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Workshop Report

The Development and Implementation

of

Intersectoral Food and Nutrition Action Plans and Policies

19-23 February 2007

Suva, FIJI

SPC and WHO in collaboration with UNICEF

with funding support from

Japanese International Corporation Agency (JICA)

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NPAN 2007 Community Education Training Centre,

Narere Suva FIJI

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Summary This is the 4th sub-regional workshop being held in the region. The five countries that were invited to participate included Fiji, Commonwealth of the Northern Mariana Islands (CNMI), Tokelau, Niue and Nauru. Each country nominated at least 3-4 participants, one each from the following sectors – health, education, agriculture and planning and economics. The workshop was organized by the Healthy Pacific Lifestyle Section of SPC, in collaboration with WHO and UNICEF with funding support from the Japanese International Corporation Agency (JICA), WHO and SPC During the five day workshop, issues related to the successful development and implementation of national plans of action and policies on nutrition were explored. This included: the historical basis and needs for national plans of action on nutrition, essential components of plans and policies, using emerging issues such as NCDs to promote nutrition plans, developing successful partnerships and advocating for support and action. The workshop was participatory in nature, with the participants mainly working in country groups to explore issues. Plenary feedback sessions allowed time for further discussions of points raised and sharing of ideas amongst country representatives. Ultimately, the country participants worked to review their existing plans and policies relating to nutrition, and to set plans for its update or improvement. They also developed plans for activities needed to ensure that their plans would be fully implemented, which is often a particular difficulty. Support will be provided by SPC and WHO over the forthcoming months which may include a follow-up visit to assess progress and assist each country. SPC has also established a small grants scheme which countries can apply for to help implement one of the activities planned at the workshop. Evaluation of the workshop by participants was positive, and progress over the next six months will indicate the impact of this workshop on national plans and policies on nutrition. Acknowledgements The Healthy Pacific Lifestyle Section of SPC would like to thank JICA and WHO for their financial support of this workshop. In addition, we would also like to express our appreciation to WHO for assisting with the travel arrangements for some of the participants. We would also like to thank the Administrative staff at the SPC Nabua and CETC campus for their support. Contributions from UNICEF and the JICA Expert to facilitate some of the workshop sessions were much appreciated.

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Contents

SUMMARY 3

CONTENTS 4

INTRODUCTION 6

OPENING SESSION 8

SESSION 1: INTRODUCTION 10

Activity 1.1: Introduction 11

Activity 1.2: Describe the importance of food and nutrition for health 12

Activity 1.3: Food news 14

Activity 1.4: Understand food supply chain and how it has changed in the region in last 20 years 15

Activity 1.5: Examining the influences on the food supply chain, and on what people eat 17

Activity 1.6: Food security 19

SESSION 2: FOOD AND NUTRITION PLANS AND POLICIES 20

Activity 2.1: What is food and nutrition policy? 21

Activity 2.2: Understanding 1992 International Conference on nutrition (ICN) commitment 22

SESSION 3: DEVELOPING INTER-SECTORAL AND INTEGRATED NATIONAL FOOD AND NUTRITION PLANS AND POLICIES 24

Activity 3.1: Linking NCD plans and policies with nutrition plans and policies 25

Activity 3.2: Assessing existing food and nutrition plans and policies 27

Activity 3.3: Identifying relevant Government policies and plans 31

Activity 3.4: Elements and Barriers for success 32

Activity 3.5: Relating emerging and re-emerging issues with food and nutrition plans and policies 34

SESSION 4: ADVOCATING FOR ACTION 36

Activity 4.1: Advocacy overview 37

Activity 4.2: Information systems 38

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Activity 4.3: PROFILES 39

Activity 4.4: Advocacy: selling your idea 40

SESSION 5: FORGING PARTNERSHIPS 42

Activity 5.1: Review Past Experiences of Partnerships 43

Activity 5.2: Discovering Possible Partners 44

SESSION 6: PUTTING PLANS INTO PRACTICE 46

Activity 6.1: Reviewing current NPAN and national needs 47

Activity 6.2 & 6.3: Develop an operational national food and nutrition plan 48

SESSION 7: REVIEW AND EVALUATION OF THE TRAINING COURSE 63

Activity 7.1: Review and evaluation 64

APPENDIX 1: LIST OF PARTICIPANT AND FACILITATORS 65

APPENDIX 2: WORKSHOP PROGRAMME AGENDA 71

APPENDIX 3: PRESENTATIONS LIST 75

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Introduction

Aims The course aims to help to build capacity in countries to develop and implement multi-sectoral national policies and plans of action for nutrition (NPAN). Learning Outcomes This training course focuses on developing effective and sustainable national food and nutrition plans and policies. At the end of this training course, participants should be able to:

• Assess food and nutrition plans and policies. • Develop effective and sustainable food and nutrition plans. • Promote implementation of food and nutrition programmes of action.

Background The 1992 International Conference on Nutrition brought together 159 countries in an effort to eliminate hunger and to reduce all forms of malnutrition. This conference agreed nine key strategies and actions to tackle these problems. In follow-up, the 1996 World Food Summit brought together many countries and confirmed this general perspective, and linked the strategy more firmly with the goals of poverty eradication and environmental protection / sustainable development. The Final Declaration of the WFS is a key document, alongside the ICN. Nutritional plans and policies when developed at a national level can be an important and effective tool in ensuring national action on dealing with nutritional issues. The main strands of a nutrition plan can also incorporate healthy lifestyles, particularly physical activity. As such they are important within the Pacific region for tackling the issues of under-nutrition (such as anaemia and failure to thrive) and also in the growing problem of noncommunicable diseases such as diabetes and heart disease. The underlying principles for a good food and nutrition plan and policy are:

1. To have “joined up” food and nutrition plans and policies that include the elements that meet the needs of good nutrition, food safety, sustainable food supply and healthy lifestyles.

2. To have food and nutrition plans and policies that address on the one hand the ill-health associated with under consumption, and on the other hand the ill-health associated with over and unbalanced consumption.

3. That the plans and policies are intersectoral in thinking and interagency in delivery.

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Outline of course content The course includes:

• Global dimensions of food and nutrition plans and policies, including factors that influence the food supply chain

• Linking NPANs with existing policy and strategy commitments, • How to address barriers to change and how to develop/implement/follow-up food

and nutrition plans and policies, • How to access and use monitoring and surveillance systems, • How to use advocacy to achieve goals • Partnerships, and how to garner support.

Participants who complete the training course will be equipped with the skills necessary to help develop, update and implement intersectoral food and nutrition plans and policies at the national or local level. Learning method The learning method encourages participants to carry out activities, as a way of finding out and learning about food and nutrition plans and policies. Participants work in groups, according to various criteria, allocated by the facilitator. Everybody is encouraged to participate and contribute to the overall conclusions. Participants Participants at this forth sub-regional workshop were from Fiji, Tokelau, CNMI, Niue and Nauru. Each country was asked to nominate 3-4 participants representing different sectors - to include Health, Agriculture, Education, Planning, or other relevant sector. The participants were requested to be policy makers or their advisors. A full list of all participants is included in appendix one. Unfortunately, only one participant from CNMI made it to the workshop. Two withdrew due to other commitments and one made it as far as Japan and had to return home the next day due to serious ill health. Organisation The workshop was organised by the Secretariat of the Pacific Community (SPC)'s Healthy Pacific Lifestyle Section (Karen Fukofuka, Nutrition Adviser) in collaboration with WHO. Wendy Snowdon was contracted by WHO to provide overall facilitation for the workshop. Other facilitators were Dr Chizuru Nishida (WHO Geneva), Dr Temo Waqanivalu (WHO, Suva), Dr Rosa Sa’vaga Banure (UNICEF), Ms Chieri Yamada (JICA Expert), Dr Viliami Puloka (SPC). Administrative assistance was provided by Anne Sloan (WHO, Suva), Marie-Ange/Jennifer Corigliano (SPC) and Aliti Samu (CETC). Funding was provided by JICA, WHO (Geneva and Manila offices) and SPC.

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Opening Session The opening was attended by all the participants, facilitators and representatives from WHO, JICA and UNICEF. The workshop was opened with a devotional word and a prayer. Mr Falani Aukuso, Deputy Director General, SPC formally welcomed all the participants with a traditional Tokelauan chant. (See Appendix 2 a detailed copy of the programme agenda) Opening remarks were then given by Mr Tetsuhiro (JICA), Dr Kamrul Islam (UNICEF and Dr Chen Ken (WHO). They welcomed all the participants and issued them with a challenge to keep in mind the objective of the workshop to develop “action plans”. Plans can be developed but useless if not actioned. Support of assistance to “action” plans developed in the workshop was also pledged to participating countries. Country participants were told not to hesitate to ask for assistance from any of the represented organisations (WHO, JICA, UNICEF and SPC). The opening presentation from Dr Chizuru Nishida (WHO Geneva Office) set the scene for the workshop with the historical background of NPAN. International Conference on Nutrition (ICN): FAO & WHO 1992. Day1\Opening remarks CN.ppt

• First global intergovernmental conference on nutrition • Strong regional and country focus. • Over 150 countries worked to coordinate in-country reviews of their national

nutrition situation. • Also meetings was held in all regions of the world during the first quarter of 1992, to

provide basis for developing the Global Plan of Action adopted by the ICN • August 1992: first meeting: 700 participants. • December 1992: ICN, Rome: 1300 participants : adopted the World Declaration and

Plan of Action for Nutrition - based on 9 goals and 9 strategies as global priority nutrition action areas - gave a technical framework for the prep NPANs.

What has happened since then: • The World Food Summit: Rome 1996 reiterated and reinforced the ICN commitment.

By December 2006, 76% of WHO’s Member States had final or draft NPAN. • Regional review undertaken in 1996-2001 identified the following obstacles to

planning: • Low priority of nutrition in the governments • Lack of coordination among ministries concerned • Lack of local experts • Political instability • Lack of reliable data on food and nutrition

• Elements of success were identified as:

• Official government adoption and political support • Intersectoral coordination mechanism

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• Prioritisation of activities and designation of responsible sectors/ministries • Ability to translate plans into action • Incorporation of monitoring and evaluation mechanisms

Futures actions identified by Western Pacific Region include:

• Review/revise/endorse national food & nutrition plans & policies • Incorporate nutrition activities into other programmes and into national

development & economic plans • Develop/strengthen intersectoral collaboration & coordination • Strengthen advocacy at all levels and raise awareness among decision-

makers i.e. use of “Profiles” • Seek/allocate/increase funding for nutrition activities • Strengthen training & capacity building in nutrition

The challenges:

• The key challenge is intersectoral policy coherence o Bring together coordinated action:

• Enhance the effective use of limited resources (both financial and human)

• Can address the problems of the double burden of malnutrition in effective manner

• Contribute to the alleviation of poverty and facilitate national development

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Session 1: Introduction Aims This session aims to:

• Break the ice • Find out who is on the course • Set the scene

Learning Outcomes. At the end of this session participants should be able to:

• Identify their own role in relation to the food supply chain • Explain key issues in food and nutrition

Day one was devoted to setting the scene by looking at the background of NPAN and why nutrition is important for health and development.

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Activity 1.1: Introduction Learning Outcomes At the end of this session each participant should be able to:

• Identify most course participants Presentation. Day1\Activity 1.1 Introductions.ppt Review of Course Content. Viliami welcomed all the participants to the workshop proper after morning tea. He reviewed the course content and the programme for the workshop. All participants were provided with a folder containing all relevant materials for the workshop. Administrative arrangements were also reviewed at this time. Physical Activity. The participants were also encouraged to be physically active throughout the week. Each one received a pedometer which was used to record the number of steps taken everyday. The total number of steps taken by each participant was recorded and those who walked the most were rewarded. It was a fun way of introducing physical activity into the training programme. Activity Participants were asked to work in pairs for 5-10 minutes and prepare to introduce each stating where they’re from, their role and what they expected to get out of the workshop

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Activity 1.2: Describe the importance of food and nutrition for health

Learning Outcomes At the end of this activity, participants should be able to:

• Identify some of the main effects of nutrition and food on public health • Appreciate the importance of good nutrition for health and countries' economies • Highlight how the four pillars encompass all key areas.

Presentation. Day1\Activity 1.2Nutrition and Health.ppt Dr Temo presented an overview of the importance of nutrition for health. Pacific health is in transition reflecting the rapid changes in what people are eating, changing lifestyles and the resulting health consequences resulting in the increasing double burden of disease due to both under and over-nutrition. Activity A Participants were divided into two groups to brainstorm the positive and negative impacts of food and nutrition. Feedback from the group work led into a discussion on the importance and the wide-ranging effects of food and nutrition in the Pacific and the need to develop comprehensive national plans of action for nutrition. Group 1

Negative Positive Increasing NCDs such as:

Diabetes High blood pressure Gout Overweight Obesity

Tooth decay Economic status of the family will be affected Malnutrition – under & over nutrition Increasing medical costs Increasing death rate due to NCDs

Longevity Improved cognitive development Energetic Look nice & healthy and happy Reduce NCDs Reduce medical costs Reduce mortality rate

Group 2 Negative Positive

NCDs Diabetes High blood pressure Cancers CVDs Poor oral/dental health

Disabilities Limited resources Malnutrition

Micro-nutrient deficiencies

Low mortality rates High productivity Less medical costs Wiser – improve mental health happier, less stress less domestic problems enjoy life less crime committed decrease in NCDs security – social + economic

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Under-nutrition High mortality rate High medical costs

– economic implications – low productivity

Poverty cycle Activity B Participants were then asked to consider the definitions for the following terms and how they cover the issues discussed above. These themes can be used as overarching areas for action:

Nutrition Food Safety Sustainable Food Supply – Food Security Healthy Lifestyle

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Activity 1.3: Food news Learning Outcomes At the end of this session each participant should be able to:

• Identify main food and nutrition concerns for public. Activity Participants were asked to look at some local news stories that had been collected by the facilitators which were directly or indirectly related to nutrition and health. They worked in random groups and were asked to feedback what they thought were the main themes of interest to the public and media. Main themes discussed included:

• Media interested in what sells, sensational news items • Human element • Current events • Advertisements aim to sell product

The media is often viewed as an adversary (promoting unhealthy products, mis-representing/misquoting health information) rather than as an ally. In order to engage the media as an ally, we need to understand how they work so we can influence how health messages are portrayed to the public. The media can be a very effective advocacy and communication tool if we know how to use/engage it properly. Advocacy is covered in more detail later in Session 4. The media is a key partner in social marketing.

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Activity 1.4: Understand food supply chain and how it has changed in the region in last 20 years

Learning Outcomes At the end of this activity participants should be able to:

• Describe the food supply chain • Explain how food supply chain has been changing in their country in last 20 years.

Presentation. Day1\Ativity 1.4 Understanding Food supply chain.ppt An overview of the food supply chain was given by Wendy. The food we eat affects our health for good or for worse so it is important to understand the processes involved in how the food ends up on our plates. The processes can be very short one (from garden ->kitchen ->plate ->body) or very long via a processing factory somewhere before it gets transported to where it’s sold for preparation for consumption. To change our diet we need to change what we eat, which means we need to change our food supply to ensure that the food we eat is not only healthy but safe from other contaminants. We need to consider how our food is being processed to make sure that its nutrition value is not severely compromised to a point where what we end up with on our plate has very little nutritious value at all. Activity – Group feedback: Participants worked in country groups for this activity and looked at how the food supply chain in their country has changed over the last 20 years. Past:

• short food supply chain • less processing activities • plenty of root crops • subsistence farming • cooking method – labour intensive • local or grown own food • very few fast food outlets

Present:

• fast foods increasing • increasing processed foods, packaging => medium to long food chains • � new crops, GM, technology • tourism influence • market driven, in-country food processing • � imported foods, increase access to imported foods • Changing demographic => increasing demands for imported foods

Future:

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• Some countries returning to what it was like 20 years ago, but not by choice, rather more due to changing economic situations

• For most countries it is more of what’s happening now. • More processing =>even longer food chain, more complex ingredients (artificially

produced, not grown naturally) • Some countries starting food processing as part of economic development

The transition from short-medium food chains (subsistence farming) to long food chains (imported highly processed) has contributed greatly to changing health profile of the region. Increase reliance on imported foods has come at the expense of locally grown produce as we have become accustomed to buying food from the shop rather than growing our own. The Nauruan experience is the exception to the general trend of moving to much longer food chains. The change in Nauru is not by choice. Changes in economic circumstances now force people to look at growing and processing their own food for consumption, thereby shortening the food supply chain, instead of buying ready to eat food from the shops as they were used to. Other changes included some countries starting their own food processing industry as a means of promoting economic development rather than as a means of improving food supply. Most of the processed products are exported overseas.

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Activity 1.5: Examining the influences on the food supply chain, and on what people eat

Learning Outcomes At the end of this activity participants should be able to:

• Identify factors which influence people's diets • Recognise the need for national food and nutrition plans and policies

Activity A: This activity was facilitated by Ms Cheiri Yamada (JICA Expert) and it flowed on from the discussions in the previous group activity. Using the food supply chain model supplied, participants discussed the main forces that drive the food supply chain.

Agricultural Input FAO, World Bank, money lenders, Department of Agriculture, Fisheries and Forestry, Reef shipping, hardware shops, Agricultural supply shops, fishing supply outlets

Food Production Govt Departments (agriculture & fisheries, lands & survey), land owners, land trusts, SPC, farmers, fishermen, community people

Food Processing Food industry, butcher, Bakery, household (main person responsible for food preparation in the home), farmers

Distribution Transport industry, Private transport, SDA church, supermarket, stores (wholesale), households

Food Retailing Shops Markets Food vendors

Food Catering Schools Restaurants Tourism industry Hotels, resorts Hospitals Government Home Food Preparation

Family Individuals Villages Communities

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Activity B. Working in groups, participants were then asked to discussed what they felt influence what people eat. Following this feedback, a group discussion was used to draw out possible policy approaches to tackle these problems. This highlighted the need to consider all the different factors that can help to ensure that a nutrition plan is sufficiently comprehensive to truly tackle the problems.

What food can the household

access?

Food consumed by individuals

Foods households & individuals choose to

purchase

Availability • Food in

shops/markets • Seasonal

availability • Environment • Climate • Land • Gardening • livestock

Information • Advertisements • Nutrition labels • Health education • Knowledge • Prices

Food preparation practices

• BBQ • Pre-cooked • Heat & eat • Skills • Equipment • Facilities • Energy • time

Access/Affordability • Transportation –

road, air, sea • Food prices • Income • Domestic storage • Weather • Distance • times

Gifts & Benefits • Food supplying neighbouring

hospitality industry, school meals

Choices • Convenience • Levels of

information • Religion • Culture, social

norms • Allergies/addiction • Age • Personal preferences

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Activity 1.6: Food security

Learning Outcomes At the end of this activity participants should be able to:

• Describe the issues with food security for this region and their own country • Consider how food security needs to be improved to secure health and economic

improvements Presentation. Day1\Activity 1.6 Food Security.ppt An overview of food security and the problems experienced in the Pacific was made by Wendy. The presentation highlighted the factors that limit food security, such as reliance on outside food sources, natural disasters and loss of knowledge of traditional food processing approaches. The vulnerability of the physical environment (isolation, soil condition) in the Pacific meant that very few countries have a secure food supply. Most small island countries experienced natural disasters (cyclones, draughts) on a regular basis. Ensuring a safe and sustainable food supply is essential for survival. The increasing globalisation of the food trade has also contributed to the increase dependence on imported foods. Increase reliance on external sources for food meant that external forces can exert greater influence on the kinds and types of food made available for consumers at high prices as well.

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Session 2: Food and nutrition plans and policies

Learning outcomes At the end of this session participants should be able to:

• Describe what are food and nutrition plans and policies. • Outline existing international policy commitments (e.g. 1992 ICN, 1996 WFS)

which are of relevance. The morning of day two of the workshop was devoted to policy and planning (“P-Day” – policy, planning and people). Why planning? Planning helps to reduce uncertainty and provide clear direction for the future – helps you to know where you want to go and how to get there.

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Activity 2.1: What is food and nutrition policy? Learning Outcomes At the end of this activity participants should be able to:

• Identify key features of a food and nutrition policy • Explain the difference between food and nutrition plans and policies

Presentation. Day2\Activity 2.1 Food and Nutrition policy.ppt Wendy gave an overview of the key aspects of nutrition policies and plans and how they are developed.

� A Food and Nutrition Policy is a written statement of commitment by a nation state. � A Food and Nutrition Programme consists of a plan and timetable of action carried out by any sub national organisations. � A Food and Nutrition Plan is an outline scheme for action.

Activity As a group the participants discussed the differences between policies and plans and how the two may be developed separately or together. Discussions highlighted the importance of developing a nutrition policy as well having nutrition issues considered when developing policies. Food and Nutrition policies must be made and not just allow to happen. It’s important to understand the food environment (food supply chain) and the various factors that influence this and impact of the food environment on health. What is the extent of the impact on health? What are the implications of not acting? What is at stake? Why is government involvement or action required? Can someone else, such as a non-profit entity, address this problem? Also nutrition issues are often not considered when policies are being developed, they need to be. For example, Trade and Economic policies may focus solely on economic development and the health impact in terms of nutritional status of the population of such policies are often not considered. Having reliable data and information to guide policy making process to ensure appropriate allocation of resources is also important. More details about this was covered in Session four on Information Systems.

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Activity 2.2: Understanding 1992 International Conference on nutrition (ICN) commitment

Learning Outcomes At the end of this activity participants should be able to:

• see how new commitments and strategies can be related back to the ICN and to a food policy, and can be used to reinforce food and nutrition policies

• See how ICN commitments are reflected within 4 key themes, and can be used together to help develop and assess nutrition policies.

Presentation. Day2\Activity 2.2 Understanding ICN.ppt Dr Chizuru’s presentation emphasised the ICN key strategic priority areas for action.

• incorporating nutritional objectives, considerations and components into development policies and programmes

• improving household food security • protecting consumers through improved food quality and safety • preventing and managing infectious diseases • promoting breast-feeding • caring for the socio-economically deprived and nutritionally vulnerable • preventing and controlling specific micronutrient deficiencies • promoting appropriate diets and healthy lifestyles • assessing, analyzing and monitoring nutrition situations

The four overarching themes as discussed in Activity 1.2:

• Nutrition • Food Safety • Food Security – sustainable food supply • Healthy Lifestyle

Activity In groups, the participants were asked to consider one of the policies/strategies included in the supplementary materials and to indicate how that policy/strategy inter-relates with the nine components of ICN. The group was divided into 4 groups to consider the following policies – HIV, Obesity, MDGS and Cyclones (Natural disasters)

Policy/Strategy INC Components HIV Improve health outcome

Food security Infant feeding Monitor food supply Co-ordinate different agencies Breastfeeding and HIV NPAN helps with HIV problems => HIV funds can be accessed to implement relevant aspects of NPAN

Obesity (Diet, Physical Activity Global Strategy)

Multi-sectoral approaches – education Incorporating nutrition issues, objectives

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Policy Advocacy Stakeholder involvement Strategic framework for action

Promoting appropriate and healthy diets Assessing, analysing and monitoring nutrition situation Protecting consumers through improved food quality, food security

MDGs Eradicate extreme poverty and hunger Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria and other diseases Ensure environmental sustainability Develop global partnerships for development

Actions to improve breastfeeding, food security, education => reduce child mortality Reduce hunger through actions to improve food security, monitor nutrition situation Incorporate nutrition issues into policies NPAN must be in-line with National Sustainable Development Plans

Cyclones/Natural Disasters NPAN play an important role in any National Natural Disaster Management Plan as people need to have access to safe and nutritious food source Disaster Aid Management – Food Aid specifications to ensure the health of the population post-disaster is not compromised further.

NPAN components cover necessary stages such as policy response, identification of needs During assessment stage – need to consider/take stock of what is in store, what are the needs of the population. How secure is the food supply chain to ensure needs of the population are met when disaster strikes? Having a national plan of action for nutrition will help to ensure that this is addressed.

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Session 3: Developing inter-sectoral and integrated national food and nutrition plans and policies

Aims This session aims to:

• Look at building links between nutrition plans/policies with other relevant ones e.g. NCDs

• Link the four key themes into an inter-sectoral national food and nutrition plan and policy.

• Produce an outline of other relevant existing plans and policies. • Identify key elements for success for policies and plans.

Learning Outcomes At the end of this session participants should be able to:

• Recommend how best to link/inter-relate existing and future strategies and policies with nutrition plans and policies

• Recommend the best approaches for success This session was introduced in day 2, where the group was introduced to the potential of linking NPAN and NCD plans together. It’s acknowledged that Pacific Island countries are facing a double burden of nutrition related disease – under-nutrition (micronutrient deficiencies) and over-nutrition (obesity and obesity related diseases). Therefore, it is essential that the two are linked or integrated into one plan where all nutrition issues are comprehensively addressed. Prior to attending the workshop, participants were asked to prepare a short presentation of the current situation in their countries with regards to food and nutrition policies and plans which they shared with the rest of the group during one of the activities in this session.

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Activity 3.1: Linking NCD plans and policies with nutrition plans and policies

Learning Outcomes At the end of this activity participants should be able to:

• Consider how best to interlink NCD plans and policies with existing nutrition plans and policies for their country

Presentation. Day2\Activity 3.1 NCD and NPAN.ppt Dr Temo facilitated this activity looking at NCDs and Nutrition plans and how they are interlinked. Although the focus of the presentation was on over-nutrition, it was acknowledged that in most Pacific countries BOTH under and over-nutrition problems are present. The burden of disease due to NCD places the Pacific on par with other developed countries such as US and Australia. Dr Temo highlighted the fact that the NCD is a neglected epidemic reflected in the current deployment of resources favours curative services rather than preventative activities. NCD prevention framework looks at addressing the key risk factors that caused diseases such as diabetes and heart diseases. The key NCD risk factors are Diet, Physical inactivity, Tobacco Smoking and Alcohol. He also noted that nutrition disorders are chronic disorders. The key principles he outlined for NCD prevention framework were:

• Comprehensive and integrated public health action : o Employs population & individual approach o Covering all risk factors

• Multi-sectoral in planning and implementation • Life Course Perspective

o ‘Womb to tomb’ approach • Prioritised for the most vulnerable and in need

o Don’t have to do everything in one go • Evidence Based

o Consider STEPS and other information available • Simple

o Keep it simple The five priority areas identified for action in NCD Planning are:

• Nutrition/Healthy Eating/Healthy Food choices • Physical Activity • Tobacco • Alcohol • MONITORING, EVALUATION & SURVEILLANCE

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He also noted that: • In one country

� National Strategy on NCD � National Strategy on Nutrition � Multisectoral body on NCD � Multisectoral body on Nutrition

• Usually driven by o SAME PERSON AND INSTITUTION

He strongly advocates ONE COUNTRY, ONE PLAN, ONE MULTISECTORAL BODY FOR ONE PEOPLE ON ISSUES OF SIMILARITY AND OVERLAP. Some countries have decided to do this and he gave examples from Marshall Islands, Nauru, Cook Islands. Incidentally, a news article “the worlds fattest countries” came out the very day this topic was introduced and it generated a lot of discussion. Eight of the top ten countries were Pacific island countries. Regardless of how the ranking was done, it reflected the health profile of many Pacific countries and concerted efforts should be on developing comprehensive national plans to address this. The model of multi-sectoral planning approach used here to develop NPAN plans is one good example of how a comprehensive national plan can be developed to address key nutritional areas for action as discussed in Activity 1.2.

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Activity 3.2: Assessing existing food and nutrition plans and policies

Learning Outcomes At the end of this activity participants should be able to:

• Assess successes, strengths and weaknesses of existing food and nutrition plans & policies

A participant from each of the countries presented the status of their national plans and policies on nutrition. (Click on links to see full presentations) Fiji Day2\Activity 3.2 Fiji Country report.ppt The Fiji group were unable to meet together before the workshop to discuss their presentation so all three presented what they had. Pushpa presented from the Health Sector perspective. She gave an overview of the nutrition situation in Fiji based on the unweighted data from the 2004 National Nutrition Survey. She also provided available information on the food supply, indicating that import exceeds export. With that background she provided an update of the activities of NPAN. The Fiji Plan of Action for Nutrition (FPAN) was developed in 1997, endorsed by government in 1998. The key themes of FPAN included:

• Incorporate nutritional consideration, objectives into development policies and plans • Promote and improve household food security • Protect consumers through improved food quality and safety • Prevent and manage infectious diseases • Care for the socially deprived and nutritionally vulnerable • Prevention of specific micronutrient deficiencies • Promote healthy diets and lifestyles • Assess, monitor and analyze the food & nutrition situation in Fiji

FPAN is now due for a review to reflect the changing nutritional profile of the population as a result of changing lifestyles. However, progress appears limited at this point in time due to insufficient resources and limiting political support. Education: Ms Rauca presented some of the nutrition related activities in the education sector. These included:

• Development of Canteen guidelines • Workshop for teachers • 2 books for Cooks and meals for Children

Agriculture: Mr Antonia presented activities that he was aware of that related to nutrition.

• Food security for the home – home gardening projects • Promotion of local foods during World Food day

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Tokelau Day2\Tokelau Country Report.doc Lisa provided some background information about Tokelau.

• Three atolls, largest is Nukunonu • Atolls are 3-5 meters above sea level • Total land mass for Tokelau is 12 km2 • Takes about 2.5hrs to walk around the island • No surface water • Shortage of natural resources • Population approximately 1,500 • Physical environment is a huge barrier • Accessible by boat only (from Samoa)

She then went on to outline the current situation in Tokelau in regards to nutrition: • Very small close knit communities • Each atoll has a hospital • One bulk store on each island, but many small household/family business selling

food items • No specific policies or legislation for nutrition. Imports are determined by a

committee (Health is not represented on committee) • No cars, no restaurants • Public Health staff have access to all households • Over 80% of referrals for specialist care are due to NCD • Dental decay is a real problem – Dental Programme targeting school children • Health Promotion Activities:

• Health promoting schools • Walking programme in schools, health staff (“Healthy Nurses for a Healthy

Pacific Programme”), Diabetes Patients • NCD STEPs survey completed (August – September 2005)

• 63.6% obese • 93% eating less then 5 servings of Fruit and vegetables/day

Tokelau currently does not have a NPAN plan. Nauru Day2\Activity 3.2 Nauru Country report.ppt The Nauruan participants were able to meet together and prepared their country presentation which was presented by Samuel. Nauru is a nation in transition. The influence of western lifestyle during the wealthy times came with a very high health prize tag resulting in low life expectancy and high mortality rates. The Nauru National Sustainable Development Plan launched in 2005 has health as one of its key objectives. The 2004 STEPs survey results showed that only 3% of the adult population consumed the recommended number of servings of fruits and vegetables per day. The STEPs results is the basis for the development of a comprehensive NCD plan with assistance from WHO and SPC. Nutrition is one of the key components in this plan. It’s still in draft but some activities in it are already being implemented. These include:

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• Home gardening • Health Promoting Schools

Its still early stages yet and the group acknowledges that there are many challenges and gaps.

• Strengthen Health Institution and Management Structure • Active Preventive Health Program • Capacity Building • Improved Infrastructure • Implementation of NCD strategic Plan • Human Resource • Community Involvement

CNMI Day2\Activity 3.2 CNMI country report.ppt Presentation was limited as only one participant from CNMI made it to the workshop. Mr. Cabrera acknowledged his limitations; his background is in Agriculture but working in the education sector as an Agriculture Consultant in schools. CNMI’s NPAN was for 1997 -2007 so it needs to be reviewed. He intends to find out when he gets back to CNMI where this is at. Issues he raised:

• Western influence • Los of traditional practices • Nutritional problems – notably obesity among young children • Increase of imported foods • Nutrition programmes in schools ($7million)

o School food programme o Food stamp programme

Niue Day2\Niue country presentation\Presentation.ppt Day2\Niue country presentation\niue educ vision.ppt Day2\Niue country presentation\school curriculum..ppt Day2\Niue country presentation\school lunches.ppt Day2\Niue country presentation\secondary.ppt Day2\Niue country presentation\school wide sports.ppt Day2\Niue country presentation\health circuit.ppt The participants from Niue were fortunate enough to spend some time together as a team before arrival in Fiji, to discuss the situation in Niue. KimRay opened their presentation with a chant and Grizelda and Hannah-Lisa did the presentation. They rounded off their presentation with a song, in true Niue style. Niue does not have a NPAN. However, a National Food & Nutrition Committee was established in the 1980s to organize activities related to World Food day. Other related activities since then included:

• National Nutrition Survey in 1987 • Moui Olaola 1996 (healthy islands initiative) • Moui Olaola Project 2001– 2003 (NZODA)

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• Tama Mana Sports • Matua Manaia

• Editorial page in local paper (no longer active) • Health Council established • Health resource development • Aerobics and physical activity programmes (2003-05) • Village show days • School based activities

• Healthy lunch box • Sports activities

Future plans include establishing a NPAN task force to start developing Niue’s NPAN plan.

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Activity 3.3: Identifying relevant Government policies and plans

Learning Outcomes At the end of this activity participants should be able to:

• Assess their own government’s policy and plans, whether formal or informal • Identify what policies are already in place that promote nutritional well-being • Explain role of four key themes in government action

Presentation. Day2\Activity 3.3 identify other relevant govt policies.ppt Wendy provided a brief outline of what this activity entailed to guide discussions. Just because a policy/strategy is not specifically called “Nutrition” does not mean it does not have an impact on nutritional status. Activity. Each country worked in their group to assess what other plans or policies were in place which had a potential impact on food and nutrition locally. This was to help each team to consider what other documents they needed to take into consideration when looking at their NPAN - and also to highlight how cross-cutting food and nutrition is. The participants then looked at all the different policies and considered how they linked in with the four themes. Some relevant policies:

• Breastfeeding policy – hospital • National Sustainable Development Strategies • School policies • Legislations

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Activity 3.4: Elements and Barriers for success Learning Outcomes At the end of this activity participants should be able to:

• Identify barriers to implementing national food and nutrition plans and policies • Determine successful elements of implementation

Presentation: Day2\Activity 3.4 Elements and barriers for success.ppt This activity was facilitated by Dr Temo who highlighted again the success elements and challenges that Dr Chizuru presented on the first day. Challenges:

• Lack of political commitment & support • Lack of stakeholder involvement • Lack of reliable data

Success factors:

• Official government adoption and political support • Intersectoral coordination mechanism • Prioritisation of activities and designation of responsible sectors and ministries. • Translation of plans into action • Incorporation of monitoring and evaluation mechanisms

Activity In country groups, the participants discussed what have been the factors that have determined the success and the barriers to success for any plans, policies or strategies. For barriers identified, participants were asked to suggest practical solutions to overcoming these barriers. Group feedback:

Barriers Possible Solutions Limited Money/resources/manpower Wise prioritisation

Integration with other Govt ministries Substitution, re-allocation Over-seas agencies Regional organisation

Multi-sectoral involvement/commitment Identify areas of commonalities Legitimisation of plan Early involvement in planning Innovations driving institutions

Duplication of activities and strategies Assessment and evaluation of benefits by countries – e.g. Aid Management Unit Inventory or take stock of existing/current activities

Political instability Flexibility in planning and implementation to

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ensure that plan is stable Consideration of political environment timeframe

Economic situation Prioritisation Sticking to budget Setting realistic goals Avoid duplication Focus on nutrition for healthy lifestyles

Lack of awareness More awareness Communication plan once policy is written

Lack of commitment Ownership Setting realistic plans Advocacy Partnerships – include NGOs

Niue is special Not enough people

Isolation Can be a solution =>limit what goes into the country, control access especially to unhealthy products.

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Activity 3.5: Relating emerging and re-emerging issues with food and nutrition plans and policies

Learning Outcomes At the end of this activity participants should be able to:

• Make links between emerging and re-emerging issues, and food and nutrition plans and policies

• Take these as opportunities to promote food and nutrition plans and policies Presentation. Day2\Activity 3.5 emerging and re-emerging issues.ppt An overview presentation for this activity was prided by Dr Chizuru. The 5 commonly cited factors affecting nutrition status included:

• Infectious diseases • Poverty • Physical inactivity • Changing dietary patterns • Poor breastfeeding practices and food insecurity.

Activity In groups, the participants worked on a given specific emerging/re-emerging issue and discussed how NPAN could potentially assist with this problem and advantages of having an NPAN when such an issue arises. This helped to demonstrate that such emerging issues can actually help to promote NPAN. NPAN would play an important role (if comprehensive) in responding to natural disasters and ensuring appropriate food is provided as well as ensuring the food supply is secure and safe. Changing global context of food and nutrition macro-policy developments can often influence what the country implements or focus its activities on.

Emerging Issue NPAN role A cyclone/typhoon wipes out local crops in an area of the country – immediate action is needed

NPAN play an important role in any National Natural Disaster Management Plan as people need to have access to safe and nutritious food source NPAN components cover necessary stages such as policy response, identification of needs During assessment stage – need to consider/take stock of what is in store, what are the needs of the population. Disaster Aid Management – Food Aid

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specifications to ensure the health of the population post-disaster is not compromised further.

The Government wants to instigate action to work towards MDGs

Actions to improve breastfeeding, food security, education => reduce child mortality Reduce hunger through actions to improve food security, monitor nutrition situation NPAN must be in-line with National Sustainable Development Plans

The Minister of Health/Government decides to tackle the problem of increasing prevalence of obesity and related chronic diseases.

Education – information to the public Promoting appropriate and healthy diets Protecting consumers through improved food quality, food security

HIV/AIDS

Infant feeding Co-ordinate different agencies Breastfeeding and HIV NPAN helps with HIV problems => HIV funds can be accessed to implement relevant aspects of NPAN

This activity concluded all the sessions for day two. We started on time so we were able to

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Session 4: Advocating for action Advocacy and promotion of the NPAN are essential to ensure its success. It is important to include activities which advocate for action, advocate for partnerships and advocate for support. Aims This session aims to:

• Provide an overview of advocacy and what it means • Highlight sources of information which can be used for advocacy for NPANs

Learning Outcomes At the end of this session participants should: Be able to identify key techniques to advocacy Be able to develop some approaches that can be used locally for advocacy. This session started in day three

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Activity 4.1: Advocacy overview Learning Outcomes At the end of this activity, participants should be able to:

• Describe the basic concepts of advocacy • Identify some approaches which would be effective to advocate for NPANs

Presentation. day 3\Activity 4.1 Advocacy overview.ppt Dr Rosa Sa’aga Banuve from UNICEF provided an overview of what advocacy is and how it can be used as a communication tool. She stated that “effective communication results in ACTION; enabling changes in policy, changes in awareness, changes in attitudes, behaviour and practices”. Key things to consider: Issue? is the issue clear Audience? Know your audience, what they believe in, how can you influence them Message? Keep it short and easy to understand Message delivery? Know what the issue it, figures and facts about the issue, be ready with credible answers Channels of delivery? Determine the best medium for your message - visual, auditory, Resources? Is it important to involve partners, who else should be involved, building a broad-based and united coalition will establish a sense of community and empowerment Anything to Develop? Do you have adequate research information to prove your case? Monitoring and evaluation? How do we know if it is working, is the message reaching the right people? Has it made any changes? Make corrections/changes to anything that isn’t working The presentation information provided by Dr Rosa formed the basis for the groups to develop a plan on how they would advocate for action in the next 6 months (Activity 6.4).

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Activity 4.2: Information systems Learning Outcomes At the end of this activity, participants should be able to:

• See why data is needed to inform, monitor and advocate for nutrition policies • Highlight which data sources exist at a regional level • Explain the basic concepts of FIVIMS, PRISM, GIS and STEPS • Use these concepts to help develop and enhance partnerships

Value of data: Why is data of interest for NPANs?

• to assist with identifying priorities (where to focus efforts) • to assist with target setting • to monitor progress and other changes • to assess effectiveness of interventions • to lobby for action by other individuals/agencies

What type of data?

• food related • social and economic indicators • population demographics • health data

Finding the data - the rest of this session looked at some possible sources of information. Presentations day 3\Activity 4.2 FIVIMS.PPT day 3\Activity 4.2 PRISM and GIS.ppt The presentation in this activity focused on PROFILES, FIVISM, PRISM and GIS. The STEPS information was provided early By Dr Temo in the NCD activity. FIVISM –

o Food Insecurity and Vulnerability Information and Mapping Systems, is a FAO programme, designed to monitor food security status

PRISM

• Pacific Regional Information System is a SPC programme • Containing summaries of regional data, templates for developing indexes for

international trade imports data; comparison data. GIS

• Geographic Information System, SPC programme for population data analysis and presentation

• Innovative way of viewing data by mapping population data onto selected geographical areas.

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Activity 4.3: PROFILES Learning Outcomes At the end of this activity, participants should be able to:

• See how data can be used to advocate for NPANs • Be aware of what approaches are more likely to work for politicians and policy

makers Presentations. day 3\Activity 4.3 Profiles.PPT Dr Chizuru provided an overview of what PROFILES is and how it can be used to advocate for NPAN. PROFILES –

• Uses current scientific knowledge to estimate the COST AND EFFECTIVENESS OF NUTRITION INTERVENTIONS

• Estimates the impact on development indicators like mort, morb, productivity • Designed to demo contribution of poor nutrition to problems and of potential impact

of interventions on these problems The spreadsheet-type design allows the country to input key national health and economic data, to provide country-specific information on costs, which can then be incorporated into provided power-point presentations. It’s currently used to estimate preventable economic costs associated with under-nutrition. It is hoped that in the future the profiles system will be expanded to not just cover under-nutrition but also over-nutrition and NCDs. Dr Temo then presented the Fiji example of PROFILES. day 3\Activity 4.3 Fiji Porfiles.ppt These tools would certainly be of great use in the region however it is very much dependent on the quality of the data being entered into these programmes. Quality data is very limited.

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Activity 4.4: Advocacy: selling your idea Learning Outcomes At the end of this activity, participants should have:

• Developed a sample advocacy presentation for NPAN • Be aware of how to use approaches that are more likely to work for politicians and

policy makers. Activity. Working in country groups, participants developed short presentations that could be used to gain the support of someone in-country who was key to the NPAN. This was refined over the next few days and presented on the last day of the workshop. This helped to highlight the importance of knowing key “drivers” or “champions” who could promote the importance of having a national plan of action for nutrition. Time spent in developing advocacy arguments is a valuable investment. Country groups came up with creative ideas of how they would sell their planned activities to their leaders. Niue: Niue developed a short drama on how they would communicate their plan to the Premier who is also the Minister of Health. It is essentially to use all the opportunities (both formal and informal) to talk to the Minister about the importance of having a national plan of action for nutrition. Niue is a very small place and everyone knows everyone. They aim to plan NPAN as part of the NCD plan. Their plan of action was presented as part of the country presentation – Future Outlook Tokelau: Day 4\Tokelau Action Plan.doc The group chose the formal channels of communication (fono) to present their plans to the Council. It is important to gain their approval for activities or whatever they plan will not be acceptable. They also developed an acronym for their communication plan. No to NCD Prepare to fight Accept responsibility Never say never Nauru: Nauru also developed and acronym for their NPAN

Nauru People Always Nourished

They plan to use all available opportunities they have to advocate for the nutrition activities outlined in the draft NCD plan.

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CNMI Day 4\CNMI advocacy plan.ppt Day 4\CNMI NNCD Action Plan.doc Shared how he was going to personally visit the Director of Health to inquire of the CNMI NPAN status through a short skit with the assistance from Dr Temo. He would share with the Director the information he has learnt from this workshop to “push” for a review of the current NPAN plan. He would also share the information with his other colleagues who were unable to attend this workshop. Fiji Only two of the participants (Education and Agriculture) from Fiji were able to share their ideas for Fiji. The other participant (Health) left early due to other commitments. They both agree that the current nutrition plan needs reviewing to reflect nutrition data from the recent 2004 National Nutrition Survey. They also acknowledged that they need to work together.

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Session 5: Forging Partnerships

Partnerships are increasingly seen and found to be the way to progress. The partnerships may be between government and the private sector, public health bodies and NGOs, Employers and Employees, national and international agencies. Aims This session aims to:

• Investigate the potential for partnerships to promote food and nutrition plans and policies

• Identify the problems and opportunities of working in partnership Learning Outcomes At the end of this session participants should: Want to work together! The activities for this session was facilitated by Dr Temo. Partnership is best demonstrated through actions.

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Activity 5.1: Review Past Experiences of Partnerships Learning Outcomes At the end of this activity participants should be able to

• Assess possible partners Presentation. day 3\Activities session 5 Partnerships.ppt Dr Temo presented an overview of the different forms of partnerships.

• Consultation? – yes we need to consult, identify potential partners • Collaborators? Yes we need to work together • Supporters? Yes we need support from others, who may not necessarily want to be

partners • True Partnership?

o Requires effort and resource sharing o Breaks barriers o It is everyone’s responsibility

How many partners?

• As little as possible • As many as necessary

Activity In country groups, participants identified at least 2 organisations with whom most of the members of their group have some experience of partnerships. They were then asked to discuss positive experiences, difficulties and opportunities of working with these partners. Potential partners were those who share a common interest.

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Activity 5.2: Discovering Possible Partners Learning Outcomes At the end of this activity participants will be able to:

• Examine role of NGOs, the private sector, and civil society in the food chain. • Develop possible partners to promote F&N P&P

Role of NGO:

• Voice of the community • Mobilise community action • Inform and act as go-between (between people and government) • Watch-dog role representing citizen’s rights (evaluation and monitoring role

to ensure consumer rights are protected) • Contribute to policy making process as counter balance for social justice

Partnership – what does that mean?

• Equal partnership mean equal share of benefit and responsibilities • Equal value • Share driving • Look for win-win situation, rather then compete • Allow partner to shine • Capitalise on each others strengths

What type of relationship you want to develop with your partners? Who do you want as a partner? How long should the partnership last? How much do you want to invest in the partnership?

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Activity 5.3: Determining which partners to work wi th regarding food and nutrition plans and policies

Learning Outcomes At the end of this activity, participants should be able to:

• Determine which partners may be able to help • Assess how partners can contribute to national food and nutrition plans and policies

Activity Participants worked in country groups to identify two potential new partners for their nutrition policy/plan. They discussed how this partner could be valuable and how to gain their support. This exercise highlighted the importance of thinking widely for potential partners and how to gain their support.

Potential Partner Contribution Fono Key decision makers

Determine finances

NISANOC Healthy lifestyle activities Sports activities Nutritional profiling Provide dietary advice

PTA Catering for schools Data – collect data

Mother’s clubs Education

Provincial Council Establish and support community networks provide data on sports activities, local shops,

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Session 6: Putting Plans into Practice Aims

• Prioritise possible actions. • Develop a strategy for the development of national food and nutrition plans. • Identify actions, areas of responsibility, partners, timing and resources.

Learning Outcomes At the end of this session participants should be able to:

• Start putting food and nutrition plans into action. • Work out who can do what where to support process of implementation.

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Activity 6.1: Reviewing current NPAN and national needs Learning outcome: At the end of this activity, participants should able to:

• Reflect back on key issues raised so far. Presentation Day 4\Activity 6.1.ppt Wendy provided a brief summary of all the main issues covered so far in the workshop.

• Why good nutrition is so important to our communities • The range of factors which affect what we eat • Why multi-sectoral approaches work best – and who we need to work with

(including media) • What is an NPAN? What is a policy. Which first? • What needs to be included in a comprehensive NPAN • How we must inter-relate nutrition plan with relevant other national plans,

policies and also regional and global ones • What we have or don’t have now.

This was to act as a refresher for participants before they moved on to work in country groups to consider where their NPAN/policy was strong and weak. This information was then used for the next activity.

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Activity 6.2 & 6.3: Develop an operational national food and nutrition plan

Learning Outcomes At end of this activity, participants should be able to

• Present proposals to implement food and nutrition plans and policies • State strategic goals for one year’s time

Presentations. Day 4\Activity 6.3.ppt Day 4\Activity 6.3 NCD.PPT Dr Temo and Wendy highlighted the importance of the Monitoring and Evaluation (M&E) components of any good plan. Working in country groups, participants assess where they wanted their nutrition policy and plan to be in one year’s time. Countries with existing NPANs looked at any areas of their NPAN which needed modifying in view of the information that they had learnt during this workshop. Those who don’t have NPANs, considered how to start developing their NPAN or policy. Each country was at a ‘different place’ with regards to their NPAN, however the opportunity to gather advice and ideas from other countries experiences was highlighted during this session, particularly from the countries that were starting the process.

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Tokelau Goals/objectives Activity Time line Person responsible Outcome 1. to present report of intersectoral food and nutrition plan and policy

Presentation of report to the DOH

Presented by 27 Feb Health manager DOH briefed on Tokelau's current status in terms of NPAN

2. to review existing policies that are in place related indirectly or directly to nutrition

Obtain any existing policy from other departments which may have overlapping issues which impact on nutrition (formal or informal)

2nd week of March 2007

Health manager Identifying ways we can utilize the existing policies to our advantage in developing NPAN

3. to develop NPAN using a multisectoral approach

Obtain approval from DOH to involve other departments in the planning of NPAN

Approval to be obtained by the end of March 2007

Health manager Approval obtained

4. involving of departments in NPAN development

Meeting of SMT Presentation by health staffs of a paper to address NPAN

End of March 2007 DOH Health manager

Agreement from all departments to e involved in planning

5. development of policies

Develop policies that will ensure food safety, food security, healthy lifestyle (ask for assistance from SPC, WHO for developing policies)

Presentation of policies to the Council meeting by Nov 2007

DOH, DOE, DOF, DOEnv and fisheries

Policies to be endorsed by council and GF

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Niue Niue outline their future plans as part of their country presentation in Day 2.

1. Establishment of a National Plan of Action for Nutrition task force, with Representatives – DAFF, Health, Education,

EPDS, Youth, NCW, Private Sector.

Terms of reference for the Task Force should include: • Review existing Action Plans, Policies etc… • Ensure objectives are linked to the Corporate Plans and NISP at the national

level. • Ensure objectives are linked to the regional plan of action for nutrition • Emphasize monitoring and evaluation of the plan. • Raise public awareness of the plan

2. Seek technical assistance from relevant organizations such as SPC, WHO, FAO etc to

develop NPAN. 3. Seek Government support through endorsement of the plan by the Cabinet once its

developed 4. All stakeholders to take responsibility of the plan to implement it.

Nauru Nauru’s starting point is the draft nutrition section of their National NCD plan.

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NAURU COMPONENT: NUTRITION – Public and Clinical Interventions OVERALL OBJECTIVE: To improve the diet of Nauruans through production and consumption of safe and nutritious foods IMPACT INDICATORS: Prevalence of Type 2 Diabetes among Nauruan population Prevalence of NCD risk indicators (obesity, blood glucose, blood lipids, blood pressure) among Nauruans

STRATEGY ACTIVITIES Person or Group Responsible

TIME FOR COMPLETION

Milestones Impact Indicators

NATIONAL – CORE

1. Implementing NCD plan

� Review TOR of the Nauru Healthy Island Council (HIPC)

� Recruit appropriate membership for committee � Train committee members to implement and

monitor NCD plan � Establish Nutrition working

group/subcommittee to assist HIPC with planning and monitoring of nutrition programmes

� Review 2002 National Plan of Action for Nutrition and integrate relevant actions into NCD plan

�

Director Public Health Public Health

3-6months • TOR reviewed and clarified • Council/Committee

appointments completed • Training of committee members

completed • TOR adopted/accepted by the

Committee •

• Nauru Healthy Island Council operating as per TOR

2. Legislation to improve access to healthy foods

� Remove excise tax on imported fruits and vegetables

� Enforce regulation on sale of expired foods as covered in the Food Act.

MPs Business community Health

12months • Submission on removal of excise tax presented to Parliament

• Submission accepted by Parliament

• Excise tax removed from imported fruits and vegetables

• Amended Food Safety Act passed and adopted by parliament.

• # food vendors selling safe and nutritious foods

• # food outlets selling fruits and vegetables at cheaper prizes

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STRATEGY ACTIVITIES Person or Group Responsible

TIME FOR COMPLETION

Milestones Impact Indicators

3. Promoting healthy and safe environments

� Review Public Health Act to include regulations to improve water sanitation, waste disposable,

� Regular monitoring and testing of water quality �

MPs Public Health

12 months • Public Health ACT reviewed and amended

• Quarterly water monitoring report submitted to Ministry of Health

• # of Health Promoting settings created that have healthy food policies

• # of quarterly water quality reports submitted as planned

4. Promotion of healthy lifestyle messages

• Review existing Nauru Healthy Island promoting material and use as appropriate

� Adapt and translate existing SPC Healthy Pacific Lifestyle Guidelines to promote key healthy lifestyle and food safety message.

• Regular promotion of health messages on TV and radio, not just on health days

Healthy Island Council Public Health Media

6-12 months • Promotion material reviewed • SPC Healthy Lifestyle

Guidelines adapted and translated and used

• Increased promotion of healthy lifestyle messages

• # of healthy lifestyle messages promoted in the media

• Increased acceptance and awareness of healthy lifestyle guidelines

NATIONAL –EXPANDED

5. Improve availability of nutritious foods

� Promote DSAP Kitchen Garden projects and programmes, including cooking demonstrations

� Develop and implement healthy food policy and guidelines within workplaces and schools

�

Public Health

2years • DSAP Kitchen Gardens promoted widely

• Number of healthy food policy established

• Healthy food guidelines established for workplace food vendors and school canteens

• # of kitchen gardens established and thriving

• # of workplaces with current healthy food policies

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STRATEGY ACTIVITIES Person or Group Responsible

TIME FOR COMPLETION

Milestones Impact Indicators

6. Improve Food safety � Nutritionist to work with food retailers and food vendors to adopt best practice of food preparation, cooking and serving techniques

� Develop and implement a food safety and food hygiene training programme in schools

�

Health Education

2-5years • Food safety training programme implemented in schools

• Food safety standards and best practice adopted

• # of food safety training programmes undertaken in schools

• # of food retailers/vendors who adopted food safety standards

• Increased awareness of food borne illnesses

7. Improve School nutrition � Promote and support implementation of Healthy Promoting Schools Guidelines

� Develop guidelines for healthy canteen service at schools

� Strengthen nutrition and health components in the national school curriculum to include use of local foods in Home Economic classes

� Include Agriculture in school curriculum and promote it as a viable business opportunity

Ministry of Education Public Health Agriculture

2years • Number of schools adopting Health Promoting Schools Guidelines

• Healthy School Canteen Service guidelines developed

• Relevant school curriculum sections reviewed and strengthened

• # schools adopting Health Promoting Schools Guidelines

• # of schools using School Canteen Service guidelines

• Food and nutrition component of the school curriculum updated and strengthened

8. Support Nauru NSDS 2005-2025 to develop and implement a national food production programme

� GON to increase investment in improving agricultural activities – improve soil condition, increase crop variety/cultivars that grow well on the land, improve agricultural productivity

� Government to provide financial assistance to local farmers to establish cash crop farming initiatives for the local market.

� Develop Aquaculture � Develop monitoring systems to ensure a more

robust food supply with adequate production and distribution networks

GON Landowners Agriculture –DSAP, Taiwan Technical Mission Community Leaders

5-10yrs • National food production programme in place

• # of Sustainable food production programmes in place

• Improved food security

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STRATEGY ACTIVITIES Person or Group Responsible

TIME FOR COMPLETION

Milestones Impact Indicators

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STRATEGY ACTIVITIES Person or Group

Responsible Time for Completion

Milestones Impact Indicators

COMMUNITY -CORE

1. Promote kitchen gardens

� Participatory education workshops in communities and schools on kitchen gardening

� Provide seedlings, cuttings etc

Community Groups Public Health Agriculture – DSAP, Taiwan Technical Mission

6-12 months • Number of kitchen gardens established

• Volume of seedlings and cuttings distributed and planted

• Increased production of local foods

• Increased food production skills

2. Improve food safety � Practical education on food safety in schools, church groups, women’s groups

� Education programme for food vendors on food policies and regulations

�

Public Health Community groups Community leaders Food retailers/vendors

12 months • Food safety education delivered to various community groups

• Food safety education programme for food vendors in place

• Increase awareness of food-borne illnesses risks

• Reduced food-borne illnesses

3. Promote consumption of local produce

� Practical cooking demonstration/workshops using local foods in church groups, women’s groups, schools

� Education on nutritional values of local foods

� Promote use of local foods in community functions/festivals

� Promote consumption of local foods through media – e.g. radio

� Promote the cultural and traditional value of local foods

Public Health Agriculture – DSAP, FAO Media Women’s Affairs CETC graduates NGOs

12 months • Number of cooking demonstrations/workshops delivered

• Increased promotion activities on local foods emphasizing nutritional values of local foods

• Increased consumption of local foods

• Increased awareness of the nutritional and traditional value of local foods

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4. Improve school nutrition

� Support revision and implementation of the Nauru Health Promoting Schools guideline

� Improve and strengthen community linkages with schools to promote healthy eating messages and nutritional values of local foods

� Support implementation of healthy food policy in schools as part of the Health Promoting Schools Guidelines

�

Public Health Ministry of Education School principals Community groups Media SPC/WHO

12 months • Health Promoting Schools Guidelines reviewed and implemented

• Increased community participation in school nutrition programmes

• Improved school nutrition

COMMUNITY –EXPANDED

�

5. Create supportive environments that promote healthy eating

� Assist schools to become health promoting schools and to include nutrition, physical activity and obesity issues as priority

� Expand settings-based programmes promoting safe and healthy foods – settings include, village, church, workplace, home (health promoting settings)

�

Healthy Island Council Public Health School principals Community Health Liaison Officers NGOs

2 years • No. schools becoming Health Promoting Schools

• Number of other health promoting settings established – e.g. Health promoting churches, workplaces

• Health promoting environments created and promoted

6. Improve maternal and child health

� Promote benefits of breastfeeding through implementing a Baby Friendly Hospital Initiative (BHFI)

� Develop and implement practical nutrition workshops for expectant and young mothers

�

Nutritionist Midwife Hospital Maternity Team

2 years • Implement Baby Friendly Hospital Initiative

• Practical nutrition workshops in place

• Improved maternal and infant health

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7. Increase Community education programmes

� Provide healthy cooking workshops, promoting use of local foods in the community

� Provide home kitchen workshops on composting

� Develop a nutrition training programme aimed at training key/selected people who will in turn train others.

Nutritionist Agriculture – DSAP, FAO Community leaders NGO

3-5 years • # of workshops provided

• # Nutrition training programmes in place

• Increase nutrition awareness and skills

STRATEGY ACTIVITIES Person or Group Responsible

Time for Completion

Milestones Impact Indicators

COMMUNITY –OPTIMAL

8. Improve school nutrition related programmes

• Strengthen school agricultural education programmes through development of practical base life skills programmes

• Encourage youth participation in school agricultural programmes

•

Ministry of Education School principals Agriculture – DSAP, Taiwan Technical Mission, FAO Healthy Island Council National Youth Council

5 years

• School agricultural life skills programme in place

• Enhanced school agricultural programmes

• Increase youth participation in school agricultural programmes

9. Increase food security • Strengthen National food programme through expanding kitchen garden programmes

Healthy Island Committee Government of Nauru Community groups Agriculture – DSAP, Taiwan Technical Mission, FAO

5-10 years

• More kitchen gardens established and thriving

• Increase production of local foods

• Increased food production skills

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STRATEGY ACTIVITIES Person or Group Responsible

Time for Completion

Milestones Impact Indicators

CLINICAL – CORE

1. Improve diabetes awareness

• Increase promotion of existing diabetes awareness campaign using existing resources (WHO developed campaign)

• Recruit and train community health liaison officer to communicate diabetes information to their district

Diabetes Team Public Health Media SPC/WHO

6-12 months

• Increased diabetes promotion activities

• Community Liaison Officers appointed and trained

• Improved awareness and understanding of diabetes

2. Improve diet • Implement community nutrition education programme aimed at developing and improving personal skills

• Review and adapt dietary guidelines based on those developed by SPC

• Trained staff on awareness and application of these guidelines

Nutritionist Diabetes Team Community Health Liaison Officers SPC

12month

• Community nutrition education programme in place

• Dietary guidelines reviewed and adapted

• Staff trained on how to use guidelines

• Improved dietary intake of people with diabetes

• Improved dietary management of diabetes and other chronic diseases

3. Improve diabetes services

• Improve links between health and community

• Review/stocktake of current clinical diabetes services and identify gaps for improvement

• Initiate quality improvement plan

• Review standards of care, treatment and management guidelines

• Train diabetes staff on the awareness and application of guidelines and standards of care

Diabetes team Community Health Liaison Officers Ministry of Health

1-2yrs month

• Stock-take of current services completed and gaps identified

• Quality improvement plan initiated

• Guidelines and standards of care reviewed and adopted

• Staff trained on awareness and application of guidelines

• Improved services for people with diabetes

59

4. Increase participation in diabetes education programmes

• Promote diabetes services and programmes available on local media

• Develop and distribute appropriate diabetes information and education resources

• Establish Community-based diabetes clinic

Diabetes Team Ministry of Health Media 18 months

• Promotion programme in place

• Appropriate diabetes information and education resources produced and distributed

• Diabetes community clinic established

• Increased uptake of diabetes services

•

CLINICAL –EXPANDED

•

5. Improve diabetes services

• Recruit and train 2 new dietitians

• Implement the SPC training programme “Diabetes is Everybody’s Business”

• Provide up-date refresher training for staff on standards of care and guidelines

• Develop quality improvement programme of diabetes services to address gaps identified

•

Ministry of Health Diabetes Team Nutrition Adviser, SPC 5years

• Dietitians recruited and trained

• SPC “Diabetes is Everybody’s Business” training programme in place

• Refresher course provided

• Quality improvement programme in place

• Improved diabetes services for clients, carers and families

•

CLINICAL –OPTIMAL •

6. Improved diabetes services

• Establish National Diabetes centre

Government Ministry of Health

10 years

• National Diabetes Centre established and in operation

• Improved services for people with diabetes and their families

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Food and Dietary Guidelines for healthy adults:

• Choose a variety of foods from the three food groups. Local is best

o Energy foods such as taro, cassava, breadfruit, cooked green bananas

o Protective foods such as all fruits and coloured vegetables

o Body-building foods such as fish, chicken, meat, sea-foods and dried beans

• Eat plenty of fruit – it is great as a snack

• Eat less foods which are high in fat, sugar and salt

• Drink plenty of clean water

• Avoid heavy alcohol drinking

• keep food safe

Key Healthy Lifestyle messages:

• Eat healthily – choose a variety of foods from the three food groups every day, local products are best.

• Be physically active

• If drink alcohol, avoid heavy drinking

• If smoking, stop. If not smoking do not start.

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Goal: To reduce the prevalence of anemia in CNMI from 26% to 10% in the under 5 population by 2012 CNMI

Objectives Activities Leading

agency Timeline Monitoring

Resource

(USD)

Incorporate nutrition education

into PTA & village meetings DOE & DOH As per meeting

# of meetings

present in 10 000

Promote fruit & vegetables

production through home-based gardening

DOA On-going # home

gardens DOA

1. Improve

nutrition and

diet of

population

esp children

DOH As per meeting schedule

# of meetings As above Community education through village meetings & IEC materials

DOH

On-going # materials produced and disseminated

20 000

2. Improve Hygiene

practices of school children in CNMI Media campaign on hygiene

practices DOE 1 per year

Campaign reach

30 000

Increase availability of

deworming medications DOH 6 monthly

# children

dewormed 30 000 3. Prevention &

treatment of Iron def Anemia

Consideration of Iron supplementation in schools

DOH As needed

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Fiji The two participants who were present shared their desire to continue to work together, to co-ordinate their efforts

63

Session 7: Review and evaluation of the training course

Aims This session aims to:

• Review Course Programme • Identify strengths and weaknesses of the course • Improve activities, timetable, and relevance of course

Learning Outcomes At the end of this session participants should be able to: Report the learning outcomes of the programme to relevant people

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Activity 7.1: Review and evaluation All participants completed an evaluation form (See Appendix 4 for detailed evaluation). They also shared information regarding their main thoughts about the workshop verbally. Closing All the participants and facilitators were given an opportunity to share their thoughts and what they learnt from the workshop. Overall the feedback from all participants was very positive. They were very appreciative of the opportunity to work together with other colleagues from around the region, sharing ideas and learning from each other.

65

Appendix 1: List of participant and facilitators

SECRETARIAT OF THE PACIFIC COMMUNITY

Sub-Regional Workshop on The Development and Implementation of Intersectoral Food and Nutrition

Action Plans and Policies (19th to 23rd February 2007 Suva, Fiji)

LIST OF PARTICIPANTS

FIJI Mr James Antonio Senior Agricultural Officer

Ministry of Agriculture Suva Fax: 679 3383426 Tel: 679 3384233

Email: no email , Contact person is Mr Semesa Tabanidalo for The Permanent Secretary Agriculture Fisheries and Forests, stabanidalo@govnet.gov.fj

Mrs Pushpa Wati Senior Nutritionist National Food and Nutrition Centre Ministry of Health Suva Fax: 679 330617 Tel: 679 3306163 Email: pushpamahabir@yahoo.com

Mrs Matelita Rauca

Education Officer, Nutrition Technical and Vocational Education and Training

Ministry of Education Suva Fax: 679 3314477 Ext. 540/541 Tel: 679 3314373 Email; matelitarauca@yahoo.com

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NAURU Mr. Bern Douwouw (withdrew) Agriculture Officer Ministry of Agriculture Nauru Fax: 674 444 3105 (via Dept. FA & T) Tel: 674 444 3133 Ext 303 Email: Nil use ron_fa@cenpac.net.nr (via Dept FA&T)

Mr. Ranwick Capelle Nutrition Officer Ministry of Health Nauru

Fax: 674 444 3105 (Dept. FA & T or Health) Tel: 674 444 3133

Email: sechealth@cenpac.net.nr (via Department of Health attention : Ranwick) Mr. Jarden Kephas

Secretary for Education Ministry of Education Nauru Fax: 674 444 3105 (via Dept. FA & T) Tel: 674 444 3133 Email: Nil use ron_fa@cenpac.net.nr (via Dept FA&T)

Mr. Samuel Grundler Planning Division Ministry of Planning & Finance Nauru Fax: 674 444 3105 (via Dept. FA & T) Tel: 674 444 3133 Ext 321

Email : kalianni@yahoo.com.au

NIUE Ms Grizelda Va’ainga Leki Mokoia Nutrition & Dietetics Officer Niue Foou Hospital, Kaimiti Alofi Fax: 683 4265 Tel: 683 4100 ext. 114 Email: Zelda_dee74@yahoo.co.nz

67

Ms Hannah-Lisa Tasmania

Head of Department Food/Nutrition/Hospitality & Clothing technology Niue High School Department of Education

Government of Niue Fax: 683 4031

Tel: 683 4039 Email: fuaniu@yahoo.co.nz

Mrs Gaylene Tasmania

Deputy Director Department of Agriculture, Forestry & Fisheries (DAFF) PO Box 74 Alofi Fax: 683 4079 Tel: 683 4032

Email: dsapniue@mail.gov.nu or gtasmania@yahoo.co.nz

Mr KimRay Vaha Government Statistician Statistics Niue Economic Planning, Development and Statistics Premier’s Department Government of Niue, Alofi Fax: 683 4148 Tel: 683 4219

Email: statsniue@mail.gov.nu

Northern Mariana Mr Isidoro T. Cabrera Islands Agricultural Consultant

(Commonwealth of the) NMC-CREES PO Box 501250 Saipan, MP 96950 Fax: 1 670 234 0054 Tel: 1 670 287 0571 Email: bonniet@nmcnet.edu

68

Mrs Patricia Leatavalavala Coleman

Diet, Physical Activity and Health Coordinator NMC-CREES PO Box 501250 Saipan, MP 96950 Fax: 1 670 234 0054 Tel: 1 670 287 0570 or 234 3690 ext.1711, 1705 Email: cnmi_coleman@yahoo.com

(withdrew Thursday 15 Feb 2007 for personal reasons) Ms Elisabeth Brooke Palacios

Systems Administrator Planning Department PO Box 503927 Saipan, MP 96950 Fax: 1 670 234 1970 Tel: 1 670 235 7399 Email: justzabet@gmail.com (DNA, fell ill in Japan and had to return home)

Ms Louise Oakley (withdrew) Clinical Dietitian

Public Health PO Box 500409

Saipan MP 96950 Fax: 1670 236-8700 Tel: 1670 236-8703 Email: wiki.r.d@gmail.com (withdrew due to other commitments)

TOKELAU Ms Tekave Reuelu Senior Nutritionist Tokelau Health Department

Tokelau Fax: 690 4132 Tel: 690 4108 Email: tnelesone@hotmail.com (via Director of Health)

69

Mrs Lisa Lister

Health Manager Tokelau Health Department

Apia Office Fax: 685 21761 Tel: 685 20822 Email: liza.kelekolio@lesamoa.net

FACILITATORS/SECRETARIAT

SECRETARIAT OF Mrs Karen Fukofuka THE PACIFIC Nutrition Adviser COMMUNITY (SPC) Healthy Pacific Lifestyle Section Secretariat of the Pacific Community BP D5 98848 Noumea Cedex New Caledonia Fax: 687 263818 Tel: 687 262000 – direct line 687 266775 Email: karenf@spc.int

Dr. Viliami Puloka Physical Activity Adviser Healthy Pacific Lifestyle Section Secretariat of the Pacific Community BP D5 98848 Noumea Cedex New Caledonia Fax: 687 263818 Tel: 687 262000 – direct line 687 260952 Email: viliamip@spc.int WORLD HEALTH Dr. Chizuru Nishida ORGANIZATION Technical Officer (WHO) Nutrition for Health and Development World Health Organization Avenue Apia, 20 CH-1211, Geneva 27 Switzerland Fax: 41 227914156 Tel: 41 227913317 Email: nishidac@who.int

70

WORLD HEALTH Dr. Temo K. Waqanivalu ORGANIZATION (WHO) Nutrition & Physical Activity Officer South Pacific Office World Health Organization

South Pacific Office Level 4 Provident Plaza One, Downtown Boulevard 33 Ellery Street, PO Box 113, Suva Fiji Islands Fax: 679 3300 462 or 3311 530 Tel: 679 3304 600 Ext. 127 Email: waqanivalut@sp.wpro.who.int JICA Ms Chieri Yamada JICA expert for food and nutrition policy JICA Fiji office

7th floor, Dominion house, Suva, FIJI (JICA private mail bag, Suva, Fiji) Tel: 679-330-2522 Fax: 679-330-2452 E-mail: cyamada-hsph@hotmail.com

UNICEF Dr Rosa Sa'aga Banuve APO Health & Nutrition Officer UNICEF Suva 3 & 5 Floors, Fiji Development Building 360 Victoria Drive, Suva Fiji Tel: 679 3300439/3301918/3301903/3301881 Fax: 679 3301667 Email: rsaagabanuve@unicef.org WHO Consultant Ms Wendy Snowdon wendy@thesnowdons.net

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Appendix 2: Workshop Programme Agenda

Day 1: Monday 19 February 2007

Time Activity Facilitator/Presenter 8.00am Registration 8.30am Welcome prayer Participant Welcome Mr Falani Aukuso Opening Remarks - WHO Dr Chen Ken - JICA Mr Tetsuhiro Ike - UNICEF Dr Kamrul Islam 9.30am Opening Presentation –

NPAN history, role and potential Dr Chizuru Nishida

10.00am REFRESHMENT BREAK 10.30am Administrative Information & house rules Karen Session 1: introduction 10.45am Activity 1.1

Introductions - Overview of workshop Course content Aims & Objectives Workshop materials

Viliami

11.15am Importance of food and nutrition for health Activity 1.2

Temo

12.30pm LUNCH BREAK 1.30pm Food News – Activity 1.3 Viliami 2.00pm Understanding the Food Supply Chain

Activity 1.4 Wendy

3.00pm REFRESHMENT BREAK 3.15pm Influences on the Food Supply Chain

Activity 1.5 Chieri Yamada

4.15pm Food Security – sustainable food supply Activity 1.6

Wendy

5.15pm END DAY 1

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Day 2: Tuesday 20 February 2007

Time Activity Facilitator/Presenter Session 2 : Food and Nutrition Plans and Policies 8.30am What is food and nutrition policy?

Activity 2.1 Wendy

9.15am Understanding 1992 International Conference on Nutrition (ICN) commitment Activity 2.2

Chizuru

10.15am REFRESHMENT BREAK Session 3: Developing inter-sectoral and

integrated national food and nutrition plans and policies

10.30am Linking Non-Communicable Disease plans with nutrition plans – an integrated policy framework Activity 3.1

Temo

11.15am Assessing existing food and nutrition plans and policies Activity 3.2

Wendy

12.15 LUNCH BREAK 1.00pm Country presentations

Activity 3.2 Wendy

3.00pm AFTERNOON FRESHMENT BREAK 3.15pm Identifying relevant Government plans and policies

Activity 3.3 Wendy

3.45pm Elements and barriers for success Activity 3.4

Temo

4.45pm WRAP UP @ END OF DAY 2

73

Day 3: Wednesday 21 Feb 2007

Time Activity Facilitator 8.30am Emerging and re-emerging issues and Food &

Nutrition Plans and Policies Activity 3.5

Chizuru

10.00am REFRESHMENT BREAK Session 4: Advocacy – Advocating for Action 10.15pm Advocacy overview

Activity 4.1 Rosa

11.30 Information systems Activity 4.2

STEPs and MOANA FIVISM

Temo Wendy

12.30pm LUNCH BREAK 1.30pm Information systems continued

PRISM and GIS Wendy

2.00pm Profiles – use of data for advocacy Activity 4.3

Chizuru

2.30pm Advocacy Activity 4.4

Rosa

3.00pm RE-FRESHMENT BREAK Session 5: Forging partnerships 3.15pm Review experiences of partnerships

Activity 5.1 Temo

3.45pm Discovering possible partners Activity 5.2

Viliami

4.30pm Determining which partners to work with Activity 5.3

Temo & Viliami

5.30pm WRAP UP @ END OF DAY 3

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Day 4: Thursday 22 Feb 2007 Time Activity Facilitator

Session 6: Putting Plans into Action 8.30am Reviewing current NPAN

Activity 6.1 Wendy

8.45am Develop an operation plan Activity 6.2

Temo

10.00am RE-FRESHMENT BREAK 10.15am Develop/implement food and nutrition plan

Activity 6.3 Wendy

12.00pm LUNCH BREAK 1.00pm Reporting back of Activity 6.3 3.00pm RE-FRESHMENT BREAK 3.15pm Action Plans

Activity 6.4 Viliami

4.30pm WRAP UP @ END OF DAY 4 Dinner @ 7pm, SPC hosted

Day 5: Friday 23 Feb 2007

Time Activity Facilitator Session 6 cont.: Putting Plans into Action 9.am Action Plans (if needed)

Activity 6.4 Wendy

10.00am RE-FRESHMENT BREAK Session 7: Review and evaluation of training

course

10.15am Review of workshop, overview of future actions, questions Activity 7.1

Facilitators

11.15am Closing remarks WHO JICA SPC UNICEF Participants

Closing prayer

12.30pm FAREWELL LUNCH 1.30pm FINISH

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Appendix 3: Presentations List

Activity Presenter Opening Presentation Dr Chizuru Nishida 1.1 Introductions –overview of workshop

Dr Viliami Puloka

1.2 Importance of food and nutrition for health

Dr Temo

1.4 Understanding the Food Supply Chain

Wendy Snowdon

1.6 Food Security – sustainable food supply

Wendy Snowdon

2.1 What is food and nutrition policy?

Wendy Snowdon

2.2 Understanding 1992 ICN Commitments

Dr Chizuru Nishida

3.1 Linking NCDs and Nutrition Plans – an Integrated Policy Framework

Dr Temo

3.2 Fiji Country report

Fiji

3.2 Tokelau Country report

Tokelau

3.2 Nauru Country report

Nauru

3.2 CNMI Country presentation

CNMI

3.2 Niue Country report

Niue

3.3 Identifying relevant Government policies and plans

Wendy Snowdon

3.4 Elements and Barriers for Success

Dr Temo

3.5 Emerging and re-emerging issues and NPAN

Dr Chizuru Nishida

4.1 Advocacy

Dr Rosa

4.2 FIVIMS

Dr Chizuru Nishida

4.2 PRISM and GIS

Wendy Snowdon

4.3 Profiles

Wendy Snowdon

Session 5 Partnerships Dr Temo

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Partnerships 6.1 Review of current NPAN plans

Wendy Snowdon

6.3 Monitoring and Evaluation, General

Wendy Snowdon

6.3 Monitoring and Evaluation NCD

Dr Temo

6.4 Tokelau Action Plan

6.4 CNMI Action Plan

77

Appendix : Summary of participant evaluations Q1. Time allotted to workshop was:

Too short About right Too long

1 10 1

Comments included: • Its at workshop • No problem as long as we have short breaks of stretching exercise • Could have an extra hour or two in the evening. This would be possible if all

participants stay together • Some activities could not be completed thoroughly • Presentations should have been condensed in some areas BUT only if the

participants were already people working on NPAN, this is assuming that they know the history behind the NPAN prior to coming to the workshop

Q 2. Was content relevant to your work

Extremely Slightly Not very Not at all

6 5 1 0

Comments: • The workshop had valuable information that is required in my work • Content of the workshop is very helpful and is relevant to my job • We don’t have an existing NPAN and never had. This has been a great

opportunity to actually find out how to develop one and in terms of using a multi-sectoral approach as health always has worked in isolation to toehr departments

• Now having a starting point • Because I work within the Govt Department of Planning & Policy Division, all

these are slightly relevant • Very relevant and educational • This is because my field of work as an Agriculturist has much to do with

healthy food production and food security which is the main key for good nutrition

• In some areas such as food production but not in all areas of my work

Q 3. Will your participation help make a contribution to the development or strengthening and implementation of NPAN and policies

Yes No Maybe

12 0 0

Comments: • I’m very pleased that our group has managed to do a draft of the NAPN

together to take home with us because more heads thinking is always better than one. This is a great starting point for us that we are determined to make it happen at home

• I gain a lot of important information from this workshop and what I learnt is very much contribute to the development of NPAN

• I’m determined to be one of the task force to plan and develop NPAN

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• I now have a wider view of nutrition/NPAN and it has implications on my work. Although I have always worked in isolation, eth multi-sectoral approach would be more effective

• I find the group to this workshop was coordinated really well, to ensure a better NPAN

• The importance of nutrition for each person and the nation really needs to be highlighted. NUTRITION = NO NCDs

• Our inter-sectoral relationship will be strengthened and then will be more collaborative in regards to NPAN and its implementation

• The way to link ICN to National Strategies and to identify common goals (ie not to duplicate) is important in developing NPANs

Q 4. The quality of the training Very high Fairly

high Fairly low Very low

8 4 0 0

Q5 Do you feel that the aims and objectives were met

Yes No Don't know

12 0 0

Comments: • Very much on track • The objectives of the training were very broad to start with so it was easily

met. Next time, try and be more specific such as “to help countries develop a Plan of Action with specific activities that can be carried out in the next 12 months”

• Presenters were focused on the subjects to be covered and at eh dame time they were understanding and humorous

• Very useful and comprehensive • The developed NPAN is made more meaningful after having gone through the

workshop. Should be able to tease it out to simple form for my work area • Learnt more about nutrition and planning of actions to be undertaken to

implement and meet timelines

Q6 What sessions did you find most useful?

• All sessions were useful • All useful • The actual policy developing stage cos it assisted us in trying to develop our own.

I’m also glad to know about ICN and the commitment our MoH had made ages ago that we know nothing about

• The advocacy session, in that we need to advocate for the NPAN when we return home

• All. The physical activities done to keep us awake were very effective • All sessions were useful in terms of formulating a comprehensive plan and

incorporating/including relevant sectors into the process. And the reasons of considering all/many aspects that may have a role to play

• Advocacy • All • The last session – specific action plans • I found every sessions were all useful

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• The Thursday session • Linking NCDs and nutritional planning

Q7 What sessions were not that useful? • Too much in-country group, rather mixing with other countries and sharing • N/A • None • They were all useful • N/A. all were useful • None • None • History of NPAN • None • None • None

Q8 What changes would you recommend we make to the workshop for next time?

• More mix group discussions, rather than country groups • Great balance between group work and teaching, keep it up ☺ • None • It will be nice to have it in Nadi the next time • More on NCDs and Advocacy • None • None • Include a session on stats/data collection techniques etc • Please if possible for the next coming workshop to be held in Nadi but also to

invite just the countries who attend this workshop • No changes except that we need to follow schedules and include Friday • Change of country venue

Other comments

• If possible each activity have available before hand, a hard copy similar to Dr Rosa’s presentation on advocacy

• Food awesome, include more pele please. Physical activity – should be set activities that EVERYONE must follow

• Thank you for the opportunity given for us to be a part of this important workshop. I’m pleased to have been given the chance to work with other govt sectors from around the Pacific and to have learnt from their experiences so that we can develop our own. It is great at last to be able to work with other smaller Island countries because from other workshops that we have been to (e.g. in NZ, Australia) where smaller PIC never really had a chance to discuss stuff properly

• This workshop has been informative and has helped put into perspective some of the things that need to be achieved in our countries. Keep up the good team work that has been clearly presented in throughout the whole workshop

• Maybe a bit more centralised workshop centre. The food was excellent but cakes and sweet biscuits in the afternoon were just a trifle too heavy

80

• None • None • There should be a separate workshop for countries who have not developed a plan

and those who have. Also this kind of workshop should be carried out in-country as well.

• I would like to thank each and everyone (facilitators) for the knowledge that you shared with us, they are so useful. Thanks

• None – the workshop went well as planned. Everything was in order and learnt a lot of new things and experiences also meeting new faces for future contacts

• None in particular