School feeding program Definition School feeding is defined as the provision of breakfast, lunch, or both to children while they are in school. Some programs provide complete meals, while others provide nutritious snacks or high-energy biscuits. There are two main groups of school feeding programs based on their modalities: in-school feeding where the children are fed in school; and take-home rations, where families are given food if their children attend school. In Vietnam, what we are discussing is the first modality, providing food/milk tor children at school. Objectives The primary objective of school feeding program is to provide meals (breakfast, lunch, snack, milk…) to alleviate short term hunger, increase attention span, facilitate learning and obviate the need for children to leave school to find food. In-school meals also act as an incentive to increase school attendance. In addition to that, micronutrient fortification and deworming could be included in the school meal program as they are cost-effective interventions. Benefits of School Feeding Programs Social benefits School meals help families support their children’s education while protecting their food security. They help break the inter-generational cycle of hunger and poverty that affects vulnerable families and communities. However, while safety net programs must reach the poor to be effective, school feeding programs face challenges in reaching the poorest. The main reson is that enrollment is always lowest among the poorest and vulnerable communities. It should be noted that in-school meals are usually served to all children in the school including non-needy children, to avoid issues of logistics, jealousies, or stigma that might arise if only some children are fed. Educational benefits Implementation of school feeding programs is associated with increased enrollment, particularly for girls from vulnerable populations in many low-income countries including some LMICs such as Vietnam. School feeding programs can help to get children into school and help to keep them there, through enhancing enrollment and reducing absenteeism; and once the children are in school, the programs can contribute to their learning, through avoiding hunger and enhancing cognitive abilities. A daily meal also allows children to focus on their studies rather than their stomachs. These effects may be potentiated by complementary (nutrition-enhancing) actions, especially deworming and providing micronutrients. Providing school meals has also been shown to improve cognitive abilities and educational achievements in both low and high-income settings as they help to alleviate short-term hunger, and if the quality of meals is improved, significant improvement of study results is observed. In Vietnam, the Vietnamese Government, through a WB supported project – School Education Quality Assurance Program (SEQAP), decided to pilot full day schooling program in 2010, and which also included a school lunch, in disadvantaged areas. An independent evaluation of the project implementation showed that full day schooling has improved the quality of education quality and performance. The evaluation noted that for the program to succeed a school needs at least minimum physical conditions (e.g. adequacy 1 of classrooms and spaces for school activities, availability of kitchen for lunch, toilets...) and more importantly, strong leadership, qualified teachers as well as strong parent and community participation and support. Nutritional benefits Because the window of opportunity for adequate nutrition for optimal health and physical and cognitive development is short and spans the first 1,000 days of life beginning at the first day of pregnancy, any undernutrition occurring during this period can lead to extensive and largely irreversible damage to physical growth, brain development and consequently, human capital formation. Therefore, interventions to improve nutritional outcomes must focus on this age group and on women of child-bearing age. From this perspective, providing food to school-age children cannot reverse the damage of early nutritional deficits. A school child who is short for her age was had her growth likely stunted by inadequate nutrition at an earlier age, and hence school feeding would not be able to address their nutritional as well as cognitive deficits. Although the most recent systematic review shows that providing meals at schools can have a significant impact on the growth of school-age children, the effect is small and probably cannot reverse the consequences of earlier malnutrition. However, there could be intergenerational benefits for younger children. The links between school feeding and increased enrollment point to a positive effect on the well- being of the next generation because both maternal and paternal education levels are strong determinants of child growth and development as measured by stunting. The odds of having a stunted child decrease by about 4–5 percent for every additional year of formal education achieved by mothers. In summary, it has been shown that the primary drivers for increased support for school feeding are the benefits for social protection and for education. Well-designed school feeding programs, which include micronutrient fortification and deworming, can provide nutritional benefits and should be considered to complement and not substitute nutrition programs targeted at the first 1,000 days of life, which should remain a clear priority in countries’ efforts to address childhood undernutrition and ensure human capital formation for future generations. Implications for Vietnam In July 8, 2016, the Prime Minister ratified the School Milk program (Decision 1340/QD-TTg) with the objective of improving the nutritional status and especially the height of pre-school and primary school children by 2020. Its main intervention is to promote daily milk consumption through policy development, education and communication, and technical assistance. The MOH manages the milk program in cooperation with the Ministry of Culture, Sports and Tourism and the Ministry of Education and Training. The program mobilizes private contributions (20%), family and community contributions (50%) and local governments (30%). The program was first piloted in big cities, Hanoi and Ho Chi Minh city and is expanded to other provinces depending on their priority and resources. Recently, some poor and mountainous provinces expressed their interest to implement the program. It is also important to note that even with School Milk/Meal programs, for the objective of improving nutrition status and tackling child stunting, nutrition interventions during 1,000-day should be prioritized. 2