrtrition into the school curriculum, the Ministry ofEducation, Training and Technology will have the task ofidentifying knowledgegaps in nutrition among 1 Kiribati, Moreover, the Ministry will integratenutritioninto the schoolhealth programmes and implement nutrition-related activities such as school gardening and livestock raising, school feeding and quality control offoods soldin schools. The :Ministry will assist in training activities and collaborate in the evaluation ofprogress of nutrition-related activities in the Ministry's area of responsibility, Ministtv o{Natun! Resogrtes and Development The majority of l-Kiribati live on the outer islands and in a subsistence based economy. It is therefore imperative that natural resources especially agriculture and fisheries shouldbeoptimally developed as sources of food. The MinistryofNatural Resources and Development will continueto identify appropriate varieties oflocal crops that can begrown in Kiribati, determine nutritional valuesof local foods, and look for ways ofimproving agricultural and fisheries production and marketing. The Ministrywill continueeducating the community in the production ofappropriate crops for local consumption and marketing. It will also concern itselfwith livestock ~i'1g as well as fishing technologies, includi..~g handling, preservation and marketing. Furthermore, the Ministry will support nutrition training programmes ofother Ministries. 14 Ministry of IIlformagon, Transport and Communigtion Efficient transportation andcommunication is still a problem in Kiribati with its widely scattered islands. The Ministry of Information, Transport and Communication hasthe task of identifying problems in these areas to help improve the transport, storage and marketing offoods. Accordingly the Ministry win be mainly concerned withefficient passageof food, goods and services, ensuring regular shipping schedules. It will also assist in the development ofinfonnation resources such as brochures, pamphlets. etc., needed in the nutrition information campaign. Migistry QfLabgur, ImpJoxmeat aad Co-qgvatives It is estimated that out of the total working-age population of37,OOO in Kiribati, only 8 thousandareemployed in gainful and productive occupations. The task ofthe Ministry is not onlyto assess the rate of employment in productive occupations more accurately, but to identify occupational opportunities locally and abroad. The Ministry promotes skills training such as the training ofmarines for merchant ships and fishing vessels. Foreign employment ofa significant number of the labourforce in these areas are in fact helping significantly in the economy not only of their families but ofthe country as a whole. Moreover. the Ministry is promoting resettlement to the outer islands and instituting replanting schemes. MiDistrv of Commuq, Iod"m aDd Tourism The trade activity in Kiribati is dominated by imports. According to the 1995 trade report, trade import bill is 1500A. the valueofall locally producedexports. The consumersare faced with highpricesofessential connnodities sold in shops, not to mention the health problems causedby unhealthy imported goods. Prices of local products arehigh because of their scarcity in the local market, yet theyareexported to nearbycountries. In linewith its function, the Ministry ofCommerce. Industry and Tourism therefore concerns itselfwith controlling pricesofessential commodities through pricelisting. It is also involved in the identification and screening of short shelf-life imported foods in order to protect the consumers. To further ensure the protection of consumers, the Ministry will draft legislation in tins area and establish the Consumer Council of Kiribati. Furthermore, theMinistry will encourage internal trade. disseminate trade information to other countries, promotelocal enterprises in food manufacturing and marketing, and encourage the consumption of local foods. Ministry of Home AfTain pd Rural Dndogmeut Considering that more than a third ofthe population of Kiribati live in the outer islands, the Ministrv of Home Affairs and Rural OewoJopmP.nt 'wi!! be ableto substantially contribute to the nutrition improvement effort through its urban and rural development programmes. By identifying ruralproblems in nutrition, the Ministrywill incorporate nutrition improvement programmes into its Outer Island Development Plan for each island. Moreover. the Ministry coordinates community development programmes involving agriculture and fisheries, health and sanitation, women and 15 youth, and transport and equipment. It will also contribute to the training oflocal leaders in community development where nutrition activities could be incorporated. Ministry of Finance and Economic Planning The Ministry ofFinance and Economic Planning and in particular the Planning Office will be responsible for determining the country's socio-economic situation and incorporating nutrition considerations into the National Development Strategy (NDS). The Ministry will also assist in securing funds for appropriate projects related to nutrition from external and internal sources. To support the above activities, the Planning Office will undertake research on socio-economic strategies, in addition to screening all matters, activities, studies and programmes and aid documents related to nutrition issues. Ministry of Works and Energy The Ministry ofWorks and Energy has a great contribution to good nutrition through the provision of safe water and good sanitation system. The Ministry will continue to install solar and hand pumps in the outer islands including primary and secondary schools. It is expected that the coverage of the outer islands will be complete by 1997. A proposal had been put for an ADB loan to improve the water and sewerage system in South Tarawa through the PUB. Moreover, the Ministry will conduct research and development on toilet facilities as well as low cost cooking systems, equipment and facilities Non-Governmental Organizations NGOs such as the Foundation for the Peoples of South Pacific (FSP) and others operating or may operate in Kiribati, are in a unique position to bring an integrated approach to nutrition activities. Integrating nutrition projects into their community development activities will be a very useful contribution to the government's nutrition effort. Thus the NGOs can undertake skills training involving small scale agriculture, backyard gardening and composting including the provision of cuttings and seeds at low cost. The NGOs can assist in educating the community on proper nutrition, cooking new recipes, and health practices particularly in diarrhoea. Moreover the NGOs can also assist in seeking funds for surveys in nutrition, and in providing audiovisual materials for nutrition education and training. To support these activities, the NGOs will work together with the Ministry ofHealth and Family Planning, the Division ofAgriculture, PRAP, and other government agencies, as well as community groups such as mothers' clubs, youth groups, etc. ;= 16~----r Monitoring and Evaluation Continuous monitoring ofall nutrition activities in Kiribati will be carried out by the National Nutrition Centre. A systemofregularand periodic submission of reports from the variousMinistries and NGOs engaged in nutrition activities will be established. Collation and analysis ofthe reports willbe done to assess programme progress and evaluateimpact. Weaknesses, problemsand constraints will be identified and solutions proposed. Feedback to the agencieswill be done through the National Food and Nutrition Committee and solutionsthreshed out. Impact evaluation will be done every year as a basis ofnext year's programme planning. After each evaluation, a reviewof the NPAN will be conductedby the NFNC and appropriate adjustments to the plan made. ~;17 ...>&4 Organizati.on and Management The NatioD8l pian of Action for NutritionofKiribati will be managed centrally by the National Food and Nutrition Committee (NFNC)whichwill serve as the advisory body to the Government ofKiribati on all matters relation to nutrition. The NFNC shall have the following functions: 1. Coordinationand planning of aU nutrition activities ofthe government and private sector for the improvement oftbe nutritional status ofall I-Kiribati. throughinter sectoral collaboration; 2. Identification ofnutrition problems and their solution; 3. Formulation of integrated policy proposals to government related to food supply, food storage and transport, food demand and biological vulnerability; 4. Instituteeducational and promotional activities for the people ofKiribati to spread the principles ofpropernutrition and improvedietarypractices; 5. Organize workshops, orientation and training involving decision makers, middle level supervisors, and the implementors ofnutrition in the concernedsectors; 6. Screenall matters, activities, studies,aid programmes and documents related to nutritioninternally and externally and provideclearance for government; 7. Conduct long-termnutrition and food researchfor future developmental improvements; and 8. Monitor and evaluate progressofall nutritionactivities. The compositionofthe Committee shall consist of(but not limited to) the following: Chairman: Secretary: Members: DirectorofPublic Health Services, M.HFP Nutritionist, National NutritionCentre,MHFP Representatives of: Health Education Unit, MHFP Environment and Sanitation Unit, MHFP District Principal Nursing Office, MHFP Ministry ofCommerce, Industryand Tourism ".- --6.- ~r..J .- ,...... • - • • mifU.ua j V1 cuu\;a.UUJI, 1 rammg ana 1ecnnoiogy Ministry ofLabour, Employment and Co-operatives Ministry of Information, Communication and Transport Ministry ofHome Affairs and Rural Development Ministry of Financeand Economic Planning Ministry ofEnvironment and Social Development Department ofAgriculture. MNRD Department ofFisheries. MNRD Energyand Water Unit. MWE Atoll Research Programme. USP Pacific Regional Agriculture Project Foundation of the PeoplesofSouth Pacific K.M.K. The Committeeshall meet at leastonce every quarter. TheCommittee shall be served by the National NutritionCentre actingas its Secretariat. - - --- - ,""-,-.,, 19 .'. "':-.~"-- ~~ Budgetary Requirement (1991-2 0 0 1) • Government of'Kiribati • Othersources &