TABLE 3.

Commonalities and Differences in School Nutrition Policies in Uzbekistan and Kyrgyzstan

CommonalitiesUnique Features in UzbekistanUnique Features in Kyrgyzstan
Key SNP intervention components
Provision of mealsProvision of free standard meals.School-aged children in schools managed by Agency for the Development of Presidential, Creativity and Specialized Schools under Cabinet of Ministers of the Republic of Uzbekistan initiative.Students in grades 1–4 at the state and municipal schools.
Restrictions/prohibitions on the sale of competitive foods in schools.
Programs developed by the government in consultation with World Health Organization and other key country stakeholders (professional organizations, nongovernmental organizations).
Main implementerSanitary-Epidemiological Welfare and Public Health Committee, an agency of the Ministry of Health.Department of Education, an agency of the Ministry of Education and Science.
Meal provisionMainly contracted out.Contracted out for 74% of public schools and directly provided to 26% public schools.
Contract administrationBy agency under the Ministry of Health through a competitive bidding process.By Department of Education under the Ministry of Education and Science.
Current implementation strategies included as part of SNPProvision of standard meals outsourced to contractors. Cost of meals covered by government.Outsourcing of meals entails thorough selection, recruitment, training, monitoring and compensation to contractors through the Sanitary-Epidemiological Welfare and Public Health Committee.The heads of local state administrations and local self-government bodies organize the purchase of food products in accordance with the legislation on public procurement.
Key outcomes and mechanisms in Theories of Change
SNP targets reduction of the incidence of noncommunicable diseases among children and adults.
Long-term outcomesReduction in the prevalence of malnutrition among school-aged children at the population-level.Improvement in metabolic measures.Improvements in micronutrients and include reduction in the prevalence of anemia, folic acid and vitamin D deficiencies among school-aged children and adolescents.
Intermediate outcomes

Individual level: Changes in habitual consumption of target foods (including the nutrient and caloric standards)

School level: improvements in nutritional practices and limited marketing of unhealthy foods in school settings.

Community level:

  • Improvement in local governance i.e., increased allocation of funds for school nutrition in their jurisdiction.

  • Increase in participation of local food vendors in supply of school meals from local communities.

  • Positive change in community’s behavior regarding nutrition and associated practices.

Policy Advocacy outcomeReadiness (human resources, technical, and financial capacity) of the Sanitary-Epidemiological Welfare and Public Health Committee under the Ministry of Health to implement the SNP.Readiness (human resources, technical, and financial capacity) of the Department of Education under the Ministry of Education and Science to implement the SNP in cooperation with the Ministry of Health and technical support from development partners (World Food Programme and Mercy Corps).
Implementation outcomes
  • Improved adherence to the nutritional standards and implementation plan by food vendors.

  • Increased acceptance of SNP interventions by all stakeholders.

  • Increase in penetration of SNP at eligible schools.

Implementation challenges
  • Lack of coordination and concordance among key players in establishing standards for school meals/nutrition.

  • Lack of performance and training standards for contractors, schools, and local communities involved in SNP.

  • Issues in enforcement of nutritional, implementation, and regulatory standards.

  • Limited system for tracking and monitoring performance of contractors.

  • Limited political buy-in at the national/sub-level levels.

  • Limited resources available for expansion of program to schools other than ones that are part of the Agency for the Development of Presidential, Creative and Specialized Schools initiative.

  • Limited pool of contractors, and lack of consistency in tendering process for hiring contractors.

  • Lack of a consistent procedure for developing meal plans across schools and vendors.

  • Variable food sourcing approach across contractors and state and municipal public schools which gives rise to variable quality of the meals being provided.

  • Lack of a coordination mechanism between state and municipal public schools and communities in schools where meals are being directly provided.

Key Theory of Change assumptions
  • Willingness of national ministries of health and education and other stakeholders to prioritize SNP.

  • Availability and motivation of competent contractors to implement SNP.

  • Stable food and commodity prices.

  • Only around 10% of children in Uzbekistan attend schools under the Agency for the Development of Presidential, Creative and Specialized Schools.

  • Sufficient population coverage of SNP for school-aged children in Kyrgyzstan.