E-Magazine

Report on the First Commonwealth Symposium and Workshop on

Chronic Non – Communicable Diseases

COMMONWEALTH CIVIL SOCIETY RESPONDS TO THE CNCD PANDEMIC:

The Formation of the Commonwealth Dietitians and Nutritionists Association

(CDNA)

CFAN CENTRE FOR FOOD AND NUTRITION Ministry of the People

and Social Development Ministry of Health

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TABLE OF CONTENT

SYMPOSIUM/WORKSHOP BACKGROUND AND RATIONALE .......................... 2 SYMPOSIUM/WORKSHOP OBJECTIVES AND EXPECTED OUTCOMES ........... 4 THE OPENING CEREMONY ....................................................................................... 5

Introduction and welcome ........................................................................................... 5 Address from Commonwealth Foundation ................................................................. 6 Highlights of the Feature address by the Minister of the People and Social Development ............................................................................................................... 7 Vote of thanks ............................................................................................................. 7

SUMMARY OF THE MAIN PRESENTATIONS ........................................................ 8 Exploring the Team Approach .................................................................................... 8 Socio-economic Impact of Chronic Non-Communicable Disease ............................. 9

WORKSHOP ONE: ...................................................................................................... 10 Introduction ............................................................................................................... 10

WORKSHOP TWO: ..................................................................................................... 10 Introduction ............................................................................................................... 10 Way Forward ............................................................................................................ 11

WORKSHOP THREE .................................................................................................. 12 Introduction ............................................................................................................... 12 1. SWOT ANALYSIS .............................................................................................. 12 PURPOSE AND ROLE ............................................................................................ 13 NAME OF CPA ........................................................................................................ 13 2. PURPOSE OF CDNA ........................................................................................... 14 Representation ........................................................................................................... 14 3. CONSTITUTION ................................................................................................. 15 4. CONCLUSION AND RECOMMENDATIONS ................................................ 15

Appendix Two .................................................................................................................... 17 FEATURE PRESENTATION BY THE MINISTER OF THE PEOPLE AND SOCIAL DEVELOPMENT ......................................................................................................... 17

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SYMPOSIUM/WORKSHOP BACKGROUND AND

RATIONALE

At the 2009 Caribbean sub-regional preparatory meeting for the Commonwealth Heads of Government Meeting (CHOGM), held in Grenada, civil society agreed that one of the priority areas for consideration at the Commonwealth People’s Forum (CPF) was the apparent increase in chronic non-communicable diseases (CNCDs), particularly in the developing countries of the Commonwealth.

At the 2009 Grenada sub-regional prep-com meeting, sponsored by the Commonwealth Foundation, civil society reviewed the data on CNCD and concluded that CNCD disorders were poised to

become the number one health issue in the Caribbean and in developing countries throughout the Commonwealth.

Further, the 2009 Grenada sub-regional prep-com meeting noted that a concerted effort was

Section 1

Introduction

Fig. 1: Ms. Shantel Munroe-Knight Deputy Chairperson of the Civil Society Advisory Committee

3

necessary to ensure that this emerging pandemic was reversed.

At the Commonwealth People’s Forum held in Port of Spain, Trinidad and Tobago in 2009, the Centre for Food and Nutrition (CFAN) in collaboration with the Caribbean Network for Integrated Rural Development (CNIRD) and the Caribbean Policy Development Centre (CPDC), spear-headed a process to have CNCD positioned as a major agenda item in the Health and HIV/AIDS Assembly at CPF.

At the end of the Health and HIV/AIDS Assembly deliberations a call was issued for Civil Society to get more involved in and, support the Commonwealth Foundation in dealing with the apparent pandemic that is chronic non-communicable disease. This led to civil society giving

themselves a clear mandate, as outlined on page 35 of the Port of Spain Civil Society Statement, to “…support the formation of a Commonwealth Professional Association on Food and Nutrition by 2011, and work with the Commonwealth Foundation and Secretariat in the monitoring and evaluation of private sector involvement in health care delivery”

To this end, this Commonwealth Symposium and Workshop, hosted in Macoya, Trinidad, served as the fulfilment of the CPF 2009 civil society mandate to create a mechanism for greater participation by civil society in reducing the incidence of CNCDs in the Commonwealth.

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SYMPOSIUM/WORKSHOP OBJECTIVES AND

EXPECTED OUTCOMES

The following were the objectives of the workshop:

o To provide a forum for experts on food, nutrition and CNCD from the Commonwealth.

o To identify and demonstrate the linkages between Food and Nutrition and the incidence of CNCDs.

o To analyse these issues from and at the community level.

o To demonstrate the relationship between unsustainable development, environmental degradation, socio-economic consequences and CNCD.

o To establish a mechanism for the strategic participation of civil society in reducing the

pandemic of CNCD globally.

The agenda was drawn up in order to achieve the following expected outcomes which will facilitate greater civil society participation in dealing the increase of CNCDs in the Commonwealth:

�he bringing together of Food and Nutrition Practitioners from across the Commonwealth;

�he confirmation of a Port of Spain Civil Society Declaration on CNCDs and,

� The formation of a Commonwealth Professional Association in Food and Nutrition.

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THE OPENING CEREMONY

Introduction and welcome

The Opening Ceremony commenced with warm greetings from the symposium Chair, Mr. Calvin James of CFAN. Following the opening Prayer and singing of the National Anthem, Mr. James welcomed all delegates and invited guest and shared a bit on the

origin of the Symposium and Workshop.

Next, Greetings were brought by one of the Directors of the Centre for Food and Nutrition (CFAN), Mr. Govin Heeraman. He noted that CFAN was formed in 2006 and was registered as a not for profit organization in Trinidad & Tobago. Its aim is to provide leadership in advocacy and research in

Section 2

Symposium Highlights

Fig. 2: Dr. the honourable Glenn Ramadharsingh, Minister of the People and Social Development

6

the area of food and nutrition.

Currently, CFAN has 20 members, all of whom are professionals in their various disciplines, but offer their expertise on a voluntary basis to further the objectives of the association.

One of the issues identified by CFAN while preparing for the Commonwealth People’s Forum (CPF), was the fact that there was very little collaboration, coordination and partnership between and among civil society organizations with respect to nutrition, primary health and issues surrounding CNCD’s.

This gave birth to the idea to advocate for a Commonwealth wide coordinating mechanism to be established to treat with and advise the Commonwealth Foundation and the Commonwealth

Secretariat on matters relevant to nutritional health. CFAN was therefore very pleased to see the start of the process.

Address from Commonwealth Foundation

Ms. Shantal Munro Knights, Deputy Chairperson of the Civil Society Advisory Committee to the Commonwealth Foundation (CSAC), brought greetings on behalf of the Foundation and its Director. She said that the Foundation was set up by 53 Commonwealth member States to serve civil society. The membership of CSAC is drawn from the Commonwealth Regions in Africa, Asia, Caribbean/Canada, Europe and Pacific Islands.

Commonwealth civil society had thoroughly discussed the issue of CNCD’s at the Commonwealth People’s Forum (CPF) held in

7

November 2009. One strong recommendation was for the formation of a Professional Association to address Food and Nutrition. The event now taking pace was very timely, and was fulfilling a Mandate from the CPF.appendix one

Highlights of the Feature address by the Minister of the

People and Social Development

Dr. the Honourable Glenn Ramadharsingh, Minister of the People and Social Development delivered the feature address on behalf of the Government of Trinidad and Tobago at the Symposium. The Minister expressed his honour to be associated with this process.

In a stirring address, Minister of the People and Social Development, Dr. Glenn Ramadharsingh, said that the country, and by extension the Commonwealth, had to be pro-active in the fight

against CNCD’s, since low and middle income countries would feel the effects of poor health and nutrition the most.

He pointed to research that showed rising incidences of Diabetes and Hypertension, and the many members of the population, including children, who were obese.

He urged children to ‘fast from fast foods, ensure a rainbow of vegetables on their plates, and reminded them that sometimes you need to eat the awful to become awesome”.appendix two

Vote of thanks

Mr. Calvin James, Executive Chairman of the Centre for Food and Nutrition, CFAN, in giving the vote of thanks pointed out that the Commonwealth Foundation was both sponsoring and actively participating in this process.

The Executive Chairman expressed thanks to the

8

Minister and Ministry of the People and Social Development for the supportive relationship given throughout this process.

The Ministry of Health was also thanked for their early involvement and for the continued technical support freely offered to this process.

He ended by thanking all the representatives of the regional nutritional associations and organizations gathered at the symposium. He praised their dedication, as seen by the work they do in their regions, and looked forward for their input in forging a coordinated, collaborative effort in promoting a healthy lifestyle throughout the Commonwealth.

SUMMARY OF THE MAIN PRESENTATIONS

Exploring the Team Approach

Dr. K. Jessamy, a young internist, gave a spirited but important presentation on “Approach to treating Chronic Non-Communicable Diseases”. The doctor’s presentation covered the definition of CNCD; how these may be treated and; recommendations for the establishment of a strategic guide for a collaborative approach to treating CNCDs.appendix three

At the end of the doctor’s presentation the floor was open to participants to poise questions.

Some of the questions the participants raised touched on the cost of treatment and the diagnosis of CNCDs.

Participants learnt that both the diagnosis and treatment of CNCDs are

9

free in Trinidad and Tobago.

Participants called for greater collaboration between doctors and dieticians in the treatment and management of CNCDs.

Finally, it was noted that there was very low subscription, by the male population in Trinidad and Tobago, to primary health care which contrasts to a high incidence of the males in Trinidad and Tobago with prostate cancer, diabetes,

hypertension and amputations.

Socio-economic Impact of Chronic Non-Communicable Disease

Mr. Christian Chambers, an officer from the Ministry of the People and Social Development, gave an in-depth presentation on the link between CNCD and the economy. He also outlined one measure his Ministry is undertaking to mitigate against the negative social fall out that the increase incidence of CNCD can present.appendix five

At the end of the presentations participants noted the gap between the affordability of health care and the inability to access healthcare. Participants also noted that many beneficiaries of the programme mentioned in the presentation did not use the service adequately.

Fig. 3: Calvin James, Executive Chairman, Centre for Food and Nutrition

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WORKSHOP ONE:

Introduction

This workshop was meant to give the delegates an orientation on the process to date and set the stage for discussions in the proceeding workshops.

There were four presentations in this session, they included:

� An overview of the Commonwealth Foundation

� The role civil society plays in the Foundation

� An introduction of the Commonwealth Professional Association

� Funding of Commonwealth Professional Associations

The presenters were Shantal Monroe-Knight and Nelcia Robinson.

Delegates indicated that the presentations were very useful and did provide a

good overview of the Commonwealth and the Commonwealth Foundation.

WORKSHOP TWO:

Introduction

The overall aim of the second session was to present to the delegates an overview of the process that led to the hosting of this Symposium/Workshop.

As such the four presentations delivered in this session gave a historical overview of the process that culminated in a clear mandate being issued at CHOGM 2009 for Civil Society to take become more engaged in efforts to reduce the incidence of CNCDs throughout the Commonwealth.

At the end of this session delegates were invited to determine and recommend

Section 3

Workshop Summaries and Responses

11

how the process should move forward.

Way Forward

Delegates were impressed with the work that was done leading up to this Symposium/Workshop, but expressed some concern that their involvement was not summoned earlier in the process.

It was re-stated that the process was initiated by non-professional. These stakeholders in many cases represented people who were affected in some way by CNCD. It was further pointed out that this was a bottom-up approach, which lead to all stakeholders agreeing to the formation of a Commonwealth Professional Association in Food and Nutrition. Finally, delegates were reminded that the outcome of these workshops must be presented at the next CPF in 2011.

Other concerns expressed by some delegates had to do with funding, specifically funding of individual organizations.

It was clarified that the funding stream for CPAs are different to that which individual organizations. Therefore, the formation of a CPA may not preclude or prevent individual organizations or associations from applying for and accessing funding from the Commonwealth Foundation.

Finally, delegates decided to proceed with a modified agenda that carefully examined role and nature of the CPA to ensure that there be no duplication of efforts moving forward. appendix six

12

WORKSHOP THREE

Introduction

On the second day, the beginning of the third workshop, delegates agreed to the following revised agenda:

1. SWOT Analysis to determine benefit and need.

2. Purpose and Role

3. Representation

4. Constitutional Matters

1. SWOT ANALYSIS At the end of discussions the following were the agreed outcomes of the SWOT analysis: STRENGTHS - Cadre of Qualified

Professionals - Have strong existing

national associations - Support of a strong,

vibrant International Confederation (ICDA)

- Commonwealth support WEAKNESSES - No Dietetics Associations

in 43 Commonwealth Countries

- Does not have the capacity to reach 43 Commonwealth States

- Lack of capacity to respond

- Does not utilize the human resources available

OPPORTUNITIES - Facilitate Networking and

Capacity Building - Exchange Programs - Strengthen capacity in

Nutrition and Dietetic Fraternity

- Interface with Government – Strengthen engagement with Governments within the Commonwealth

- Conduct of Research THREATS - Existing associations may

not want to be part of CDNA

- Alternative Medicine - Limited Funding

13

- Government Policy on Health and Nutrition, even in the formation of associations

- Lack of political will

It was hereafter determine by all delegates that it will be worth the effort to continue the process of establishing a framework for the establishment of a dedicated civil society agency, within the Commonwealth, that will have as its remit the responsibility of advising the Foundation and the Secretariat on Food and Nutrition matters.

Delegates noted that some of the key functions of such an agency will include:

� Strengthening Food and Nutrition Education

� Broadening the capacity of Food Security

� Agricultural and other affiliations towards Food Security

� Networking to build Associations to deal with Issues of Food Security, Nutrition and Health

PURPOSE AND ROLE

During this session delegates raised a concern as to the focus of the proposed agency, taking into consideration that the main drivers of this process are Dietitians.

NAME OF CPA

As such, it was decided that the name of the agency should reflect the professionals who will drive the process forwards.

Coming out of that discussion three options were table for consideration:

1. Commonwealth Nutrition and Dietetic Association – CNDA,

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2. Commonwealth Dietetics and Nutrition Association – CDNA, and

3. Commonwealth Dietitians and Nutritionists Association – CDNA.

The option that was settled upon was option number three, Commonwealth Dietitians and Nutritionist Association – CDNA.

2. PURPOSE OF CDNA The purpose of the CDNA is to contribute to the improved health and nutrition well being of citizens of the Commonwealth, by building the capacity of the Dietetics and Nutrition profession within the Commonwealth.

Representation

Delegates went on to discuss the geographic representation of the Association. Several models were examined and it was

agreed that the following will compose the geographic representation of the Commonwealth Dietitians and Nutritionists Association:

- Americas

- Caribbean

- Eastern/Central/Southern Africa

- Europe

- Pacific

- South Asia

- West Africa

Appendix () shows the country grouping for each of the above Commonwealth regions. Further, it should be noted that four (4) out of the seven (7) regions were represented. This translates into a country representation of seventeen (17) countries:

- Americas - 1

- Caribbean - 14

- Europe - 1

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- South Asia - 1

It was proposed that a representative chosen from each of the afore stated regions would comprise the board of the Commonwealth Dietitians and Nutritionist Association. In other words that full board would be made up of seven (7) members chosen from their region.

3. CONSTITUTION

The final set of discussions on achieving the mandate handed down by civil society at CHOGM centred on the constitution of the Commonwealth. A working document was used to guide the discussions and at the end of a one hour dialogue the first draft constitution of the CDNA was approved.appendix seven

4. CONCLUSION AND RECOMMENDATIONS

1. The Commonwealth Dieititian and Nutritionist Association (CDNA) was adopted.

2. The Centre for Food and Nutrition (CFAN), out of Trinidad and Tobago shall serve as its Secretariat.

3. The Delegates from:

a. Atlantic - Cana

b. Caribbean – Caribbean Association of Nutritionist and Dietitians

c. Europe – British Dietetic Association

d. South Asia – Indian Dietetic Association

Shall form the Interim Board of CDNA.

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4. The Secretariat shall prepare to:

a. Get a team to the next CHOGM

b. Reach out to associations from other regions

c. Develop a workplan

d. Begin marketing and networking the Association.

Appendix Two FEATURE PRESENTATION BY THE MINISTER OF THE PEOPLE AND SOCIAL DEVELOPMENT

MINISTRY OF THE PEOPLE AND SOCIAL DEVELOPMENT

FEATURE ADDRESS

BY

MINISTER OF THE PEOPLE AND SOCIAL DEVELOPMENT

DR. THE HONOURABLE GLENN RAMADHARSINGH

AT

FIRST PAN-COMMONWEALTH SYMPOSIUM AND WORKSHOP ON CHRONIC NON-COMMUNICABLE DISEASE

ON

MONDAY 22ND NOVEMBER 2010

TRINIDAD AND TOBAGO BUREAU OF STANDARDS CONFERENCE ROOM

10:00AM

Page 18 of 27

Thank you, Mr. James.

� Executive Chairman, Centre for Food and Nutrition � Regional Representative of the Commonwealth Civil

Society Advisory Committee, Shantel Munroe-Knight � Representatives of the various Nutrition and Dietetic

Associations within the Commonwealth � Other Distinguished Guests

� Members of the Media

� Ladies and Gentlemen

Good Morning,

Page 19 of 27

INTRODUCTION

It is an honour to be associated with this symposium and

workshop. I am informed that representatives from both the

developed and developing countries of the Commonwealth are

represented here this morning.

On behalf of the Prime Minister of the Republic of Trinidad and

Tobago and People of this great twin island Republic I wish to

welcome you to our shores, and pray that your deliberations

produce the results needed to assist the Commonwealth in

reducing the incidence and prevalence of Chronic Non

Communicable Diseases.

Ladies and Gentlemen I want to sincerely thank the organizers of

this meeting for bestowing upon me the honour of PATRON for

this process. This process that will see the unveiling of a brand

new and most important commonwealth professional association

Page 20 of 27

in food and nutrition. It will be my distinguished pleasure to be

associated with the launch of this important body at CHOGM

2011 in Malta.

OVERVIEW

Chapter 6 of Agenda 21 – a global programme of action on

sustainable development – stresses the need to protect and

promote human health, with emphasis on meeting primary health

care needs, particularly in rural areas; control of communicable

diseases; protecting vulnerable groups; meeting the urban health

challenge, and reducing health risks from environment pollution

and hazards.

As such, underpinning the concept of sustainable development is

the increasing recognition that the goals of sustainable

development cannot be achieved when there is a high prevalence

of debilitating illness.

Page 21 of 27

Social factors such as political instability, violent armed conflict,

discrimination, inequalities and inequities are all inimical to health,

and to sustainable development.

ACHIEVEMENTS OF THE PAST DECADE

The Caribbean Food and Nutrition Institute, the World Health

Organization and the Centre for Food and Nutrition all report that

over the last decade countries of the Commonwealth have

witnessed the increase in average life expectancy, a decline in

infant and child mortality rates, and a decrease in the proportion

of underweight and stunted children. I am informed that the

Ministry of Health has report a parallel trend in Trinidad and

Tobago

Other milestones of note include the unprecedented progress

being made towards the eradication or elimination of various

major infectious diseases has been made. This includes the

Page 22 of 27

unprecedented effort currently being carried out to eradicate polio

globally.

However, despite the undisputed and unprecedented health

advances in many areas, poor health continues to be a constraint

on development efforts.

THE HEALTH TRANSITION

As traditional infectious diseases recede, the incidence of chronic

non-communicable disease (CNCDs) of mid and later adulthood

is rising worldwide. The steep projected global increase in the

burden of CNCDs represents just one of the major challenges to

future sustainable development of Commonwealth countries.

WHO projects that by 2020 CNCDs, injuries and violence will

account for 80% percent of the global burden of disease. By then,

CNCDs are expected to account for 73% of deaths and 60% of

the disease burden. The data coming out from WHO identifies

Page 23 of 27

low- and middle- income countries as those that will suffer the

most. This country profile, Ladies and Gentlemen, describe the

majority of countries that make up the Commonwealth.

It is informative to note that CNCDs were not highlighted in

Agenda 21 and yet it is clear that they represent a clear and

present threat to sustainable development.

The economic fallout of CNCDs goes beyond the costs to health

services. Indirect costs, such as lost productivity, can match or

exceed the direct costs. In addition, a significant proportion of the

total cost of care falls on patients and their families. People die

from all chronic diseases at dramatically younger ages in the

countries of the Commonwealth. In Africa, because CNCDs are

underappreciated as development issues and underestimated as

diseases with profound economic effects, many governments take

little interest in their prevention and control and CNCDs have not

Page 24 of 27

received the priority attention in public health policies and

programs commensurate with their disease burden.

Progress in implementing comprehensive CNCDs strategies and

policies has been hampered by fragmented, scarce and lack of

resources. Scarce resources and lack of policies and strategies

for controlling CNCDs are key challenges in the Commonwealth.

There is the need for A STRONG ADVOCACY in favour of

prioritizing CNCDs and for technical assistance in implementing

and monitoring cost-effective and integrated approaches for the

early detection and management of cardiovascular diseases,

cancers, diabetes, sickle cell disease, chronic respiratory

diseases, oral health and establish standards of health care for

common conditions.

WAY FORWARD

Ladies and Gentlemen, it is easy to see that we had much to

consider here today. It is my sincere hope that the delegates who

Page 25 of 27

will be engaged in the workshops after the symposium will

emerge from their deliberations with a mechanism for being the

advocates within the Commonwealth on CNCDs.

The Ministry of the People and Social Development pledges its

continued support in collaborating with ALL stakeholders in

treating with this emerging pandemic within the Commonwealth.

CLOSING

In closing, I extend our gratitude to our partners in this process,

the Ministry of Health, the Commonwealth Foundation, and the

Centre for Food and Nutrition.

Page 26 of 27

And I especially want to thank all of you for coming out to support

this symposium and ultimately support the welfare and well-being

of our nation.

Thank You and May God Bless You.

The “People’s Commonwealth”

Commonwealth Foundation

What is the Commonwealth?

•An intergovernmental organisation founded in 1949 with 53 nation members

• Shared commitment to good governance, democracy, rule of law, sustainable development, human rights and equality of all people

• Able to sanction wayward members• Regular meetings of ministers and Heads of Government•

Commonwealth Intergovernmental Bodies

Commonwealth Secretariat (London)• Political affairs, Ministerials, CHOGM, technical assistance• 300 staff; Secretary-General HE Kamalesh Sharma (India)• Turnover $50MCommonwealth Foundation (London)• Strengthen & support civil society; address cultural affairs • 20 staff; Director Mark Collins (UK)• Turnover $8MCommonwealth of Learning (Vancouver, Canada)• Open and distance learning • 30 staff; Director Sir John

Daniel (Canada)• Turnover $8M

The Foundation’s Origins• Established 1965 as fund for interchanges between

organisations in professional fields • In 1979, in Lusaka, governments recognised NGOs

as well as professional associations• Areas of interest expanded to include culture,

information and the media, development, socialwelfare, the disabled and the role of women: “civil society”

The Foundation’s Origins

In 1982, a decision was taken to reconstitute the Foundation as an–International Organisation a process that was completed on 14 February 1983. Since then, the remit of the Commonwealth Foundation has continued to broaden and grow. With the aim of strengthening civil society and enhancing its contribution to development in the Commonwealth, the Foundation now works with non-governmental and voluntary organisations, faith-based institutions, the media and trade unions.

Mission of the Commonwealth Foundation

…. to strengthen civil society organisations across the Commonwealth…

as they promote democracy, advance sustainable development and foster inter-cultural understanding……

Vision of the Commonwealth

A Commonwealth where citizens are able to give voice to aspirations, identify their own solutions and fulfil their role in society. It is a Commonwealth where citizens individually and collectively express themselves for the public good at local and national and international levels facing global challenges building strong communities and promoting citizens rights.

It is a Commonwealth where civil society organisations realise their full potential, engaging with their governments and the private sector in the shared enterprise of transformational nationa-building and international cooperation

What Does Civil Society Do & Why Is It Important?

• Advocacy & pressure groups• Human rights organisations • Development organisations • Faith groups • Trade unions• Professional bodies • Cultural groups• Sports clubs and organisations

Many people work in the public & private sectors, but are members of civil society organisations at the same time!

What Civil Society Wants• Recognition in a democratic framework• Freedom of expression & association• Dialogue with governments and business• A central role in planning & development• A fair regulatory environment• A beneficial tax environment• Opportunity to deliver public

services

In other words, a full role in democracy and nation-building, as citizens and as voters

Challenges for Commonwealth Governments & Diplomats

• Adopting a service culture• Accepting that democracy

only BEGINS at the ballot box• Encouraging constructive debate & criticism• Empowering civil society organisations to play a

full part as stakeholders in development• Balancing dialogue with civil society and the

private sector• Creating a fair regulatory & fiscal environment• Maintaining security without penalising CSOs

Today’s Trends• Huge growth in the number of CSOs since the1970s• Growing voice in multilateral and national decision-

making forums• Some notable successes in policy advocacy, for

example in debt relief, development aid, environment• Less success where economics over-rides public

opinion and science• Conflict between maintaining security and

human rights

Is space for civil society growingor shrinking in the Commonwealth?

What Are We Aiming For?

• Commonwealth people speakingup for themselves without fear

• CSOs as genuine partners with governments in development

• Civil society making a differencein terms of participatorydemocracy, sustainabledevelopment and culturalunderstanding

How Does the Foundation Help?In six ways:

• Projects for analysis & policy research • Case-studies and best-practice toolkits• Dialogue at Commonwealth Ministerials & CHOGM • Grants for networking, training, education• Awards & prizes for

excellence • Knowledge-sharing and

capacity-building

Finding a FocusCivil society statements

Four-year Strategy

What are our Programmes?

3. Human

Development

1. Culture

1. Promoting cultural understanding

2. Giving CSOs a voice in the Commonwealth

3. Helping CSOs contribute to development

4. Promoting sustainable societies

4. Communities &

Livelihoods

2.Governance and

Democracy

Culture

Activities:•Mainstreaming culture into development•Raising cultural awareness & pride•Supporting artists, writers & performers•Distributing cultural reference materials •Promoting social cohesion

Governance & Democracy

Activities:•Improving regulatory frameworks •Toolkits to engage with governments •Creating dialogue •Building capacity •Providing grants

Human DevelopmentActivities:1.Strengthening development networks 2.Exploring civil society viewpoint 3.Building consortia on environment, education, health4.Engaging with UN initiatives SIDS,MDGs5.Grants to CAs engaging in development

Communities and Livelihoods

Activities:• Promoting adaptation to climate change• Improving management of fisheries• Creating sustainable cities• Promoting community management

of natural resources• Grants for communities and livelihoods

The Future for Grant-Making

• Currently grants amount to about £1M per year• Divided between accredited Associations and

“responsive” grants• 25% for Associations and 75% for NGOs• Recently developed “Special Grants Reserve” for

use in times of national crisis

The Foundation has good procedures in place and would like to attract voluntary contributions to the grants fund.

The Commonwealth under Review

At their 2009 meeting in Port of Spain, Trinidad and Tobago, Commonwealth leaders called for the “creation of an Eminent Persons Group to undertake an examination of options for reform in order to bring the Commonwealth’s many institutions into a stronger and more effective framework of co-operation and partnership.”

This distinguished Group will set out decisive recommendations on how to strengthen the Commonwealth and fulfill its potential in the 21st century,

The Group’s work will aim to ensure that the Commonwealth remains relevant to its times and makes the best use of its networks and partnerships to do so.

Members of the EPG

Tun Abdullah Ahmad Badawi (Malaysia, Chairperson) Ms Patricia Francis (Jamaica)Dr Asma Jahangir (Pakistan)Mr Samuel Kavuma (Uganda) – (Commonwealth Youth Caucus)The Hon Michael Kirby (Australia)Dr Graca Machel (Mozambique)Rt Hon Sir Malcolm Rifkind (UK)Sir Ronald Sanders (Guyana)Senator Hugh Segal (Canada)Sir Ieremia Tabai (Kiribati)

The Role of CSAC

The CSAC is selected so as to ensure that it contributes to the development and implementation of the Foundation’s programme. It is broadly representative of the different regions of the Commonwealth and different sectors and constituencies of civil society; and maintains a balanced gender profile. Only nationals of Commonwealth Foundation member countries employed by or holding an honorary position in an established civil society organisation (including Commonwealth Associations) will be eligible to be a member of the CSAC.

CSAC advises the Foundation on Its programmatic agenda The organisation of the CPF and civil society statementsIt is part of the governance structure of the Foundation

Further Information

Commonwealth FoundationMarlborough HousePall MallLondon SW1Y 5HYUKTel: +44 20 7930 3783Fax: +44 20 7839 8157

www.commonwealthfoundation.com

Questions?

MINISTRY OF THE PEOPLE AND SOCIAL DEVELOPMENT

FEATURE ADDRESS

BY

MINISTER OF THE PEOPLE AND SOCIAL DEVELOPMENT

DR. THE HONOURABLE GLENN RAMADHARSINGH

AT

FIRST PAN‐COMMONWEALTH SYMPOSIUM AND WORKSHOP ON CHRONIC NON‐COMMUNICABLE DISEASE

ON

MONDAY 22ND NOVEMBER 2010

TRINIDAD AND TOBAGO BUREAU OF STANDARDS CONFERENCE ROOM

10:00AM

Page 2 of 10

Thank you, Mr. James.

� Executive Chairman, Centre for Food and Nutrition � Regional Representative of the Commonwealth Civil

Society Advisory Committee, Shantel Munroe‐Knight � Representatives of the various Nutrition and Dietetic

Associations within the Commonwealth � Other Distinguished Guests

� Members of the Media

� Ladies and Gentlemen

Page 3 of 10

Good Morning,

INTRODUCTION

It is an honour to be associated with this symposium and

workshop. I am informed that representatives from both the

developed and developing countries of the Commonwealth are

represented here this morning.

On behalf of the Prime Minister of the Republic of Trinidad and

Tobago and People of this great twin island Republic I wish to

welcome you to our shores, and pray that your deliberations

produce the results needed to assist the Commonwealth in

reducing the incidence and prevalence of Chronic Non

Communicable Diseases.

Ladies and Gentlemen I want to sincerely thank the organizers of

this meeting for bestowing upon me the honour of PATRON for

Page 4 of 10

this process. This process that will see the unveiling of a brand

new and most important commonwealth professional association

in food and nutrition. It will be my distinguished pleasure to be

associated with the launch of this important body at CHOGM

2011 in Malta.

OVERVIEW

Chapter 6 of Agenda 21 – a global programme of action on

sustainable development – stresses the need to protect and

promote human health, with emphasis on meeting primary health

care needs, particularly in rural areas; control of communicable

diseases; protecting vulnerable groups; meeting the urban health

challenge, and reducing health risks from environment pollution

and hazards.

As such, underpinning the concept of sustainable development is

the increasing recognition that the goals of sustainable

Page 5 of 10

development cannot be achieved when there is a high prevalence

of debilitating illness.

Social factors such as political instability, violent armed conflict,

discrimination, inequalities and inequities are all inimical to health,

and to sustainable development.

ACHIEVEMENTS OF THE PAST DECADE

The Caribbean Food and Nutrition Institute, the World Health

Organization and the Centre for Food and Nutrition all report that

over the last decade countries of the Commonwealth have

witnessed the increase in average life expectancy, a decline in

infant and child mortality rates, and a decrease in the proportion

of underweight and stunted children. I am informed that the

Ministry of Health has report a parallel trend in Trinidad and

Tobago

Page 6 of 10

Other milestones of note include the unprecedented progress

being made towards the eradication or elimination of various

major infectious diseases has been made. This includes the

unprecedented effort currently being carried out to eradicate polio

globally.

However, despite the undisputed and unprecedented health

advances in many areas, poor health continues to be a constraint

on development efforts.

THE HEALTH TRANSITION

As traditional infectious diseases recede, the incidence of chronic

non-communicable disease (CNCDs) of mid and later adulthood

is rising worldwide. The steep projected global increase in the

burden of CNCDs represents just one of the major challenges to

future sustainable development of Commonwealth countries.

Page 7 of 10

WHO projects that by 2020 CNCDs, injuries and violence will

account for 80% percent of the global burden of disease. By then,

CNCDs are expected to account for 73% of deaths and 60% of

the disease burden. The data coming out from WHO identifies

low- and middle- income countries as those that will suffer the

most. This country profile, Ladies and Gentlemen, describe the

majority of countries that make up the Commonwealth.

It is informative to note that CNCDs were not highlighted in

Agenda 21 and yet it is clear that they represent a clear and

present threat to sustainable development.

The economic fallout of CNCDs goes beyond the costs to health

services. Indirect costs, such as lost productivity, can match or

exceed the direct costs. In addition, a significant proportion of the

total cost of care falls on patients and their families. People die

from all chronic diseases at dramatically younger ages in the

Page 8 of 10

countries of the Commonwealth. In Africa, because CNCDs are

underappreciated as development issues and underestimated as

diseases with profound economic effects, many governments take

little interest in their prevention and control and CNCDs have not

received the priority attention in public health policies and

programs commensurate with their disease burden.

Progress in implementing comprehensive CNCDs strategies and

policies has been hampered by fragmented, scarce and lack of

resources. Scarce resources and lack of policies and strategies

for controlling CNCDs are key challenges in the Commonwealth.

There is the need for A STRONG ADVOCACY in favour of

prioritizing CNCDs and for technical assistance in implementing

and monitoring cost-effective and integrated approaches for the

early detection and management of cardiovascular diseases,

cancers, diabetes, sickle cell disease, chronic respiratory

Page 9 of 10

diseases, oral health and establish standards of health care for

common conditions.

WAY FORWARD

Ladies and Gentlemen, it is easy to see that we had much to

consider here today. It is my sincere hope that the delegates who

will be engaged in the workshops after the symposium will

emerge from their deliberations with a mechanism for being the

advocates within the Commonwealth on CNCDs.

The Ministry of the People and Social Development pledges its

continued support in collaborating with ALL stakeholders in

treating with this emerging pandemic within the Commonwealth.

Page 10 of 10

CLOSING

In closing, I extend our gratitude to our partners in this process,

the Ministry of Health, the Commonwealth Foundation, and the

Centre for Food and Nutrition.

And I especially want to thank all of you for coming out to support

this symposium and ultimately support the welfare and well-being

of our nation.

Thank You and May God Bless You.

Dr. K. Jessamy

ObjectivesTo understand what is meant by the term “Chronic Non‐Communicable Disease”To identify the different types of Chronic Non‐Communicable DiseasesTo understand how Chronic Non‐Communicable Diseases are detected, treated and prevented.To identify the strategies involved in the prevention of Chronic Non‐Communicable Disease

IntroductionThe most common Non‐Communicable Diseases (NCD’s) are: Cardiovascular disease, Cancers, Diabetes Mellitus and Chronic Respiratory Disease. These four diseases cause an estimated 35 million deaths yearly (60% of deaths globally 1) with 80% occurring in low and middle income countries1.These diseases are preventable by eliminating shared risk factors: tobacco use, unhealthy diet, physical inactivity and alcohol use.

http://www.who.int/nmh/Actionplan‐PC‐NCD‐2008.pdf [accessed 21/11/10 at 4:50pm]

IntroductionTrinidad and Tobago had the 6th highest mortality rate due to NCD’s when compared to 35 states in the Americas. The estimated mortality rate in 2004 was 751.5 per 100,0002.

2https://apps.who.int/infobase/Comparisons.aspx?l=&NodeVal=GBD_10_mo.cc.059&DO=1&DDLReg=ALL&DDLSex=1&DDLAgeGrp=All_Ages&DDLYear=2004&DDLMethod=INTMDQUA&DDLCateNum=6&DDLMapsize=800x480&DDLMapLabels=none&DDLTmpRangBK=388.9088&DDLTmpColor=‐3342388 [accessed – 21/11/10 at 5:02pm]

DefinitionChronic Non‐Communicable Diseases are diseases of long duration and generally slow progression which are non‐infectious in nature3.

3http://www.who.int/topics/chronic_diseases/en/ [accessed‐ 21/11/10 at 5:00pm]

Chronic Non‐Communicable Diseases

Diabetes MellitusCardiovascular DiseaseCancerChronic Respiratory Disease

Diabetes Mellitus (DM)Type 1 – Childhood disease, thought to be caused by auto‐immune destruction of the pancreas

Type 2 – Adulthood disease, thought to be caused by decreased tissue sensitivity to the hormone Insulin

Gestational Diabetes – Occurs in pregnancy and predisposes to Type 2 Diabetes Mellitus

Diabetes MellitusTrinidad & Tobago has the highest estimated Diabetes‐associated Mortality Rate in the Americas: 128.2 per 100,0002


Diabetes MellitusDiabetes Mellitus has been linked to:Vascular diseaseNephropathyDiabetic RetinopathyCataracts

Diabetes Mellitus TreatmentRecombinant Insulin – Short, Intermediate and Long ActingOral Medications

Cardiovascular DiseaseIschemic Heart Disease – heart muscle deprived of blood flow resulting in Angina or eventual Myocardial Infarction

Cerebrovascular Disease – Hemorrhagic Stroke or Ischemic Stroke.

Cardiovascular DiseaseTrinidad & Tobago has the 7th highest estimated Mortality Rate due to Cardiovascular Disease in the Americas: 364.0 per 100,0002


HypertensionJNC 7 Classification of Blood Pressure (BP)4

Goal is to treat to BP of <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or chronic kidney disease.

Category Systolic BP (mmHg) Diastolic BP (mmHg)

Normal <120 and <80

Pre‐hypertension 120‐139 or 80‐89

Hypertension, Stage 1 140‐159 or 90‐99

Hypertension, Stage 2 ≥160 or ≥100

4http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf

Hypertension TreatmentAngiotensin Converting Enzyme InhibitorsAngiotensin II Receptor BlockersBeta‐blockersCalcium Channel BlockersCentrally Acting Adrenergic DrugsDiuretics

Cancer (Malignant Neoplasms)Breast CancerCervical CancerColorectalProstateOral

CancerTrinidad & Tobago has the 21st highest estimated Mortality Rate due to Cancer in the Americas: 122.5 per 100,0002


Cancer ScreeningBreast Cancer – Mammography, Breast Self ExamCervical Cancer – Cytology Screening (Pap smear)Colorectal Cancer – Sigmoidoscopy, Fecal Occult

Blood TestProstate Cancer – Digital Rectal Examination, Prostate

Specific Antigen

Cancer TreatmentChemotherapyRadiotherapyPalliative Treatment

Chronic Respiratory DiseaseChronic Obstructive Pulmonary Disease (COPD):Chronic BronchitisEmphysema

Chronic Respiratory DiseaseTrinidad & Tobago has the 27th highest estimated Mortality Rate due to Chronic Respiratory Disease in the Americas: 23.9 per 100,0002

This figure is expected to rise in the future due to the smoking epidemic


COPD TreatmentBronchodilators – β‐receptor agonists Corticosteroids

WHO Global StrategyGlobal Strategy has three main objectives1:1. To map the emerging epidemics of NCD’s and to

analyse their social, economic, behavioural and political determinants

2. To reduce the level of exposure of individuals and populations to the common risk factors for NCD’s: tobacco consumption, unhealthy diet and physical inactivity

3. To strengthen health care for people with NCD’s by developing norms and guidelines for cost‐effective interventions

http://www.who.int/nmh/Actionplan‐PC‐NCD‐2008.pdf [accessed 21/11/10 at 4:50pm]

The End

Thank You

The intervention of Targeted Conditional Cash Transfer Programme, Ministry of the People and Social Development,

Trinidad and Tobago.

0%

5%

10%

15%

20%

25%

30%

35%

Hypertension Diabetes Asthma Heart Renal Disease

Psychological Disorder

Cancer HIV/AIDS

31%

20%

9%8%

4%

2%1% 1%

PERCENT

HEALTH PROBLEMS

PERCENTAGE OF CARDHOLDERS WITH HEALTH PROBLEMS(MULTIPLE RESPONSES)

0

10

20

30

40

50

60

None Primary Secondary University

53.7 Yrs

50.3 Yrs

38.8 Yrs

36.5 Yrs

AGE

EDUCATIONAL ATTAINMENT

AGE OF CARDHOLDER AND EDUCATION

0 10 20 30 40 50 60

No Health Problems

One Health Problem

Two Health Problems

Three Health Problems

Four Health Problems

42.2 Yrs

48.8 Yrs

54.8 Yrs

55.5 Yrs

56.8 YrsNO.

OF

HEALTH

PROBLEMS

NUMBER OF HEALTH PROBLEMS BY AGE

AGE

3%8%

17%

32%

37%

26%

8%

15%

26%

47%

54%

46%

1%2%

6%

14%

18%17%

0%

10%

20%

30%

40%

50%

60%

17‐30 31‐40 41‐50 51‐60 61‐70 71 Plus

PERCENT

AGE GROUPS

DIABETES, HYPERTENSION AND HEART DISEASE BY AGE ( CARDHOLDERS)

Diabetes Hypertension Heart Disease

Conditional ComponentMonitoring and EvaluationPersonal Development and Employment EnhancementThe Social ContractFamily Intervention Network (FIN)

TCCTP’s intervention can be seen within the context of the benefit perspective which explores the accruable gains from timely interventions.

- 1 -

ADVANCED DRAFT CONSTITUTION OF THE

COMMONWEALTH DIETITIAN AND NUTRITIONIST ASSOCIATION

CDNA

- 2 -

PROPOSED CONSTITUTION

CONTENTS Article Page ARTICLE 1- NAME ................................................................................................. - 3 - ARTICLE 2 - DESCRIPTION ................................................................................. - 3 - ARTICLE 3 - PURPOSE .......................................................................................... - 3 - ARTICLE 4 - OBJECTIVES .................................................................................... - 3 - ARTICLE 5 – FUNCTIONS .................................................................................... - 4 - ARTICLE 6 - MEMBERSHIP ................................................................................. - 5 - ARTICLE 7 - GOVERNING BODY ....................................................................... - 6 - ARTICLE 8 – COMPOSITION OF CONGRESS ................................................... - 6 - ARTICLE 9 – FUNCTIONS AND POWERS OF CONGRESS ............................. - 6 - ARTICLE 10 - MEETINGS OF THE CONGRESS ................................................ - 7 - ARTICLE 11 – COMPOSITION OF THE BOARD ............................................... - 7 - ARTICLE 12 - FUNCTIONS AND POWERS OF THE BOARD .......................... - 9 - ARTICLE 13 - MEETINGS OF THE BOARD ....................................................... - 9 - ARTICLE 14 - OFFICERS OF THE ASSOCIATION .......................................... - 10 - ARTICLE 15 - SECRETARIAT ............................................................................ - 11 - ARTICLE 16 – FUNCTION OF THE SECRETARIAT ....................................... - 12 - ARTICLE 17 - REGIONAL COUNCILS .............................................................. - 13 - ARTICLE 18 – THE CONSULTATIVE PROCESS ............................................. - 13 - ARTICLE 19 – COMMON VOTING PROCEDURE IN ORGANS AND BODIES OF THE ASSOCIATION ....................................................................................... - 14 - ARTICLE 20 –VOTING IN CONGRESS ............................................................. - 14 - ARTICLE 21 –VOTING ON THE BOARD .......................................................... - 15 - ARTICLE 22 – VOTING BY PROXY .................................................................. - 15 - ARTICLE 23 - SUBSCRIPTIONS AND OTHER INCOME ................................ - 15 - ARTICLE 24 - AMENDMENTS TO THE CONSTITUTION .............................. - 16 - ARTICLE 25 - INTERPRETATION ..................................................................... - 16 - ARTICLE 26 - DISSOLUTION ............................................................................. - 16 - Commonwealth Dietitians and Nutritionist Association c/o Centre for Food and Nutrition 3 St. John’s Road St. Augustine Trinidad and Tobago Tel: (868) 290 4317 Fax: E-mail: [email protected] Note: This Constitution provides the framework by which the CDNA shall function.

- 3 -

.

ARTICLE 1- NAME 1.1 The Association shall be known as The Commonwealth Dietitian and

Nutritionist Association (CDNA).

ARTICLE 2 - DESCRIPTION 2.1 The CDNA is an Association of Commonwealth national/regional Dietetic

Associations which have been formally admitted into membership and which have objectives in accordance with those of the CDNA.

ARTICLE 3 - PURPOSE 3.1 The purpose of the CDNA is to contribute to the improved health and nutritional

well being of citizens of the Commonwealth by building the capacity of the Dietetics and Nutrition profession within the Commonwealth.

ARTICLE 4 - OBJECTIVES 4. The CDNA has formal objectives, which are as follows: 4.1 To maintain, facilitate and develop Commonwealth Dietetic Networks. 4.2 To influence health and food policy throughout the Commonwealth. 4.3 To enhance nutrition and dietetic education 4.4 To increase awareness of the profession within the Commonwealth 4.5 To foster membership among all countries of the Commonwealth, 4.6 To collaborate in its work with a range of international organizations, such as

The International Confederation of Dietetics Association, WHOP, FAO, and other relevant major Associations

4.7 To be the channel to facilitate the access to the Best Practices (Mention Criteria)

4.8 To assist National Dietetic Associations throughout the Commonwealth to improve the standards of Dietetics and competency of Dietician and food practitioners.

4.9 To assist Dietitians within the countries of the Commonwealth to develop leadership roles in health matters and food and nutrition policy.

4.10 To seek and to receive appropriate grants, subscriptions, donations and gifts for the benefit of dietetic profession and Dietitians within the countries of the Commonwealth.

4.11 To do all such other lawful things as may be conducive or incidental to any of the objectives set out above.

- 4 -

ARTICLE 5 – FUNCTIONS 5. The CDNA has functions as follows: 5.1 To maintain, facilitate and develop Commonwealth Dietetic networks by: 5.1.1 communicating dietetic and nutrition trends and issues related to

nutrition, food and health policy issues in the countries of the Commonwealth;

5.1.2 promoting co-operation and co-ordinated activities between member

associations in a particular Region and also between Regions; 5.1.3 co-operating and collaborating with other Commonwealth professional

groups to bring about inter-professional interchange in particular Regions and also between Regions.

5.2 To assist, in collaboration with other organisations as appropriate, national

dietetic associations throughout the Commonwealth to improve dietetic standards and the competency of Dietitians by:

5.2.1 promoting International Standards in Nutrition and Dietetics (ICDA) 5.2.2 sharing educational priorities and developing access to current dietetic

knowledge; 5.2.3 sharing research findings and where possible, undertaking collaborative

projects in a particular Region and between Regions; 5.2.4 encouraging the provision of scholarships to enable Dietitians to

undertake advanced studies within their own country where possible, or further afield if necessary.

5.3 To assist Dietitians within the countries of the Commonwealth to develop

leadership roles by: 5.3.1 encouraging the development of leadership development programmes

within the countries of the Commonwealth; 5.3.2 promoting the value of the Dietitian’s role in development throughout

the Commonwealth and demonstrating the cost effectiveness of professionally qualified Dietitians;

5.3.3 lobbying for a more effective roles for Dietitians at government level

throughout the countries of the Commonwealth. 5.3.4 prepare Dietitians and Nutritionists to attend various Commonwealth

Forums.

- 5 -

5.4 To influence the development of nutrition, food and health policy throughout the countries of the Commonwealth by:

5.4.1 offering CDNA networks as a resource on key areas of policy; 5.4.2 promoting understanding of the unique role of the Dietitian, especially in

developing countries; 5.4.3 the analysis of policy proposals and their implications for Dieticians, in

order to influence the Commonwealth Health Ministers' meetings, thereby promoting a significant Dietitian contribution to Commonwealth health policy.

5.5 To seek and to receive appropriate grants, subscriptions, donations and gifts for

the benefit of dietetic profession and dieticians within the countries of the Commonwealth by:

5.5.1 setting subscription rates for member associations, which help the

CDNA to carry out its objectives; 5.5.2 actively seeking funding from other sources.

ARTICLE 6 - MEMBERSHIP 6.1 Full membership shall be open to the national/regional dietetic association in

each Commonwealth country/region. Such an association shall have objectives, which are in accord with those of the CDNA. Where more than one association exists the Board shall have absolute discretion in determining which association is to be accepted into full membership.

6.2 Affiliate membership, with no voting rights, may be granted to any group who

satisfy the Board that, in a Commonwealth country where no national dietetic association exists, they are working towards establishing an association whose objectives would accord with those of the CDNA

6.3 Associate membership, with no voting rights, may be granted to any group,

institution, inter-government agency, association or academic institute who satisfy the Board that their work compliments the objects of CDNA.

6.4 Applications for full membership shall be considered by the Board, which shall

be authorised to accept or reject applications from associations on the basis of the following criteria:

6.4.1 the association's constitution, regulations or rules should define objectives, which are not in conflict with the purpose and objectives of the CDNA as set out in Articles 3 and 4;

6.4.2 if the association is a section of another health workers organisation, the

section should have its own separate regulations, which are not in

- 6 -

conflict with the purpose and objectives of the CDNA as set out in Articles 3 and 4;

6.4.3 the association should be controlled by Dieticians/Nutritionists gaining

its authority from its members and speak on dietetic matters;

6.3.4 the association should be the most representative of Dieticians/Nutritionists in the country/region.

6.5 Any association wishing to withdraw from membership shall give twelve months

notice in writing to the CDNA Secretariat. 6.5 In the event of any country leaving the Commonwealth the member association

in that country shall not be automatically deemed to have withdrawn from the CDNA. The matter shall determine the matter on its own merits.

ARTICLE 7 - GOVERNING BODY 7.1 There are hereby established the governing bodies of the Association (a) Congress (b) The Board 7.2 In performance of their functions, the organs stated in 7.1 of this paragraph shall

be assisted by the following organ: (a) The Secretariat

ARTICLE 8 – COMPOSITION OF CONGRESS 8.1 The Congress of the CDNA shall consist of the Heads of Regional Associations,

on each from the following regions:

- Americas - Caribbean - East/Central/Southern Africa - Europe - Pacific - South Asia - West Africa 8.2 Any Head of region may designate an appropriate representative to represent her

or him at any meeting of Congress.

ARTICLE 9 – FUNCTIONS AND POWERS OF CONGRESS

- 7 -

9.1 Congress is the supreme Organ of the Association. 9.2 Congress shall determine and provide policy direction for the Association. 9.3 Congress may issue policy directives of a general or special character to the

organs of the Association concerning the policies to be pursued for the achievement of the objectives of the Association and effect shall be given to such directives.

9.4 Notwithstanding any other provision in this Constitution, Congress may consider

and resolve disputes between members. 9.5 Congress shall appoint the Board of the CDNA on a rotating basis. 9.6 Subject to the provisions of this Article, the Congress shall regulate its own

procedure and may decide to admit at its deliberations as observer representatives outside of the Association.

ARTICLE 10 - MEETINGS OF THE CONGRESS 10.1 Congress shall meet once every four years. 10.2 An emergency meeting of Congress can be called if the importance of the

business so warrants. At three quarter of the members of Congress must agree before an emergency meeting can be called.

10.3 Agenda items should be submitted by members of Congress to the Executive

Director no less than two months prior to Congress. The Executive Director shall send out the final agenda to members of Congress no less than two weeks prior to the meeting of Congress. The Executive Director shall keep a record of this despatch and, as long as these conditions are met, failure to receive such notice shall not invalidate the meeting or any of the proceedings.

10.4 Funding shall be sought to facilitate the attendance of members of Congress at

the meeting of Congress by the Secretariat. 10.5 A quorum for Congress meetings shall be four out of seven elected members. All

decisions shall be taken by a simple majority. In the event of an equal number of votes the Chair shall have a casting vote.

ARTICLE 11 – COMPOSITION OF THE BOARD 11.1 The Board of the CDNA shall consist of the five regional members from the

regions outlined in 8.1 of this constitution. 11.2 Directors will be elected on a four year rotational basis from each regional

association outlined in Article 8.1.

- 8 -

11.3 At the first meeting of the Board, the Board shall appoint its President and Vice President who shall serve for a period of four years.

11.4 A casual vacancy is to be filled by election at a general meeting of the Region

which originally elected the Director vacating office. A Director elected to fill a casual vacancy will hold office until the end of the term of the originally elected Director who vacated office. This Clause does not apply to the President.

11.5 If a Region cannot fill a casual vacancy after one attempt the Board will appoint a

Director. The Director appointed to fill the casual vacancy will hold office until the end of the term of the originally elected Director who vacated office.

11.6 The region which has elected one of its numbers to hold office as a member of the

Board, may, by ordinary resolution at a Regional general meeting, revoke that election and elect another of its Members with Dietetic Qualifications to hold office as a member of the Board.

11.7 If the President dies, is removed from office or is deemed to have vacated the

office, the Vice-President shall become the President but shall hold office only until the next general assembly meeting is concluded. If there is no Vice-President at the death or removal from office of the President or at the time the President is deemed to have vacated office, the Board shall elect one of its members as President. Such person shall hold office only until the next bi-annual general meeting is concluded.

11.8 The Association in general meeting may by ordinary resolution (of which

special notice has been given) remove any member of the Board from office. If that member was originally elected to office by a Region that Region may by ordinary resolution at a Regional general meeting elect another of its Members with Dietetic Qualifications to hold office as a member of the Board until the end of the term of the originally elected Director who vacated office.

11.9 A member of the Board shall be deemed to have vacated their office if the

member: (a) ceases to be a member of the Board by virtue of the Law;

(b) becomes bankrupt or insolvent or makes any arrangements with creditors generally;

(c) becomes prohibited from being a member of the Board by reason of any order made under the Law;

(d) becomes a person whose person or estate is liable to be dealt with under any law relating to mental health;

(e) resigns their office by notice in writing to the Board;

(f) is absent without permission of the Board from two consecutive meetings;

(g) ceases to be a Member; or

- 9 -

(h) becomes an employee of the Association.

ARTICLE 12 - FUNCTIONS AND POWERS OF THE BOARD 12.1 The Board, in accordance with the policy directives established by Congress,

have primary responsibility for the development of a strategic plan. 12.2 In pursuance of 11.1 in this Article, the Board shall:

(a) approve the programmes of the Association on the basis, inter alia, of proposals emanating from the Secretariat.

12.3 Without prejudice to the generality of the foregoing provisions, the Board shall:

(a) examine and approve the Association’s budget (b) establish a system of regional and national consulations in order

to enhance decision making and implementation orocesses of the Association.

(c) receive and consider allegations of breaches of obligations arising

under this constitution, including disputes between members.

(d) on the instructions of Congress, issue directives to the Regional Associations and the Secretariat aimed at ensuring the timely implementation of Congress decisions.

(e) undertake additional functions remitted to it by Congress arising

under this constitution.

ARTICLE 13 - MEETINGS OF THE BOARD 13.1 The Board shall meet at least once every two years. Whenever possible, board

meetings and full meetings shall be held every two years at the time of meetings of the International Council of Dietetic Associations. In the interim, any business shall normally be transacted by correspondence.

13.2 An emergency meeting of the Board can be called in between ordinary meetings

if the importance of the business so warrants. At least three members of the Board, one of whom must be the President, must agree before an emergency meeting can be called.

13.3 Agenda items should be submitted by Board members to the Executive Director

no less than two months prior to a Board meeting. The Executive Director shall send out the final agenda to Board members no less than two weeks prior to the Board meeting. The Executive Director shall keep a record of this despatch and, as long as these conditions are met, failure to receive such notice shall not invalidate the meeting or any of the proceedings.

- 10 -

13.4 Funding shall be sought to facilitate the attendance of Board members at the

Board meetings by the Secretariat. 13.5 A quorum for Board meetings shall be three out of five elected members. All

decisions shall be taken by a simple majority. In the event of an equal number of votes the Chair shall have a casting vote.

13.6 The President shall take the Chair at all meetings of the Board except that, in

the unavoidable absence of the President, the Vice President shall act as Chair. In the event of the absence of both the President and Vice President the Board shall elect a Chair from among those Board members present at the time.

13.7 The Executive Director shall distribute Board minutes, after approval by the

President, within two months of the Board Meeting. 13.8 Agenda items for the full meetings of the CDNA should be submitted by any

association in membership, to the Executive Director no less than three months prior to the meeting and the Executive Director should send out the final agenda no less than two weeks prior to the full meeting. The Executive Director shall keep a record of this despatch and, as long as these conditions are met, failure to receive such notice shall not invalidate the meeting or any of the proceedings.

13.9 Unless otherwise specified in this Constitution, all decisions shall be taken by a

simple majority. In the event of an equal number of votes the Chair shall have a casting vote.

ARTICLE 14 - OFFICERS OF THE ASSOCIATION 14.1 The President: 14.1.1 shall be elected by the Board at the first Board meeting after the

general assembly meeting of the associations. 14.1.2 shall serve for a four year period and shall be eligible for re-election for

the same office for a second term only. 14.1.3 shall act as Chair of the Board and any full meetings of the CDNA. 14.2 The Vice President: 14.2.1 shall be elected by the Board at the first Board meeting after the

general assembly meeting of the associations 14.2.2 shall serve for a period of four years and shall be eligible for re-

election to the same office for a second term only. 14.2.3 in the absence of the President, the Vice President shall act as Chair of

the Board and any full meetings of the CDNA.

- 11 -

14.3 The Executive Director

14.3.1 shall be the Chief Executive Officer of the Association and shall, in

accordance with the financial and other regulations, perform the following functions:

(a) represent the Association (b) be responsible for the hiring and supervision of staff of

the Association. (c) develop, as mandated, decisions of the Board into

implementable proposals (d) identify and mobilise, as required, external resources to

implement decisions of the Board (e) undertake studies and develop proposals for

implementation (f) implement, as mandated, decisions at the regional level,

decisions which do not require Board approval (g) monitor and report on, as mandated, implementation of

Association decisions. (h) initiate or develop proposals for consideration and

decision by the Board and or Congress in order to achieve Association objectives, and

(i) Such other functions assigned by the Congress or Board of the Association.

14.3.2 Shall be appointed by the Centre for Food and Nutrition (CFAN)

14.3.3 Shall be a salaried officer of the Association

ARTICLE 15 - SECRETARIAT 15.1 The Secretariat shall be the principal administrative organ of the Association.

The headquarters of the Secretariat shall be The Centre for Food and Nutrition (CFAN)

15.2 The Secretariat shall comprise an Executive Director and such staff as is

required. 15.3 The Executive Director shall, in addition to the powers conferred by or under this

constitution, be the Chief Executive Officer of the Association and shall act in that capacity at all meetings of Congress and the Board. The Executive Director shall make an annual report to the Board on the work of the Association.

15.4 In the performance of their duties the Executive Director and staff shall seek nor

receive instructions from members of the Association or Regional Associations or from any other authority external to the Association. They shall refrain from

- 12 -

any action which might reflect adversely on their position as officials of the Association and shall be responsible only to the Association.

15.5 Members of the Association as well as Regional Associations undertake to

respect the exclusively international character of the responsibility of the Executive Director and staff and shall not seek to influence them in discharging their responsibilities.

15.6 Congress shall approve staff regulations governing the operations of the

Secretariat 15.7 The Board shall approve the financial regulations governing the operations of the

Secretariat 15.8 The Executive Director shall establish Staff Rules for the operation of the

Secretariat.

ARTICLE 16 – FUNCTION OF THE SECRETARIAT 16.1 The functions of the CDNA secretariat shall be:

(a) To service meetings of the Association, including regional meetings, and to disseminate the reports and recommendations of the meetings;

(b) To initiate, organize and conduct studies on issues for the achievement of

the objectives of the Community; (c) To provide, on request, services to the Members of the Association on

matters relating to the achievement of it objectives; (d) To collect, store and disseminate to the Members of the Association

information relevant for the achievement of its objectives; (e) To assists the various organs of the Association in the development and

implementation of proposals and programmes for the achievement of objectives of the Association.

(f) To promote the establishment and maintenance of CDNA networks of

stakeholders at the national and regional levels within the Commonwealth; (g) To undertake the necessary fundraising, logistical arrangements for the

Association; including facilitating the preparation of draft budgets for the Association, as well as all financial, monitoring and evaluating, and audit reports of the Association.

(h) To establish and maintain an information clearing-house in order to

provide services such as advice to members and countries on the implementation of various strategic nutrition and dietetic approaches,

- 13 -

referral of requests for information to relevant sources, and facilitation of access to expertise in support of specific national/regional actions;

(i) Establish a mechanism, coordinated with the information clearing-house

function, for the exchange of relevant scientific and technical information, including through links to established forums for such exchanges, newsletters and other publications;

(j) To ensure that recommendations from the Association are conveyed to

relevant global and regional organizations and institutions; (k) To provide, request, technical assistance to national authorities to facilitate

implementation of Association decisions (l) To promote the exchange of relevant scientific and technical information; (m) To conduct, as mandated, fact-finding assignments for Members and

Regional Associations; (l) Develop the capacity to advise member on the full range of available

sources of funding and counsel members in the preparation of project proposals;

ARTICLE 17 - REGIONAL COUNCILS 17.1 Regional Councils shall comprise the grouping of member associations in that

region. 17.2 Each Region of the CDNA is entitled to establish a Regional council,

composed of representatives of each full member association in the Region. The purpose of the council will be to determine activities and initiate projects within the Region.

17.3 Regional councils shall report on their activities, through their Board member,

to the Secretariat. 17.4 Regional councils are encouraged to cooperate with other health disciplines in

the development of health care programmes. 17.5 Subject to the provisions of this Article, the Regional Councils shall regulate its

own procedure and may decide to admit at its deliberations as observer representatives outside of the Region.

ARTICLE 18 – THE CONSULTATIVE PROCESS 18.1 In order to enhance the decision – making process in the Association, the

Board, assisted by the Executive Director, shall establish and maintain an efficient system of consultation at the national and regional level.

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18.2 The system of consultation shall be structured to ensure that determinations of

the Board are adequately informed by relevant inputs and are reinforced by consultations undertaken at successively lower levels of the decision making process.

ARTICLE 19 – COMMON VOTING PROCEDURE IN ORGANS AND BODIES OF THE ASSOCIATION

19.1 Subject to paragraph 20.2 of this Article, each Region represented in Congress

and on the Board shall have one vote. A simple majority of members shall constitute quorum.

19.2 Regions, whose contributions to the regular budget of the Community are in

arrears for more than two years, shall not have the right to vote except on matters specific to that region, but may otherwise participate in the deliberation of the Bodies of the Association. Congress may, nevertheless, permit such Regions to vote if it is satisfied that the failure to contribute is due to conditions beyond their control.

19.3 Decisions on procedural issues in Organs of the Association shall be reached by

simple majority of the Members of the particular Organs. 19.4 Subject to the agreement of Congress, a member association may opt out of

obligations arising from the decisions of competent Organs of the Association provided that the fundamental objectives of the Association, as laid down in this Constitution, are not prejudiced thereby.

19.5 Prior to taking decisions on any issue to be determined by Governing Bodies of

the Association, the Secretariat shall bring to the attention of the meeting the financial implications of such decision and any other matter which may be relevant.

19.6 Subject to the relevant provision of this Constitution, Organs of the Association

shall establish their rules of procedure.

ARTICLE 20 –VOTING IN CONGRESS 20.1 Save as otherwise provided in this Constitution and subject to paragraph 2 of this

Article and the relevant provisions in Article 19, the Congress shall take decisions by an affirmative vote of all its members and such decisions shall be binding

20.2 For the purpose of this Article abstentions shall not be construed as impairing the

validity of decisions of the Congress provided that the three-quarter of the regions comprising Congress are gathered, vote in favour of such decisions.

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20.3 Omissions by a member region to participate in the vote shall be deemed abstention within the meaning of 20.2 of this Article.

20.4 Subject to the relevant provisions of this constitution, Congress shall establish

their rules of procedure.

ARTICLE 21 –VOTING ON THE BOARD 21.1 Each Regional Member represented on the Board shall have one vote. A simple

majority shall constitute a quorum. 21.2 Decisions on procedural issues of the Board shall be reached by simple majority

of the Board. 21.3 Subject to the agreement of the Board, Members of the Association may opt out

at obligations arising from the decisions of the Board provided that the fundamental objectives of the Association, as laid down in this constitution, are not prejudiced thereby.

21.4 Prior to taking decisions on any issue falling to be determined by the Board, the

Secretariat shall bring to the attention of the meeting the financial implications such decisions and any other matters which may be relevant.

21.5 Subject to the relevant provisions of this constitution, the Board shall establish

their rules of procedure.

ARTICLE 22 – VOTING BY PROXY 22.1 Votes may be given personally or in the event of a poll either personally or by

proxy. The proxy voting form, which shall be valid only for the meeting specified therein, shall be signed and deposited at the office of the Secretariat not less than 15 full days before the time for holding the meeting at which the person named proposes to vote. An official form of proxy will be supplied and that form must be used.

ARTICLE 23 - SUBSCRIPTIONS AND OTHER INCOME 23.1 Full member associations shall pay membership subscriptions, on an annual

basis, of an amount as shall, from time to time, be reviewed and recommended by the Board, following membership consultation.

23.2 Affiliate members shall pay reduced membership subscriptions, on an annual

basis, of an amount as shall from time to time be reviewed and recommended by the Board.

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23.3 Associate members shall pay reduced membership subscriptions, on an annual

basis, of an amount as shall from time to time be reviewed and recommended by the Board.

23.4 The CDNA shall seek to attract funds from the Commonwealth Foundation and

other sources for the maintenance of its work and for the establishment of scholarships, the furtherance of projects, and attendance at workshops and meetings.

23.5 The Executive Director shall be responsible for fund raising for the Association. 23.6 The Board shall be informed of the annual budget of the CDNA, which shall be

prepared by the accounting officer of the Association, the Executive Director. 23.7 The accounts of the CDNA shall be the subject of annual audit by a professional

auditor appointed by the Board. The accounts shall be presented to the Board and full meetings for approval.

ARTICLE 24 - AMENDMENTS TO THE CONSTITUTION 24.1 The Board may make alterations, amendments or additions to this Constitution.

Agreement to effect such changes shall be confirmed by a majority of not less than two-thirds of the Regional Association present and voting at a Congress meeting, with provision for a proxy voting system for those unable to attend.

24.2 Proposals for changes to this constitution shall be put in writing by any full

member association, to a meeting of Congress and considered at that time. Such proposals must be seconded by another full member association. Agreement to effect such changes shall be in accordance with the procedure set out in Article 24.1.

ARTICLE 25 - INTERPRETATION 25.1 Any question of interpretation of any clause in this Constitution shall be decided

by the Board based on legal advice by the Secretariat.

ARTICLE 26 - DISSOLUTION 26.1 A resolution for the dissolution of the CDNA must be carried by a two thirds

majority of the CDNA member associations, having been put to a meeting of Congress and decided at that time, with provision for a proxy voting system for those unable to attend. If carried the CDNA shall cease to exist within one year.

26.2 Any assets held by the CDNA at the time of its dissolution after all liabilities

have been met shall be disposed of in the following manner:

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26.2.1 where these assets may have derived from grants made by the

Commonwealth Foundation, they shall be returned to the Foundation.

26.2.2 any remaining assets shall be transferred to an association or other

body whose sphere of activity is within the Commonwealth and whose aims and objectives accord with those of the CDNA before its dissolution.

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