Nutrition Policy Implementation: Issues and Experience PDF
Preview Nutrition Policy Implementation: Issues and Experience
Nutrition Policy Implementation Issues and Experience Nutrition Policy Implementation Issues and Experience Edited by NEVIN S. SCRIMSHAW Institute Professor, Massachusetts Institute of Technology Director, MIT/Harvard International Food and Nutrition Program Senior Adviser, World Hunger Program, United Nations University and MITCHEL B. WALLERSTEIN Associate Director, MIT/Harvard International Food and Nutrition Program Lecturer, Departments of Political Science and Nutrition Massachusetts Institute of Technology Sponsored by the United Nations University, Tokyo, Japan PLENUM PRESS. NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Main entry under title: Nutrition policy implementation. Includes bibliographical references and index. 1. Nutrition policy. I. Scrimshaw, Nevin S. II. Wallerstein, Mitchel B. TX359.N8861982 363.8'56 82-9137 ISBN-13: 978-1-4684-4093-5 e-ISBN-13: 978-1-4684-4091-1 DOl: 10.1007/978-1-4684-4091-1 ©1982 Plenum Press, New York Softcover reprint ofthe hardcover 1 st edition 1982 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical. photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Preface The MIT International Nutrition Planning Program (INP) was initiated in the fall of 1972 with a grant from the Rockefeller Foundation, later supplemented by funds from USAID under the 2110 Program. Con ceived as a multidisciplinary undertaking, the INP was a joint effort of the Department of Nutrition and Food Science and the Center for Inter national Studies at MIT that also included representatives of the Depart ments of Economics, Political Science, Urban Studies, Humanities (Anthropology), and Civil Engineering. It has been successful in attract ing graduate students and conducting research on various international food and nutrition problems, including the design of intervention pro grams. A condition of the original grant from the Rockefeller Foundation was the organization of a meeting to summarize and evaluate the prog ress of the program. It was ultimately decided that the best approach would be a workshop that would attempt to assess what had been learned about the implementation of food and nutrition policies since the start of the INP. Out of concern for food and nutrition policy issues, the World Hunger Programme of The United Nations University (UNU) and the Ford Foundation also agreed to cosponsor the workshop. The interest of the UNU stemmed from an expert group meeting in 1975 that identified research and training in food and nutrition policy and planning as a major subprogram priority. In 1977 the UNU signed an agreement of association with a consortium consisting of the MIT -INP and the Center for International Health of the Harvard School of Public Health, with the resulting program to be known as the International Food and Nutrition Program (IFNP). At the time of the workshop, a total of 20 UNU Fellows, drawn from all parts of the world, had participated in the IFNP advanced study program, taking advantage of the resources of both institutions. The workshop itself drew upon faculty and staff v vi PREFACE members at MIT and Harvard, as well as individuals from instituions both within and outside the United States to discuss, in various cate gories, the implementation of nutrition policies. Because the conference marked the end of the first phase of the pro gram at MIT, the moment was considered particularly auspicious for merging the UNU-sponsored IFNP and the MIT-sponsored programs, both to avoid confusion and duplication of effort and to indicate that concern with planning activities and field studies necessarily involves policy analysis across a broad range of disciplines. From the beginning, the INP approach has been multidisciplinary, and the involvement of the Harvard School of Public Health brought into the program yet another group of disciplines. Students entering the program through either Harvard or MIT may take part in courses in both institutions through cross-registration and participate in a weekly Food Policy Sem inar:~ It is intended that the present volume will be a reference source on the kinds of food and nutrition issues that occupy IFNP students and staff. The IFNP has benefited greatly from the participation in this work shop of individuals from other institutions in the United States and abroad. This has been possible through the support of the Rockefeller and Ford Foundations and The United Nations University World Hun ger Programme. Thanks are extended to these institutions for making this volume possible. NEVIN S. SCRIMSHAW MITCHEL B. WALLERSTEIN Contents Introduction .................... . xiii I • THE RATIONALE FOR INVESTMENT IN NUTRITION .............................. . 1 1 • Nutrition and Work Performance .................. . 3 F. E. VITERI Comment ....................................... . 15 HARRY L. JACOBS Discussion ..................................... . 19 2 • The Impact of Malnutrition on Behavior ...... . 21 JOSEF BROZEK Comment .......................... . 37 ERNESTO POLLITT Discussion ...................................... . 39 3 • Malnutrition and Infection. . . . . . . . . . . . . . . . . . . . . . . . . 41 R. K. CHANDRA Comment........................................ 53 GERALD KEUSCH Discussion ...................................... . 57 II • FOOD FORTIFICATION. .. . .. ... . ........ .... . . .. . 59 4 • Food Fortification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 STANLEY N. GERSHOFF Comment .................................. . 73 F. E. VITERI vii viii CONTENTS 5 • The Program of Fortification of Sugar with Vitamin A in Guatemala: Some Factors Bearing on Its Implementation and Maintenance . . . . . . . . . 75 GUILLERMO ARROYAVE 6 • Prevention of Iron Deficiency ..................... . 89 MIGUEL LAYRISSE Discussion ...................................... . 97 III • SUPPLEMENTARY FEEDING AND FORMULATED FOODS..................................... 99 7 • Programs of Supplemental Feeding and Weaning Food Development................................ 101 NEVIN S. SCRIMSHAW Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 ALBERTO CARVALHO DA SILVA 8 • Food Aid for Supplementary Feeding: A Case Study from Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 STEPHEN R. ALLEN AND ANDREW J. KOVAL 9 • The Nutri-Pak: Experience with an Indigenous Supplementary Feeding Intervention in the Philippines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 GEORGE H. ROPES 10 • Supplementary Nutrition: A Case Study from India. . . 141 BADRI T ANDON 11 • Supplementary Feeding and Formulated Foods: Some Comments ....................................... 151 RICARDO BRESSANI Comment ....................................... . 161 GRETCHEN BERGGREN Comment ....................................... . 163 HOSSEIN GHASSEMI Discussion ...................................... . 167 CONTENTS ix IV • INTEGRATED, MULTI SECTORAL VILLAGE-LEVEL INTERVENTIONS. ... . .. . . ... .. . .. . . . . . . . . 171 12 • Integrated Multisectoral Interventions at the Village Level. . . . . . . . . . . . . . . . . . . . . . . . . 173 BRUCE F. JOHNSTON 13 • Development from Below: Transformation of Village Based Nutrition Projects to a National Family Nutrition Program in Indonesia ..... . 209 JON E. ROHDE AND LUKAS HENDRATA 14 • Integrated Multisectoral Nutrition Intervention at the Community Level: The Colombian Experience ... 231 LUIS FAJARDO Comment .... 243 RICARDO L. SANCHEZ 15 • Interface Problems between Nutrition Policy and Its Implementation: The Philippine Case Study 247 R. FLORENTINO, C. ADORNA, AND F. SOLON Comment 269 VVARRENBERGGREN Comment ..................... . 271 JOHN O. FIELD Discussion ..... 275 V • SMALL-FARM AGRICULTURAL SYSTEMS. . . . 277 16 • Some Issues in Expanding Small-Farm Agricultural Production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 SOLON BARRACLOUGH 17 • A Regional Approach to Agricultural Development and Its Potential Insights for Nutrition Planning 289 DONALD R. FIESTER 18 • Nigeria's Experience with Programs Aimed at Expanding Small-Farm Agricultural Production 307 BEDE N. OKIGBO x CONTENTS Comment ..................................... . 325 MICHAEL LIPTON Discussion ...................................... . 331 VI • POST-HARVEST FOOD CONSERVATION........... 335 19 • Post-harvest Food Losses in Developing Countries: A Survey. . . . . . . . . . .. . . .. . . . . ... . .. ... ... . . .. . .... . . 337 E. R. P ARISER 20 • Who Is the Loser in Post-harvest Losses? ............ . 373 HANS GUGGENHEIM 21 • Problems in the Post-harvest Processing of Rice in Southeast Asian Countries ... . . . . . . . . . . . . . . . . . . . . . . 385 Y ASUMASA KOGA Comment ....................................... . 419 H. A. B. P ARPIA Comment ....................................... . 421 PIERRE SPITZ Comment ................. . 423 HANS GUGGENHEIM Comment ................. . 425 MICHAEL LIPTON Comment ....................................... . 429 RICARDO BRESSANI Discussion 433 VII • FOOD PRICE CONTROLS AND CONSUMER SUBSIDIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435 22 • Food Prices as a Nutrition Policy Instrument. . . . . . . . . 437 C. PETER TIMMER 23 • Consumer Food Price Subsidies in Pakistan . . . . . . . . . . 453 BEATRICE LORGE ROGERS 24 • Food Subsidies in Egypt 473 LANCE TAYLOR CONTENTS xi 25 • Strategies and Mechanisms for Urban and Rural Subsidization: The Case of CONASUPO . . . . . . . . . . . . . . . . 481 JAMES E. AUSTIN Comment ....................................... . 499 ALBERTO CARVALHO DA SILVA Comment ................... . 507 JAMES GAVAN Discussion ...................................... . 509 VIII • NUTRITION POLICY IMPLEMENTATION... . . . ... . 513 Final Discussion ................................. . 515 Summary Comments ..... . 521 SOL H. CHAFKIN CONCLUDING AFTERTHOUGHTS ........................ . 527 ALAN BERG ...................................... . 527 MERRILL S. READ .................................. . 528 BADRI N. TANDON ................................ . 530 MICHAEL LIPTON .................................. . 532 MITCHEL B. WALLERSTEIN AND NEVIN S. SCRIMSHAW ..... 535 Participants .............................................. . 539 Index ................................................... . 543
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