MDG-F Joint Programme: Concept Note Narrative

Transcription

1 MDG-F Joint Programme: Concept Note Narrative Title: Support for the fight against anemia in vulnerable groups in Cuba I. Programme Summary The objective of this joint programme is to contribute to decreasing the prevalence of anemia in boys and girls aged 0-5 (placing priority on those up to 24 months old) and in pregnant women. This will be achieved through increasing the production and access to foodstuffs rich in micronutrients, mainly iron, and by maximizing their use. Cuba s food and nutritional surveillance systems will also be enhanced. The programme will focus on the most affected and vulnerable municipalities of the five eastern provinces and Pinar del Río province. A strategic entry point for nutritional enhancement will be the Maternity Homes, which form part of the national social welfare infrastructure. This programme will support the nationwide policy framework, with a special contribution to the National Iron Deficiency and Anemia Prevention and Control Plan currently underway. This will ensure greater protection of the vulnerable groups. This joint programme will reinforce the actions currently undertaken by the Cuban Government towards achieving the MDGs, taking into consideration the peculiarities of the Cuban context, working at both the national and local levels. Actions will be particularly focused on MDG 1, MDG 4 and MDG 5. The joint programme is based on the United Nations Development Assistance Framework (UNDAF) for , in which one of the five areas of concentration is food security with a specific outcome linked to anemia in pregnant women, infants and children under 5. UNICEF is proposed as the lead agency on behalf of the UN System. II. Background and Rationale: Cuba, which imports nearly 80% of the food it consumes, has been seriously affected by the swift and continuous increase in food prices on the international market. In July 2008, it was estimated that in order to import the same volume of food as 2007 and additional US$ 1.1 billion more was required. 1 In addition, in September 2008, the country was struck by two strong hurricanes. Their combined effect caused losses estimated at US$ 5 billion, approximately 10% of the Gross Domestic Product (GDP). The agricultural, livestock and food sectors, in particular, confront major disruptions, which are expected to continue despite the broad-based recovery programme being implemented by the Government. Although malnutrition is not considered to be a health problem in Cuba, there are widespread nutritional disorders through micronutrient deficiencies. Iron deficiency is regarded as the main cause of anemia in fertile-age, pregnant and breastfeeding women, and in girls and boys under 24 months. 1 Statement by the President of the Councils of State and Ministers at the closing session of the VII Legislature of the Cuban Parliament. Submission of UNCT Cuba i

2 Around 50% of infants aged 6-11 months and 30% of boys and girls aged 6-23 months suffer from anemia. [2][3]. Anemia is also present in 30% of fertile-age women, 50% of pregnant women and 24% of pregnant women in their third quarter; 12% of this population group is also affected by insufficient weight gain [4][5]. In absolute numbers approximately 1 million Cubans face anemia. Anemia compromises the adequate growth and development of children, causes cognitive disorders and curtails their learning skills. Anemia is a recognized hazard to reproductive health, connected with maternal and perinatal mortality (when coexisting with pre- and post-labor hemorrhages), with premature childbirth and with low-birth weight. Given the current international and Cuban context, the identified problem is the existing risk of not being able to guarantee the necessary micronutrients for the population and a possible aggravation of the anemia prevalence levels in children aged 0-5 years (with emphasis of boys and girls up to 24 months old) and in pregnant women. These vulnerable groups will be the beneficiaries of this joint programme, taking into account that it is in this age, and target population, where most influence can be exerted on their nutritional status and development and where the greatest impact can be achieved. The implementation area will be determined at the provincial level, emphasizing the municipality, a geo-demographic and socio-political unit characterizing the local level. It will focus on the most affected and vulnerable municipalities located in the eastern provinces (Guantánamo, Santiago de Cuba, Holguín, Granma and Las Tunas) and in Pinar del Río province, areas hard hit by recent hurricanes and agricultural losses. Anemia in Cuba has a considerable food component to it, given the low bio-availability of iron in diets and the use of available foodstuffs. The Cuban diet is based on rice, beans, tubers (mainly potato, sweet potato, cassava, malanga, plantain and pumpkin), eggs and, to a lesser extent, meat products and very little fish. However, there is available knowledge for production of other crops (for direct human and animal consumption) and animal species, which can improve the quality of diets by supplying iron. Other causes such as parasites or malabsorption are infrequent in Cuba. Food-based strategies are the best choice to confront iron deficiency. It is essential to ensure availability of, and access to, iron-rich foods and enriching others to complement such supplies. This latter action is low-cost, although the country currently has to import the enriched premixes. The national authorities are undertaking several programmes and projects, which support the policy to reduce anemia. These are the National Plan for Iron Deficiency and Anemia Prevention and Control; the National Mother-Infant Health Programme; the National Low-Birth Weight Control Programme; the National Mother Breastfeeding Programme; the Food and Nutrition Surveillance System, among others. [2] Gay J, Padrón M, Amador M.: Prevention and control of anemia and iron deficiency in Cuba, Rev. Cubana Aliment. Nutr, 1995; 9: [3] Reboso J, Jiménez S, Macias C y Pita G.: Anemia in Cuban children aged 6 months to 2 years, summary book, III ACTAC Congress, Havana, Cuba. March [4] Cuban Public Health Prospects up to Ministry of Public Health. February [5] Pan-American Health Organization (PAHO). Family and Community Health (FCH) area. Situation Analysis, Submission of UNCT Cuba ii

3 Notably the National Plan for Iron Deficiency and Anemia Prevention and Control, is multisector in nature in coordination with the health sector. This Plan envisages a 15% nationwide reduction, up to 2015, of anemia in boys and girls under two years and in pregnant women. PAHO/WHO, UNICEF and WFP are working closely with the national authorities in the context of this Plan by supplying food supplements and undertaking social communication and training campaigns. The joint programme will directly contribute to achieving the objectives of the National Plan: preventing and controlling anemia; diminishing the risk category of anemia as a health problem thereby improving the population s health and quality of life. This is the result of direct alignment with the core strategies of the National Plan: food diversification, food enrichment and intervention surveillance upon which this joint UN programme is based. The Food and Nutritional Surveillance System (SISVAN) is another important nationwide initiative that assesses the availability of food, consumption and biological use (including anemia in pregnant women), according to settlements and regions. It is led by the Institute for Food Nutrition and Hygiene (INHA), attached to the Ministry of Public Health (MINSAP). PAHO/WHO, UNICEF and WFP complement each other in supporting this nationwide surveillance system. One of the outcomes of this joint programme is precisely aimed at enhancing this important system. The National Mother-Infant Programme, led by MINSAP and also supported by PAHO/WHO, UNICEF and WFP, will be strengthened by supporting the institutional system of care for pregnant women and boys and girls up to 24 months old, training, nutritional health education and surveillance. The joint programme is closely linked with the nationwide policies contained in the Cuban Public Health Outlooks for 2015, in which goals and strategies are put in place with a view to improving mother-infant health and its nutritional component, preventing and controlling anemia from iron deficiency, promoting exclusive breastfeeding up to six months of age and efficiently protecting very low-weight newborns and undernourished infants. Together UNICEF and UNESCO support the Cuban non-institutional educational model, particularly Educate Your Child and For Life, social programmes of care for boys and girls at the family, community and sector-wide levels, including hygienic, food and nutritional components. This joint programme will further support and take place in the context of the country s process of readjustment of its agricultural policy, which began implementation in 2007, with the aim of increasing the food production levels and efficiency, and substituting imports to relieve pressure on the balance of payment. This nationwide initiative is actively supported by FAO and UNDP and forms the essential productive complement to the consumption focus of the other agencies. Spanish cooperation supports nutrition- and anemia-related projects in Cuba. It is now contributing to the WFP Project Support for the National Plan of Iron Deficiency and Anemia Prevention and Control in the country s five eastern provinces. As part of this project, it has contributed to local capacity building for the production of an enriched food for children under two years; to training and social communication on nutrition and anemia issues and to the enhancement of the surveillance system. Spanish decentralized cooperation has also been particularly important in supporting the UNDP-led Programme for Human Development and UNICEF s assistance to Maternity Homes both of which emphasize the eastern provinces. These efforts are in line with the priorities established in the 8 th Joint Commission on Cooperation and Development between Cuba and Spain agreed in September Submission of UNCT Cuba iii

4 Despite these actions, the incidence of anemia continues to be high, particularly in children under 2 years of age. Therefore, the Cuban Government has considered it necessary to expand the sector-wide nature of the national plans, attain more stability and sustainability in actions, strengthen the institutional capability to reach vulnerable groups, strengthen its monitoring and evaluation system and enhance its communication and training component. Although guaranteeing the supply of micronutrient-rich foodstuffs is a government priority, there are population segments within the vulnerable groups requiring more direct and effective interventions given their biophysical, environmental and social conditions, which constitute risks for serious health problems. These groups will be addressed by this joint programme. The childhood-nutrition relationship is of the utmost importance to the development of both individuals and society at large, for present and future generations. Food security is an important way for boys and girls to have access to the benefits of adequate nutrition. It is along these lines of logic that this joint programme has been outlined. This joint programme is an innovative initiative as detailed hereunder: It will provide support at the local level to develop the food chain (input-productiontransformation-distribution-consumption); It will strengthen the approach to anemia and mother-infant nutrition, emphasizing risk reduction and community involvement; It will enable the re-formulation of the model to address these problems, thereby creating a new community-based service; It will support the creation of a new surveillance system for mother-infant health to integrate the nutritional component; Any new experiences will be systematized and documented so that these contribute to South-South cooperation, an issue of the utmost relevance to the Cuban Government. This joint programme is based on the United Nations Development Assistance Framework (UNDAF) for One of the five areas of cooperation prioritized in the UNDAF is food security. Guaranteeing food and nutritional security for the Cuban population on a sustainable basis, emphasizing the most vulnerable groups is a national priority. In this area of cooperation, the UNDAF outcome 5 is: Sustainable food and nutritional security for the most vulnerable groups improved by Particularly, the interagency programme outcome 5.2 agreed in this area of cooperation is to have anemia levels diminished in relation to the current levels found in pregnant women, infants and children under 5 years of age. Another two UNDAF areas, Health and Human Development, and their outcomes, also support the basis for the preparation of this joint programme. These interventions will be instrumental in supporting the efforts undertaken by the national authorities to continue working on MDG 1, MGD 4 and MDG 5. Interventions on South-South cooperation will enhance the country s commitment to MDG 8. III. Joint Programme Results As pointed out, Cuba s anemia problem in young boys and girls and in pregnant women needs to be addressed from a multisector perspective. To that end, the UN Country Team in Cuba, based on an inter-agency approach, has designed interventions that complement each other to support achieving the expected results. Submission of UNCT Cuba iv

5 The macro objective of this joint program is to diminish the prevalence of anemia in boys and girls aged 0-5 (with priority on those up to 24 months old) and in pregnant women. The causes of the identified problem are directly linked with (i) availability, (ii) access and (iii) use of foods rich in micro-nutrients, particularly iron. Based on these gaps and taking the program s objective into consideration, four outcomes of this joint programme have been designed. 1. Increased availability of foods rich in micro-nutrients, particularly iron, for pregnant women and children under 5 years of age. To achieve this outcome, there will be an increase in, and diversification of, agricultural and industrial products rich in iron and other micro-nutrients, including food enrichment. Food security will be widely promoted based on local foods, with special emphasis on vulnerable population groups through interventions and strategies ranging from national policies to small producers. This will enable an improvement in quality and variety of diets through diversification and enrichment with key micro-nutrients such as iron. 2. Improved physical and economic access to foods rich in micro-nutrients, mainly iron, for pregnant women and children under 5 years of age. To this end, management capabilities in distribution and marketing, mainly at the municipal level, will be enhanced. There will be additional support for the development of an institutional system of comprehensive care for pregnant women and boys and girls up to 24 months old within the high-risk bracket via Maternity Homes. 3. Improved adequate use of foods rich in micro-nutrients, mainly iron. Actions will be undertaken to increase the knowledge of families, community agents, healthcare and education personnel responsible for the necessary interventions to prevent and control anemia in pregnant women and boys and girls under 5 years of age. Emphasis will be placed on promoting joint support campaigns to increase awareness and understanding of food and nutrition problems linked to human health and wellbeing. 4. Strengthened surveillance and monitoring mechanisms. Surveillance and monitoring systems for food, nutrition and anemia will be strengthened, as well as the quality control monitoring of the enriched products. This will contribute to enhancing the existing information and surveillance systems by means of designing appropriate indicators and information, mainly on the industrial production of food (enriched food in particular) and on health. This programme will be instrumental in strengthening national, provincial and local capacities in institutions, producers and communities. Specially enhanced will be: 1. The capacities for local production of iron-rich foods, instrumental in sustaining availability in the selected municipalities; 2. The municipal capacities to support the implementation of a local supply system that guarantees access; 3. The institutional capabilities for care of pregnant women and young boys and girls up to 24 months old; 4. The capacities of the community-based institutions and agents in charge of training programmes with a view to changing attitudes on food and nutrition; Submission of UNCT Cuba v

6 5. The capabilities of the centers in charge of controlling the quality assurance of enriched food products, both at the national and provincial levels; 6. The capabilities of the existing food and nutritional surveillance systems, both local and national. IV. Joint Programme Design and Implementation Plan The design of this joint programme is the result of inter-agency work with the active presence of representatives from national institutions and with the national coordination of the Ministry for Foreign Investment and Economic Collaboration (MINVEC). This Ministry is the counterpart for the cooperation activities of the agencies and programmes of the UN System in Cuba. The activities of the joint programme have been defined taking into account the causes of anemia in the country, the programmes and polices already undertaken by the national authorities on this issue and the comparative advantages of each participating agency. The direct involvement of five agencies is justified by the principle focus of two on the food production and marketing side (FAO and UNDP) and of the three who are already working on the vulnerable groups nutrients consumption side (WHO, WFP and UNICEF). The programme will be implemented through an inter-agency and inter-sector mechanism with broad-based participation by concerned national institutions. In all outcomes, there will be activities undertaken with a view to sharing experiences and results on the programme through South-South cooperation. The main national partner for this activity will be the Ministry for Foreign Investment and Economic Collaboration (MINVEC). The lead agency on behalf of the UN System to promote coordination will be UNICEF supporting the Resident Coordinator. In order to achieve the 4 proposed outcomes, the activities of the joint programme will be: 1. Outcome 1 availability: research on native species and introduction of new iron-rich species, as well as production of basic cereals and grains to be used by the national industry in producing enriched mixes; rehabilitation of agricultural infrastructure and equipment; technical and training assistance in production techniques and technologies; capacity building for business and cooperative management; installation of primary capacities for the local processing of agricultural products and increases in the industrial production of enriched foods. 2. Outcome 2 access: identification of needs and potential at the municipal level for distribution and marketing; enhancement of strategic planning capacities in municipal entities; implementation of a municipal self-supply mechanism; expansion and improvement of care services in Maternity Homes 2 ; development of human milk banks and support for the furnishing of food-collecting centers, grocery stores and markets at the community level. 3. Outcome 3 use: training activities for health and education staff, community agents, pregnant women and families; dissemination of Food Guides; promotion of breastfeeding and implementation of a social communication campaign. 4. Outcome 4 monitoring: support for the creation of a National Nutritional Status Observatory to integrate the nutritional component and anemia, with surveillance sites in 2 Maternity Homes are state supported health centres where at risk pregnant women and their young infants receive nutritional, medical and other support in Cuba. Submission of UNCT Cuba vi

7 every province; enhancement of the information processing capacities in provincial and municipal units attached to the Food and Nutritional Surveillance System (SISVAN); support for quality surveillance and control in both the product or food in all stages of the process: preparation, processing, distribution and consumption. The main risks faced by this joint programme are as follows: incidence of natural disasters which compromise agricultural production; transport limitations for timely distribution of foods; difficulties in procuring equipment and materials; inadequate storage conditions of food products; disruptions in the production of enriched foods through local factory breakdowns and the scarcity of human milk as a result of difficulties with the donors. V. Monitoring and Evaluation Monitoring and evaluation activities for the joint programme will be aligned with the UNDAF monitoring and evaluation plan, particularly with the follow-up and evaluation matrix of the Food Security cooperation area and defined results. The National Nutritional Status Observatory and nationwide SISVAN, along with specialized human resources from the local to the national level, will contribute a large part of technical information for evaluation. Indicators for impact, outcome and processes will be put in place to monitor and evaluate the joint programme s outcomes and products. These indicators will be obtained from quantitative and qualitative information. The monitoring process will take place throughout the programme and two evaluations will be made, one in the mid-term and the other upon completion of the programme. These indicators are also reflected in the UNDAF. The impact indicators for this programme will be: (i) anemia prevalence rate in pregnant women; (ii) anemia prevalence rate in young boys and girls up to 24 months old; (iii) anemia prevalence rate in boys and girls from 24 months old to 5 years of age. The main outcome indicators will be: 1. Outcome 1: (i) quantities of agricultural production of foods rich in micronutrients, mainly iron; (ii) quantities of production of enriched foods; (iii) quantities of enriched foods produced with local food inputs. 2. Outcome 2: (i) quantities of distributed foods, disaggregated by natural, iron-rich foods and enriched foods; (ii) number of beneficiaries protected through food supply, disaggregated by iron-rich foods and enriched foods, sex and vulnerable groups; (iii) number of days of food supply; (iv) percentage of infants being breastfed through the human milk banks. 3. Outcome 3: (i) percentage of infants being exclusively breastfed up to the sixth month; (ii) percentage of young boys and girls being breastfed as a complement up to 24 months; (iii) number of health staff, community agents, pregnant women and families with improved knowledge on food and nutrition. 4. Outcome 4: (i) percentage of surveillance system centers offering thorough and timely information; (ii) percentage of food samples with acceptable enrichment levels. Submission of UNCT Cuba vii

8 The aforementioned indicators will be complemented through other indicators, mainly processbased ones, which will be put in place in the follow-up and evaluation matrix of the joint programme. VI. Institutional Arrangements and Management Plan The UN System in Cuba is composed of seven resident agencies and another seven with programmes and activities in the country. This joint programme is implemented as part of the United Nations Development Assistance Framework (UNDAF) for , which includes food security as one of its five priority areas for cooperation. As a strategy to reach dialogue, planning, implementation, follow-up and evaluation in this area an Inter-Agency Food Security Group was established, which has been working jointly for over a year now. This inter-agency group has obtained important analytical results, which were instrumental in identifying joint programming opportunities and facilitating the design of this joint programme. Furthermore, the UN System in Cuba is experienced in undertaking articulated local projects as a result of interagency cooperation in the context of the Human Development Programme (LHDP). As a lead agency to support the coordination of this joint programme, UNICEF will report to the interagency group, United Nations Country Team, and Resident Coordinator to provide progress overviews on behalf of the UN System. The main national institutions connected with this programme, under the coordination of the Ministry for Foreign Investment and Economic Collaboration (MINVEC), will be directly linked with the Ministry of Agriculture (); the Ministry of Public Health (MINSAP), mainly the Institute for Food Nutrition and Hygiene (INHA); the Ministry of Food Industry (MINAL) and, indirectly, with institutions from other Ministries involved in the agro-food and nutritional chain. Also envisaged is the active participation of local institutions, particularly at the provincial and municipal levels. The participating UN agencies are FAO, PAHO/WHO, UNDP, UNICEF and WFP. UNESCO will participate in collaboration with UNICEF on the activities defined in the Results Framework as an implementing agency. The National Steering Committee to provide overall strategic guidance is composed of a representative from the Government of Cuba, the Resident Coordinator of the UN System in Cuba, the heads of UN System agencies and a representative from AECID, Spanish Agency of International Cooperation for Development. The Coordination Committee, composed of the members of the Inter-Agency Food Security Group and members of the participating national institutions, will be in charge of coordinating programme implementation and monitoring/evaluation based on the joint results matrix. As the lead agency UNICEF will provide programme overviews to the group. Programme finance will be disbursed by UNDP, as is the case of all programmes from this fund. Once approved, a Memorandum of Understanding will be signed between UNDP, as Administrative Agent, and all participating UN System agencies to support funds transfer at the headquarters central finance level. Submission of UNCT Cuba viii

9 Appendix A Joint Programme Results Framework Expected UNDAF Outcome: Outcome 5 Sustainable food and nutritional security for the most vulnerable groups improved by 2012 Interagency outcome 5.2 Anemia levels in relation to the current levels found in pregnant women, infants and children under 5 years of age diminished Joint Programme Outcomes Outputs (by Agency) Budget (by output) Indicative activities* (by Agency) National and local partners 1. Increased availability of foods rich in micro-nutrients, particularly iron, for pregnant women and children up to 5 years of age. 1.1 Agricultural production of products rich in iron and other micronutrients increased and diversified (FAO, UNDP, PAHO) Do research on and introduce new species or exotic varieties rich in iron and other micro-nutrients, utilizing the results of the global bio-enrichment programme (FAO) Disseminate and foster the production of native species rich in iron and other micro-nutrients (FAO, UNDP) CITMA INHA MINAZ Rehabilitate and develop the agricultural infrastructure and equipment for food production, through grants or credits (FAO, UNDP) BANDEC Strengthen technical and training capacities in new production techniques and technologies (FAO, PAHO/WHO) 1.2 Industrial capacity for food production, processing and Support capacity building in business and cooperative management, fostering new production strategies (UNDP, FAO) 12.1 Support the creation of local processing industries in productive facilities based on municipal surveys (FAO) Universities MINAL MINAZ xv

10 2. Improved physical and economic access to foods rich in micro-nutrients, mainly iron, for pregnant women and children up to 5 years of age. 3. Improved adequate use of foods rich in micro-nutrients, mainly iron. enrichment strengthened (FAO, WFP) 2.1 Management and coordination capacities at local and regional levels in iron-rich food distribution and marketing strengthened (FAO, UNDP) 2.2 Institutional mechanisms facilitating access to foods rich in micro-nutrients, mainly iron, for pregnant women and children under 5 years of age strengthened (PAHO/WHO, UNICEF, FAO, UNDP) 3.1 Knowledge by families, community agents and health/education staff responsible for necessary anemia prevention and Deliver enriched food to children under 5 years of age and pregnant women, including those in Maternity Homes, in vulnerable areas (WFP) Conduct surveys on municipal requirements and potential for distribution and marketing (UNDP, FAO) Strengthen strategic planning capacities of entities responsible for municipal distribution and marketing (UNDP, FAO) Implement a self-supply plan to integrate productive players with the distribution entities of every target municipality (FAO, UNDP) Support the establishment and improve the infrastructure of Maternity Homes, expanding the model so far used (PAHO/WHO, UNICEF) Support the development of Human Milk banks (UNICEF) Creation of food-collecting centers for agroprocessed products (FAO) Upgrade community-based grocery stores and markets for food distribution (UNDP) Hold courses, seminars and workshops on food, nutrition and anemia prevention for health/education staff, day-care center staff, community agents, pregnant women and families (UNICEF, WFP, PAHO/WHO) MINAL MINCIN MINSAP MINSAP MINCIN MINCIN MINSAP DNMI INHA CNPES MINED xvi

11 control actions in pregnant women and boys and girls up to 5 years of age increased (PAHO/WHO, UNICEF, WFP, UNESCO) Make Food Guides available for Cuban boys and girls up to 2 years of age and use them in spaces such as the Educate Your Child Programme, the For Life Programme, Maternity Homes, among others (UNICEF, UNESCO) Promote and foster Exclusive Breastfeeding up to the sixth month and complementary breastfeeding up to 2 years of age, revitalizing the national breastfeeding programme and the Mother-Infant Friendly initiative, which also covers primary healthcare (PAHO/WHO, UNICEF, WFP) Undertake social communication campaigns to modify behaviors on food and nutrition with health staff and families in a differentiated manner for each region in the country (WFP, UNICEF, UNESCO, PAHO/WHO) MINED MINSAP DNMI INHA CNPES MINSAP CNPES 4. Strengthened surveillance and monitoring mechanisms. 4.1 Iron deficiency surveillance, prevention and treatment system strengthened on a sustainable basis (UNICEF, WFP, PAHO/WHO) 4.2 Quality assurance control systems for enriched products strengthened (UNICEF, WFP) Support the creation of a National Nutrition Status Observatory in the country to measure the impact of actions (PAHO/WHO) Support the enhancement of SISVAN in order to monitor and evaluate on a regular basis the nutritional situation (emphasizing anemia) of pregnant women, boys and girls up to 5 years of age (WFP, UNICEF, PAHO/WHO) Contribute to the surveillance and quality control of the product or food in all stages of the process: preparation, processing, distribution and consumption (UNICEF, WFP) MINSAP DNMI MINAL INHA INHA (Provincial and Municipal Hygiene and Epidemiology Departments) MINAL CNICA * Each output will have an activity aimed at sharing experiences and results on it through South-South cooperation. The main national partner will be the Ministry for Foreign Investment and Economic Cooperation (MINVEC) xvii

12 List of Abbreviations: AECID BANDEC CITMA CENICA CNPES DNMI FAO GISA INHA LHDP MDG MINAL MINAZ MINCIN MINED MINSAP MINVEC PAHO/WHO SISVAN UNDAF UNDP UNESCO UNICEF WFP Spanish International Cooperation Agency for Development Bank for Credits and Commerce Ministry of Science, Technology and the Environment National Center for Quality Inspection National Center for Health Promotion and Education National Mother-Infant Division (Ministry of Public Health) United Nations Food and Agriculture Organization Food Security Inter-Agency Group Institute for Food Nutrition and Hygiene Human Development Programme Millennium Development Goals Ministry of Agriculture Ministry of Food Industry Ministry of Sugar Industry Ministry of Domestic Trade Ministry of Education Ministry of Public Health Ministry for Foreign Investment and Economic Cooperation Pan-American Health Organization/World Health Organization Food and Nutritional Surveillance System United Nations Development Assistance Framework United Nations Development Programme United Nations Education, Science and Culture Organization United Nations Children s Emergency Fund World Food Programme xviii

13 Appendix B - Capabilities statement by UN Participating Organizations The United Nations Food and Agriculture Organization (FAO) is responsible for increasing the production of quality foods with a view to attaining food security for the people. The Organization works at the global, regional, subregional and national levels, following a decentralization process in pursuit of greater closeness with the problems related to agriculture and fishing in its member countries. FAO s current performance in Cuba falls within the priorities set by the last Regional Conference, held in 2007; mainly Food and Nutritional Security as a continental priority. The Organization has undertaken over two tens of projects in the country, comprising agriculture, food, mountains and fishing. The World Health Organization and the Pan-American Health Organization (WHO/PAHO) work towards the improvement of health and the living standards of the people. Their mission is to promote health equality, fight diseases, improve quality and prolong the duration of life for the people in the Americas. In the new millennium, Headquarters and the PAHO/WHO Representation in Cuba have been working on various priority areas, including disease prevention and control; family and community health; sustainable development and environmental health; health technology and healthcare services; information and knowledge management; analysis of health situation and information systems; preparations for emergency situations and disaster relief; Primary Healthcare and strategic health development. All these issues are drawn from the Strategic Note signed between the Organization and the Ministry of Public Health, which defines the work priorities. From the regular funds, 100% has been earmarked for these priority matters, particularly for local level management and in support of the Mother-Infant Programme with a specific project entitled Life Cycle and Community Health. The Organization is working along with the Global Alliance for Vaccines and Immunization (GAVI) in order to approve a project, currently undergoing the endorsement process, which will improve conditions in 70 out of the 291 existing Maternity Homes. Since 1996, WHO/PAHO has been working on Technical Cooperation Development Projects with the Ministries of Health and Agriculture. With the Ministry of Agriculture, it has implemented the Healthy Municipality Strategy in 71 of the country s municipalities, an initiative now being spread across the country on instructions from the Ministry, which has incorporated this cooperation strategy as an instrument of work. The Organization has worked on the Healthy Municipality and Community Strategy with social communication campaigns for health promotion and has joined the Ministry of Health in the Public Health Outlooks up to 2015 through specific actions: in Primary Healthcare, at the Institute for Food Nutrition and Hygiene, in the Mother-Infant Healthcare Programme, in doing research, interventions and actions to attain the Cuban population s Food and Nutritional Security. xix

14 The World Food Programme (WFP) works with governments in order to address famine. In the Latin American and Caribbean region, WFP continues to address emergency situations enhancing the national commitment to food and nutrition programmes in the area of food-based social programmes, fostering micro-nutrient enrichment programmes and providing assistance to governments in areas such as humanitarian or development assistance management, where WFP is vastly experienced: (Vulnerability Analysis and Mapping (VAM), Purchases, Logistics and Programmes). Since 2002, WFP has been implementing a food assistance project in Cuba s eastern region with a view to improving the nutritional status of infants, pregnant women and breastfeeding mothers through the direct distribution of enriched foods and with a nutritional education component in health centers and schools. In the cycle, taking into consideration the experience gained in micro-nutrient enrichment programmes, WFP intends, along with the Cuban Government, to contribute to the objectives of the National Anemia Control and Prevention Plan. WFP provides expertise in food assistance and logistics. It procures regional or local foods at affordable prices, relying on the support of procurement (purchase) specialists, both in food and in nonfood inputs. It also has nutrition and logistics specialists to deal with storage and transfer of items/assets. Furthermore, it implements food projects for vulnerable groups in a number of countries, thus becoming an ideal participant for this kind of project, as it also receives technical assistance from PAHO and UNICEF. The United Nations Development Programme (UNDP) is the United Nations worldwide network in terms of development, which promotes change and connects countries with the necessary knowledge, experience and resources to help build a better life. UNDP s main contribution is capacity building the how of development. In the national context, UNDP s efforts support those countries in which national and local capacity building programmes are being implemented with a view to achieving human development and the MDGs, emphasizing efficient aid management and South-South solutions. This joint programme envisages actions in one of the five global areas of UNDP work, where it has ample experience: poverty reduction and achievement of the MDGs. Through its Human Development Programme (LHDP), one of the four main areas of the Country Programme Document (CPD), UNDP Cuba has a long experience of 10 years in building local capacities, strategic planning, territorial articulation and easing local economic development, particularly in the agricultural sector. Its contribution is through knowledge, staff, methodology and tested instruments, which will make available to the project. These include business and cooperative management training programmes, the credit-granting mechanism for producers or the municipality s comprehensive strategic planning methodology for the insertion of productive players. The United Nations Organization for Education, Science and Culture (UNESCO), in its over 60 years of experience, has endeavored to contribute to international peace and common prosperity for humankind, furthering cooperation among nations through Education, Science, Culture and Communication. In the field of education, the work of xx

15 the Office has focused on supporting its member countries in achieving the Dakar Objectives and complying with the Millennium Development Goals; in all cases, on the basis of attaining quality education for all. In this regard, UNESCO, in close cooperation with the Ministry of Education (MINED) and the UNESCO partner schools, has implemented an intense program to reach these objectives, as in the case of the Educate Your Child Program. Food education is part of the child s educational training, both in terms of health and in relation to his/her cultural identity, as highly nutritional food traditions can be restored to favor local human development. The United Nations Children s Fund (UNICEF) is an organization centered on childhood and youth. All its actions are instrumental in the full development of potential for children. The work of UNICEF in favor of childhood takes on a necessarily central dimension to pursue these objectives and transform the world into a better place for all. Six of the eight MDGs can be better achieved if there is protection for the rights of the child in health, education, protection and equality. In this context, UNICEF Cuba, in its current Cooperation Scheme, includes the Early Childhood Comprehensive Development Programme, aimed at assisting the government in ensuring that boys, girls and pregnant women receive better-quality health care and services. It focuses on pregnant women with pre-natal risk, who require more continuous, comprehensive and differentiated medical care. In the field of nutrition, it has been supporting for some years now the enrichment of fruit-based purees a line of food for boys and girls from 6 months to 2 years of age that is widely consumed. It also supports campaigns to foster and promote breastfeeding exclusively up to 6 months and complementary nourishment up to 2 years of age, adding educational actions of food nutrition and hygiene with a view to improving food practices through healthy lifestyles. xxi