Rejoinder: nutrition planning is alive and well,thank you

This article is a rejoinder to an article by John Osgood Field which discussed the failure of multisectoral nutrition planning. The author argues that, although nutrition planners may have been overly optimistic in their hopes that political political systems could be made responsive to the problems, significant advances have been achieved. Many of the successes of nutrition planning and theimportance of multisectoral work are outlined. Malnutrition is a problem that escapes all the standard programs, and cannot be tackled through the health and agriculture sectors alone. There has been much critical thinking by many concerned people various countries. To suggest that nutrition planners moved blindly is to ignore much of the literature. A number of cautions--some of them very early--make it clear that practitioners were not oblivious to the bureaucratic constraints and political realities Professor Field now identifies. It would be cruelly wrong to suggest that no progress has been made. Nutrition planning may have borne fruit of a different sort than some of its early advocates envisioned, but there is no question that it bore fruit. The issue is whether nutrition planning has influenced the way people think about nutrition and the way they analyze problems. And about this there can be no doubt.     

National nutrition planning: lessons of experience

National nutrition planning has failed to fulfill its initial promise because of inadequate consideration of political and administrative obstacles to applying the methodology. The political and operational contexts within which multisectoral nutrition planning has occurred are reviewed in order to draw insights and lessons from the experience of the last 10 years. Considered are the political process, macro and micro planning, the multisectoral approach, integration with agricultural and health planning, nutrition interventions, community participation, cost benefit analyses, and information systems evaluation, management and organization. Emphasis on the multisectoral causation of malnutrition has contributed substantially to nutrition programming and remains indispensable for improving nutrition, but requires more thoughtful response to practical implementation problems. Integrating nutrition concerns more effectively into health and agriculture systems offers a more promising approach than efforts to attack malnutrition by encouraging multisectoral nutrition coordinating agencies and national plans.     

Multisectoral nutrition planning: a post-mortem

Multisectoral nutrition planning emerged in the early 1970's as a bold new approach to combating malnutrition in low-income countries. Conceptually elegant and operationally ambitious, it blossomed on paper but collapsed in practice notwithstanding vigorous promotion by international assistance agencies. This essay reviews the meteoric rise and fall of the multisectoral approach and then proceeds to examine its theoretical underpinnings. The essay concludes by identifying 12 lessons learned that, if heeded, can help the current generation of intersectoral initiatives against malnutrition to realize their potential. In retrospect, it was a mistake to assign responsibility for nutrition to economic planners and scientists who possessed little political influence or operational authority. Nutrition requires high-level political sponsorship if it is to command resources, be integrated with established ministerial responsibilities and have staying power. Nutrition planning bcame attractive to basically conservative governments anxious to accommodate international benefactors without having to accept more fundamental reforms; the analysis of malnutrition causality focused primarily on attributes of the malnourished and their families, not on the social, economic, and political order around them.     

Nutrition and the governance of agri-food systems in South Asia: A systematic review

Malnutrition is a multicausal challenge that requires multisectoral responses to make comprehensive and sustainable progress, over the long term. How is agriculture and the wider agri-food system positioned within the constellation of factors and processes that determine nutrition outcomes in different contexts and countries? What is known about the role of enabling environments and the governance of agri-food systems in driving nutrition outcomes, for better or worse? In this paper we will highlight the findings of a systematic review that focuses on this question, drawing on work from the South Asian region including research undertaken by LANSA. We conclude with a discussion of the major implications and recommendations for future policy and practice.     

Nutrition policies and programmes: a decade of redirection

This article assesses the effectiveness of nutrition programs and policies since the World Food Conference, 10 years ago. The authors perceive several distinct approaches. Just before the World Food Conference, nutrition programs had passed through an era of enchantment with technological solutions (single-cell protein, oilseed protein isolates). Supply was regarded as the problem; protein inadequacy as the crisis. None of the technological fixes had much of an impact on the malnutrition problem. This contributed to a willingness to entertain a much broader approach to nutrition. The new paradigm manifested itself 1st as a movement toward integrated nutrition planning. The national planning process was assumed to be the appropriate vehicle for applying this methodology. However, integrated nutrition planning threatened, conflicted with or at least brought pressure for change in the administrative and political reality of governmental organizations. Moreover, the nutrition community's capacity to respond to the demands flowing from the new paradigm was limited. The difficulties encountered in trying to achieve full integration led to a reexamination of working within traditional sectors but addressing the problem in several key sectors simultaneously, such as health and agriculture. The past decade also saw a move toward analyzing and improving the design and implementation of various kinds of nutrition interventions. The emphasis was on understanding and dealing with the administrative, economic and political realities of such efforts. Incorporation of consumption and nutrition considerations in the analysis and formulation of food policies in some countries is 1 of the important achievements of the past decade. This overwhelmingly economic approach focuses on pricing policies and market effects, recognizing that poverty and purchasing power are central to the malnutrition problem. Analysis of macrofood policy has filled an important void, giving a more concrete and inclusive view of food security. Nutrition progress during the next decade will require the development community to confront a changed environment and several key challenges, namely the surge of conservative politics in the early 1980s, and the severe economic problems most countries face. There is a need to be realistic about the tenacity of the problem and the multiple barriers to implementation of nutrition policies. The challenges face both national governments and development agencies. There is agreement that, during the decade since the World Food Conference, the field of nutrition has gone through a metamorphosis and that there has been progress. However, the development community still faces an unfinished nutrition agenda.     

Does nutrition have a place in agricultural research?

There are very few examples where nutritional objectives have made an effective contribution to planning agricultural research for developing countries. The complex nature of nutrition and the limitations of formal planning procedures help explain the failure. But most commentators ignore the personal, political and ideological factors that seriously limit the effectiveness of nutrition as a parameter for research planning. Three cases are discussed where nutrition has played a role in setting agricultural research directions, without evident nutritional impact. Conclusions are proposed for making agricultural research planning more relevant to nutritional concerns.     

Human rights in nutrition and nutrition in human rights

Many countries around the world are involved in nutrition planning and nutrition program implementation. This concern and activity with regard to nutrition, however, has failed to give the issue proper and adequate consideration in development plans and programs of action. The author proposes a two-pronged approach to promote nutrition as a human right. One approach is to include nutrition as a human right in educational and training programs in nutrition. Another approach is to include nutrition as a human right in educational and training programs on human rights. These approaches are described using examples from experiences in the Philippines. Families, universities, and other training institutions have roles to play in making sure that individuals and groups receive the nutrition they need. It should be stressed that nutrition is both a right and an input for development.     

The soft underbelly of applied knowledge: Conceptual and operational problems in nutrition planning

Nutrition planning features a ‘rational choice’ bias that often characterises applied knowledge. John O. Field questions this bias by exploring the softer side of success in nutrition planning efforts. He contrasts the scope of nutrition planning as understood by the international community of experts and by administrators in low income countries. He examines the politics of planning and programme implementation. Consideration of nutrition planning in an ideological and historical perspective reveals both the ambivalence of nutrition planners as agents of change and the tenuous, untested nature of nutrition planning as an approach to ameliorating malnutrition.     

Food policy, nutrition planning and survival : The cases of Kerala and Sri Lanka

Sri Lanka and Kerala enjoy mortality conditions that are unusually favourable in light of their limited per capita income. To what extent can food policies and nutrition planning efforts account for this? An examination of the available evidence suggests that food and nutrition policies taken by themselves can probably explain a part, but only a part, of the favourable health status achieved. Much more important is the way in which food and nutrition efforts have served as central integrating themes for a wide range of development activities directed toward the alleviation of poverty.     

Survey on attitudes to nutrition planning

The results of a worldwide survey of nutrition planning professionals' attitudes towards nutrition policy are presented. The objective of the survey was to determine what those involved in nutrition planning perceive to be the causes of hunger and malnutrition, and their views on the effectiveness of the programs implemented to overcome these problems. In mid-1979, a questionnaire was compiled comprising 48 questions related to attitudes towards nutrition policy, voluntary questions about social class, political classification and professional behavior and a question on perceived major impediments to solving malnutrition in the world. The questionnaire was sent to 728 professionals 87 countries; 250 replies from 55 countries; 250 replies from 55 countries were received. 44% of respondents resided in the US, 16% in Latin America and the Caribbean, 14% in the Far East, 12% in Africa and the Middle East and 13% in Europe, Canada and Australasia. Self-classification of political beliefs is the most clear cut correlate in predicting attitudes towards food and nutrition policy. There appear to be 2 clear schools of scientific/political behavior in the sample: one holds a more moderate, but generally liberal, set of views regarding the failure of modern technology in resolving world hunger and nutrition problems; a 2nd more liberal group believes political causes to be at the root of hunger. There is no single profession that can be typified as a breeding ground for nutrition planners. While the European trained and/or native group tends to be more to the left in their attitudes than their counterparts in the US, both groups are decidedly liberal and believe that social structural changes are needed to solve the problems of hunger and malnutrition in the world.     

Nutrition in socioeconomic planning in LDCs

Nutrition should be seen as an integral part of the national planning effort. The author examines longterm determinants of food consumption in developing countries and shows that progress in improving nutrition is closely related to raising productivity and efficiency in the national economy. Optimum programmes in nutrition should be part of the design of appropriate social and economic development. This should be done at national and regional levels, with particular emphasis on the regional level.     

We can be farmers,just for one day

Academics from the University of Cambridge and the London School if Hygiene and Tropical Medicine (LSHTM) have developed a simulation game of the role of agrarian change in a traditional community of small farmers in India. Following extensive data collection and trials of ad hoc games in a variety of institutions over the past ten years, the game has now been marketed in a commercial form as The Green Revolution Game. The primary aim to the game is to give participants an idea of what life is like for a small farmer in a dynamic society in developing country. The designers hope that it will be of value in training and sensitizing professionals and students in agricultural extension, project appraisal, rural and development planning, nutrition and economics.     

Data requirements and use in nutrition planning in Costa Rica

In designing data systems for food and nutrition planning, little attention has been given to the type of data which may be needed at different stages of the planning process, ie political motivation and definition of policies, selection of programmes, geographical distribution of resources within a programme, delivery of services at the local level and monitoring of changes. The authors examine some experiences in terms of how decisions are made, available data and its use in national programmes, and the consequences relevant to the nutritional status of the Costa Rican population.     

Implementing the World Food Summit Plan of Action: organisational issues in multi-sectoral planning

Despite current ideological and philosophical objections to planning, it survives in new forms, generating Policy Framework Papers, Poverty Assessments or multi-sectoral Action Plans to implement the resolutions of international conferences. The World Food Summit Plan of Action will generate a new wave of such plans. History shows that the road to multi-sectoral planning is littered with organisational elephant-traps. The traps can be avoided, however, by learning the lessons of past experiments with multi-disciplinary or multi-sectoral planning. The literatures on integrated rural development, multi-sectoral nutrition planning, farming systems research, national food security planning, poverty planning and industrial organisation are all of help. They suggest that the key is to establish a task culture, characterised by co-operative goal definition, a high degree of participation, supportive leadership, and strong integration of planning and implementation. A ten point action plan is derived from these principles for follow-up to the World Food Summit.     

Research notes and communications strategic planning as competitive advantage

Since 1970, over forty empirical studies have examined the performance consequences of formal strategic planning. This line of research has drawn heavy criticism from reviewers on methodological grounds, and has produced confusing, apparently contradictory results. This article reevaluates the planning-performance relationship from a resource perspective, arguing that strategic planning does not satisfy the criteria for sustainable competitive advantage– although it may produce economic value, it is easily imitated and may be substitutable. The article suggests that previous studies produced inconsistent results because they did not account for the dissemination of strategic planning over time, or for industry differences in strategic planning factor markets. An empirical test in two industries finds that formal strategic planning and financial performance are unrelated in a ‘planning equilibrium’ industry, but positively related in an industry with strategic planning factor market imperfections.     

Capacity development in food and nutrition in central and Eastern Europe: A decade of achievements

This article summarizes the activities performed by the Network for Capacity Development in Nutrition in Central and Eastern Europe and Balkan countries (NCDNCEE) in the past decade. The article gives a retrospective of the achievements and challenges in building capacity in nutrition research.Recognizing the lack of capacity and incoherent nutritional situation in CEE/BC, the United Nations University (UNU), Food & Nutrition Programme and the UN Standing Committee on Nutrition (SCN) encouraged the formation of NCDNCEE in 2005, which became CAPNUTRA in 2012.The network’s aim was to initiate and support tailor-made activities for capacity development in food & nutrition in research and training in CEE/BC. To identify the challenges and needs of nutrition research in the region, the network performed inventories on existence of food composition databases, food systems elements, dietary surveys, micronutrient recommendations, application of dietary assessment methods and grey literature. Further on, the network focused on the development of food composition databases and concomitant data management software, the Diet Assess & Plan platform for food consumption collection, dietary intake assessment and nutrition planning. These and other elements form the Balkan Food Platform, which underpins harmonized nutrition research in CEE/BC. Among key actions promoted by the platform are EFSA-supported dietary surveys conducted in four Balkan countries, on children and adults, in which food consumption data are collected and analysed in a harmonized way. Cooperation with FAO and active participation in international research projects enhanced the exchange of information and knowledge and brought international recognition to the CAPNUTRA network.     

The complex relationship between inventory control and organisational setting: Theory and practice

Within companies it is widely recognised nowadays that the performance of inventory systems is not only determined by the way the inventory system is planned and controlled but also by its organisational architecture. Notwithstanding its importance, the field of production and operations management still lacks however, a comprehensive body of knowledge integrating both control and organisational aspects of inventory systems. One of the reasons for this shortcoming seems to be a lack of understanding of how inventory planning interacts with its organisational embedding in practice. In this article, this interdependence is further explored. Firstly, a conceptual framework is presented. The framework has been the starting point for five case studies performed during the last years. In this article data gathered over a period of more than fifteen years concerning one company is further explored. One of the main conclusions derived from this longitudinal case study is that organisations often try to neutralise shortcomings in the inventory planning and control system by applying organisational measures. In addition to this positive congruence, negative forms of congruence were also found. Shortcomings in the inventory control system are then negatively re-enforced by its organisational setting. The findings of the case study also suggest that companies often do not apply a clear and well-defined policy regarding the organisational setting of advanced inventory planning and control systems. We end this article by arguing that objectified notions on (re)designing inventory planning and control and its organisational design often under-emphasise irrational behaviour of the parties involved. A further elaboration of the framework presented in this article integrating operations management concepts and organisational theory therefore seems to be worthwhile.     

Nutritional considerations in project planning

This paper discusses procedures for "ex ante" assessment of likely nutritional effects of development projects. Reported are results of 1 field trial in the Philippines of the "ex ante" assessment procedure in terms of: its feasibility and timeliness and the recommendations for project design that can be made and their influence. In the procedure described, emphasis is placed on assessing likely direct effects--through income, environmental changes and access to services. Indirect effects through food output and prices are assessed qualitatievly. 2 primary questions are addressed in the "ex ante" assessment: 1) who is to benefit directly from the project, in relation to their need (measured in terms of nutrition) and 2) is there reason to suppose that these benefits will not improve their nutrition? The procedure began with an initial assessment to identify the main issues based on reviewing existing data and a short field visit; since there was insufficient information, a rapid nutrition survey was conducted and analyzed; recommendations for project design were made within the necessary time for inclusion. The assessment of the large-scale development project in the Philippines indicates priority to remote areas, small farmers and subsistence fishermen. It is concluded that production-oriented components (e.g., agricultural and infrastructure development) of the project appear likely to improve nutrition insofar as they reach the priority groups defiend above. There is little reason to believe that increased income will not improve nutrition. Finally, there is evidence that an intervention to improve water supply is likely to be effective. Limitations of the procedure are that the assessment is limitied to direct, microlevel effects; long-term influences on nutrition, through changes in the overall economy of the area, are not assessed. Also, the data used cannot easily quantify expected effects on nutrition of project participants. Future application of such procedures are seen to be important if they can be fully integrated with the overall project planning.     

Towards a food and nutrition policy in Tanzania

Fragments of a nutrition policy are seen throughout the different phases of Tanzania's modern history. Efforts of the pre-Independence period culminated in formation of a committee on nutrition which advocated improving food storage, food legislation and standardization, and nutrition education. After independence, an initial period of concentration on cash crops was followed by increased cooperation with the Ministry of Agriculture, and some nutritional surveys were undertaken. After the Arusha Declaration in 1967 a basic needs strategy giving greater stress to food production and adequate nutrition received emphasis, and a Food and Nutrition Centre was established with 4 departments: food science and technology; manpower development; medical nutrition; and planning and coordination. Emphasis on production is reflected in a target of reducing malnutrition by 30 to 50% in every region by 1981, and an interdisciplinary approach is being used to achieve this goal. The basic similarity in proposed activities during the various phases of Tanzania's history indicates that political will is necessary for carrying out the policies.