Fill the Nutrient Gap Timor-Leste Final Report December 2019 1 2 Contents Contents ...................................................................................................................................................................................................................................... 3 List of Figures ............................................................................................................................................................................................................................ 4 List of Tables .............................................................................................................................................................................................................................. 7 List of Appendices .................................................................................................................................................................................................................... 7 Acknowledgements ................................................................................................................................................................................................................. 9 Acronyms and abbreviations .............................................................................................................................................................................................. 11 Executive Summary ................................................................................................................................................................................................................ 12 Introduction ............................................................................................................................................................................................................................. 16 Background ........................................................................................................................................................................................................................ 16 FNG in Timor-Leste: Process......................................................................................................................................................................................... 17 Fill the Nutrient Gap: Situation Analysis for Multi-Sectoral Decision-Making on the Prevention of Malnutrition: Overview of FNG Methods .................................................................................................................................................................................................................................... 19 Collection of Primary Food Price and Availability Data ............................................................................................................................................. 20 Cost of the Diet (CotD) analysis methods ...................................................................................................................................................................... 22 A note on the Findings of the FNG Analysis ................................................................................................................................................................. 23 Key Finding 1: Nutrition has long been recognised as a fundamental human right in Timor-Leste and is incorporated throughout sector-specific and intersectoral policies. Evidence-based prioritisation of actions is now needed so that feasible, affordable nutrition interventions can be implemented across sectors. ........................................................................................................ 24 Key Finding 2: Diets are poor and lack diversity; especially for vulnerable groups such as mothers and children. Including a variety of foods from diverse food groups is essential to meet nutrient requirements. .......................................................................... 28 Key Finding 3: Almost all Timorese households could afford to meet their energy needs. For most households, a nutritious diet that meets energy, protein and micronutrient needs would be unaffordable. ................................................................................... 33 Key Finding 4: Women are particularly impacted by poor nutrition. This both negatively affects their and their families’ health, wellbeing and future potential. ................................................................................................................................................................................... 44 Key Finding 5: Improving the nutrition of infants and young children would require small investments in the short term that could deliver lasting returns over generations. ...................................................................................................................................................... 48 Key Finding 6: Programa Merenda Eskolar provides a valuable entry point to improve nutrition in children, but menus need to be diverse and include micronutrient-dense foods. ....................................................................................................................................... 51 Key Finding 7: Meeting the nutrient requirements of adolescent girls would cost more than any other member of the family. They are at high risk of micronutrient deficiencies, but few interventions exist to address their needs and data to inform programming is limited. ................................................................................................................................................................................................ 56 Key Finding 8: Timor-Leste is a nation with strong participation in the agricultural sector and produces a great diversity of foods, yet productivity is low. Interventions targeting both the quantity and nutritional quality of foods produced could improve access to nutritious diets for all. ................................................................................................................................................................ 58 Key Finding 9: Diets across the country are overwhelmingly dependent on staples such as white rice, which provide energy but are low in essential micronutrients. Exploring the potential for supporting rice fortification could mean greater access to nutritious diets. ................................................................................................................................................................................................................. 67 Key Finding 10: Social protection has significant potential to improve access to nutritious diets for the most vulnerable, but only if realistic transfer amounts and nutrition-sensitive packages are provided. ..................................................................................... 68 Final observations: combined impact of household packages ............................................................................................................................... 74 Draft KONSSANTIL Recommendations ........................................................................................................................................................................... 77 References ................................................................................................................................................................................................................................ 80 Appendices ............................................................................................................................................................................................................................... 85 3 List of Figures Figure 1: Overview of the FNG process and Timeline in Timor-Leste ................................................... 18 Figure 2: The Administrative Posts in which Market Data was collected ............................................. 20 Figure 3: Images from the market price survey data collection ........................................................... 21 Figure 4: Municipalities selected for the CotD analysis for the Timor-Leste FNG ................................ 23 Figure 5: FNG Leadership and technical partners ................................................................................. 23 Figure 6: Overview of interventions modelled per group across the life cycle and by sector ............. 27 Figure 7: Percentage of IYC aged 6-23 months per municipality achieving minimum dietary diversity as per the 2019 IPC report (3) ............................................................................................................... 28 Figure 8: Percentage of energy provided by food group in diets of 6-23mo: Diet A (left) a hypothetical diet for this target group based on reported dietary patterns (estimate based on qualitative results) and Diet B (right) the lowest cost, nutritious diet modelled for this target group in the CotD Analysis (example from Oecusse). ...................................................................................................................... 29 Figure 9: Cumulative percentage of micronutrient requirements met (capped at 100% RNI) by each additional food group for Breastfed IYC (6-23mo) (Oecusse) using the modelled lowest-cost Nutritious Diet (CotD Analysis), in order of