as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.

1. Advancing The food system for growth , Job
creation and better Nutrition
Prof. Gihan Fouad
Consultant of Pediatrics
Consultant of Clinical Nutrition
National Institute of Nutrition

2. Outline
 Introduction to Food System and food security.
 How do peoplein Egypt get access food?
 OVERLAPS OF DIFFERENT FORMS OF
MALNUTRITION.
 The Potential of Agricultural Value Chains to Improve
Nutrition.
 Is Nutrition specific intervention is enough?
 Importance of Nutrition sensitive intervention.
 Go home messages.

3. Introduction
 Food system is defined as:
-i) All the activities related to the
production, processing, distribution,
consumption and disposal of food,
ii)All the factors affecting its activities:
the environment, actors, infrastructures
and institutions,
iii) The outcomes of these activities that
contribute to food security and a range of
socio-economic and environmental
issues

4. introduction
 Food security has been acknowledged internationally as
a basic human right and governments are obliged to
work on asserting this right for every individual.
 A joint report by the WFP and CAPMAS in 2011 on the
status of poverty and food security in Egypt highlighted
an increase in food insecurity levels to reach 17.2%
(13.7 million) of the Egyptian population and the
numbers have been in continuous increase since then.

5. Egyptian food insecurity levels
Environmental drivers
Socio-economic drivers
Managerial drivers

8. “FOOD SECURITY:
At what cost?”
Dietary and behavioural coping strategies
of low-income households in Cairo and
implications on children’s food security
By Radwa Saad
Spring 2014
The American University in Cairo
School of Global Affairs & Public Policy
In partial fulfilment of the requirements for the degree
of
Master of Public Administration

9. Population and Food system
 Egypt has one of the world’s fastest growing populations.
The Egyptian Central Agency for Public Mobilization and
Statistics (CAPMAS) estimates Egypt’s population at 92
million (December 2016), with a growth rate of 2.2
percent.
 At current rates, the population grows by close to 1
million people every six months.. The population is also
quite young, with a median age of 25.3.

11. Young consumers increasingly demand processed
products and snack foods

12. Since the mid-1990s, Egypt has been
among the top three wheat-importing
countries ,the largest importers of
many bulk commodities (wheat,
sugar, oils), as well as an important
vendor of subsidized food products.
 This reliance on wheat and cereal
imports to feed an ever-growing
population makes Egypt especially
vulnerable to international price
volatility and supply shocks

15. Basic Commodity Prices
(Dec 2011-Oct 2013)
0
10
20
30
40
50
60
70
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
PricePerUnit
Date
Corn Oil
White Rice
White Cheese
Milk
Eggs
Potatoes
Lentils

16. Protein Prices
(Dec 2011-Oct 2013)
0
10
20
30
40
50
60
70
80
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
PriceperKg
Date
Beef
Chicken
Tilapia Fish

17. How do people access food?
 The majority of the city’s food is purchased on
frequent visits to small shops, markets and informal
vendors. This reflects the income insecurity of much
of the population, with many people finding it difficult
to purchase significant quantities of food at one time.
Where food is purchased from varies by food type

18. Street food
 Street foods provide cheap sources of often nutritious food and are a
good source of income for informal food sector workers, most of
whom are women and more likely than men to invest that income in
the wellbeing of their children.
 With rising costs for food and cooking fuel, the use of street foods
tends to increase as prices in this informal sector are inclined to rise
slower due to the economies of scale of production. Lack of
infrastructure (i.e. water, sanitation), lack of basic training in food
hygiene of vendors and weak or arbitrary enforcement of the legal
framework (if street foods-specific regulations do exist at all) are all
factors contributing to the variable and sometimes poor safety of these
foods.

19. OVERLAPS OF DIFFERENT FORMS
OF MALNUTRITION

23. Healthy eating Pattern in
Egypt
The majority of energy supply for Egyptians is derived
from carbohydrates, fats and protein.
 Cereals represent the main source of energy, providing
about 64% percent of the total energy Relatively little is
consumed in terms of vegetables and fruits, and meat
and dairy products.
 This is partly explained by the relative easy access to
staples via the subsidy programme but the consumption
of vegetables fruits and animal protein is improving.
(FAO 2014)

24. Healthy eating Index
 In Egypt National Survey conducted by NNI 2005
Report That Heathy Eating Index Indicate Poor
Nutrition Habit and this confirmed by Small Scale
study show that HEI-2010.48% had a poor diet and
49% had a diet that needs improvement while 3% had
a good diet.
 Lower percent subgroup scores were found for whole
grains, total fruits, whole fruits and sea food and plant
protein.(Fouad et al 2014)

25.  Unfortunately Egypt Off –Course for achieving six
global World Health Assembly (WHA) nutrition
targets Which are :
 (1) Reducing child stunting by 40 percent,
 (2) Reducing anemia in women of reproductive age
by 50 percent,
 (3) Reducing low birth weight by 30 percent,
 (4) Preventing an increase in child overweight,
 (5) Increasing exclusive breastfeeding of infants up to
at least 50 percent,
 (6) Reducing and Maintaining child wasting to less
than 5 percent.

26. Cost of hunger

27. The Potential of Agricultural Value Chains
to Improve Nutrition
 In the past, the development of agricultural value chains mainly
focused on the promotion of cash crops in developing countries.
With the global food price crisis in 2008/2009 the focus shifted
towards staple crops.
 More recently, the professional discourse has once again shifted,
highlighting the importance of the production and supply of nutritious
foods. The aim thereby is to not only increase income and contribute
to increased local availability of nutrient-dense foods to reduce the
prevalence of food insecurity but also to reduce the burden of
malnutrition.
 However, there is mounting evidence that neither the availability of
nutritious foods nor increased incomes necessarily lead to improved
nutrition and food security [LANSA 2015, Galli 2015].

28. The Potential of Agricultural Value Chains
to Improve Nutrition
Apart from availability and accessibility of
foods, dietary behavior is influenced by food
preferences and traditions on the one hand
and nutrition knowledge and awareness on
the other [Contento 2008].
Though agricultural value chain projects do
have the potential to include components of
nutrition education and awareness
communication for improving food and
nutrition security,

29. Is Nutrition intervention
is enough?
 In the last 25 years, many nutritional and disease control
interventions have targeted linear growth deficits acquired in
early life with disappointing results .
 The smaller-than-expected effect sizes associated with these
interventions have been attributed to the complex relationships
between infection and undernutrition .
 In Evidence shows that children who live without adequate
sanitation, hygiene, and clean drinking water don’t grow as
well as children who do.

30. Nutrition-sensitive intervention to be hand
in hand with Nutrition specific intervention

32. Toxins
 The toxins aflatoxin, fumonisin and deoxynivaenol, which arise from
moulds contaminating foods such as maize and peanuts, have been
linked to impaired growth and gut inflammation in children but have not
yet been studied in the specific context of EED
 Infants and children are especially vulnerable to mycotoxin
exposure,
 Mostly because of a lower detoxification capacity, rapid growth
and high intake of food and water per kg body weight.
 Eg:aflatoxin (AF), fumonisin (FB), deoxynivalenol (DON) and
zearalenone (ZEA)]

33.  However, average intestinal absorptive capacity by country
also correlated very closely with national Gross Domestic
Product (GDP) per capita, independent of climate,
suggesting that at the individual level, poverty or
environment may play a more significant role.

34. The economic benefits of improving
nutrition levels
 Prior to 2008, economists estimated that undernutrition reduced a
nation’s economic growth by between 2 and 3% of GDP.
 In The Lancet 2013 series, a figure of up to 8% is given owing to
reasons such as the reduction in a child’s ability to attend and
learn in school, loss of long- term cognitive functions owing to
chronic lack of essential vitamins and productivity losses due to
in- creased mortality rates.
 Children who not undernourished have been shown to earn 20%
more in labor market and are 10% more likely to own their own
business.
.

35.  In 2008 a team of Nobel laureate economist, as part of the
Copenhagen Consensus project, identified that nutrition-specific had
the potential to save one million lives, reduce stunting by one third and
halve the number who are wasted; all at a benefit to cost ratio of 16-1.
These benefit-cost ratios are competitive with the benefit- cost ratios
generated by overall investments in health as reported in( Stenberg et
al. 2014).

36. The Egyptian Nutrition
intervention

37. Food Subsidization Program In
Egypt
 Social safety nets provide cash and food transfers to a billion poor
people and reduce poverty. They also have an important role in
mitigation of the negative effects of global changes, conflicts, and
shocks by protecting income, food security, and diet quality. When
targeted to women, they enhance several aspects of women’s
empowerment. Pooled evidence, however, shows limited effects of
these programmes on child nutrition, although some individual
studies showed effects in younger and poorer children exposed for
longer durations (Lancet).

38. Cash transfer Programs
At the International Conference on Financing for
Development held in 2002, FAO, the International
Fund for Agricultural Development (IFAD) and the
World Food Program (WFP) agreed upon a “twin-
track approach” for combating hunger and poverty:
strengthening the productivity and incomes of
hungry and poor people, targeting the rural areas;
and direct and immediate access to food by hungry
people and social safety nets.

39. UNICEF And MOH
 Strengthening the capacity of communities to raise
awareness of mothers on maternal and child
malnutrition.
 supports community-based nutrition programmes for
improving community awareness, mainly in Upper
Egypt rural areas, with a focus on the most deprived
and vulnerable populations. Awareness activities
include building the capacity of community health
workers to support in-community awareness and
counselling for nutrition,

40.  Supporting the national vitamin A, iron and folic acid
supplementation programme for women and children
within the primary health care sector to strengthen
prevention and treatment of malnutrition,
 Supporting the national Iodine Deficiency Disorder
programme to promote universal salt iodization and
household consumption of iodized salt and implementing
community awareness and social mobilization
campaigns to address low iodized salt consumption in
seven governorates.

41. Flour fortification
 Given the increased prevalence of anemia in Egypt, the Ministry of
Social Solidarity in cooperation with the National Institute of Nutrition
(NNI), started a project for the fortification of subsidized wheat flour
used in the production of Baladi bread with iron and folic acid through
assistance from the World Food Programme (WFP) funded by the
Global Alliance for Improved Nutrition (GAIN).
 This National Program started to fortify flour in 2008 in Aswan
governorate and reached complete national coverage by early 2010.
The program continues to provide fortified subsidized Baladi bread to
almost 56 million citizens Till It face some Funding Problem in 2014.

42. School feeding program
 The idea of the establishment of SFP in Egypt is considered as a
policy instrument for achieving the Millennium Development Goals of
universal primary education and the reduction of hunger for Egyptian
children in the school age group.
 The school snack in the form of pie provided by the program usually
provides from one fifth, one-fourth, one third and one-half of the
recommended daily allowance for energy, protein, folate and iron for
the school-age group targeted by the program respectively.

43. Go home messages

45. Marketing of food for children
 In spite that WHA63-14 Resolution to reduce the impact
on children of the marketing of foods high in saturated fats,
trans fatty acids, free sugars or salt by restricting
marketing, including in settings where children gather, for
example, at schools, But Egypt not comply to resolution
and no active policy in place.

47. The causes of nutrition problems in Egypt are a
function of many factors
 Most households are food insecure because of low income, high food
prices and low local agricultural production, in addition to poor dietary
practices due to lack of awareness, and inadequate health service
provision capacities.
 There are also the problems of environmental pollution and food safety
challenges due to lack of enforcement of existing laws. There is an
overarching health system challenge that derives from uncoordinated
and disjointed planning of nutrition activities; often leading to sub-
optimal use of resources and impact on nutrition status.
 The slow improvements in public health systems and community
infrastructure in Egypt have been cited among the factors that
contributed to the slow progress in reducing malnutrition.
 On the other hand the adoption of Western diets high in refined
carbohydrates, saturated fats and sugars, as well as a more sedentary
lifestyle are commonly cited as the major contributors to the increase
in overweight and chronic diseases

48. Recomendation
 One type of integrated nutrition- agriculture program is
homestead food production (HFP). The standard HFP
model includes gardening and small animal
production and a behavior-change communication
strategy designed around the so-called essential
nutrition actions. It is typically targeted to vulnerable
households with children under five years of age.

49. Universal Salt iodization
 MOH, NNI and UNICEF designed social marketing plans
to increase the awareness of the population in the 7
governorates with the lowest rate of consumption of
iodized salts (according to National IDD 2006 survey). At
the same time IDDSSE was initiated to coordinate the
effort of prevention of IDD in Egypt and to achieve the
USI Goal. IDDSSE, with the support of UNICEF,
conducted many activities to increase the collaboration
between salt iodization industry partners and
international organization to increase the quality of
iodized salt and improve the usage of iodized salt at
market and HH level. GAIN, UNICEF and ICCIDD
support MOH to reach the USI Goal. Their technical
teams support MOH activities to eliminate IDD in Egypt.

50. Dietary quality among men and
women in 187 countries in
1990 and 2010

66.  Imported food products in the Egyptian retail market
face heavy competition from domestic and imported
products. Egyptian snack producers fill much of the
domestic demand for chips, crackers and cookies,
though imported brands are perceived as being of
higher quality. Egypt produces a wide variety of
horticulture products, most of which is sold on the
domestic market .

67.  fresh or further processed product. Similarly, Egyptian
production of meat meets approximately 60 percent
while about 40 percent of consumption is met through
imports. Despite growing fluid milk output, Egypt still
imports close to $1 billion/year in dairy products.
Domestic egg production covers almost all demand.
In the case of poultry, domestic production meets
about 90 percent of demand with the balance
imported; however, US poultry parts remains
unjustifiably blocked from the market. Egypt’s per
capita consumption of chicken at about 11 kg./capita
is low.

72. The Evidence of nutritional challenges in Egypt
to 1 2 to 3 4 to 5 6 to 8 9 to 11 12 to 17 18 to 23 24 to 35
1
20.7
15.8 16.7
14.1
10
4.9
1.7
5.8
28.3
34.3
25.2
23.1
14
8.1
Bo le feeding
2008 2014
0 to 1 2 to 3 4 to 5 6 to 8
9 to 11
12 to 17
18 to 23
24 to 35
78.9
57.5
28.8
12.3
3.9
0.7
0.4
0.1
70.6
43
13.3
3.2
1.3
0.5 0.1
Exclusive breas eeding
2008 2014

78. This has driven Egyptian households to apply
severe coping strategies to their food
consumption that led to further deterioration in
the nutritional and health status of the Egyptian
community; having long-term negative effects,
most notably in the aspects of health, education
and productivity