School Lunch Programs in Rural China

Background and purpose: “Zero Hunger” is one of the 17 sustainable development goals set by United Nation to succeed the Millennium Development Goals (MDGs) to further improve the well-being of people. In order to improve the nutrition intake of rural students, the central government of China started the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) in 2011, which gave 3 yuan per student to subsidize their school lunch and in 2014, raised to 4 yuan per student. NIPRCES is one of the key strategies Chinese government uses to achieve the SDGs. Seven years have passed since the first implementation of the plan. However, the impact of this program has not been systematically examined. This paper reviews all the evaluations conducted on the NIPRCES in China and compared the NIPRCES with other nationwide school lunch programs in developing countries.

Methods: This review covers studies published in both Chinese and English in peer-reviewed journals. Therefore, the major Chinese and English electronic databases were included: Chinese National Knowledge Infrastructure, Weipu database, Wanfang Database, Social Proquest, PubMed Central, Science Direct and Scopus. Government websites and major research centers in the US with a strong focus on rural China were also searched for grey literature and evaluation reports. The inclusion criteria were (a) clear statement that the NIPRCES has been implemented for at least one year; (b) evaluation of at least one of the nutrition-related outcomes of students: anthropometrics, dietary intake, or micronutrients status; and (c) inclusion of reliable data on the outcomes they measured.  

Results: Only 14 studies were found which reported the nutritional outcomes of students participate in the NIPRCES.  NIPRCES tries to provide students with sufficient nutrients, but the diets provided by the NIPRCES do not meet the basic requirements of a balanced diet, especially the requirement for micronutrients. Majority of the studies found the improvement of nutritional status among participants, but some studies found the existences of the dual burden of malnutrition among the students. NIPRCES also faced similar problems as other nationwide school lunch programs face: lacking professional staff and management. Teachers often take the roles in managing the programs, which results in increasing the workloads of teachers and interfering with the teaching quality.

Conclusions and implications: NIPRCES should be designed to tackle the double burden of malnutrition. Preventing increase of overweight and obesity does not contradict the goal of reducing the rate of underweight.  The keys are balanced dietary diversity and better management processes. Schools need to increase the frequency of providing dairy products and fruits.  NIPRCES can learn from dietary planning and management experiences from nationwide school lunch program in Japan. Japan has the one of the lowest obesity rates among all developed countries. Management is also a pivotal element in ensuring the sufficient dietary intake of students. Encourage participation of communities and families in monitoring school lunch program can further ensure the quality of diets and dietary diversity of NIPRCES.