Case Study

Mozambique has a higher rate of stunting among children aged under five than any other country in Africa. As such, there is an urgent need to improve nutrition, especially for pregnant women and infants. Particularly in Niassa province, which has the nation's highest poverty rate, JICA conducted a household survey on the nutritional status of the population between 2019 and 2020 to design cross-sectoral nutrition intervention, focusing on daily life and the actual needs of individuals in the province. The results showed that "initiation of complementary feeding at the right time of a child's growth" is key to reducing stunting in Niassa. JICA will keep promoting multisectoral efforts toward improved nutrition.

In order to draw lessons learned that can be applied to developing countries from Japan's experience with improved nutrition, JICA analyzed driving factors that drove improvements in nutrition in post-war Japan. The results showed that the driving factors included not only rising household income due to national economic growth, but also various policies and programs conducted across multiple sectors such as public health (e.g., antenatal care), public nutrition (e.g., nutritional guidance), rural development (e.g., deployment of life improvement extension workers), living environment (e.g., water supply), and education (e.g., school lunches). This suggests that a multisectoral approach is necessary for effectively delivering nutrition-related intervention. It also implies that appropriate policies and measures can improve the state of a population's nutrition even before economic growth begins in full swing.

Japan's experience and success in improving nutrition through multisectoral efforts, as confirmed in this study, will be used to help developing countries enhance theirs.

JICA invited representatives of Japanese hospitals in Brazil to Japan and had opportunities to learn Japanese medical technologies and services. This led to the establishment of the Japanese Hospital Cooperation Council in May 2018, connecting Japanese hospitals that had not previously had much interaction with each other. In addition, a new "Nutritionist Project" was started during the discussions of this council. This began with the proposal of Santa Cruz Hospital at the first meeting to "incorporate Japanese food into hospital meals with the aim of popularizing Japan's proud tradition of healthy foods throughout Brazil."

After this, training was held at Kyushu University with the cooperation of JICA to learn about Japanese hospital meals, and these nutritionists participated from Japanese hospitals are currently developing recipes for Japanese hospital meals with Kyushu University. When a recipe book has been completed, they are thinking about sharing this information not only with Japanese hospitals in Brazil, but also with all hospitals throughout the country. The activity aims to improve health in society as a whole through the spread of Japanese food as a healthy foods.

About half of all children aged under five in Guatemala are stunted due to inadequate food intake and nutrition. The project therefore aims to improve the population's health and nutritional situation by disseminating knowledge about measures for preventing malnutrition, as well as appropriate treatments and remedies for malnutrition among officials of the Ministry of Health, local administrations, and health workers.

Malnutrition is a serious problem in Madagascar, where stunting among children aged under five is 49%—the fifth highest in the world. In the Central Highlands, where 80% of the population engages in agriculture, JICA experts collaborate with the people in the central and local governments, as well as communities, to find ways to improve the income of farmers, to be able to afford nutritious food, and to improve the balance and diversity of daily diets by growing nutritious crops in home gardens.

Access to safe water and sanitation facilities in Mozambique is poorer than other countries in Southern Africa. Especially in rural areas, social infrastructure had been destroyed during the civil war. Niassa province in particular is affected by a shrinking water supply due to the lack of construction of new water-supply facilities despite its growing population.

The project aims to strengthen the capacity to maintain and manage piped water-supply facilities in the pilot district. The experience gained will then be disseminated and introduced to other districts. At the same time, the project will also provide training on safe and appropriate use of the water, such as water storage and treatment in homes. These activities will enable people to prevent water-borne diseases while improving the state of their nutrition. The project also involves collaboration with some projects from other sectors in the same province, such as agriculture and health, to achieve a multisectoral approach to improved nutrition.

Malnutrition is a serious problem in Madagascar, where stunting among children aged under five is 49%—the fifth highest in the world. The project has been supporting a voluntary school lunch program that utilizes community resources to meet the needs of parents and local residents who want to feed their children adequately during the lean season (usually from December to March), when it is difficult to secure food. It disseminates information on ingredients, food costs, and cooking personnel, as well as the role that voluntary school lunches play in improving children's education and nutrition. Through delivering this project to communities in a way that is easy to understand, community participation and resource mobilization have increased and voluntary school lunches have become more sustainable than ever before.

Japan Overseas Cooperation Volunteers (JOCVs) deployed around the world are also working to improve nutrition in developing countries. Volunteers have various backgrounds such as nutritionists, agriculture-related workers, elementary school teachers, and community development workers. They are operating at the grass-roots level to meet the needs of local people. Some of them provide maternal and child nutrition guidance to mothers and families in health centers and other facilities, some support nutrition education in educational settings, and others conduct hygiene awareness activities to reduce water-borne diseases and prevent malnutrition (e.g. the Water Security Action Team (W-SAT)).

In Madagascar, JOCV set up a volunteer "Cooking Team" and is working on improved nutrition through the spread of nutritious food. The team creates recipes to cook nutritious dishes from readily available local ingredients, and bring them back to communities in their own assigned area. The cookbooks produced as a result of these activities have been approved by the Ministry of Health and officially endorsed.

In rural areas of Ghana, many children were suffering from stunting and anemia due to unbalanced nutrition in the common complementary food called "koko" (porridge made from fermented corn). Through cooperation with the private sector, "KOKO plus" was developed. It is a nutritional supplement that can be added to complementary food to supplement nutrients such as minerals and protein. The project aimed to prevent malnutrition by selling the product at a low price and distributing it together with the maternal and child health handbook.

Awareness of nutrition-related problems is still low in Vietnam, and there are few experts on nutrition. To respond to the need to develop human resources with suitable knowledge of nutrition and food hygiene management, JICA's private sector collaboration scheme provided support to Ajinomoto Co., Ltd. for their project to establish a human resource development system for nutritionists in Vietnam. This project was based on the Japanese pre-service education curriculum and national registration system for nutritionists. Also, a foundation for human resource development was established to contribute to spreading nutritionally balanced school meals.

Ajinomoto Foundation continued the work after the project ended, and as a result of collaboration with Vietnamese stakeholders, a nutrition course has been established at Hanoi Medical University, sending off the first nutritionists in Vietnam.

The poorest children living in Bangladesh's slums are deficient in nutrients such as vitamin A, B12, zinc, and iron. This causes serious health problem such as underweight, stunting, and anemia. Since 2014, euglena Co., Ltd. has been delivering nutritious cookies with euglena to the poorest children through schools in Bangladesh. As at the end of September 2020, the total number of meals provided through this activity, which is called the Euglena Genki Program, has reached 10 million.

To make this activity a sustainable model, the company, in collaboration with JICA, conducted a study to verify the cycle of selling food products containing euglena to the upper-middle class in Bangladesh and expanding the provision of cookies with euglena to the poorest children with the profits earned from sales. At the same time, blood tests and physical measurements were conducted through a local medical research organization, which helped improve business operations. In addition to cookie distribution, the company's activities also include education on food, nutrition, and hygiene, with the aim of improving children's nutrition through multi-sectoral efforts.

Preah Vihear Province is home to some of the most malnourished children in Cambodia, and many parents there are unaware of how underweight and malnourished their children are. Together with health centers and health volunteers, the project team conducts infant health screenings in local communities and provides interventions to improve nutrition. They conduct educational activities on proper nutrition, co-organize baby food classes, and develop baby food recipes using ingredients available in the province.