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Food and nutrition bulletin
Published by the united nations university press. Tokyo, Japan.

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Food and Nutrition Bulletin
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The Food and Nutrition Bulletin incorporates and continues the PAG Bulletin of the former Protein-Calorie Advisory Group of the United Nations system and is published quarterly by the United Nations University Press in collaboration with the United Nations ACC Sub-committee on Nutrition. The views expressed are those of the authors and not necessarily those of the United Nations University or the ACC Sub-committee on Nutrition.

All correspondence concerning the content of the Bulletin, comments, news, and notices should be sent to the editor at the Cambridge office address given above. All material may be freely reproduced provided acknowledgement is given and a copy of the publication containing the reproduction is sent to the Bulletin.


Editorial policy

The Food and Nutrition Bulletin is intended to make available policy analyses. state-of-the-art summaries, and original scientific articles relating to multidisciplinary efforts in alleviate the problems of hunger and malnutrition in the developing world. It is not intended for the publication of scientific articles of principal interest only to individuals in a single discipline or within a single country or region. Notices of relevant books and other publications will be published if they are received for review. The Bulletin is also a vehicle for notices of forthcoming international meetings that satisfy the above criteria and for summaries of such meetings.

The Food and Nutrition Bulletin also serves as the principal outlet for the publication of reports of working groups and other activities of the UN ACC Sub-committee on Nutrition (SCN) and its Advisory Group on Nutrition. The SCN itself is a focal point for co-ordinating activities of FAO, WHO, UNICEF, the UNU, Unesco, the World Bank, the World Food Programme, the World Food Council, the United Nations Environment Programme, and other bodies of the United Nations system which have an interest in food and nutrition.

Unsolicited manuscripts of articles of the type published in this and previous issues may be sent to the editor at the Cambridge office address given above. They must be typed, double-spaced, with complete references and must include original copy for any figures used (see the 'Note for contributors" in the back of this issue). All articles submitted will be reviewed promptly and the author will be notified of the editorial decision. Any disciplinary or conceptual approach relevant to problems of world hunger and malnutrition is welcome, and controversy over some of the articles is anticipated. Letters to the editor are encouraged and will be printed if judged to have an adequate basis and to he of sufficient general interest.

It is expressly understood that articles published in the Bulletin do not necessarily represent the views of the United Nations University or of any United Nations organization. The views expressed and the accuracy of the information on which they are based are the responsibility of the authors. Some articles in the Bulletin are reports of various international committees and working groups and do represent the consensus of the individuals involved; whether or not they also represent the opinions or policies of the sponsoring organizations is expressly stated.

The United Nations University (UNU) is an organ of the United Nations established by the General Assembly in 1972 to be an international community of scholars engaged in research, advanced training, and the dissemination of knowledge related to the pressing global problems of human survival. development, and welfare. Its activities focus mainly on peace and conflict resolution, development in a changing world, and science and technology in relation to human welfare. The University operates through a worldwide network of research and postgraduate training centres. with its planning and co-ordinating headquarters in Tokyo, Japan.

The United Nations University Press, the publishing division of the UNU, publishes scholarly books and periodicals in the social sciences, humanities, and pure and applied natural sciences related to the University's research.

Food and Nutrition Bulletin

Editor: Dr. Nevin S. Scrimshaw
Assistant Editor: Ms. Edwina B. Murray
Editorial Consultant: Ms. Sarah Jeffries
Associate Editors:
Dr. Hernán Delgado, Director, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala Dr. Peter Pellet, Professor, Department of Food Science and Nutrition, University of Massachusetts, Amherst, Mass., USA Dr. Aree Valyasevi, Professor and Institute Consultant, Mahidol University, Bangkok, Thailand

Food and Nutrition Bulletin, vol. 12, no. 2

(c)The United Nations University, 1990

United Nations University Press
The United Nations University, Toho Seimei Building
15-1 Shibuya 2-chome, Shibuya-ku, Tokyo 150, Japan
Tel.: (03) 499-2811 Fax: (03) 499-2828
Telex: J25442 Cable: UNATUNIV TOKYO

ISBN 92-808-0792-7
ISSN 0379-5721

Typeset by Asco Trade Typesetting Limited, Hong Kong
Printed by Permanent Typesetting and Printing Co. Ltd., Hong Kong


Institution building in nutrition

Editorial: Sustainability, capacity, and institutions

John B. Mason

Development depends on people. Sustained development depends on people being productive and effective in the long run. People need skills, motivation, resources, and much else besides, including a satisfactory institutional setup to work in.

Such overall concepts relating to development in general apply with equal force to nutrition, and are now being elaborated in this context. The two papers that follow-by Dr. Scrimshaw and Dr. Gillespie- concern institutions for nutrition, looking at two different aspects: one a historical view of largely successful institution building, the other an analysis of how to enhance the future benefits of external assistance for institutions.

For nutrition, the long-run objective is to reduce and finally eliminate malnutrition in children, mothers, and everyone else. This has been articulated by WHO and UNICEF as specific goals for the 1990s [1]. A necessary interim objective, because it is people in developing countries who must ultimately achieve this, is to build the capacity for reaching this goal. Sustainability in this context means keeping effective programmes going, with flexibility in response to changing conditions, and starting and maintaining necessary programmes where nutrition is deteriorating or not improving as fast as it should.

Where is capacity needed? What are the "institutions" concerned? Four aspects of institutions are put forward in this context by Soekirman [2]: human resources, technology, information, and organization. He recognizes, both with reference to Indonesia and in general, that "human resources are the key element in institution building." Since this essentially means people with the necessary skills, training is involved, but the issue goes much further. Motivation comes not only from dedication to a worthwhile cause, but from satisfactory rewards, prospects, contacts, and recognition. People also means the staff who must maintain programmes in the field day in and day out, who are often the missing link between successful pilot programmes and the long haul of "going to scale," managing routine service-delivery programmes, as well as planning and monitoring them.

In his paper, Dr. Scrimshaw describes the development of a number of largely successful nutrition institutions in developing countries. Both a reason for their success and a mark of it is that they continue to command financial support, internal and external. An important insight given by Greiner [3] in a recent review of external support to institutions in Africa, is that the first-reaction logic of external funding should be reversed: When institutions are not functioning well is precisely not the time to pull out; but, when they are up and running, the donor should, with due care, withdraw in order to foster self-reliance. The donor can be a midwife to the institution, but it does not own the baby. Nor should it give it up because of a difficult gestation. Certain of Dr. Scrimshaw's examples well illustrate these principles.

While such principles are becoming better understood, it remains to incorporate them usefully in most external assistance projects. The issue is complicated by the concern that many activities, unrelated in intention to institution building, may in practice inhibit the development of self-reliant and effective institutions. One way to begin is to find out what is actually happening.

The procedure put forward in Dr. Gillespie's paper is a step toward this. Prospectively, the way would be to set institutionally related objectives for projects, to extend the process of defining problems and hence programme needs, and to include the institutional requirements for running the programmes. To provide guidance, knowledge is needed, first, on how the capacity of institutions relates in practice to programme responsibilities and, second, on how externally assisted projects (with or without specific institution-building objectives) have in fact affected the capacity of local institutions. The framework outlined in Dr. Gillespie's paper proposes a way of getting some urgently needed information.

What is an institution in this context? The idea goes beyond those that are clearly identifiable by having buildings, equipment, and budget-line staff. Research institutions, universities, and government departments are all clearly defined as institutions. Effective programme-management units have many of the same needs as more "bricks-and-mortar" institutions; these should be included. The aims of "institutional capacity" in reality include the ability of all those working in the area of nutrition in a country or region to be productive. This relates to many of precisely the same factors as those that allow institutions to flourish: adequate skills, motivation, and some assurance of continuity. SO, in assessing institution building, the interests of the network of field workers, in communities as well as headquarters and in clinics as well as ministries, should be included. Projects that enhance these people's sustained ability to function well should be judged worthwhile institutionally.

The information that Dr. Gillespie proposes gathering would be enlightening. One can guess at some results, and foresee the types of policy changes that donors might want to consider. Increased sensitivity to the effects of programmes on local institutions is one possible outcome. A longer time-horizon in donor project planning could be another. Because of real political and bureaucratic considerations, donor planning has sometimes sought instant gratification- short-term, definable, "concrete" impact-despite the complexity of the problems and the desirability of fostering self-reliance. Is it dreaming to imagine tenor twenty-year time spans for projects? (The Chinese, for example, routinely think in such terms.) Could one imagine a financial commitment, say for a million dollars, deliberately spread out as $$50,000 for twenty years, rather than $50O,000 for two-accepting the long delay of impact? Some financial investment projects are planned in this way. Maybe recognizing that people are central, and that their institutions need development too, would lead in this direction.


  1. WHO-UNICEF common goals for health development of women and children by the year 2000. UNICEF-WHO Joint Committee on Health Policy, 27th session, Geneva, 23-25 an 1989.
  2. Soekirman. Principles of institution building in nutrition: based on experience in Indonesia. Paper for the Advisory Group on Nutrition. Geneva: ACC/SCN, 19B8.
  3. Greiner T. The building of nutrition institutions: a search for guiding principles based on SIDA experience in Africa. Paper for the Advisory Group on Nutrition. Geneva: ACC/SCN, 1989.

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