Nutrition policy, Healthcare reforms, and Population based change

Dr. Arshad Mahmood Uppal

 Outline
1. Healthcare Reform

2. Public Policy

3. Regulatory Activities

4. Formulating Nutrition Policy

5. Policy Elements in Nutrition

6. Elements of Change
 Healthcare reforms

• It is a general rubric used for discussing major health policy creation or changes—for the
most part, governmental policy that affects healthcare delivery in a given place
 Healthcare reform
1. Its overall goals are to: 1. Pakistan has so far introduced little
fundamental change in its HCS.
1. Enhance efficiency of the healthcare
system (HCS), both technical and 2. Recently introduced Devolution Plan
allocative; provides an opportunity to introduce far-
reaching changes to make HCS truly
2. Improve the quality of services; and/or responsive to the needs of people.

3. Generate new resources for HCS. 3. The extremely precarious and deteriorating
economic reality in Pakistan alone demands
such restructuring and reorganization of its
HCS.

4. Basic performance indicators of the HCS also

point to this need.
Islam, A. (2002). Health sector reform in Pakistan: why is it needed?. JPMA. The Journal of the Pakistan Medical Association, 52(3), 95-100.
6. It should typically attempt to:

1. Broaden the population that receives healthcare coverage through either public
sector or private sector

2. Expand the array of healthcare providers consumers may choose among

3. Improve the access to healthcare specialists

4. Improve the quality of health care

5. Give more care to citizens

6. Decrease the cost of healthcare the package should include MNT, for its being cost
effective and helpful in managing most of the chronic diseases like, T2DM,
cancer, hyperlipidaemia etc.
 Coalition for nutrition services in healthcare reform

1. Appropriate nutrition is important to all stages of lifecycle, from developing healthy

eating practices and cholesterol screening to high tech interventions requiring
specialised nutrition support services. It is required that

1. Quality health & nutrition services (NS) are available, accessible, & affordable to
the people

2. NS shold meet the preventive, therapeutic & rehabilitative healthcare needs of the
people

3. Quality NS should be reimbursable and provided by qualified professionals

 1.3.Any basic benefit plan should include screening/surveillance, assessment,
counselling & treatment for individuals receiving primary & acute care, outpatient
services, home and long term care

1.5.Nutrition interventions & education programs that promote health & prevent
diseases should be fundamental to reform

1.6.NS should be coordinated with supplemental food programs & other food
assistance programs and delivered to a variety of settings that are both traditional &
innovative

Pakistan has developed nutrition services at district level.

 Public policy

• It is the principled guide to action taken by the administrative executive branches

of the state with regard to a class of issues, in a manner consistent with law and
institutional customs.

• The foundation of public policy is composed of national constitutional laws and

regulations.
 Public policies
1. It is a framework to make decisions & guide actions that aid the public
good.

2. These exert significant impact on

1. Societal behaviour

2. These develop when science, economics, social & political situations

evoke government response & direction to meet a need or some a
problem
3. Local governments are expected to provide a leadership role to ensure that
needs of local communities are met

4. Health professionals can initiate collaborative opportunities with various

organisations in their communities to

1. Clarify the roles and responsibilities of different levels of governments

2. Identify how legislative & program initiatives affect local government

and identify opportunities to collaborate on the issues of food &
nutrition
 4.3.Advocate for legislative & program changes to to strengthen local public health
capacity

4.4.Investigate traditional & future links between local government to components of

food system and identify the opportunities for collaboration on future food & nutrition
issues

4.5.Strategically plan comprehensive, but simply presented, local food system data

4.6.Apply food system discussions and case studies to aid local health management
when planning programs

4.7.Identify opportunities to interact with local government

 Food & Nutrition Policy
Policy is a course or principle of action adopted or proposed by an organization or individual
 Policy
1. It is wise, expedient, or prudent conduct or 1. Regulation
management
1. Little “P”
2. A principle, plan, or course of action, as pursued by
a government, organization, individual, etc. 1. Protocols

3. Policy making 2. Procedure manuals

1. The act or process of setting and directing the 3. Organizational rules

course of action to be pursued by a government,
business, etc. 4. Administrative rules

4. Policy=Ruels 5. Incentives/disincentives

1. Big “P”

1. Legislation

2. Litigation
 Food & nutrition policy
1. Nutrition policy (or nutrition planning)is

1. A set of concerted actions,

2. based on a governmental mandate,

3. intended to ensure good health in the population through informed

access to safe, healthy, and adequate food

"Nutrition policy." A Dictionary of Food and Nutrition. Retrieved November 05, 2016 from Encyclopedia.com:
http://www.encyclopedia.com/education/dictionaries-thesauruses-pictures-and-press-releases/nutrition-policy
 Nutrition Policy Framework
Policy
development
Identify relevant Evaluate health
Describe policy
nutrition & obesity outcomes &
development
related policy strategy consequences of policies
Examine policy
areas Model policies & policy
implementation
Identify relevant policies briefs
Design policy
Communicate &
Policy identification content, intent &
disseminate policy
enforcement
research
research Policy evaluation &
products
 Introduction
1. Food and nutrition are basic requirements for the promotion and protection of health, enabling the full
potential of human growth and development, with quality of life and citizenship.

2. The recent social transformations have changed our standards of health and food consumption, apart from
reducing hunger and food shortages, they have improved access to foods and hence exposed us to new set
of malnutrition, the overnutrition.

3. Inspire of these improvements a large segment of our population is living in extreme poverty.

4. Legislation in the form of

1. Pure Food Laws 1960

2. Pure food Act 1966

5. Collaboration with international agencies

6. IYCF practices 6. Our regular diet is varied as we
consume from traditional (wheet &
1. Promotion of breast feeding vegetables) to ultra processed foods.

2. Its continuation for 24 months 7. SES factors influence our food

pattern
3. Complementary feeding
8. Age has a say in food habits, young
are invested in easy foods, whereas
in orders fruit & vegetable
consumption is more.

9. Rural population consumes more

staple foods.
11. People like to eat away from homes 11. Over nutrition is emerging as a
and high consumption of junk foods. nutritional issue.

12.We consume more calories, through 12.Chronic diseases are emerging as a

calorie dense foods. realtime threat to us, may be due to
longevity.
13.Micronutrient deficiencies are on the
rise, due to our altered eating habits, as 13.Tackling this situation calls for action
above. in various sectors, from production to
the commerce of food and
14.We are facing the problems of food guaranteeing environments that
insecurity. facilitate behavioral change in
individuals and society.
 Objectives of food & nutrition policy
1. Its purpose is to improve the

1. Diet,

2. Nutrition and

3. Health of the population by promoting

1. Healthy & adequate eating habits,

2. Food & nutrition surveillance, and

3. Prevention and comprehensive care of

diseases related to food and nutrition.
 Principals
1. It’s pretexts are the rights to Food & Health and it is guided by the doctrinal and organizational principles
of the Unified Health System (universality, comprehensiveness, equity, decentralization, regionalization
and hierarchization and popular participation), to which are added the following principles:

1. Diet as an element of humanization in healthcare practices

2. Respect for diversity and food culture

3. The strengthening of individual autonomy: Keep in notice that there is a fine line between pleasure
and harm

4. Social determination and the interdisciplinary and intersectoral nature of food and nutrition

5. Food and nutritional safety with sovereignty: Right of access to safe & abundant food
 Guidelines
1. The guidelines should indicate various 1. Social Participation and Control
initiatives to achieve its purpose that are
capable of modifying the determinants of 2. Qualification of the Workforce
health and promote the population's health.
These are consolidated into: 3. Food Control and Regulation

1. Organization of Nutritional Care 4. Research, Innovation and Knowledge in

Food and Nutrition
2. Promotion of Adequate Healthy Eating
5. Cooperation and Articulation for Food
3. Food and Nutrition Surveillance and Nutrition Security

4. Management of Food and Nutrition

Actions
 Gl 1-Organization of Nutritional Care

1. The current food and nutrition situation in the country stresses the need for
better organization of health services to meet the demands created by health
problems related to poor diet, both in relation to diagnosis and treatment
and related to for disease prevention and health promotion.

2. Also included are surveillance initiatives to identify their determinants and

conditionants, as well as the most vulnerable regions and populations.
Gl 2- Promotion of Adequate and Healthy Nourishment

1. Adequate and healthy eating is understood as the dietary practice that is

appropriate to the biological and sociocultural aspects of individuals as
well as to a sustainable use of the environment.

2. Thus, it must be in accordance with the needs of each phase of life and with
special dietary needs; referenced by food culture and by gender, race and
ethnicity; accessible from a physical and financial standpoint; harmonious
in quantity and quality; based on adequate and sustainable production
practices; with minimum quantities of physical, chemical and biological
contaminants.
 Gl 3-Food and Nutrition Surveillance

1. Food and nutrition surveillance consists of a continuous description and

prediction of trends in the population's food and nutrition conditions and
their determinants.

2. It should be considered from an expanded approach that incorporates

surveillance in health/nutrition care services and integrates information
from health information systems, population surveys, health and nutrition
day surveys and scientific production.
 Gl 4-Management of Food and Nutrition Actions

1. This in addition to representing a political and normative reference for the

realization of the rights to food and health, represents a strategy that
combines two systems:

1. the Unified Health System, its institutional place, and

2. the Food and Nutritional Security System, a space for intersectoral

articulation and coordination.
 Gl 5-Social Participation and Control

1. The Unified Health System is a landmark of democratic and participatory

making of public policies.

2. Its legislation has defined mechanisms so that public participation is key to

its constitution and takes part in its operation through the practice of social
control in the Health Councils and Conferences in all the three government
levels.
 Gl 6-Qualification of the Workforce

1. Food & nutrition security, rightly demands for ordering the training of
workers involved in the food & nutrition agenda.

2. In this context, it is essential to align the qualification of professionals with

the population's health, diet and nutrition needs, and it is strategic to
consider the working process in health as a basis to organize the training of
the workforce.
 Gl 7-Food Control and Regulation
1. The planning of initiatives to ensure the innocuity and nutritional quality of
foods, controlling and preventing risks to health is part of the agendas of
promotion of adequate and healthy eating and of health protection.

2. The concern in offering healthy food and guaranteeing of biological,

sanitary, nutritional and technological quality to people, is the end product
of a chain of processes from production (including traditional and family
agriculture), processing, manufacturing, commerce and supply, up to
distribution, whose responsibility is shared with different sectors of the
government and society.
 Gl 8-Research, Innovation and Knowledge in Food and
Nutrition

1. The development of knowledge and the support to research, innovation and

technology in the field of food & nutrition in public health enable
generating the evidence and tools necessary for the implementation of the
F&NP
 Gl 9-Cooperation and coordination for Food and
Nutritional Security
1. Food & Nutritional Security is the realization of all people's right of to regular
and permanent access to quality food in sufficient quantity, without
compromising access to other essential needs, based on food practices that
promote health, that respect cultural diversity and that are environmentally,
culturally, economically and socially sustainable.

2. This concept encompasses issues related to food production and availability

(sufficiency, stability, autonomy and sustainability) and the concern for health
promotion, linking the two approaches into Food & Nutritional Security: the
socioeconomic approach and health and nutrition approach.
 Institutional responsibilities
1. In observance of the principles of the Unified Health System, health managers
at all three government levels, in a cooperative manner and in compliance with
their general and specific duties, will act to enable the achievement of the
purpose of the National Food & Nutrition Policy.

1. Responsibilities of the Ministry of Health

2. Responsibilities of the State and Federal District Health Departments .

3. Responsibilities of the Municipal and Federal District Health Departments

 Summary
Physical
It addresses the "supply side" of food security and is determined by the level of
AVAILABILITY of food production, stock levels and net trade.
food
Economic and An adequate supply of food at the national or international level does not in itself guarantee
household level food security. Concerns about insufficient food access have resulted in a
Physical ACCESS greater policy focus on incomes, expenditure, markets and prices in achieving food security
to food objectives.
Utilizations is commonly understood as the way the body makes the most of various
nutrients in the food. Sufficient energy and nutrient intake by individuals is the result of
Food UTILIZATION good care and feeding practices, food preparation, diversity of the diet and intra-household
distribution of food. Combined with good biological utilization of food consumed, this
determines the nutritional status of individuals.

STABILITY of the Even if your food intake is adequate today, you are still considered to be food insecure if
you have inadequate access to food on a periodic basis, risking a deterioration of your
other three dimensions nutritional status. Adverse weather' conditions, political instability, or economic factors
over time (unemployment, rising food prices) may have an impact on your food security status.
 Nutrition policy overview
Inputs Processes Outputs
h
Science policy Socioeconomic policy
ar c
e se Research
R Health/Medical care policy
Educational policy
Agricultural policy Improved health status
of the individuals

n
ntio
Food supply Food assistance

ve
programs Quality of
Production

Pre
•
life
• Processing
• Distribution/Market
Food consumption
ing Healthier environment
Programs & sustainable food
services
systems
Environmental policy
Pakistani scenario
 Formulation of National Food& Nutrition Security
Policy

1. In pursuance of the recommendations of the National Food Security

Conference, Standing Committee of the National Assembly on Food
Security & Research and the directive of the Prime Minister of Pakistan,
the MNFSR constituted a Core Committee in December, 2012 to prepare a
draft of the National Food & Nutrition Security Policy.

2. After a series of meetings, a draft policy has been prepared with the
following salient features:
 Policy Vision

1. All Pakistanis, at all times, have physical, social and economic access to
sufficient, safe and nutritious food to meet their dietary needs and food
preferences for an active and healthy life.
 Target

1. Halving food insecurity and malnutrition in the country by 2030 from 2012
baseline, and achieving food security for all by 2050.
 Strategic Interventions
1. Establishment of National Food & Nutrition Security Council to

1. Coordinate the actions of Federal and Provincial ministries in fight

against hunger and malnutrition and

2. Ensure multi stakeholder dialogues between government and all other

relevant actors (civil society organizations, INGO, UN Agencies,
private sector & bilateral funding agencies etc) and at all levels for the
implementation of its programs and policies.
 Launching of the National Zero Hunger Program-the
proposed interventions
1. School feeding programs in most food insecure districts

2. Nutrition programmes for less than 5 year children and pregnant and lactating
mothers.

3. Conditional cash/food transfers to the most food insecure households.

4. Cash/food support for vulnerable communities affected by man-made and

natural disasters.

5. Stimulus programmes to expand farm outputs and market access.

6. Targeted and conditional social safety nets.

7. Rationalization of market prices of food commodities.

8. Food supply and distribution programmes for the poor and highly food
insecure people.

9. Improved nutritious quality of food intake (fortified food).

10.Diversification of food and habit.

11. Revitalizing processing industry community at sub- national and national
level.

12. Food and nutrition awareness and education.

13.Overcoming malnutrition through health and nutrition programs; and

14.Enhanced coordination among various federal and provincial institutions in

the spirit of public-private-civil society partnership.
Online Monitoring of Food Security and Policy Reforms
1. To monitor 1. trade,

1. food security and supply of 2. food balance sheets and

nutritious food, information sharing with
stakeholders, and
2. prices,
3. undertake food policy research,
3. stocks,
4. proper pricing of inputs and
outputs to facilitate millions of
small farmers and vulnerable
groups.
 Capacity enhancement of Ministry for National Food
Security and Research
1. To build capacity of the Ministry to reform its affiliated institutions for

1. implementing the National Food Security and Nutrition Policy,

2. work on new challenges of food security and

3. develop & implement food security programs in coordination with other

relevant Ministries, Provinces, private sector and civil society
organizations.

2. Establishment of "Food Safety Animal & Plant Health Regulatory Authority"

Processes for Changing Problem Identification
Clarify the problem &
frame/ define it for Policy

Policies, Environments
Agendas
Policy formulation
Conduct analyses to

and Systems identify a solution to

promote

Advocacy
Police are a dynamic process and are bound Promote the solution to
to change under different situations & decision-makers

requirements Implementation
Ensure that enacted changes
becomes
rule/processes/budgets

Evaluation
Evaluate the impact in terms of each
process and overall goal
 Food and Nutrition Policy Entrepreneurs
Consumer Interest groups &
Other NGOs
Government – at all levels

NGOs
CIG

G
o
Health/Nutritional

v t
HN
PA
Professional Associations
Food &
Nutrition
Farmers/Commodity groups
FCG
Policy
B R
S
Scientific Bodies &

FI
Researchers

Food Industry
 What Can Nutrition Advocates Do?

Get set: Name & frame the solution: a) Research & identification of change objectives, b)
Grow:
Go: MoveBuild
theprotect & defend:
proposal: a) Implementation,
a) Induction enforcement
of change proposal, & monitoring
b) Launch of campaignof for
proposed
change, c)
Get
Framing
ready:
theBuild
issuethe
& base:
changea) objectives,
Issue identification,
c) Identification
b) Community
& cultivation
visioning
of allies,
& organization,
d) Identification
c)
change, b) Influence
Movement of proposed
& modification change
of change on other
proposal andequity issuesredirection
d) Success, & objectives, c) Further
or failure of change
Initial
& development
power analysis
of strategies
and d) for
Planning
isolation
the of
advocacy
opponents
strategy
and e) Negotiations with decision makers
development of equity leadership and d) Cultivation & protection of equity improvements
proposal
to develop change proposal
Those who dare can do