An ambitious project in Cambodia aims to transform the lives of children in 150 schools by ensuring balanced nutrition and food safety for these young minds, from classrooms to dining tables.
06 September 2024 Andreea Enea
Imagine travelling across vast fields of rice, when you suddenly find yourself in a schoolyard. A Buddhist pagoda with gardens and ornate shrines stands out, a bit farther from the school in front of you. Built on land donated by the pagoda, the school serves as a learning hub for 450 children in the community.
From morning to evening, the schoolyard is animated with the sights and aromas of food vendors. In this remote area, where shops are a rarity, these vendors are a vital link, responsible for providing nourishing meals for the children.
It's in this setting that an ambitious project has just begun. Targeting 150 schools and their communities in four provinces, the project Reducing non-communicable disease (NCD) risk in Cambodia has an exciting goal: to ensure healthy nutrition and food safety for children in schools.
Supported by a grant of $1.5 million, this initiative is about more than just providing nutritious meals for children. It is about cultivating sustainable health-enabling environments with the active participation of everyone – parents, children, teachers, authorities, and school food vendors – in creating a healthier future for the next generation.
Rapid socioeconomic development in Cambodia has increased access to foods high in fat, sugar, salt, and ultra-processed ingredients. This shift has contributed to a triple burden of malnutrition (undernutrition, overweight/obesity, and micronutrient deficiencies), raising the risk of NCDs in adulthood. A significant proportion of children under the age of 5 who are overweight are either chronically or acutely malnourished. At the same time, it is estimated that more than half of the people with diabetes in Cambodia are not being treated.
Food insecurity
Additionally, a food and nutrition security trend analysis report found that 25% of households were vulnerable to food insecurity in 2019, primarily due to economic vulnerability. This issue is particularly acute in rural areas, where access to food is limited.
Poor diet quality
Despite a more frequent consumption of fruits, vegetable consumption has also been decreasing. This, along with an increased intake of fats and sugars, has led to a deterioration in diet quality and less diversity in important micronutrients.
Hidden hunger
Various data suggest that 'hidden hunger' (lack of essential micronutrients) and malnutrition are critical public health issues. While their effects on health, mortality, and development are well documented, they can be invisible and protracted. Unfortunately, healthy diets are not prioritised by most or are simply not affordable.
The project’s focus on children's eating habits looks at the long-term impact, as the schooling years are a period when they start making independent decisions, setting the stage for lifelong changes and behaviours.
By increasing public investments in evidence and awareness around healthy diets and their benefits, as well as responses to malnutrition, the new project in Cambodia seeks to promote safe eating habits among children.
The project is led by Helen Keller International (Helen Keller), a respected international organisation with extensive experience in leading nutrition and children’s and maternal health initiatives, in close cooperation with the Ministry of Health (MoH), the Ministry of Education, Youth and Sport (MoEYS), and the Council for Agricultural and Rural Development (CARD).
A strong WDF partner since 2009 for projects in Bangladesh, Indonesia, and Myanmar, Helen Keller has been a close ally to the Cambodian MoH in developing nutrition and health policies and training modules, being involved in projects with the government and local partners for 30 years.
In 2022, the organisation led the Healthy Schools, Healthy Snacks, Healthy Futures pilot in three schools in Cambodia, as part of the Healthy Food Challenge by Novo Nordisk and the EAT Foundation.
The pilot contributed to the initial stages of implementing Directive No. 18, MoEYS' school health policy. This directive underscores the importance of nutrition education and food safety standards in schools by prohibiting six categories of unhealthy foods and drinks.
Helen Keller's role extends beyond raising awareness about healthy habits, by designing interventions in collaboration with parents, schools, students, teachers, and the community to identify local needs and create local solutions.
The new project builds on the pilot outcomes to curb the rise of NCDs on a larger scale.
'This project is Helen Keller International's first large-scale school food environment initiative in Cambodia, spanning multiple settings beyond schools, including communities, children's homes, and antenatal care clinics', explains Hou Kroeun, Country Director for Helen Keller in Cambodia.
'It promotes healthy behaviours through education and support in schools, community outreach, institutional care for children, and maternal health services. By addressing both individual behaviours and structural barriers such as access to healthy foods and opportunities for physical exercise and NCD screening, we seek to provide a holistic approach to improve health outcomes across diverse environments.'
This model follows WDF’s primary prevention strategy with a focus on childhood, adolescence and a woman’s reproductive years – key windows of opportunity for the prevention of NCDs.
Addressing systemic barriers is key to preventing malnutrition, and the world must collectively do more to create healthy and sustainable environments.
Despite government efforts to influence children's diets, challenges persist due to limited integration of MoEYS’ Directive 18, early exposure to unhealthy foods, limited health education, and time and financial constraints on preparing nutritious meals.
The new project will empower the government through a multifaceted approach involving health education, awareness campaigns, policy implementation, and monitoring. At the same time, a guiding principle is the cultivation of understanding by facilitating a process that encourages people to genuinely uphold these standards.
This whole-of-society approach will better equip stakeholders to tackle and prevent NCDs long-term.
‘Our partners are connecting everyone – children and parents, teachers and school authorities, food vendors – but the project doesn't stop at the school gates', explains WDF’s programme manager Mads Holst Jensen, who recently visited our partners. In the wider community, we're working with Youth Health champions and community health workers. It's truly a team effort’.
Strong leadership and positive involvement from national and local authorities, schools, and communities have been evident.
During the visit, Mads had the opportunity to meet Seng Sara (pictured left), Deputy Chief of the School Health Office in Kampot, who oversees the compliance with health and food policies of approximately 400 schools in the province. She sees the project as a catalyst for change.
‘I hope it will inspire a shift in mindset among school staff, students, and parents, and foster a sense of ownership.
The goal is to have a deeper appreciation for Directive 18, which is an important step for healthier living among students, and encourage everyone to take an active role in transforming our schools.’
The new project is set to transform three key environments to foster healthier lifestyles: school environment, community context, and national policy:
With children particularly vulnerable to micronutrient deficiencies and diet-related NCDs, there is a pressing need to transform school food environments.
Food from school vendors often becomes the primary source of their children's unhealthy foods and beverages. To address this, the partners will hold co-creation workshops to engage all school-level stakeholders. This will involve routine monitoring of vendor compliance and children’s diets, and increasing access to healthy foods and beverages in and around schools.
For Vith Saolee and Thon Vichera (pictured above), two students at the primary school Mads visited, Khmer noodles, sticky rice and fresh juice are examples of healthy foods. They both help in the kitchen with cooking their family meals, which often include ‘frying chicken, eggs and pork’.
Despite the limited knowledge of healthy nutrition, both are excited about how the project would help change mindsets, not just menus. ‘We hope to learn about nutritious food so that we could bring new ideas for what to cook at home, and proper hygiene’.
The school food vendors are aware of what healthier options look like. However, they struggle with other challenges.
‘These fruits are healthy and I sell a lot of them’, Sorn Sarem (pictured left) tells us. She is one of the five vendors at the school that Vith and Thon go to.
‘I sell a lot of these deep-fried cakes as well...But I would get much more profit from selling fruits, which I can just pick from the trees. I spend a lot of resources on making the deep-fried cakes’.
Local farming families will be linked with the school food vendors under the WDF-funded project, increasing access to fresh fruits and vegetables in schools.
Bridging agricultural producers and school food vendors
‘What is interesting is how our partners are also looking at local food production through another project’, Mads adds. ‘Imagine a child helping to grow vegetables in the afternoon, and then eating them at school the next day’.
Helen Keller has partnered up with Germany's development agency GIZ on a sustainable agriculture project, enhancing household food security. This initiative empowers over 4,000 farming families and 100 agricultural cooperatives across the provinces of Takeo, Kampot, and Kampong Thom, equipping them with the tools and knowledge for a food-secure future.
Further on, the project will prioritise peer-to-peer education on dietary diversity, low-salt, low-sugar, low-fat foods, safe water, food hygiene, and regular exercise outside the school environment. Caregivers and communities are educated on healthy food skills and physical activity. Access to NCD risk screening is expanded, and provincial working groups and community councils are capacitated to support NCDs.
A gap in antenatal care (ANC) guidelines has been identified, with pregnant women not routinely screened for gestational diabetes. Our partner plans to advocate for glucose screening in national ANC protocols. Pregnant women are also invited to education fairs and screenings, promoting early detection and management to enhance maternal health outcomes.
To curb the rise in diet-related NCDs among school-age children, the government is focusing on strengthening food environment policies and guidelines.
This includes promoting healthy food options, reducing unhealthy ones, enhancing nutrition education, and creating supportive environments for physical activity. Advocacy efforts are also geared towards better regulation, policy implementation, monitoring, and revised ANC guidelines to ensure a holistic approach.
The Cambodian MoH has been integrating diabetes and hypertension management, with provincial NCD Focal Points coordinating the program. In addition, working groups have been established to address food insecurity and malnutrition, while the National Nutrition Program (NNP) provides community-level training on NCDs. Collaborations with CARD ensure the training of Youth Nutrition Champions for peer-to-peer education and awareness.
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Thanks to this multisectoral platform, the new project is set to elevate the understanding and capacity of provincial government departments, civil society, academic institutions, and communities altogether.
This strategy would optimise resource distribution and strengthen supervision in the areas of nutrition, health, and NCDs, fostering truly sustainable outcomes for healthier futures.
Our focus is on implementing multi-sectorial activities across 150 schools and their associated communities within four provinces
Our focus is on implementing multi-sectorial activities across 150 schools and their associated communities within four provinces. In addition to school food environments and community context at the operational level, the project also targets the national policy level with the aim of enhancing governance for NCD prevention through coordinated national response, enhancement and adoption of food safety and nutrition legislation and guidelines,and integration of screening for Hyperglycemia in Pregnancy (HIP).