5-a-Day TYPE PROGRAMMES IN DEVELOPING COUNTRIES:
THE SOUTH AFRICAN EXAMPLE
Developing a 5-a-Day type programmed within the developing country context poses some unique challenges both in terms of the nature and messages of the
programmed as well as the funding and partnership models. These challenges also pose unique opportunities for significantly impacting on the improved overall health of the population.
The South African example:
Research shows that consumption of vegetables and fruit is very low in sub-Saharan Africa at 27-114kg/capita per year, far below the WHO/FAO recommendation of 146kg/capita per year. In South Africa the Medical Research Council reports that on average the population only just reach three servings of vegetables and fruit a day
Generally developing countries demographics include a mix of developed and
developing communities. Each of these, come with their own associated health
problems and risk profiles. There will be areas/communities where individuals will
increasingly suffer from diseases such as obesity, diabetes, heart disease and cancer. Against this, the incidence of micronutrient malnutrition, stunting and even overt malnutrition will be high in other areas and communities. It is thus essential when developing a 5-a-Day program, to have a detailed understanding of the health demographics of the overall country as this will be required in order to determine the balance between the required focus areas (micronutrient malnutrition versus diseases of lifestyle) of any campaign and campaign needs for different sectors of the population.
The South African example:
It is estimated that 3000 deaths a year in the age group of 0-4 years are caused by diarrhea due to vitamin A deficiency and the National Food Consumption Survey revealed that 1 out of 2 South African children take in less than half the recommended levels for a number of important nutrients (energy, folate, vitamin A, vitamin E, vitamin C, vitamin B6, vitamin B12, riboflavin and niacin). Against this, 29% of men, 56% of women and already 6% of children under 6 years are overweight.
Global and national health experts are warning that in the next 2 decades the
increasing burden of heart disease, and many other lifestyle diseases, will be borne mainly by developing countries. This highlights the very real need for action. One of the common threads towards the prevention of all these conditions is the need to increase the consumption of vegetables and fruit.
Where education and literacy levels are low, it is also important to specifically
structure and test messages to ensure that they are clearly understood. A subtle
difference in wording of the message might have a great effect on ultimate
behaviour change.
The South African example:
In South Africa the research when developing the food based dietary guidelines indicated that the message to eat more fruit and vegetables is felt to be more achievable when it is worded ‘vegetables and fruit’ rather than ‘fruit and vegetables’ as vegetables are perceived to be more accessible and affordable.
Barriers to eating more vegetables and fruit also become critically important to
understand and research within the developing country context. Accessibility and affordability issues and strategies might need to be emphasized and actively addressed – e.g. food gardens and storage methods. This is key, when one considers that many of the world’s developing countries have arid conditions making growing of the required vegetables and fruit difficult. A focus on indigenous vegetables and fruit is an essential element especially as people become more urbanized and ‘lose’ their traditional and often valuable foods and recipes.
There are also certain countries and cultures where the people are either
traditionally livestock farmers or crop farmers and this needs to be assessed and considered. Added to this is the impact of cultural beliefs and perceptions that can often strongly influence food choices and food security within families.
The South African example:
In some cultures fruit is regarded as food for children and not as a food for men and so much education is required to overcome this limiting factor. If we are to get men to reach the 5-a-Day through a variety of vegetables AND fruit target.
It is critical that the program be evidence based as myths and urban legends are
common around a variety of foods and eating practices and this need to be
addressed. Any 5-a-Day type program must consider all the limiting factors and
include strategies to overcome the broad constraints to eating more vegetables and fruit.
There is the added problem that in many countries there may be limited government resource and knowledge, making it difficult to expect government to do the necessary research or provide the required funding. For example many developing countries do not have national food based dietary guidelines in place and this makes it all the more important to elicit the support academics, active NGOs and private partnership.
A strong and fully inclusive stakeholder’s forum should be established and where
possible NGOs that support the 5-a-Day type message should be included in
discussions and alignment with their programs and advice encouraged. Including
both health and agriculture departments within government is critical if key issues of accessibility and affordability are to be overcome.
The South African example:
The 5-a-Day for Better Health TRUST is an NGO that receives all it’s financing from the private sector but is the official partner of the Department of Health in promoting its food based dietary guideline, ‘Eat plenty of vegetables and fruit everyday’ and the government endorses the 5-a-Day message. Joint projects such as National Nutrition Week campaigns and World Food Day themes focusing on vegetables and fruit together with quotes from officials in press releases, add credibility to the 5-a-Day message.
In developed countries budgets may be larger for 5-a-Day campaigns allowing for
greater use of advertising and paid messaging. In developing countries, program
resources need to be very carefully utilized. This makes strategic planning and
partnerships of special importance and there is a great need to harness options and occasions for free publicity and to use existing campaigns to drive the 5-a-Day message.
Key to achieving this is the need to develop one-on-one relationships with key
people within the media, to look for well respected ambassadors to promote the 5-a-Day message and to manage finders as true partners. This in turn requires quality press releases and releases with a local story.
The South African example:
The 5-a-Day for Better Health TRUST has invested a great deal of time in nurturing key, well respected journalists within selected different target group publications/media and provided them with exclusive story ideas and opportunities. In addition, a bi-annual journalism award has resulted is a number of excellent stories focusing on vegetables and fruit in leading publications/media. We are also currently exploring the right person who is seen as a role model, to act as the 5-a-Day patron.
Real emphasis has to be placed on win-win partnerships with funders. Real
partnerships that are designed together with the partner and that deliver on their
needs and expectation are critical to success and on-going, rather than once-off
funding. One cannot expect to receive funds without giving back in return.
The South African example:
Through a partnership with one of our largest retailers, we are in 2008 reaching 1.2 million school children with an education program that fits with the curriculum and that will promote the 5-a-Day message and give us and our logo extensive visibility. The partnership – we developed the messages and context and they have funded the project.
Key in determining plans, actions and strategies is to form partnerships with others running similar programs. Global sharing of experiences and networking is invaluable in avoiding making the same mistakes or re-inventing the wheel and allows for a sounding board for concepts and sharing of materials.
The South Africa example:
Being part of IFAVA has allowed us to benefit from years of global experience in setting up 5-a-Day type programs and the global network has enabled us to gain valuable insights in getting started on this exciting campaign.
Finally no matter how small a budget, it is critical to put in place some measurable way of determining your programs success.
The South African example:
Initial research was undertaken to understand the level of knowledge, issues, beliefs and perceptions of South African consumers. A 5-year strategy plan was developed from this and research will then be undertaken again to assess the shift in thinking and behaviour. The research was funded by our private partners as it not only proved the 5-a-Day for Better Health TRUST with valuable information but also partners with unique insights into South African consumers’ thinking on vegetables and fruit.
Here’s to the growth of 5-a-Day type programs in many developing countries where the potential to make a positive health impact is the greatest.
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