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35^th Session SCN Hanoi, Vietnam March 2008

MENANA Report

Background:

          After the NNI reviewed a brief description of the Middle East nutrition situation it was decided to establish an Egyptian National Nutrition Capacity Building Task Force (which includes distinguished scientists & nutritionists from different organizations and universities in Egypt) and the task force’s main activities was to call for a the First Regional 2- day Workshop on Nutrition Capacity Development, which was held July 2004, in Cairo (NNI/UNU/IUNS) under the patronage of the Egyptian Minister of Health and Population. The workshop was organized by the National Nutrition Institute (NNI), funded by UNU, and included 11 countries from the region (Sudan – Kuwait - Lebanon – Oman – Libya – Saudi Arabia – Yemen – Jordan – Palestine – Egypt), representatives from UN agencies (FAO, UNICEF) and various Egyptian nutrition-related organizations and institutes.

          The workshop’s outcomes was highlighting a 10-year action plan that was developed by workshop participants. The plan include 5 core areas (Nutrition Research, Nutrition Training, Nutrition Academic Education & Accreditation, Nutrition Advocacy / Education Communication, Nutrition Networking). The  workshop’s called for the establishment of “The Middle East and North African Nutrition Association” (MENANA).

Establishment of MENANA 

          The first General Assembly & Scientific Meeting of MENANA was hosted by NNI, Cairo, Egypt on December 21-22, 2006. The meeting was financially supported by UNU and was attended by 33 participants, endorsed by 14 countries and attended by 9 country representatives: Egypt, Jordon, Sudan, Kuwait, Morocco, Lebanon, Palestine, Iran and Libya (attended), Bahrain and KSA (last minute cancellations) Oman, Tunisia and Yemen (apologized) while Iraq could not attend due to political disturbance.  

          The Meeting started with opening & welcome remarks from Professor Mamdouh Gabr / Egypt, Past IUNS president, Professor Osman Galal/Egypt, Secretary General, IUNS, and Dr. Azza Gohar, Director NNI and MENANA coordinator. IUNS vision and policy was presented by Professor Ibrahim El- Madfaa/Austria, IUNS President Elect.

          Objectives of the meeting were highlighted by Professor Galal and Dr. Gohar. The  bylaws of MENANA were reviewed, modified & adopted. MENANA Council Elections were conducted and supervised by Professor El-Madfaa and Dr. Malek/Lebanon. Election results were as follows:

The following task forces were nominated:
 

       MENANA website Administrator Dr. Abdel Hady Abbas.

       Nutrition Friendly School Initiative (NFSI) Dr. May Mattar.

       Food Industry / Public- Private Cooperation Task force Dr. Galal & Dr. Fahmy.

       Fund Raising groups TBD.

Scientific discussions during the General Assembly meeting amd among task force groups during 2007 centered around the following strategic concepts that would guide the task forces for setting up nutrition capacity building priorities for the region.

1.      There was a general consensus that we are all interested in advancing "applied research" in the field of nutrition in the region and hope that a well organized inter-country initiative will help in directing  and energizing this effort. It was clear that this initiative can create a critical mass. It can also become a mechanism for sharing knowledge and experiences and, it can find better resources and attention within the global nutrition arena. It was also understood that expected outcomes is not a straight jacket research program that all regional countries will follow. The decision was that three major objectives are accepted, and the group worked on the needs of thye three different sets of strategies with considerable overlaps among them.

2.      To start this initiative it was agreed that tools for better problem analysis and action is needed. We also agreed that a synthesis on the regional profile of food insecurity and malnutrition is needed. The current research capacity and activity needs to be spelled out in accord with the line of research that the scientists and stakeholders (both national and international) prefer. This action will need a rational assessment of priorities and potentials and  consensus building effort in addition to a supporting mobilizing effort.

3.     In trying to put the current pieces of contributions by the MENANA group into a some what cohesive context, "applied research” in the region can be viewed on at least two axis. these are "problems or issues" of priority interest and the "process" issue. The problem areas of interest may differ in different countries in the region, but the process should be the same and agreed upon by all members of MENANA. We created a general consensus on regional priority issues which need attention in the next 5 and 10 years and a clear understanding of the process and a plan to advance it.

The Three Priorities Areas for MENANA to be Presented to SCN, 2008

A)     The ultimate goal of the MENENA initiative is "capacity building in the region" and at this point the research task force is putting together a plan and begin a campaign for support. In this context, applied research is used as a tool for building evidence based plans and programs. On top of it, we will build a consensus on priority food and nutrition issues to be addressed. This will be left to the decision to the individual country which may have different interests and skills. The task force sensed that the nutrition community is much more comfortable to work on issues, priorities and research techniques. We found out that the real challenge is capacity building issues and raising the skills of nutritionists in each country. The key point here is that the serious limitations in local capacities are the main reason behind the intervention failures. The capacity gaps are many including analytical skills, policy and program design and management skills, mobilization of political support, fund raising, interdisciplinary team work, problems in working relations between academics and practitioners. Given adequate resources, the nutrition community has no problem in deciding priorities and developing research techniques.

Needs:

What is needed now are to raise the skills for research among nutritionists in the region by implementing series of several workshops, seminars and short courses covering the following topics; leadership building workshops, approaches to study design and data analysis, and  scientific communication skill.  This will require financial support from outside the region.

B)     In the Middle East, it is generally believed that high caliper dietitians are lacking.  This thought keeps on despite the fact that large numbers of "nutrition"-undergraduates pour into work markets every year. The vast majority of these "nutrition graduates" find room for employment at clinical setups, filling the posts of "dietitians". Unfortunately, and in most of the instances, they fail within the medical team to show competence in working with patients independently. Clinicians, who are ever in need of supportive help and professional assistance from qualified "clinical nutritionists", keep expressing their complaint and raising degrading remarks about there abilities. Clinicians do take into account that dietetics - practice at the level of clinical setups can affect the outcome of disease management. Clinical nutrition, therefore, is an area of concern to the medical body. At the same time, however, setup- administrators of clinics and hospital do not adequately recognize that failure of recruiting competent dietetics - practitioners may jeopardize health and life of individual patients and increase the cost of clinical care. Within this confused and conflicting situation and poor administrative frames of working, these degraded "dietitians' end with working away from the scientific practice, feeling inferior all through. As do other workers in nutrition, these dietitians do not keenly practice solid self-qualification that would empower them to confront the inferior feeling precipitated by the clinicians’ attitude of monopolizing the health issue. Beside the fact that the clinicians' critical view produces a feel of "dejection and loss" at the side of appointed "nutrition graduates", it is apparently a loss of community resources at many levels. This chronic problem has its roots lying on the side of the academic institutions and their misreading of the "quality" graduate. 

For the greatest majority of universities in the Middle East region, the Schools of Agriculture, constitutes an integral component of the academic teaching setup. Within the structures of these schools the Departments of Nutrition and Food Sciences, undertake the responsibility of conducting undergraduate programs in nutrition.  The headings of these departments offers undergraduate diplomas that gives the general statement which put into words that the specialty of the graduate is "Nutrition".  Generally, universities in many of the countries in the Middle East region do not maintain an after math follow up for their undergraduate after starting their careers.

Needs and Resources 

MENANA  is in real need for a capacity building - move toward the    certification of clinical nutrition practitioners. Qualifying programs similar to that of the ADA is highly needed. Lebanese and Egyptian hospitals may offer the room for such programs.

C)  MENANA Task Forces strongly believe that a common project should be implemented that  represent the minimum package to be acceptable at the world nutrition scientific arena.

All of the participating institutions in the Middle East have some active research in nutrition. There are financial resources to support research within the Middle East countries. Financial resources to support research costs are largely internal, and while there is review of proposed projects the system has relatively little peer-reviewed competition for resources.  Further, there is little flexibility for nutritionists to adjust their workloads to take advantage of opportunities for major research efforts.  There is some international funding for research in the form of WHO Collaborative Centers; additionally there are usually some international collaborations active that involve funding from outside sources through the international collaborator, but these tend to be the exception rather than the norm.  The analysis of research output makes it clear that in spite of multiple institutions of higher learning and research and thousands of biomedical scientists across basic, clinical and applied disciplines, the internationally accessible research output in biomedical sciences from MENANA is extremely limited.  We have not been able to identify a similar analysis for the social sciences, but we assume that it is just as disproportionate in terms of identifiable output compared to capacity.  Clearly, the scientific nutrition community is part of a larger environment in which research productivity is limited in spite of great potential.  The present MENANA priority proposed program has an opportunity to exert real leadership in demonstrating the possibility of acceleration of research activity, output and utilization and engagement of the Middle East scientific community with the larger international enterprise. 

Third Priority:
 

MENANA Task Forces propose a new infrastructure with no additional financial resources, for nutrition research as part of the initial priority nutrition capacity building.  Implementing a Middle East Nutritional Status Monitoring System. Having participated in a relatively one year planning process with regard to needs for improvement of food and nutrition security in the Middle East and subsequently with regard to development of several new training programs to strengthen research, training and program capacity the participating institutions are poised to begin a major expansion of their capacity.  Indicators for nutritional status will be chosen from already data collected regularly to the MoH without asking for new indicators. After collecting these indicators analysis will be performed and next steps decided.

Nearly all the suggested indicators will be simple and relevant data that can be collected easily in cooperation with the countries Ministry of Health. They are already available data.  Only the indicators related to dietary patterns which might be difficult to obtain. The dietary data will support the anthropometric and laboratory data but cannot replace them. However, the importance of conducting dietary surveys may become less urgent / needed at an early stage if not going to be conducted by professional and dedicated teams. On the other hand, MENANA believes that most of the nutritionists in the region need to start from the MOH level . Ministries of Health should be oriented about this task which will serve the national health-development goals of each country. Since all of us "the MENANA -Meetings participates" were technical individuals and not government' representatives, it seems now that our individuals' efforts needs some backing from internationally recognized bodies. In this course, the WHO regional office in Cairo should be informed of "and recruited" for the task.

* The MENANA Council and Scientific Meeting,
13th- 14th Jan 2010
Cairo, Egypt.

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* 1st. Menana Conference in Collaboration with 3rd Africa Nutritional Epidemiology Conference.

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* Last Council Meeting

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