Thanks to Professor Wan Abdul Manan Wan Muda, Jarud Khalidi Romadan, Dr Teoh Ai Ni and Nadia Malyanah Azman of Khazanah Research Institute, Zaiton Daud and Dr Teo Choon Huey of the Malaysian Ministry of Health. However, I am solely responsible for remaining errors and deficiencies.
Addressing Food Agriculture, Malnutrition and Health - An 'All of Government' Proposal
Jomo Kwame Sundaram
2 December 2024
Child malnutrition in high middle-income Malaysia
1 in 3 students
overweight or obese
1 in 10 children wasted
underweight for height
1 in 10 students1 stunted
short for age
Source: Nutrition Society of Malaysia, 2015
Micronutrient deficiencies among Malaysian children
Nutrient intakes as % of children’s recommended intakes
Calcium
Iron
Thiamin
Riboflavin
Niacin
Vitamin C
Vitamin A
0
10
20
30
40
50
70
60
80
90
100
29.9
41.3
90.1
92.3
53.4
58.9
89.1
83.7
63.1
76.2
55.7
58.1
90.1
92.3
Boy
Girl
Anaemic adult population by age group, 2015
Anaemic Malaysians!
Total population 4.9 million
(95% CI 4.6-5.1)
Overweight, obesity fast growing
Obesity (BMI-for-age) among Malaysians aged <18 yr | Obesity among adults aged ≥18 years |
| |
Sources: NHMS 2006, 2011, 2015 | Sources: NHMS 1996, 2006, 2011, 2015 |
�
[1] As noted earlier, there are different BMI thresholds at different ages for children to be considered overweight or obese.
Malaysia is the 2nd fattest country in ASEAN (after Brunei) & 3rd in Asia
2 x
4 x
2 x
Khazanah Research Institute
Malaysian Diabetics Tripled in 2 Decades
Previously mainly Type 1 (inherited), increase mainly due to Type 2 (lifestyle) |
|
Source: NHMS 1996, 2006, 2011, 2015 |
1
2
Khazanah Research Institute
Addressing problems together
A well-designed school feeding program tackles 5 challenges:
Avoid child hunger, improve food safety
Overcome malnutrition, by ensuring adequate macro- and micro-nutrient intakes to prevent hunger and ‘hidden’ hunger, stunting, and diet-related non-communicable diseases (diabetes), obesity
Improve performance, values, behaviour & socialization of school children, other stakeholders
Ensure safer and more nutritious food supply & choices
Improve farmers’ incomes and wellbeing
1
2
3
4
5
School feeding modalities
Provision
of food to
school
children
Fortified biscuits, snacks
Can be part of a school snack program
In-school feeding
School meals
To provide breakfast, mid-morning meals,
lunch or some combination to alleviate
short-term hunger, improve
attentiveness, and facilitate learning
Take-home rations
and regular attendance by children
In-school feeding
Take home
Effects of school feeding on�education outcomes, cognitive abilities
School feeding | Enrolment | Attendance | Educational achievement | Cognitive abilities |
In-school meals | + (enhance girls’ enrolment) | +++ | +++ | +++ |
Take-home rations | + (enhance girls’ enrolment) | + | ++ | ++ |
Fortified biscuits | + | ++ | + | ++ |
Source: Bundy, D, et al. (2009). Rethinking school feeding: Social safety net, child development and the education sector. World Bank.
+ = evidence from quasi-experimental evaluation
++ = evidence from at least one randomized controlled trial
+++ = evidence from more than one randomized controlled trial
4 key benefits of school feeding programmes
Health and Nutrition
Dietary diversity, growth and development
Education
Learning and enrollment, girls’ education
Agriculture
Rural economy, food systems
Social Protection
Income transfer, household food security
School Feeding Programs
4 key benefits of school feeding programmes
Health and Nutrition
Dietary diversity, growth and development
Education
Learning and enrollment, girls’ education
Agriculture
Rural economy, food systems
Social Protection
Income transfer, household food security
School Feeding Programs
All-of-government approach
National School
Feeding Programme
(NSFP)
Ministry of Health
Ministry of Entrepreneur & Cooperatives Devt
PTAs, NGOs, Farmers’ Cooperatives, etc.
Ministry of Education
Ministry of Women, Family and Community Dev.
Ministry of Agriculture
Relevant
Federal & State
Agencies
Ministry of Domestic Trade and Consumers
All-of-government approach
National School
Feeding Programme
(NSFP)
Ministry of Health
Ministry of Entrepreneur & Cooperatives Devt
PTAs, NGOs, Farmers’ Cooperatives, etc.
Ministry of Women, Family and Community Dev.
Ministry of Domestic Trade and Consumers
Ministry of Education
Ministry of Agriculture
Relevant
Federal & State
Agencies
Clinics, hospitals and nutritionists
School administration
Farmers & Suppliers
Civil Society Organisations
School feeding governance: Interministerial cooperation
School level governance
School level stakeholders:
Including parents
School level governance
School Administrations
Parents-teachers Associations
Food suppliers
(especially fresh food)
Monitoring of food preparation: hygiene, safety, standards
Including parents
1
2
3
4
School level stakeholders:
Access to food in schools
School canteens
- 8,000 schools with �canteens selling food to children.
- The new School Canteen Guidelines underlined 2 food and drink categories: allowed and not allowed for sale.
- The school canteens are being monitored for compliance with School Canteen Guidelines by nutritionists at district level.
Supplementary Feeding Program/ Rancangan Makanan Tambahan (RMT)
- Provision of meals to primary
school children from hardcore poor families, children with special needs, and OA/Penan children.
- Healthy, balanced meals served cover 25-30% of total caloric requirements.
- Subsidized by government at daily rate of RM2.50 (in Pen. Malaysia), RM3.00 (in Sabah, Sarawak, Labuan).
Program Hidangan Berkhasiat
di Sekolah (HiTS)
- Healthy meal package program served during recess time.
- Food served meets 25-30% of daily calorie requirement.
- Food package consists of staple foods such as rice, chicken, vegetables, fruit, nutritious drinks: fruits, vegetables intake especially encouraged
- 59 schools in the country participate on voluntary basis.
REVISED
Unhealthy food, drinks in school canteens
Coverage | |
2017 (monitoring coverage: new schools) | 2018 (monitoring coverage: new schools + schools with poor scores) |
68.1 % | 70.8% |
Compliance | |||||
2017 | 2018 | ||||
0-59% | 60-79% | 80-100% | 0-59% | 60-79% | 80-100% |
47.8% (848) | 32.4% (575) | 19.8% (351) | 42.2% (3335) | 13.5% (1066) | 15.1% (1196) |
�HiTS: Healthy School Meal Programme�
Zaiton & Teo (2019), presented at “School Feeding Program: International and Malaysian Experience” at Khazanah Research Institute
20
Comprehensive Nutrition and Health Education modules to train teachers
Transformation of canteens to serve healthier menus
MoH Revised Healthy Catering Module
every day
School nutrition programmes
Nutrition education
Supportive healthy
school food environment
Zaiton & Teo (2019)
21
Cost of 1 nutritious meal: RM1.80-3.00
State | District | Cost (RM) |
Johor | Muar | 1.80 – 2.50 |
Batu Pahat | 2.00 – 2.50 | |
Tangkak | 2.00 – 2.50 | |
Johor Bahru | 2.50 | |
Negeri Sembilan | Seremban | 2.50 – 2.80 |
Kedah | Lunas | 3.00 |
| Alor Setar | 3.00 |
Pulau Pinang | Bukit Mertajam | 3.00 |
Terengganu | Kemaman | 3.00 |
HITS implementation in Malaysia
As of July 2019, 59 schools in 11 states had
11,160 students participating in implementing HiTS
Legend:
STATE
Districts of participating schools
Number of participating schools in state
23
HiTS is expanding…in with efforts by
We want to be HEALTHY!
School
authorities
Government Nutritionists
Parent-Teacher Associations
Ibu penyayang / Canteen caterer
24
Impacts of SNP on children
Nutrition Knowledge
Breakfast, Lunch, Dinner & Morning Tea Consumption
Physical activity
Cognitive performance
Teo CH. 2019. Evaluation of School Nutrition Program. Master's thesis. Universiti Putra Malaysia.
BMI-for-age
Pupil
Order
Non-discriminatory
No choice
Showing appreciation
Responsibility
School
Discipline
Strong focus
Canteen
Less oil, salt & sugar
Clean
No waste
Guaranteed fixed income
HiTS benefits
Japan school lunch programme
27
1 student × 192 school days × 6 years = 1,152 plastic bags
Waste from the canteen
School feeding programme benefits
School feeding programme benefits
Parental involvement improves school food monitoring for better, safer, healthier food supplies and preparation
Practical nutrition education for life
1
2
Improve critical awareness of influences on human food behaviour, practices
3
Also improve food security and nutrition
Food procurement for school feeding programs can:
Also improve food security and nutrition
Promote healthier farm crops
Improve farming practices
Ensure safer food for consumption
Make healthier food widely available
1
2
3
4
Food procurement for school feeding programs can:
Make farmer cooperatives viable
Raise farmers’ net incomes
5
6
Conclusions
Implementing a large-scale school feeding programme is
complex and challenging.
However, evidence from around the world shows such programs have multiple positive impacts on inclusive sustainable development:
It is rare that a single programme has as many diverse benefits as school feeding programmes.
Thank you
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