Between October 2012 and May 2013, an assessment was done of capacity in Public Nutrition in three Asian countries: Nepal, Indonesia, and Bangladesh. The assessment was one of four interrelated Result Areas of a EU funded partnership with UNICEF (i.e., the Maternal and Child Nutrition Security Initiative in Asia (MYCNSIA)) aimed at developing an approach for capacity building of decision-makers, service delivery personnel and communities. Three two-member teams were hired through an international consultancy firm (i.e., Public Health Solutions, Ltd., Hong Kong). The team members were chosen for their skills, knowledge and experience in field and academic research. All were members of the World Public Health and Nutrition Association. The teams were made up of Roger Shrimpton and Stephen Atwood in Nepal; Roger Hughes and Barrie Margetts in Indonesia, and Jacky Knowles and Geoffrey Marks in Bangladesh. John Mason and David Sanders served as Senior Advisors.
The assessments weighed the capacities of individuals, communities, organizations and systems in public health nutrition. Each team worked in concert with the local UNICEF country office during an eight to ten day visit, to develop findings and recommendations based on extensive literature reviews, key stakeholder interviews, and institutional visits to academic and other training venues. The written reports prepared by each team were vetted by the government and the local team and presented to the UNICEF office. The output from each country was aggregated into a regional overview paper prepared by Shrimpton, Atwood, Mason and Sanders and used as the content for a regional workshop in Bangkok on 16 May 2014 convened by UNICEF and involving representatives from each country including the UNICEF country offices as well as NGO actors and other UN agencies involved in public nutrition in the region. The findings discussed at that meeting were used to outline the way forward.
Of significance, there were more similarities than differences between the three countries: (i) in each there was a general lack of understanding of the life-cycle contribution to both under- and over-nutrition (particularly in the importance of empowering women and protecting their health, social status, and nutrition before, during, and after pregnancy); (ii) “capacity development” was equated almost entirely with investment in training programs, both in-service and pre-service, and missed the importance of supportive organizational and systemic policies and practices; and (iii) each country felt that their sizeable workforce across sectors at all levels had insufficient capacity in public nutrition along with the necessary organizational or systemic support to reduce the double burden of malnutrition.
Two of the key short term recommendations were to target suitable districts in each country for full implementation of public health nutrition inputs needed to reduce stunting, maternal anemia, low birth weight along with key IYCN targets, and to build the capacity of staff and systems to manage community based programs with interventions aimed at empowering women. The full country reports, the summary of the workshop, and the Regional Overview are available below.
AN OVERVIEW AND REGIONAL PERSPECTIVE ON THE ASSESSMENT OF NUTRITION CAPACITY OF NATIONAL AND MID-LEVEL PERSONNEL CARRIED OUT IN THREE ASIAN COUNTRIES
This paper provides a regional overview based on three country reports (Nepal, Bangladesh and Indonesia), as well as an assessment of what was available at the East Asia Pacific regional level. The authors conclude that while there are many “nutritionists” in these Asian countries, the majority has been trained in clinical or individual based nutrition which is often outdated and more focused on research than on managing nutrition programmes. In view of constraints encountered at system, organizational, workforce and community levels in all three countries, a series of recommendations are made with a short, medium and long term perspective. The recommendations are directed at the country level and extrapolated to the regional office, and are not what UNICEF alone should be doing, but what it should be advocating for others to be doing as well. The short term priority, building on the opportunities created by the recent upsurge in nutrition’s profile, is to resolve the community and workforce level constraints and create capacity to accelerate stunting reduction in a few selected districts to begin with. The medium and long term recommendations aimed at fixing organizational and system level shortcomings cover a three to five year and five to ten year period respectively, and all need to be started now.
REGIONAL WORKSHOP ON NUTRITION CAPACITY BUILDING: DISSEMINATION OF RESULTS AND WAY FORWARD. MEETING REPORT, BANGKOK, 16 MAY 2013
This is a report from the workshop that was held in UNICEF EAPRO Regional Office in Bangkok on May 13th involving representatives of each of the participating UNICEF country offices and government counterparts, as well as representatives of other agencies and some academic institutions active in nutrition in the region. The workshop participants reviewed and discussed the recommendations from the three assessments and the regional report came up with a set of short medium and long term recommendations on how to strengthen nutrition capacity in the region. For the short term it was agreed that in each of the countries starting to scale up nutrition actions to: (i) work with country level staff in each country to identify suitable districts for full implementation of public health nutrition inputs required for short term improvements in selected nutrition indicators; (ii) provide transitional public health nutrition support for capacity development to each country and District. In the medium term it was proposed to begin process of in-country academic capacity development.
CAPACITY BUILDING TO STRENGTHEN LOCAL GOVERNMENT AND COMMUNITY PARTICIPATION IN MULTISECTORAL NUTRITION PROGRAMS IN NEPAL
This is a community level assessment (community to district) done in Nepal with World Bank and
UNICEF support (with EU funds) in order to help develop the multisectoral nutrition programme, which is being built in the country from the community upwards in 12 districts initially.
This study provides a new, innovative methodology that can be used as inspiration for other programme planning initiatives with active community participation.
NUTRITION CAPACITY ASSESSMENT: COUNTRY REPORTS
Since 2012, various regional capacity assessment exercises were conducted with support from UNICEF EAPRO. Three country reports were prepared, in Nepal, Bangladesh and Indonesia. They show the results of a capacity assessment to identify existing capacity and gaps in local government and community structures and recommend ways to strengthen them to accelerate the reduction of maternal and child undernutrition.