Fortifying Bhutan’s dietary habits

A WFP study reveals 11.4 percent of Bhutanese obese and 33.5 percent overweight

By Tandin Wangchuk

Over the years, the health and nutritional status of children in the country has improved with wasting and underweight prevalence reduced to 4 and 9 percent respectively.

However, a study conducted by WFP Bhutan reveals that stunting is persistent at 21 percent while overweight/obesity is emerging and increasing in Bhutan’s population with 11.4 percent of Bhutanese obese and 33.5 percent overweight.

Among other health issues micronutrient deficiencies remain a major public health issue while anemia, a proxy indicator for micronutrient deficiencies, is at 44 percent for 6-59 months old children.

The study also reveals that Bhutan is facing the triple burden of malnutrition with co-existence of undernutrition, micronutrient deficiencies and overnutrition.

“Over 35 percent of non-pregnant women and 31 percent of adolescent girls are anaemic – important indicators of future health as 6 percent of girls are married by the age of 15, and 26 percent by the age of 18,” the study reveals.

Further, more than 1 in 5 preschool aged children and 17 percent of pregnant women are deficient in Vitamin A. Amongst school aged children (5-19 years), several outbreaks of Vitamin B deficiencies including peripheral neuropathy and glossitis have been reported over the years.

The findings also reveal that non-communicable diseases (NCD) continue to be the main health burden in the country, responsible for 69 percent of Bhutan’s disease burden and 71 percent of deaths in 2019 caused by hypertension, cardiovascular diseases, cancer and diabetes.

In terms of diets, the risk factor survey of 2019 records salt consumption at 8.3 grams, significantly higher than the recommended daily intake of 5 grams.

School children are big consumers of junk food – 40 percent of students drink carbonated soft drinks and 32.2 percent eat fast food 4 days in a week.

COVID-19 and dietary habits

It was revealed that COVID-19 constitutes a significant risk to the nutrition status of children and communities.

Additionally, direct and indirect impacts of the pandemic such as reduced household income, higher food price volatility also reduced availability of fresh foods and have adversely affected the quality of Bhutanese diets.

Therefore, in view of this, WFP in Bhutan is working closely with government partners to maintain and improve nutrition, hygiene and food safety during the pandemic including assistance to the safe reopening of schools.

Among a host of other initiatives, WFP is partnering with the Ministry of Health and UNICEF in help building Human Capital through better Child Nutrition and to revise the National Health Policy (2020-30), and develop the National Nutrition Strategy and Action Plan (2020-25).

WFP states that these policies aim to increase national goals and multi-sectoral collaboration with other sectors required for effective national health and nutrition programmes and services.

Further, WFP is assisting the Ministry of Education (MoE) to improve the nutritional and health status of children by transforming the National School Feeding and Nutrition Programme. Nutritious meals help children achieve their full physical and cognitive potential to lead more productive lives.

“As a mountainous country, transportation of food commodities to all schools across the country has significant financial implications for the Royal Government of Bhutan (RGoB),” WFP states.

In addition, given the Government’s plan to reach all rural schools with school meals in the country within the 12th Five Year Plan (2019-2023), WFP is working with government partners to analyze and optimize the supply chain costs for the National School Feeding and Nutrition Programme.

It was also opined that timely, multi-sectoral and quality data is critical for evidence-based decision making to improve programme effectiveness.

“WFP, along with the MoE, have developed and rolled out a real-time integrated nutrition, health and education monitoring, and reporting system. A major success of this intervention has been the increased dietary diversity in school meals and reduced food waste at schools from 2% in 2017 to 0.5% 2019,” the report further elucidates.

In order to meet the demand for healthy, locally sourced, nutritious school meals WFP is collaborating with the Ministry of Agriculture and Forests to connect 9000 farmers across the country with schools providing fresh and nutritious foods while assuring income for smallholder farmers.

They are also working with the MoE to develop national standards for school kitchens, stores and kitchen equipment and supporting the expansion of school meals to additional rural schools via the construction of 23 new kitchens and stores as well as refurbishment of additional 36 existing school kitchen and stores across the country.

Furthermore, WFP in Bhutan is collaborating with the MoE to roll out PLUS School Menus, a userfriendly software tool which optimizes school menus by making them simultaneously more nutritious, cost-efficient and locally sourced.

A pilot has demonstrated that meals can the designed at a 20% lower cost, with the same nutrient value and with a higher proportion of local food.

It was revealed that healthy diets sustainable transformation of health and nutrition requires interventions on both demand and supply side.

“WFP is assisting the RGoB in developing a national SBC strategy to improve dietary and health practices of school children (ages 5-18) by creating demand for healthier diets,” the report states.

This is further reinforced through nutrition and health education using an improved school curriculum, currently being developed with the Royal Education Council and UNICEF as well as through developing a digital and interactive game-based learning platform.

Adopting a whole-of-society approach, WFP has partnered with Tarayana Foundation to work across 4 districts to help rural and vulnerable population groups eat and stay healthy during the COVID-19 pandemic and beyond.

The focus of this nutrition and health outreach is on children and adolescents aged between 5-19 years.

Food Fortification

As part of the larger scheme, the government has also prioritized food fortification as a public health strategy to address micronutrient deficiencies amongst school children using the National School Feeding and Nutrition Programme as a platform.

With growing evidence on the effectiveness of the programme, the government plans to scale up the use of fortified rice to cover other vulnerable population groups including monastic institutions with gradual introduction through the open market.

Through its engagement with the food fortification taskforce, WFP provides technical assistance and capacity strengthening towards developing the regulatory framework and compliance mechanisms to ensure food safety and quality.

WFP states that to ensure a successful food fortification programme and meet the future demand of fortified rice, WFP is supporting enhancement of national production capacity through the establishment of a fortified rice blending facility.

It is also working with relevant agencies to strengthen the quality assurance system, food testing capabilities, and develop tools and create a trained cadre of professionals.

Strengthening the capacity of relevant agencies across all aspects of the fortified rice value chain and facilitating continuous advocacy and policy dialogue through exposure visits and knowledge sharing events are also some of the activities undertaken by WFP.  

WFP states that with these foundations laid, WFP, together with the government of Bhutan, would sustainably expand the consumption of fortified foods in Bhutan.