Saturday 31 October 2015

Health ministers meeting - Milan EXPO2015

NUTRITION THROUGH DIFFERENT LIFE STAGES AND CONDITIONS: WHICH INDICATIONS FOR POLICY MAKERS. 27TH -28TH OCTOBER 2015: ITALY, MILAN.

Dr. Mumtaz Kassam

Honorable Ministers of Health  Development partners and UN Agencies
Civil society organizations,
The Private Sector,
Distinguished guests
Although Uganda has made a lot of progress in reducing poverty over the years, malnutrition sadly, affects many Ugandans in various ways, especially women, babies and children.
Optimal feeding of infants and young children is a crucial factor in determining their health, nutrition, survival, growth and development. We all know that for young children, the period from conception to their second birthday, is characterised as the 1000 days of opportunity to effectively address malnutrition.
There is evidence, throughout the world of poor Infant Young Child Feeding practices in regard to breastfeeding and complementary feeding resulting into high prevalence of under nutrition and micro nutrient deficiencies among children under-five.
Uganda with its favourable climate has at least 2 least two harvest seasons with potential of feeding the entire population and neighbouring countries is also faced with similar issues.
For every 100 children, 33 are stunted, 63 are exclusively breastfed for the first 6 months, complementary foods are not introduced timely with only fewer than seven in ten children (68%) receiving complementary foods at six months of age and anemia among children 5 years of age was at 49%. 

The dietary diversity and frequency of feeding are also low. Only 13% and 45% received food from at least four food groups and were fed the minimum number of times or more.
we all know that when malnutrition strikes children in the first years of their lives, it permanently stunts their bodies, their minds, and their potential to fully contribute to their country’s economy.
This great loss holds back our countries potential for a vibrant, productive labour force and their ability to realize the promise of the demographic dividend.
Uganda loses USD310 Million worth of productivity per year due to high levels of stunting, iodine deficiency ,disorders,iron deficiency and low birth weight. Malnutrition is expensive to treat. For example, treating severe malnutrition costs more than 120USD per child., and it contributes a loss of 4.1 per cent of GDP per year. It also affects education and intellectual potential of schoolchildren.
For our countries to grow, our children must grow while their mothers also remain healthy. We all must understand that we cannot make real gains in tackling poverty, hunger, or reduce inequality if we do not urgently address the nutrition of infant, child, adolescent, maternal, and other vulnerable groups. These under-nourished and stunted segments of children have little hope of ever achieving their full potential or contributing to economic growth. In a study on the socioeconomic cost of hunger in Uganda (2013) estimated that up to 5.6% GDP is lost each year because under-nourished children grow up to be less productive youths and adults.
The Government of Uganda has put in place statutes, Laws and Regulations to support breastfeeding. Among many are; Child’s statutes of 1996, the Convention on the Rights of a Child, Regulations of Breast milk Substitutes of 1997, and Legislation for Food Fortification. These instruments aim to provide the framework for ensuring the survival of, and enhancing the nutrition, health, growth and development of infants and young children, as well as strengthening the care and support services to their parents and caretakers to help them achieve optimal Infant Young Child Feeding.
Uganda is among the 5 early “SUN” raiser countries .Nutrition issues therefore are high on the agenda of the government and the National Development Plan as well as a component within the Health Sector Investment Plans to be implemented for the good health of the people.
In addition we have adopted the Uganda Nutrition Action Plan (2011-2016) , with the assistance of several local stakeholders and international donor community such as UNICEF ,WHO and CIDA.It was launched in October 2011, and gives a clear outline of how government and partners including the Private Sector should respond. In 2012, Uganda through WHO received funds from the Canadian International Development Agency (CIDA) entitled Accelerating Nutrition Improvements (ANI). The project aimed at improving infant and young child feeding practices through increasing consumption of nutritious foods and adequate complementary feeding, improving nutrition knowledge and practices, especially in the “critical window” of conception through 23 months.
One of the interventions undertaken was the scaling-up of evidence-informed nutrition action focusing on improvement of complementary feeding of Children 6-23months by use of Food Based Approach.  Hence recipe from the local foods is now available to improve complementary feeding of children 6-23months for the regions of Eastern and Western Uganda. Some of the interventions being implemented with potential to reduce stunting include; Growth Monitoring and Promotion, giving health and nutrition education, and supporting mothers’ to exclusively breastfeed their children for the first six months of life.


In addition other health interventions sensitive to nutrition such as immunization, malaria prevention and treatment, Antenatal care attendance, Family Planning and others are also encouraged. 

Working in collaboration with Agriculture sector we can improve nutrition of children using local crops and scaling up bio-fortified foods such as orange fleshed potatoes, iron rich beans and others.
Improving young child and maternal nutrition in Uganda over the next five years will have the following benefits
  1. Reduce the number of maternal deaths by over deaths by over 6,000 and child deaths by over 16,000 every year. One in 3 of the deaths of women could be prevented if we doubled our coverage of iron supplementation among pregnant women.
  2. Increase national economic productivity, both physical and intellectual, by an estimated Uganda shillings 130billion per year.
  3. Provide a strong return on public investment,for every Ugs1,000 invested,about Ugs 6,000 worth of increased productivity will result from reduced child stunting,improved maternal health,enhanced micronutrient intake,and improved nutrition care. Investing in nutrition makes economic sense, with the economic benefits far outweighing the investments required for scaling up nutrition programmes.
I commend the initiatives and spirit of partnership illustrated by the Government of Italy to the Government of Uganda that has made it possible to share our experience and also learn from others eminent representatives from around the world, in regard to nutrition through different life stages. 

The Government of Uganda welcomes the initiative taken by the Government of Italy with key line sectors of Health and Agriculture, academia, local governments and various NGOs to address food security and nutrition issues with aims to improve the livelihoods of the people and increase productivity of our country.
Finally Uganda-s Ministry of Health pledges to continue working with Italian Government in order to eliminate hunger, ensure availability, accessibility and affordability of food in the quantities and qualities sufficient to satisfy dietary needs of individuals sustainably and good nutrition for all stages of life..




Amb Dr. Mumtaz Kassam.
Representing Minister of Health at the Health Minister-s Meeting in Milan.
27th& 28th Oct 2015.


FAMILY FARMING IN UGANDA

EMPOWERING FAMILY FARMERS SO THEY CAN FEED THEMSELVES ,THEIR COMMUNITIES AND THE WORLD. AN ILLUSTRATION OF UGANDA.





The agriculture sector is the main driver of uganda’s economy ,employing most of the country’s labour force and providing food for the population and exports of cash crops. in its current national development strategy , the gov outlined its key goals for the agriculture sector; enhancing production and productivity, improving access to markets, adding value, creating an enabling environment for agriculture growth and strenthening the sector’s institutions.

Uganda is branded the food basket of africa having 2 harvest seasons with a strategic location in the heart of africa. agriculture is the most important sector of the economy employing over 80 per cent of the work force and providing most of the country’s exports. 73 per cent of the population over 10 years of age is directly employed in agriculture, 83 per cent of all women and 71 per cent of men. traditional agricultural production activities include growing,processing and packaging coffee, tea, and cotton. we also grow tabacco,cocoa,export fish,involved in forestry and in livestock production.

The country has over 18 million hectres of arable land ,of which less than 30 per cent is currently under cultivation. with improved efficiency and with involvment of women and youth in the agro sector , the natural advantage could be exploited to make uganda a major exporter of agricultural produce.

Recently Uganda accented to the tripartite agreement combining the three regional blocks, the east African community, community market of eastern and southern africa ,comesa, and southern africa development co operation,sadc.

The free trade area will stretch from Cairo to cape town with the exception of the newest nation of south Sudan, which is yet to become a member of the respective regional blocs. these countries have a combined population of 600 million people and a gross domestic product, gdp of usd 1.3 trillion –almost 60 per cent of the continents total gdp,according to a 2013 COMESA policy document.

As Uganda is part of the coffee cluster and is Uganda's main exports with 80 per cent of the coffee being exported to Europe, i will outline the importance of involving women and youth in this sector to not only improve the quality and production of coffee, but to also enable value addition strategies and market access

Throughout the world, an estimated 25 million smallholder coffee farmers produce 80 per cent of the world’s coffee. women do much of the work on these farms including key cultivation and processing activities that affect coffee yields and quality. despite their contributions, women are often excluded in decision making processes and enjoy less access to resources , including land,credit,agricultural inputs,training,information and leadership opportunities.

Women’s role in production of coffee vary significantly from one country to another. for example, in uganda women in coffee farming households are responsible for upto 70 per cent of productive activities on an unpaid ,family labour basis. however, they have liittle or no say in management of a Farm enterprice oor use of coffee income. do majority of the field work, while men do the marketing and selling part.a more equal distribution is needed to support women to fully utilise their potential in the commercial sector and it is important to analyse the workload of women and involve them more in decision making.

Although women predominate in world food production ​( 50 to 80 per cent) women own less than 10 per cent of the land.the distinction between ownership and user-rights,and co ownership for married couples is sometimes not clear. there are many differences from one country to another, men appear to own most of the land, equpment and means of transport. equitable ownership of land is fundamental to improved production and usage of land as ownership is linked to other benefits such as credit facilities, training programmes, membership of relevant organisations and coopearatives and marketing tactics.

In uganda, for example, bukonzo joint cooperative socity faced many problems and their coffee quality was low .members mentioned that they considered coffee a real ‘man’s crop’ even though as mentioned before, women managed the farm in terms of picking, drying, hulling and sorting.yet it was the men who would receive the payments from the cooperatives. however, after the gender action learning system approach,the bukonzo joint cooperative society went through several positive changes. currently men and women share share more of the work on the farm, men and women go for joint land ownership and joint decision making on income,productivity levels have improved, and quality has increased significantly.the building coffee farmers alliance in uganda project not only positively changed gender relations within the household ,but also positively impacted productivity and quality of coffee ,increasing the family income by 44 per cent.the return on their investment was now 479 per cent with gender intervention,compared to 375 per cent without gender intervention.thee household approach of involving the family generated social, economic and financial benefits for actors along the chain and leading to a win win situation for all.

I shall give an example of the role of women,men and youth in the coffee chain in uganda under the the hanns r. neumann stiftung programmes. this is a private foundation which supports environmental programmes and runs grassroots projects with smallholder coffee farmers all over the world and has been supporting the coffee value chain in uganda since 2009. hrn’s field officers in uganda were trained on how to focus on gender in their activities to upgrade coffee value chains. their activities also concluded that men perform tasks that require physical strenth, i.e preparing land,planting or deal with the technical know how. the women, whereas perform the more tedious and time consuming tasks, such as weeding,sorting etc. women additionally do the housework and grow vegetables for the family consumption.
An action to redress these issues by the foundation was to organise household sensitization trainings and point out the advantages of shared responsibility and decision making for the welfare oof the family. if men and women decide together on coffee proceeds they have an incentive tomproduce better coffee together.
Gender inequalities are therefore generally accepted as not only a key to household povery and constraints on women but also poor coffee quality.gender inequality also contravenes the un convention on elimination of discrimination against women signed by many countries in 1979.it is aso against the spirit ofvfair trade and corporate social responsibility.

The example given earlier of bukonzo joint cooperative union , has shown how with implentation of the improved coffee practices, the farmers as a family can get a much better price , as they have been able to change their coffee from one oof the worst in the rregion to one of the best. they are processing their own coffee and are exporting to japan, us and other countries.

The way agriculture is relayed to youth is not very appealing. it is like a last resort occupation , and it is important to harness the growing youth population into accepting agriculture in a modernised technological way as a productive source of income for their families.

As regards more youth participation in the coffee growing sector in uganda, one of the oldest licenced coffee exportes in uganda following liberlisation of the uganda coffee industry in 1992,kyagalanyi coffee limited klc have just started a ‘coffee youth teams project’ as part of their sustainability approach. under the scheme a minimum of 120 rural youth between the ages of 18 and 35 will be assisted to create their own employment and thereby earn an income. 40 youth teams shall be formed in operational areas of kcl’s coffee schemes. each team will consist of 3 youths , and will have at least one woman per team.each team will receive several training kits , including gender aspects and use oof smart phones. the business training will focus on business models,and feedback workshops would allow the teams to exchange ideas and learn from each other.each team will be supervised by a commercial guardian, who are entrprenuers in their own rights. such supervision will promote the coomercial drive,accountability and performance of the youth teams.kcl will sign mou’s with the teams nd guardians that shall set out the rights and responsibilities of each party. each team will be linked to reputable agro input dealers.

Each coffee youth team would offer 2 lines of services to farmers in their area; provision of services such as knowledge on planting and applying agro-inputs. farmers would pay for these services. 2. management of farms for aged or absent farmers. each team to manage 2 farms a year

The aim is that 5,200 coffee farming households would benefit from increased ,sustainable coffee production due to better management by 2017. and it would increase coffee production by 20 per cent on average.
In addition each team will serve as a role model for 12 secondary school classes and show opportunities of creating own enployments,in coffee. the aim is that 24,000 secondary school children benefit from the role model provided by the coffee youth teams to create their own employment in the coffee value chain.

The coffee youith teams shall present their services to the larger coffee community at the district coffee shows,organised annually by café africa.and within 3 years, the project would organise field days for coffee value chain partners including ucda and coffee exporters to share successes and Failures if any, of the approach. facebook and other internet forums will be used to share the concept with a wider community. the project plans to pproduce a short film and information leaflets to promote the coffee youth teams concepts in other areas.

Access to land as mentioned briefly could increase youth and women participation in agriculture. young people will not work in agriculture simply because their parents are aging. they will only do so if our countries invest in the tools and knowledge that allow agriculture to fulfil their dreams of a more prosperous future.
Last week, hundreds of agriculture experts from public and private sector met in lusaka, zambia for the 2015 africa green revolution ,agrf,whose president is dr. kalibata who was previously the minister for agriculture in rwanda.. a priority of this years meeting is to move aggressivly to incorporate africa-s soaring youth population 0the 226 million people between 15 and 24 who have made africa the world-s youngest continent to embrace our our family farmers as the focul point of economic transformation.

However an analysis by agra found that lack of land,extension of services,credit,quality farm inputs,machinery markets and other impediments is preventing agriculture from providing jobs on and off farms for the youth population that accounts for 65 per cent of the total population in africa with more than 10 million entering the labour market annualy.our region now holds 19 per cent of youth and will increase to 27 per cent by 2030.

Although agra,s status report shows that though in rural areas two third of the youth are engaged in agriculture, they havr a dim view of farming as a career .african children are stereotyped from a young age to get an education in a field outside agriculture however, enormouse progress is made in countries where african farmers are given more options in the seeds they plant the fertilisers they use and the technical know how. for example in rwanda a serous investment focused attention to progress agriculture led to a 20 per cent reduction in poverty in less than 10 years.

The food we see in shopsin most african countries comes from abroad. africans spend 40 billion usd each year on food imports, and almost 80 per cent of the high value food products consumed in africa are grown,processed and packaged outside africa.

But the economic opportunities in agriculture are enormous. an assessment by world bank shows that found that serving the food demands of africa-growing middle class alone can create a market worth 0one trillion usd.african agri0preneurs can own that marlet if we tap the 2 assets that should be an unbeatable combination,the world-s largest youth population and the world-s largest holdings of uncultivated arable land. many studies have found that access to land could dramatically increase youth participation in agriculture,particularly for young women farmers.

Therefore two of africa-s biggest challenges, 0its fight to achieve food security and its urgent ned to find employment for its young people 0can be transformed into its biggest assets.

Several ngo,s are actively involved in working with governments of african countries. in uganda we have fanta ,the food and nutrition technical assistance 111project. we also have feed the furure programme, which is a usaid initiative to help africa great lakes region maintain its position in the coffee market by assisting in the quality and production mainly to small holder farmers.feed the future initiatice has seen a reduction of 16 per cent in poverty rates.other NGO-s such hivos have drawn very useful toolkits to assist in creating awareness for the farming family.
In uganda for world food day, we officially launched the united nations womenempowerment principles,wep-s in the country. this is a joint inititaive of the un global compact and un women offering practical guidance to business on how to empower women.

In concluson
Increase women's participation in training programmes and decision making.
Develop a list of gender sensitive equity principles for high level corporate leadership for gender equality.

Treat all women and men fairly at work. respect and support human rights and ensure joint and equitable ownership of land. land is always a sensitive issue and many landowners are reluctant to have their spouses be joint owners due to factors such the land being owned by extended family members, including other siblings. as a lawyer practising in uganda, i advise these families to maintain the freehold interest in the family, but form a company or a partnership that can have a leasehold interest for purposes of farming activities. mutation of title can also be done whereby the land can be divided up and shared equally. in such cases, it is important to point out to the family members grow the same crop and maintain the quality and here cooperatives are very useful.

Improve women’s access to credit and assets. here offer loans to women that do not rely upon ownership of land per se as this may disqualify many women.
Provide support for cooperative based women’s savings groups and revolving fund groups. in uganda several banks are now involved in agri financing. provide women with access to micro credit financing . banks such as standard chartered are providing credit facilities to farmers with future crops as security.
Provide financial literacy trainings for better business management.
Support joint decision making and ownership of income and resources at the household level.offer gender sensitisation trainings focused on men and encourage men’s full participation as partners and change agents in the effort to achieve gender vequity.

involve the youth by encouraging and creating awareness programmes on the benefits of farming by introducing new technology and innovations in agriculture.disseminate information and share knowledge and skills.
All these factors are important for enhancement of food security.



Ambassador dr. mumtaz kassam
Deputy head of mission/protocol officer for uganda at expo 2015.
Paper presented at a seminar on empowering family farming organised by the domenican republic at the expo conference center as part of their national day events.