Presented by Truong Tuyet Mai, Fred Unger and Stef de Haan at the CRP-A4NH, Vietnam Partner Day Sharing Progress and Planning ahead for Collaborative Research Workshop, Hanoi, Vietnam, 23 March 2018

1. Contextualization
Nutrition, Food System and
Food Safety Issues in Vietnam
Truong Tuyet Mai, Fred Unger and Stef de Haan,

2. Outline
1. Vietnam – Background
2. Nutrition situation
3. The Food System
4. Food Safety
5. Take away messages

3. Vietnam Profile
 Population (2018): 94 million
 Urban population: 33.1%
 Life expectancy: 73.6
 No. of Doctors per 10,000 population:9
 % of CHS having doctors: 78%
 Health Insurance coverage: 76%
 % of health budget in GDP: 3.5%
 % of Health budget in State budget
expenditure: 12.9%
Source: Health statistical Yearbook 2014

4. • 24.3% stunting (2016)
• 15/63 provinces have
stunting rate over 30%
• 5.3% overweight
• Anemia: 27.8% children;
25.5% women
• Huge strides forward:
- Supplementation
- Complementary feeding
- Breast feeding promotion
2. Nutrition situation: general facts

5. Vietnam – trends in malnutrition 2000 to 2015
Source:Nutrition Surveillance – National Institute of Nutrition 2016

6. 20.8
54.5
26.3
60.3
25.5
63.6
0
20
40
60
80
Anemia Zinc deficiency
Prevalence(%)
Sources: Micronutrient survey 2014 - 2015, NIN
Prevalence of anemia and zinc deficiency
among women of reproductive age by region
Urban Rural Total

7. 22.2
8.2
49.7
28.4
13.1
71.6
27.8
13
69.4
0
20
40
60
80
Anemia Subclinical vitamin A
deficiency
Zinc deficiency
Prevalence(%)
Sources: Micronutrient survey 2014 - 2015, NIN
Prevalence of anemia, subclinical vitamin A deficiency
(<0.7mcmol/L) and zinc deficiency among children by
region
Urban Rural Total

8. Prevalence of overweight in U5 Children (WHZ>+2Z)
Source:National Institute of Nutrition 2011
0.9
0.5 0.62
5.5
1.7
2.8
5.7
2.2
3.6
5.8
4.2
4.8
6.5
4.2
5.6
8.2
4.4
5.5
0
2
4
6
8
10
Urban Rural Overall
Prevalence(%)
Prevalence of overweight in U5
Children (WHZ>+2Z)
2000 2004 2005 2008 2010 2014
2. Overnutrition and NCD’s

9. 5.4
10.8
15.3
17.1
22.1
2.3
3.5
6.6
12.0
14.9
1.4 3.0
5.3
9.8
11.2
0
5
10
15
20
25
1993 2000 2005 2010 2015
Prevalence(%)
Urban
Overall
Rural
Trends of overweight/obesity in adults
1993-2015
Source:TuanT Nguyen and MinhV Hoang,Asia Pac J Clin Nutr 2018;27

10. NCD burden in Vietnam
Currently the NCD prevalence is high and
is increasing:
Hypertension/cardio-
vascular diseases
12,5 million people
(25% of aged 25+)
COPD
2 million people
Diabetes
2,5 million people
(5,4% of aged 30-69)
New types of
cancer
150,000/year
Prevalence

11. High level of risk factors of NCDs
Risk factors by sex among people aged 18-69; National Risk
Factors Survey 2015
Percent%
Data sources: STEPS Surveys 2015

12. High level of risk factors of NCDs
Percent%
High levels of smoking, alcohol consumption, lack of fruit/vegetable, physical
inactivity; especially in men (Risk factors survey 2015)
• * Smoking: GATS survey 2015
• ** 60 gram of alcohol at least once in past 30 days
Data sources: STEPS Surveys 2015

13. 15.4
13.2
12.3
11.2
17.6
12.0
8.4
6.2
67.0
74.8
79.3
82.6
0% 20% 40% 60% 80% 100%
2010
2000
1990
1985
Protein Lipid Glucid
Changing Energy intake (P: L: G)
2. Dietary Intake

14. 91.0 80.3 118.7
188.0
698.2 685.0
696.6
689.2
0
200
400
600
800
1000
1985 1989 2000 2009
SốgamLTTP
Năm
Food consumption (gram/capital/day)
Thức ăn nguồn thực vật Thức ăn nguồn động vật

15. The trend of food consumption 1985-2010
(gram/capital/day)
13.6
51
84
40.1
52
59.8
1.7
10.3
32.3
0
20
40
60
80
100
Meat Fish Egg/milk
1985
2000
2010

16. 0
50
100
150
200
250
năng lượng protein sắt kẽm calci vitamin A vitamin C vitamin B1
2010 Toàn quốc 2015 Lạng Sơn 2015 Hưng Yên 2015 Hà Nội
% meet the RDA in <5U Children’s Dietary Intake

17. Challenges for Nutrition in Vietnam
• In some localities, government, and community
authorities have not given adequate attention to
nutrition issues, or not recognized their importance
• Resource investment has not met actual needs
• Management and operation constraints
• Capacity of the implementation network
• Inactive involvement of relevant sectors and mass
organisations at all levels.
• Globalization, urbanization,climate change, rapid
aging of the population, changes in lifestyles and
unbalanced diets

18. NATIONAL
NUTRITION PLAN
OF ACTION 2018-
2020
Objective
1: To improve the nutrition status of mothers and children
2: To reduce micronutrient deficiencies among people
3: To improve Vietnamese people’s height
4: To improve the quantity and quality of Vietnamese diets, to
control overweight/obesity and nutrition-related risk factors of
some chronic non-communicable diseases in adults.
5: To reinforce capacity and effectiveness of the network of
nutrition services in both community and health care facilities
Prime Minister’s Directions
on Strengthening Nutrition
in New Period, Dec 2017
1. Proper diet/nutrition
2. The first 1000 days of
life
3. Multi-sectoral
collaboration

20. 3. The Food System
GLOPAN
Framework
A = Diet quality
B = Consumer
C = Food Environment
D = Food Supply System
E = Drivers of change

21. There is an emerging food systems interest
within a rich policy environment
• Food - feed security
• Food safety
• Climate change
• Urbanization
• Trade
• ‘Modernization’ of
retailing
• Others
Food System
Transformation
Demand
& Food
environ.
Policies
&
Programs

22. • High dietary diversity
• High vegetable intake
• > consumption of animal
products
• Pockets of micronutrient
deficiency
• > unhealthy diet components
• Food borne diseases and
contaminants
Diet
quality
Breakdown of urban and rural household
food expenditures in 2002 and 2012
3A - Diet Quality
Vietnamese diets are diverse and changing

23. Change in Food Supply per Food Group (50 years)
Calories Food weight
Fat Protein
http://ciat.cgiar.org/the-changing-global-diet/
3A

24. Source: Ipsos Business Consulting. Meat
Market in Vietnam
Production and consumption of livestock in
Vietnam from 2013 to 2019f
• Quality
• Trust
• Tradition
• Convenience
• Purchasing power
• Food choice under
researched
• Misconception:
price
Consumer
Diet
quality
3B – Consumer
What types of consumer behavior are important?

26. Food
environment
Consumer
Diet
quality
Urban  Wet markets (upgraded to temporal
 Street venders and street food
 Urban agriculture, roof gardening
 Specialty “safe food shops”
 Supermarkets and convenience stores
Peri-urban  Hybrid
Rural  Production (family farming)
 Wet and village markets
 Small shops / street food
3C - Food Environment
Modernization and parallel pathways

27. • Smallholder and family farming important
• Self-sufficiency: rice and most vegetables
• Partial self-sufficiency for fruits and fish
• Feed import is substantial (soya)
• Meat export (pig) and import (beef)
• Smallholder supply chains predominant
• Food companies with vertically integrated supply
chain on the rise
• Key challenges: labeling, traceability, information,
access and trust. Incipient: sustainability, animal
welfare.
• High levels of diversity are maintained in supply
chains, including landraces and NUS
3D - Food Supply Systems
From production to retail

28. Vietnam- Agricultural Imports - Exports
3D

29. Agrobiodiversity high in Retail
(comparison of species and varietal diversity at wet and supermarkets in Cầu Giấy district, Hanoi)
3D
Source: Lama, 2017

30. Agricultural production Food storage, transport and trade
 Intense agricultural production
 Main crops: rice (4 million ha),
cassava (0.8 million ha), coffee,
rubber, cashew,
 6th largest producer of pig meat (30
million animals)
 Rise of national milk production
 Food loss and waste under-
researched
 Rapid / direct supply
 Demand for post-harvest
technology
 Excellent infrastructure (expanded)
 Import: feed, fruit, beef
 Export: rice, coffee, pepper,
cassava, aquaculture produce
Food retail and provisioning Food processing
 Predominance of wet markets
 Rapid growth of supermarkets, safe
food shops and convenience stores
 Culture of eating out
 Preference for fresh
 Range of ‘typical products’: noodles,
fish sauce, etc.
 Products on the rise: milk products,
instant noodles
Selected Sphere of Influence: components
3D

31. Food Waste in Vietnam
• National State of Environment report (2011) reports that total
FW is about 5,743,056 tons per year
• It accounts for 60% of the entire municipal solid waste (MSW)
• FW per capita is estimated around 0.06 kg/day.
• According to Olivier (2008), more than half the weight of landfill
in Vietnam is FW.
Source: Le Thi Thanh Huyen et al., 2015
Estimation of food waste in Vietnam from 2007 to 2025
3D

32. 3E - Drivers of Food System Transition
Biophysical, political, economic, technological, demographic
Some of the big issues for Vietnam:
• > Population and urbanization
• > Purchasing power and shifting demand for
food
• Modernization and inclusive food supply
• Sustainable intensification and food safety
• Climate change and food supply

33. 4. Food Safety in Vietnam
• Food safety is perceived as one of the most pressing issues by
Vietnamese people, more important than education or health care
Perception
• Vietnam has a modern food safety legislation system but the use of
risk based approach is limited
Legislation
• Willing to pay 5-10% premium for safer food, not easy to decide for
consumer what is “safe”
Consumers’ Behavior
• Food exports relatively well managed but deficits in domestic
markets
Market Situation
Food safety risk management in
Vietnam. WB 2017

34. 4. Food Safety in Vietnam
Repeated episodes of adulterated and unsafe food
• Pesticides in vegetables, mass fish intoxication,
antibiotics residues
Risk perception towards chemical hazards
Reported outbreaks 370 (2014-2015), 66 fatalities, high
underreporting expected (>1/100)
Majority of risk from biological hazards are related to cross-
contamination and consumption of raw/fresh or undercooked
products
Information for selected hazards exists but rarely on related
health impact
Use of risk based approach and risk communication limited

35. Institutional setup
The structure of food safety management
from central to local level
4. Institutional setup

36. Value chain and food safety by commodity:
vegetable
Consumption (Ha Noi & HCMC)
Total consumption of vegetables in Ha Noi and Ho Chi Minh City is projected
at 2,800 tons per day and 3,290 tons per day, respectively.
Supply (Ha Noi & HCMC)
60 – 70% supplied by neighboring provinces
Market (Ha Noi & HCMC)
Hanoi: 15% supermarkets, 33% whole sale markets, remaining covered by
local markets
HCMC: 15% supermarkets, 85% whole sale markets
Food Safety risks
Limited information on hazards:
• High contamination with fecal bacteria, pathogenic bacteria, and parasites
• Pesticides, 23% of vegetables exceeded the maximum levels for pesticides
(MARD)
Food safety risk management in
Vietnam. WB 2017

37. Value chain and food safety by
commodity - Seafood
Export
- Seafood export value of US$ 8.32 billion in 2017, increasing
- Violations notified by EU* and Japan (highest in seafood, compared
to other commodities) but overall violations remain stable while
volume of exports increases
- “yellow card” from EU for illegal fishing
Domestic market
- the aquaculture sector confronts drawbacks:
(1) environmental pollution issues caused by the overuse of
antibiotics and chemicals,
(2) instability in aquaculture output due to projected restrictions
in antibiotic use
(3) the unpredictability and large scale of disease occurrence.
- Many chemicals are used, including lime, chlorine, iodine, saphonine,
microbial enzymes, and dolomite lime.
http://seafood.vasep.com.vn/657/whybuy/food-safety.htm
https://www.tandfonline.com/doi/full/10.1080/23311932.2016.1207398*Rapid Alert System for Food and Feed

38. Value chain & food safety by
commodity: PORK
Pork is an important component of the Vietnamese diet
• The most widely consumed meat: 56% of total meat intake
(OECD, 2016)
• Annual pork consumption per capita in Vietnam: 29.1kg
• 83% comes from very small or small farms
• 76% of pigs are processed in small slaughtering, nearly 30,000
• Preference for fresh “warm” pork supplied
in retail traditional markets
(>80% of all pork marketed)
• affordable, address local demands
• often escape effective control
PigRISK, ILRI & partner 2017

39. ILRI’s work on Pork & Food Safety
PigRISK
Jun
2012
Sep
2017
Pig competiveness
2008
-2012
SafePORK
-Small holder pig sector
is important and
competitive
Oct
2017
To assess impacts of pork-borne
diseases on human health and the
livestock.
Policy engaegement* **
*NTFFS National Food Safety Taskforce
** World Bank Food Safety Risk Assessment for Vietnam
Capacity building
Mar
2022
To develop and test market based
food safety interventions

40. Research questions
Is pork in Vietnam safe?
Are the risks serious?
Integrated approach
Interdisciplinary team: Vets, MD, economist
Risk based approach: Hazards & risks
Food safety hazards:
Biological and chemical
From farm to fork
Study sites: Hung Yen
& Nghe An
PigRISK Food Safety assessment - pork

41. Pig RISK – key results
Microbial risk assessment:
Salmonella contamination started at farm and increased along the pork
chain (farm – slaughter – market) mainly due to poor hygienic practices
44.7% of pork at market
Risk for pork consumer: 1 – 2 person from 10 estimated to suffer
Salmonella caused FBD annually
Hospitalization costs of foodborne diarrhoea per treatment episode and
per day: USD 107 and USD 34, respectively.
Pig RISK Key results from assessment
Chemical risk assessment: Risk due to chemical hazards is low (heavy
metals, grow promoters and antibiotics) low
What we are concerned most is not what makes us most sick –
risk from microbiological hazards far higher compared to chemicals
PigRISK, ILRI & partner 2017

42. Pig Risk overall research question:
Is pork in Vietnam safe? - It is not !
Are the risks serious? - Considerable!
Study sites: Hung Yen
& Nghe An How to reduce the risk for the consumer?
Safe PORK
Focus on food safety interventions & risk
communication
Involvement of private sector
From assessment to intervention

43. Challenges to improve food safety
• Various approaches to improving safety had been tried, largely based
on systems used in developed countries e.g.:
– GAP, traceability, certification, and modernising retail
• However, safe meat production has not yet take a significant share of
the market
• The key constraints to uptake include:
– high cost of adoption
– lack of direct, visible benefits from changing behaviour
– low consumer trust in certification
• We concluded that incentive-based, light-touch interventions are
needed to overcome these constraints
• Focus will be on gradual improvements to the food system in place,
rather than introduction of a new system
Challenges to improve food safety
SafePORK ILRI & partner 2017

44. • Simple, cheap tests that detect contaminated food (“Pregnancy test” model)
– Could be used directly by retailers or consumer to have direct verification of safety
• Reduce contamination of carcass
– Portable ozone machines to plug into water supply
• Ozone is highly effective disinfectant;
– Spraying of carcass (e.g. trisodium phosphate)
– Avoid floor slaughter
• Reduce use of antimicrobial
– Replacement of antimicrobials by pro-biotics, in collaboration with private sector.
• Increasing transparency and traceability in food system
– 24 hour camera that shows conditions on farm, consumer visits at producer
– Branding and certification, in collaboration with private sector
Examples for low cost interventions to
improve pork safety
SafePOR ILRI & partner 2017

45. In a slaughterhouse pilot trial, technical
evidence was provided to improve slaughter
hygiene when using a set of tailored intervention
(e.g. avoiding floor slaughter). The trial also
demonstrated that changing the practice of
workers is a key challenge for sustainability.
Technical innovations vs. practice change
PigRISK, ILRI & partner 2017

46. Nutrition
• Vietnam has made huge strides forward addressing
malnutrition in the country with a significant drop in
stunting and wasting
• Elements of success: supplementation, complementary
feeding, breast feeding promotion, fortification
• Yet, micronutrient deficiencies remain a critical
challenge in selected pockets in the country
characterized by marginal environments and poverty
• Overweight and NCD’s are on the rise and a new
important focus of nutrition and education programs
• Dietary shifts are taking place at a rapid pace with
increasingly higher of intakes of fat, energy, and
protein, but the RDA of micronutrients not met in some
geographies and populations.
5. Take away messages

47. 5. Take away messages
Food systems
• Food systems transition occurring at multiple levels
in the food supply chain
• Food environment and consumer behaviour are
unique, but also changing
• Key needs to understand food system interactions
at multiple scales and to identify leverage points to
improve food systems
• Key outcomes should include the food system
capacity to deliver and assure healthy diets,
sustainability in production and food supply, and
inclusiveness for smallholder producers and SME’s.

48. 5. Take away messages
Food safety
• Shift from a dominate focus on food safety for export to
address deficits in the domestic market (formal and
informal)
• Shift from hazard-based approaches to food safety
assessment to risk-based approaches that are more
effective, sustainable and appropriate for LMICs
• Strengthen capacity on risk assessment and
communication
• Prioritize good practices and behavioural change
towards improved hygiene (slaughter and markets),
rather than only focusing on infrastructural
improvement