Flying high in Cambodia: Tips for embedding nutrition into food systems transformation

Cambodia is a classic nutrition paradox. Home to a vast array of nutritious food, including aquatic foods, eggs and diverse fruits and vegetables, the country continues to face overt nutrition challenges and yet is more determined than ever to address them. Cambodia’s active engagement in the country dialogues leading up to the UN Food Systems Summit (FSS) are case in point, with the UN agencies mobilizing effectively and efficiently to support government and work jointly with other stakeholders (e.g. donors, civil society organizations) in shaping the path ahead.

According to the latest Global Nutrition Report, Cambodia is 'off course' to meet global nutrition targets.[1] Both child stunting (estimated at 32% in 2014) and wasting (approximately 10% in 2014) are high by WHO standards and surpass the regional averages. Anaemia continues to afflict a sizable portion (about 47%) of women of reproductive age, while overweight and obesity have been steadily rising among adults since 2000. The COVID-19 crisis has accentuated vulnerabilities and official development assistance (ODA) for nutrition is declining, further complicating the situation.

The large number of severely wasted children who lack access to proven treatment adds to the burden of morbidity and mortality, which necessitates the urgent scale-up of prevention and treatment interventions, especially given the ongoing pandemic” says Hedy Ip, Chief of Health and Nutrition at UNICEF.

With diet being the leading risk factor for the global disease burden and COVID-19 (and related restrictions) eroding incomes and disrupting the flow of goods ‒ including perishable foods that are nutritious ‒ there is a considerable need and appetite to transform food systems so that they nourish Cambodians, including at risk groups. There is also the general sentiment that this transformation is the way forward for promoting good human, animal and planetary health, and possibly avoiding other pandemics.

A shining SUN in Cambodia

Joining the Scaling Up Nutrition (SUN) Movement in 2014 was further testament to the government’s commitment to nutrition. His Excellency Sok Silo, the SUN Country Coordinator, has stepped up to the challenge and has looked to the respective SUN networks, including UN Nutrition (formerly the UN Network for SUN), for support. The presence of SUN has, in turn, increased demand for public-private partnerships and given impetus to increased collaboration among the UN agencies on nutrition.

A strong UN Nutrition collective confers multiple benefits

At present, four agencies ‒ FAO, UNICEF, WFP, and WHO ‒ comprise UN Nutrition in Cambodia although there is talk of expanding membership to others. UN Nutrition does more than link the four agencies together. “It also serves as an anchor point for other agencies whose work can influence nutrition or whose goals are affected by nutrition,” says that Iean Russell, FAO-EU FIRST Senior Policy Officer. The current members see the COVID-19 crisis as an opportunity to bring additional UN agencies into the nutrition and food systems arena in view of new vulnerabilities and as part of efforts to build back better together. They have also issued joint statements since 2020 about the impact of the pandemic on food security and nutrition and what needs to be prioritized.

Cambodia is fortunate that it does indeed have a strong UN Nutrition and further the Resident Coordinator has prioritized nutrition through the establishment of a Nutrition Accelerator in support of UNDAF and in recognition of the cross-cutting role that nutrition has to play in the achievement of all the SDGs,

notes Lindsey Wise, Nutrition Advisor at the World Food Programme office in Phnom Penh. Recognizing the virtues and importance of joint action for an interdisciplinary area like nutrition, individual agencies see their success in their ability to succeed as a collective. This is a motivating force for many members. The UN Nutrition platform helps the UN colleagues forge a united front as they work with the SUN National Coordinator and Technical Working Group on Food Security and Nutrition (TWG FSN) to strengthen capacity, including coordination capacity.

UN Nutrition helps the government see nutrition in its entirety and mobilize several sectors from social protection to agriculture, education, health, WASH and labour, in order for them to each fulfil their important roles in safeguarding nutrition,” says Claire Conan, WFP Representative and Country Director and UN Nutrition Chair in Cambodia.

It also gives partners, including the Royal Government of Cambodia and the other SUN networks, a simplified channel for communication and amplified impact.

Factors driving UN Nutrition’s success in Cambodia

Having formalized joint working modalities, such as a UN Nutrition annual workplan and regular meetings, have enabled the member agencies to align their efforts so that they are complementary. The workplan is structured around six thematic areas, with a balance of agencies taking the lead on different activities. This arrangement leverages the comparative advantages of each agency while articulating clear roles and responsibilities. The six thematic areas ‒ (1) the UN Food Systems Summit (FSS); (2) the Global Action Plan for Child Wasting (GAP); (3) school health and nutrition; (4) the food value chain, food safety, and food fortification; (5) nutrition and the COVID-19 response;[2] and (6) analytics, research and evidence generation ‒ were selected as a group, recognizing that they were the main areas of convergence.

The nutrition focal points meet monthly to take stock of the latest progress, address bottlenecks and plan next steps in addition to sharing information about things of common interest (e.g. new nutrition data and guidance).

“We use our comparative advantages and it’s really fulfilling," says Nargiza Khodjaeva, WHO Technical Lead on NCDs and Health through the Life-Course, who is based in Phnom Penh.

At the same time, the group appreciates the need to remain flexible so that it can respond quickly. This “allowed UN agencies to collectively respond to COVID-19 with a united voice and to ensure that nutrition is front and center across responses and policy discussions,” says Anna-Lisa Noack, FAO-EU FIRST Nutrition Policy Officer. Her colleague, Iean, elaborated, explaining that the group’s flexibility applies to its technical capabilities and resourcing.

“In some cases, funding can come from one agency, while the expertise comes from others, with our work on school-based nutrition interventions being a prime example,” he adds.

When ambition is matched with action

Things are moving in Cambodia and in a big way. Many activities, such as the development of a GAP action plan and roadmap, have been completed. Cambodia was among the first countries in the world to complete its country GAP operational roadmap in May, after a concerted effort that started at the beginning of 2021. Others activities are ongoing in full force, such as: the country Food Systems Summit Dialogues; support for the development of national school nutrition guidelines and standards; the second phase of the Cost of the Diet (CotD)/Fill the Nutrition Gap analysis; legislation to support the enforcement of the code on breast-milk substitutes, which is critical for ensuring food systems are safe for infants; and support to Integrated Early Childhood Development programmes, linking health, nutrition, social protection, WASH and early education services through stronger community engagement. Furthermore, many activities are being pursued in collaboration with other SUN networks, namely: Civil Society Alliance (CSA), SUN Business Network (SBN) and the SUN Donor Network (SDN), including the FSS dialogues. The food systems roadmap, based on nearly six months of dialogues with over 1500 people, is an opportunity to prioritize actions and focus on joint technical assistance and implementation.

Zooming in on UN Nutrition’s support to FSS

Over twenty dialogues have taken place at national and sub-national level in Cambodia, often with a strong nutrition angle, including visibility to breastfeeding which has largely been absent in FSS dialogues in some countries. “When you put nutrition front and center in the dialogues, people start to understand that food systems are not just about feeding people but making sure people are well-nourished so that they can reach their full potential and contribute to the prosperity of the nation,” says Claire. Iean has been in Cambodia for many years and spends part of his time at the FAO office within the Council for Agriculture and Rural Development (CARD), where H.E. Sok Silo, the SUN Country Coordinator/FSS National Convener, is also based. These institutional arrangements enable him to provide technical support to H.E. Sok Silo and serve as a liaison with the other UN Nutrition members, ensuring that communications on FSS are timely and that the UNN provides input to each step of the process. Nargiza explained that his standing with CARD together with the strong UN collaboration have helped the Cambodia group gain CARD’s trust.

UN Nutrition was a leading force in supporting various dialogues, ranging from food fortification and its potential to address micronutrient deficiencies to home-grown school feeding, the role of private sector in improving the nutrition of the Cambodia people, the global action plan for prevention and treatment of wasting, and many more. In many cases, the UN Nutrition colleagues worked closely with the SUN CSA and SDN to prepare for these in-depth dialogues, including the one on school-based nutrition. The latter is contributing to an emerging coalition on schools, led by WFP through the regional bureau. In addition, UNICEF and WFP supported the engagement of school-age children and adolescents in the FSS dialogues through face-to-face sessions at sub-national levels, which involved learning activities focused on food poverty, nutrition, climate change and livelihoods in their local communities, building on the youth network for nutrition that FAO and WFP closely supported.

Furthermore, the UN colleagues interviewed from FAO, UNICEF, WFP and WHO unanimously agreed that H.E. Sok Silo’s dual role as the SUN Country Coordinator and the National Convener for FSS was a major factor in seamlessly integrating nutrition in the FSS dialogues. “He really understands the intersection of food security and nutrition,” Lindsey acknowledged, and this considerably helped to sharpen the nutrition lens of the FSSDs in the country. H.E. Sok Silo also explained that “this rapid progress was possible thanks to the alignment of national strategies and a series of policy dialogues since 2019 that introduced food systems concepts, supporting the release of the Second National Strategy for Food Security and Nutrition, 2019‒2023. The SUN networks were also key in mobilizing the necessary technical and financial assistance for the dialogues.”

Framing opportunities as triple wins ‒ livelihoods, environment and nutrition ‒ for food systems transformation was yet another effective strategy that UN Nutrition employed in Cambodia. “When people see clear mutual benefits, they start to listen,” says Iean. This helps to raise awareness among diverse stakeholders in different technical areas about how actions that support nutrition gains, such as cash transfers for mothers and children can also be used to foster equitable access to balanced healthy diets of diverse foods, including underutilized species. They can also promote increased resilience of local livelihoods from smallholder farmers to small-scale fishers and food processors.

As stakeholders in Cambodia shift from what should be done to what will be done and who will do it, there is a common sentiment that community-driven approaches, youth engagement, a strong consumer orientation, multi-stakeholder/sector engagement, public-private partnerships as well as efforts to strengthen the humanitarian-development nexus (HDN) will be crucial to the success of related follow-up from the FSS dialogues and approaching summit in September. One key outcome of the dialogues is a nationally endorsed operational roadmap for the prevention of child wasting (2022‒2024), as a key step for ensuring access to sufficient, safe and nutritious food. Anna-Lisa recounts that one of the

major ‘take-aways’ from the dialogues is from the process itself: opening the door for cross-stakeholder and sectoral understanding, dialogue, coordination and collaboration and raising awareness on what food systems are to improve the governance of food systems and making planning and implementation processes more inclusive and participatory.

Looking ahead

UNICEF and WFP are already working to design a joint programme in two provinces where ECD activities will be implemented alongside a nutrition intervention. The continued inequalities and deprivations affecting children demonstrate the need for strengthening holistic, interdisciplinary approaches to support and advance ECD. At the same time, continued support to Government in scaling up proven nutrition-specific interventions, such as maternal, infant and young child nutrition counselling, micronutrient supplementation, and early identification and treatment of SAM, is needed. Furthermore, all four agencies are involved in school-based nutrition programmes, which includes the transition to home-grown school feeding and related nutrition-sensitive value chains. This will safeguard the nutrition of school-age children and instill healthy eating practices to prevent the double-burden of malnutrition.

Cambodia’s UN Nutrition platform, in collaboration with the SDN, is also exploring the possibility of conducting a mapping exercise, cognizant that this will bolster ongoing efforts to systematically include nutrition in government investment plans. They also see how the mapping has informed advocacy and generated information that can be used to better coordinate actors across the vast nutrition landscape. “ As CARD works to support the decentralization of the FSN TWG to provincial level, it could be beneficial to understand the capacity strengths and gaps at provincial level and to devise a costed plan to support strengthening,” says Lindsey in a recent interview with the UN Nutrition Secretariat.

The UN colleagues in Cambodia are proud of what they have accomplished as a group and eager to share their experience. The FSS dialogues have increased momentum around nutrition in the country. Nargiza acknowledged National Nutrition Day and the Youth Nutrition Forum, organized by WHO with support from FAO and HKI in 2020, as being other key moments to advocate for food safety and healthy diets, including measures to reduce the consumption of salt and sugary drinks which help to prevent diet-related noncommunicable diseases and obesity.

They also realize there is much more work to be done, including efforts to drum-up more nutrition financing. UN Nutrition is working to develop a joint agenda for nutrition in Cambodia, which will more clearly lay out the synergies and efficiencies gained by working collectively in support of national nutrition efforts. The UN Nutrition in-country Chair adds that,

we will work to jointly to mobilize resources for nutrition and the GAP Roadmap that was facilitated by UN Nutrition was an important first step. I was baffled when I learned that nutrition receives less than 1% of ODA despite bringing a high return on investment and being linked to all SDGs.”

Selamawit Negash, Nutrition Specialist at UNICEF, highlighted that the UN is committed to strengthening advocacy and moving towards sustainable financing and specific, measurable, achievable, realistic and timely (SMART) investments in relation to the GAP. The Nutrition for Growth (N4G) Summit at the end of the year is giving impetus to such. The Cambodia dream team also appreciates that tracking domestic resources allocated to nutrition is important and can confer opportunities to better advocate for more resources. As with so many things, pursuing multiple strategies and acting together can help to maximize prospects for attracting additional investment in nutrition and create multiplier effects for poverty reduction, health and stewarding the environment.

[1] https://globalnutritionreport.org/resources/nutrition-profiles/asia/south-eastern-asia/cambodia/ 

[2] In 2020, UNN ensured clear priorities were articulated to protect and improve food security and nutrition as part of the UN’s Socio-Economic Framework (SERF) for COVID-19, which is currently being implemented and monitored as part of the joint workplan.