Nutrition policy for Sudan and strategy for implementation.

Salih, Osama Awad ; Khattab, Abdel Gadir Hassan

Abstract

This article describes the process for development of the first national nutrition policy in the Sudan; an effort which was made possible by the willingness of the Sudan Federal Ministry of Health and the Support from the UNICEF--Sudan. The process for the development of this policy document is in fact a useful learning tool that should be documented and made available for researchers, for the purpose of updating and for monitoring and evaluation. The goal of this nutrition policy was to define a framework through which available technical, human, and financial resources may be mobilized in order to ensure the health and nutrition status of all Sudanese citizens is significantly improved through nutrition and other related interventions.

Introduction

Improving the health and nutrition status of the people of Sudan is one of the priorities for the Federal Government of Sudan (FMOH, 2005), and is vital to its development. While Sudan has enormous potential in terms of natural and human resources (FAO, 2005), it is not on track to meet the Millennium Goals by 2015 (UNICEF, 2006). Health, education, social services, and vital infrastructures for transport and utilities have all stagnated in recent years (Abdel Ati, 2002). Decades of civil conflict have contributed to high rates of morbidity and mortality, for the most part due to preventable communicable diseases and suboptimal health seeking behaviour, which has been exacerbated by the limited coverage and quality of health services and education infrastructures.

Recurrent episodes of natural and manmade disasters have crippled the economy and livelihoods of both urban and rural populations, contributing to rising levels of poverty and resulting in well over half of the population living below the poverty line.

A low but significant and rising prevalence of HIV+ and AIDS adds to the threats to health, productivity and wealth, and must be approached preventively, now, as well as through treatment (SHHS, 2007; FAO, 2005). Nutrition indicators from recent studies (SHHS, 2007) show a worrying nutrition profile in the country. Almost one third (31%) of children under the age of five in Sudan are moderately underweight, while 9.3% are severely underweight. Almost half (48%) of children under five suffer from moderate or severe chronic malnutrition, while 18.1% of children under five suffer from moderate or severe acute malnutrition.

Overall, nutrition status is found to be positively associated with increasing levels of maternal education and increasing household financial resources (SHHS, 2007), suggesting that efforts to reduce poverty and improve human resources is necessary to see improvement in nutrition for the population.

While not common, 3.6% of children under five are overweight (SHHS, 2007). In the context of increased access to non traditional, and processed foods, as well as limited physical exercise, children are put at risk of developing lifestyle diseases such as type 2 diabetes at a young age. Infant and young child feeding practices are not optimal (SHHS, 2007). Less than half of the children in Sudan are exclusively breastfed to four months (42 per cent), and only one in three infants (33.5 per cent) are exclusively breastfed to six months. Complementary foods are often introduced early, and continued breastfeeding until two years not common.

This effort of developing a national nutrition policy did not stem out of nothings, for instance, the Sudan's First National Food and Nutrition Seminar (Yousif et. al, 1973) recommended that a "malnutrition problem of such magnitude needs a coordinated and well-planned approach and requires the active cooperation of a large number of agencies". The seminar's findings are still relevant: the same course of action is still the key to improving the situation. On the other hand, the Sudan's National Plan of Action on Nutrition (Sudan government, 1995), written at the request of the 1993 FAO-WHO International Conference on Nutrition, and adopted by the Government of Sudan on 21st May 1995, reiterated the need for coordinated action in the area of nutrition.

The process for the development of the policy document

The consultants held series of meetings with the director of the National Nutrition Directorate (NND) and his staff and reviewed their activities and what has been documented in this matter. They then held several meetings with the relevant ministries including Federal Ministries of Health, Agriculture, Social Affairs, Humanitarian Affairs, General Education, and Higher Education as well as the Khartoum State Ministry of Health, the Population Council and the Sudan Central Bureau of Statistics. All academic and research institutions in Khartoum (the Capital) were visited and the issues of nutrition activities and their role in this regards was also discussed with them. UN Agencies concerned with food and nutrition such as UNICEF, FAO, UNFPA and UNDP were also visited and their concerns were taken into consideration.

After those interviews and discussion meetings a first draft document was produced and presented to a steering committee constituted by the director of the Primary Health Care (PHC) for this purpose. After obtaining the feedback from the committee, a corrected document was presented for a validation workshop. This included all State Nutrition Directorate (15 States) and representatives from South Sudan Government in addition to the other stakeholder and all Ministries and academic and research institutions involved in nutrition in the Sudan.

After a thorough discussion within the different groups and in a panel form, the document was finalized and presented to the Federal Ministry of Health and UNICEF for the final approval.

Components of the policy document

The document is composed of a nutrition policy statement linked to a strategy for its implementation in the Sudan. The other components of the documents are;

Policy vision

This Nutrition Policy for Sudan addresses a vision of a country at peace, investing its national wealth in its people and in economic development which focuses on eradicating poverty.

The policy vision calls for commitment to promoting nutritional wellbeing for all people in Sudan.

Policy Rational

Sudan potential for agricultural production, a major food industry and now the development of its oil products sector offer an ideal opportunity for future improvement of quality of life for all its citizens. With peace and good management of the country natural and mineral resource and with equitable distribution of products and wealth, the whole population could benefit from being well fed, from good services and from rising prosperity.

Nutrition is an integral aspect of development and particularly in the accelerated development that may be now be possible (Horton, 1999; ACC-SCN, 2002). Good nutrition ensures the strength, stamina and productivity of all Sudanese to work to escape from poverty and contribute to the country's wealth.

Health and other sectors

There is little the health sector alone can do to address inequities and shields people from economic austerity and conflict, or indeed to remedy a poorly regulated food industry and trade, and a poorly-informed media encouraging unhealthy eating habits in people with minimal food knowledge beyond their traditional diet. Neither health nor other relevant sectors currently recognise the diverse roles to be played by each of them, together, to remedy this anti-nutritional situation, prevent it deteriorating further, and build up a healthy, well-nourished labour force.

Policy objective

The objectives of the policy are:

1--Reverse the current deterioration in nutritional status, among various population groups, of all ages; and gradually improve it, particularly among the physiologically vulnerable.

2--During the short-term improvements brought about by emergency interventions, increase local skills and develop adequate programmes to sustain the improvements.

3--Expand nutrition resources for state- and local-level activity, both human and financial.

4--Actors across the sectors will talk together and coordinate activities

5--Mainstream nutritional status as a key development indicator during Recovery and Reconstruction

2006-2010 Strategy for Implementing Sudan's Nutrition Policy

The 2006 Policy sets out the potential for improved nutrition in Sudan; this first 5-year Strategy adds to ongoing activities the building-blocks needed to ensure that the vision can be reached in a further ten to twenty years.

The first of the three strands of the Strategy focuses on the key sector--health, which holds the nutrition mandate, a second has a broad address to collaboration and coordination across the sectors, and a third addresses the human resource development required to guide and coordinate the implementation of the first two.

The Strategy is not an action plan; what it does is outline the steps needed to achieve the Policy. These steps are elements to be incorporated into work-plans and fleshed out there, ready for implementation as financial and human resources become available.

Layout and priorities

--Each strategy and its sub-strategies are allocated to one of the three strands (NH = nutrition-in-health, NC = nutrition across sectors, or NL = nutrition leadership), according to the objectives for the strand and the rationale for the strategy.

--The numbering of each strategy and its sub-strategies follows whichever strand they are allocated to. Ongoing nutrition activities are denoted by "0", eg NH 1.0.

--The internal priorities for each strategy are indicated by S = short-term, 2006-7; M = medium-term, 2008-10; and L = should be done now to ensure development towards the Policy Goal in the next strategy period.

--Suggested leads in the partners clusters are marked (*)

NH: developing nutrition throughout the health sector (Table 1 and 2)

The objectives of the NH strand are:

--Developing a broader vision and operating framework for nutrition within the health sector, for nutritionists in NND/FMOH and in MOH (South).

--Creating strong partnerships within the sector for improving the nutrition of every age-group.

The framework for the NH strand is Breaking the IGCM (inter-generational cycle of malnutrition). The NH strategies make explicit the assumption of a family context, and addresses nutrition for those without families and those families and individuals finding themselves in difficulties during emergencies.

NC: collaboration on nutrition across sectors (Table 3)

The objectives of the NC strand are

--fostering strong and active partnerships in many sectors around key issues of nutrition

--identifying relevant stakeholders for each cub-strategy, and thus maximizing the number of sectoral partners relevant to nutrition in each sub-strategy

--raising the level of discussion around nutrition within and between sectors

The framework for the NC strand is Practice and Learning, incorporating elements of the food chain/system, elements of education, and elements of public health beyond the current mandate of the health sector.

NL: strategies for nutrition leadership (Table 4)

This strand of the Strategy addresses the people and organizational aspects that will be needed to lead the implementation of the Policy in the next five years, and what institutional issues they may be expected to address. The Federal Ministry of Health is the government body mandated to address nutrition. FMOH has established the National Nutrition Directorate (NND) in the Primary Health Care General Directorate in Khartoum, headed by a Director and currently staffed by 11 professional officers, of an establishment of 25. There is a similar nutrition unit in the Juba ministry.

Meanwhile, there are nutritional aspects to many areas of work across the health sector. In addition there are significant nutritional aspects to work in other sectors, notably Agriculture, Education and Social Affairs; and nutritional concerns are addressed in Water, Industry, Trade, and not least in the Media. As the only government nutrition agency, it is national level nutritionists, together with the Nutrition Directors in the various States' health ministries, who will be responsible for taking and developing a leading role in pursuing the vision outlined in the Policy. They will be expected to advise on, coordinate, monitor and evaluate many elements of its associated Strategy, as well as initiate or be involved in planning in their own and other sectors, at both Federal and State levels.

During the five years of this Strategy, nutritionists working in and with the health ministries in North and South, coordinating, implementing, monitoring, evaluating, and advising, as well as planning at State and Locality level, will need support, upgrading, and expansion of their numbers. The objective of the NL strategies is to address this. The main focus for the NL strategies is Sudanese government nutrition professionals. The framework for these strategies is nutrition-friendly institution-building, all supporting the life-cycle approach of the NH strategies and the cross-sectoral collaboration of the NC strategies.

Suggested Steps for the implementation of the document

Since the document is initiated by the National Nutrition Directorate (NND) of the Primary Health Care (PHC), Federal Ministry of Health (FMOH) and since FMOH is mandated to look after the activities of the nutrition in the country, it is expected that they will follow up the process of the endorsement of this policy by the Council of Ministries.

At the same time the document should be translated into Arabic Language so that a wider range of those involved in its implementation can have the opportunity of reading through.

The Arabic version should be discussed by the state Nutrition Directors so that they can define what can be implemented at the state and local levels. This document should be made available to all education and research institutions in the country so that they can use it for teaching, training and research activities.

Finally the media should be requested and make it known to raise their awareness about the importance of this document for the socio-economic development at all levels.

References

Abdel Ati HA (2002). Sustainable Development in Sudan: Ten Years After Rio Summit, A Civil Society Perspective, 281pp, Environmentalists' Society, EDGE & Heinrich Boll Foundation, Khartoum

ACC-SCN, (2002), Nutrition, A Foundation for Development: why practitioners in development should integrate nutrition, Geneva

Dirar HA, (1993). The Indigenous Fermented Foods of the Sudan: A Study in African Food and Nutrition, 552pp, CAB International

FAO, (2005). Sudan Nutrition Country Profile, FAO.org

Sudan Government, (1995). National Plan of Action for Nutrition (NPOAN)--Sudan

Sudan Government /EU/FAO, (2005). Institutional Capacity Programme: Sudan Integrated Food Security Information System for Action (SIFSISA), Khartoum

Horton, S. (1999). "Opportunities for Investments in Nutrition in Low-income Asia", Asian Development Review, vol. 17, nos. 1,2, pp 246-273

Hunt JM, (2005). "The potential impact of reducing global malnutrition on poverty reduction and economic development", Asia Pac J Clin. Nutr. 14 (CD Supplement), pp10-38

SHHS, (2007). The Sudan Household Health Survey (SHHS). Federal Ministry of Health, Government of the Sudan.

UNICEF (2005). Country Profiles: Northern Sudan, Southern Sudan

UNICEF Sudan, (2006). Annual Report 2006

Yousif, Y.B.; Bagchi, K. and Khattab, A.G. (1973). Food and Nutrition in the Sudan: Proceedings of the First National Nutrition Seminar, March 1972, National Council for Research, 236pp, Tamaddon Press, Khartoum

Salih, Osama Awad and Khattab, Abdel Gadir Hassan-(Nutrition Centre for Training and Research, Ahfad University for Women)

Table 1. Nutrition-in-Health strategies (NH) Titles and Rationales

Ref Nutrition-in-Health strategies--(NH), Key
No Titles and Rationales Sectors

NH 1 Supporting good food, health and care Health,
 in the family Univ's,
 Education,
MDGs As the context for most meals and health Media,
1,2,3,4, care, the family is the main influence SocAff,
5,6 on individual nutrition behavior. Community
 Ensuring that this influence is as CBOs
 healthy as possible provides each member
 with the basis for his/her food and diet
 choices, also in adversity and
 humanitarian contexts.

NH 2 Nutrition in crises Community,
 Health,
MDGs During natural disasters, displacement Water,
1,2,3,4, and conflict, as well as in medical Humanitarian,
5,6 crises like AIDS in the family, it is International
 family units who are able to stay Civil Defense
 together who are best able to maintain Local org's.
 health and nutritional levels. Their
 own strategies under stress, for finding
 drinking water, and for getting,
 preparing and eating food they know,
 will need supporting. When one or more
 family members becomes malnourished,
 s/he should as far as possible be able
 to get help while remaining together
 with his/her family. People separated
 from their families may need special
 support.

NH 3 Pre-marital and new baby nutrition Youth,
 Media,
MDGs Small babies are less healthy and at Community,
1,2,3,4,5 greater risk of early death or of illness Health,
 in adulthood. Young men and women both Education
 need to know that prospective mothers
 must be well-nourished in order to have
 healthy babies. They and their families
 may need support in order to put good
 nutrition for prospective mothers into
 practice.

NH 4 Pregnancy, lactation and nutrition Youth,
 Media,
MDGs Small babies are less healthy and at Community,
1,2,3,4,5 greater risk of early death or of illness Health,
 in adulthood. The mother herself needs Education
 reserves of strength and energy. All
 family members should be aware of this
 and encourage her to eat well. Where
 eating well during pregnancy is
 difficult, support and advocacy in the
 local community contributes to healthy
 outcomes. All family members should
 encourage lactating mothers to eat well.
 Where eating well during lactation is
 difficult, support and advocacy in the
 local community contributes to health
 outcomes.

NH 5 Nutrition at birth "

MDGs New babies belong with their mothers,
1,2,3,4,5 and both may need help to start
 breastfeeding soon after birth. Babies
 who are exclusively breastfed for the
 first few months thrive more, and their
 mothers return to normal health quickly.

NH 6 Infants and nutrition Health, Media,
 Community,
MDGs Low birth weight pre-disposes infants to SocAff,
1,2,3,4,5 poor health. Breast-milk is the best Food industry
 food for infants under 64months (even Agr Millers
 for infants with HIV+ mothers) since it
 contains immunizing and other protective
 ingredients. If infant growth falters
 significantly after 6 months, the carer
 may need supporting with relevant advice
 and directing to nutritious weaning
 products.

NH 7 Young children and nutrition Health,
 Food research,
MDGs By the age of 6 months infants are Food industry
2,3,4 already becoming interested in foods in Media
 addition to breast milk. These need to
 be as nourishing as possible if child
 growth is to be given the best chance.
 Carers may need advice on weaning
 preparations and the introduction of
 solid foods.

NH 8 Pre-schoolers, school-age children and Community
 nutrition Education,
 Health
MDGs Children at school need to be Media
234 well-nourished in order to stay awake
 and learn attentively, as well as walk
 to and from school and do their home
 chores properly. Those children kept at
 home need to be well-nourished to do
 their home chores properly.

NH 9 Adolescents and nutrition Media
 Health
MDGs Adolescent growth is not as rapid as Education
1,2,3,6 that of infants, but the development of Sports
 critical potential takes place,
 including boys' bodily strength, and
 girls' reproductive capacity. Good
 nutrition maximizes these potentials.

NH 10 Adult nutrition Employers
 Labor, Media,
MDGs Most adults have families to support. Health
1,3,4,5,6 and risk the well-being of their Education
 dependents if they neglect their own
 nutrition, particularly in a crisis
 (v NH 2) Any nutritional programme for
 other age-groups should consider the
 nutritional situation of the relevant
 adult carer(s), and if the need help
 should also advocate on their behalf.

NH 11 Elderly nutrition SocAff,
 Media,
MDGs Many elderly work hard into old age, Health,
1,3,4,5,6 often supporting the social, care and Labour
 even financial needs of younger members Communities
 of their families. They need to eat well
 to do so; but both they and more
 sedentary elderly people have changing
 nutrient and food needs, not least as
 their digestive systems and teeth become
 less robust with increasing age. They
 and their families need to know how to
 manage this well on a daily basis.

Table 2. Nutrition-in-health Strategies (NH): Summary

 NH Nutrition-in-health strategies NH
 NH 1 Supporting good food, health and care in the family
 1.0 Continue and expand all Essential Nutrition Actions
 1.1 Family knowledge of foods and nutrition
 1.2 Family knowledge of traditional diets
 1.3 Family knowledge of new foods and healthy eating
 1.4 Nutrition in prevention of disease and in care for ill
 family members
 1.5 Population focus for IDD prevention
 NH 2 Nutrition in crises
 2.1 AIDS in the family
 2.2 Shanty-town living
 2.3 IDPs
 2.4 Natural disasters and conflict
 NH 3 Pre-marital nutrition, new baby and new parents
 3.1 Awareness & community outreach
 3.2 Advocacy
 3.3 Review schools curricula
 NH 4 Pregnancy, lactation and nutrition
 4.0 Continue improving existing ante-natal care
 4.1 Awareness, for all
 4.2 Breastfeeding support
 NH 5 Nutrition at birth
 5.0 Continue improving existing services
 5.1 Awareness, for all
 NH 6 Infants and nutrition
 6.0 Continue existing services
 6.1 Breastfeeding and complementary feeding
 6.2 Good local complementary foods
 6.3 Maternity entitlements
 NH 7 Young and re-school children and nutrition
 7.0 Continue ENA in health facilities
 7.1 Local weaning foods
 7.2 Complementary food ideas in relevant curricula
 NH 8 School-age children and nutrition
 8.1 Review nutrition aspects of School Health guidelines
 8.2 Upgrade nutrition component in teacher training
 8.3 Introduce HFA monitoring of first-year pupils
 8.40 School gardens
 8.50 School meals
 NH 9 Adolescents and nutrition
 9.1 Health eating habits
 9.2 Media role models for adolescents
 9.3 Health activity
 9.4 Health and medical staff roles
NH 10 Adult nutrition
 10.1 Awareness
 10.2 Lifestyle diseases
NH 11 Nutrition and the elderly
 11.1 Awareness, for all
 11.2 Gentle gymnastics
 11.3 Screening
 11.4 Devising interventions
 11.5 Screening in emergencies
 11.6 Training and advocacy

Table 3. Nutrition across sectors (NC) Titles and Rationales

Ref Nutrition across sectors (NC) Titles and Key
no Rationales Sectors

NC 1 Media and nutrition Media
 Universities
MDGs Advertising and TV are playing an ever Health
1-6 greater role in influencing which foods Research
 urban Sudanese look for when shopping or Food industry
 going out to eat, as well as which health
 products and remedies people try. Media
 influence is also growing in rural areas.
 The sub-strategies throughout suggest some
 ways the various media can access
 reliable information from professionals,
 and create the variety of collaborative
 partnerships that can be formed which
 impact positively on nutrition.

NC 2 Nutrition in food security Agriculture

MDGs A well nourished, healthy workforce is a (Food
1,4,5 precondition for successful economic and security)
 social development, and nutritional status Health
 is internationally recognized as a key Universities
 indicator of food security and national International
 development. Agriculture and its related Trade
 activities constitute a major source and Industry
 often the main source of employment and Finance
 income. Thus direct investment in Food industry
 improving the nutritional status of rural
 populations is likely to have a significant
 pay-off in raising labor productivity and
 incomes. National agricultural research,
 in its role of enhancing food production
 and productive capacity of a country,
 can benefit from information about the
 specific nutritional needs of populations
 in order to contribute towards the
 nutritional well-being and productive
 capacity of the agricultural work force.
 Nutrition is also a major factor in
 deciding when food is needed to support
 hungry people, and what types of food
 the support should consist of.

NC 3 Water, sanitation and nutrition Water
 Health
MDGs More food is lost to children through Agriculture
 diarrheas caused by unclean drinking water Media
1,4,5,6,7 and poor sanitation than through storage
 losses and food spoilage. Reducing
 diarrheas and other intestinal complaints
 associated with poor sanitation will
 both improve health and save food.

NC 4 Schools, nutrition and foods Education
 Health
MDGs After the family, the school is, or should Agriculture
1,2,3 be, the best source of general Community
 knowledge about foods, diets and nutrition. Media
 Teachers, parents, pupils and the
 local community can all support this
 learning by contributing to school plots
 and school meals, which can in turn be
 used as practical examples in lessons.

NC 5 Higher learning, Community Colleges, Universities
 Nutrition teaching Media
 Health
MDGs The currently limited scope of nutrition Education
1 thru' 7 work in Sudan neither challenges nor
 enhances the scope and depth of nutrition
 teaching, learning and research in the
 country. As economic development refreshes
 perspectives on a broader spectrum
 of nutritional activity, medical health
 horizons will lift beyond the purely
 curative; agricultural knowledge and
 practice will stretch beyond a production
 focus; and social and cultural studies
 will also encompass food culture.

NC 6 Adult and non-formal education Community
 SocAff
MDGs Many adult learners, especially those Education
1 thru' 7 who missed out on some years of Health
 schooling, are surprised to find that Media
 there is a great deal about foods, diet
 and nutrition that can be learnt. They are
 keen to learn and to apply what they learn
 immediately. This opportunity to improve
 nutrition habits should not be missed.

NC 7 Food industry and retailing--a healthy Consumers
 foods code Association,
 Industry
MDGs Rapid developments in Sudan's food Health
1,4,5 industry have seen an imbalance develop; Agriculture
 on the one hand growing investment in and Media, Food
 advertising for sure-sale foods and research
 drinks with high fat/salt/sugar content,
 and on the other little attention to
 developing and promoting healthy food
 products. This is one factor contributing
 to rising rates of diabetes and heart
 disease in urban areas. This is now an
 opportunity to right the imbalance and
 encourage Sudan's food industry to profit
 from developing the healthy eating market.

NC 8 Restaurants and caterers--a healthy Food trade,
 eating code Health, SSMO
 Consumers'.
MDGs The market for meals as well as products
1,5 that support eating healthily will grow.
 Restaurants and other eating laces can
 profit from developing this market.

NC 9 Healthy institutional feeding Health
 Institutions
MDGs Sports clubs, schools, army camps,
1,2,5 hospitals, prisons should all be budgeting
 for nutritional balance in the meals the
 provide, as well as keeping costs low.

NC 10 Monitoring nutritional impacts Health
 Research
MDGs Hitherto monitoring data has largely been Community
1,4,5 kept by central officers and funding
 agencies. There is now an opportunity to
 make more use of this data, to inform
 the development of nutrition and other
 programmes.

NC 11 Evaluating nutritional progress Health,
 Soc Aff.
MDGs Making use of monitoring data from many Planning
 sectors can give a rounded picture of how Community
1,4,5 far nutritional progress develops in Agriculture
 parallel with the impacts of relevant International
 programmes in those sectors. This is
 crucial to understanding nutritional
 mechanisms in development, and consequently
 for formulating and adapting programmes in
 the relevant sectors in order to maximize
 nutritional and other impacts.

NC 12 Surveillance International
 Agriculture
MDGs Routine responses to the trigger-levels Health
 provided by nutritional status will
1,4,5 continue to play an important role in
 crisis situations where speedy action is of
 the essence. However this limited data is
 insufficient for monitoring the role of
 nutrition in recovery, rehabilitation and
 development processes. A broader
 surveillance and more nuanced
 interpretation and discussion is required.

NC 13 Food safety, food quality and food hygiene Food industry
 SSMO, Health
 More awareness of this nutrition and
 health contribution to consumer protection
 will help raise awareness of foods and
 food products.

NC 14 Nutrition research and nutritional Food research
 aspects of research Universities
 health
MDGs Many areas being researched by agriculture,
 education, social sciences and
I thru' 7 economics have nutritional elements.

NC 15 Nutrition competencies Health
 Other sectors
MDGs Regularizing the status and employability Universities
 of nutritionists, and filling the quotas
1 thru' 7 for government recruitment should encourage
 more to join the profession.

NC 16 Food and Nutrition Forum All

MDGs As more nutrition work in areas other than
 emergencies and MCH is developed,
1 thru' 7 the network of people working in nutrition
 in several sectors will need a forum
 for discussing their work and its
 perspectives.

NC 17 2012-2017 Policy &/or Strategy Development All

MDGs Before 2012 this Policy will need
 reviewing to establish its level of
1 thru' 8 continuing validity in the context at that
 time. Similarly, a new Strategy may need
 to highlight other priorities or be
 re-formulated. The F&N Forum could draft
 terms of reference for this work and
 recommend people and institutions capable
 of doing it.

Table 4. Nutrition Leadership strategies--(NL) Titles and Rationales

Ref Nutrition Leadership strategies--(NL) Key
no Titles and Rationales Sectors

NL 1 Nutrition-friendly programming in health Health

MDGs Nutrition in Sudan should be more than a
 problem of malnourished children that
4,5,6 falls to the health sector to sort out. A
 capable and competent nutrition leadership
 is urgently needed as the basis for
 developing support for both the NH and the
 NC strategies. Much learning can be done
 by meeting other sectors and developing
 their own nutrition focus with them. This
 work and this approach should start in
 Health.

NL 2 Nutrition-friendly health facilities Health
 Community
MDGs The ongoing process of integrating Education
 services at this level supports the SGNED
4,5,6 involvement of nutritionists in many
 aspects of people's lives and health.
 This can only benefit the communities
 using the health facilities where
 this is effected.

NL 3 Nutrition-friendly hospitals Health

MDGs When dietitians and nutritionists are
 involved in consultations with
3,4,5,6 medical doctors, after-care as well as
 in-patient care will benefit.

NL 4 Nutrition officers do nutrition; trainers Health
 do training

MDGs The broad Nutrition Policy and pro-active
 first five-year Strategy require
1 thru '7 nutritionists with breadth and depth who
 can operate pro-actively within Health and
 in other sectors. While Nutritionist
 numbers remain inadequate, their
 non-nutrition work (administration,
 data-entry, and training) should be done
 by others.

NL 5 Leading through advocacy in other sectors Health
 All sectors
MDGs Thinking nutrition, broad nutrition, may
 be new to many; specific projects will be
1 thru '7 need to be promoted by nutritionists in
 order to illustrate the links and the need
 to work inter-sectorall .

NL 6 Focal-point nutrition Health, SSMO
 Agriculture
MDGs Many sectors, and many departments in Education
 Health, will need to appoint and train a Food industry
1 thru '7 Nutrition Focal Point to liaise with Planning
 nutritionists in NND and elsewhere, with a
 view to achieving inter-sectoral action
 on nutrition.