Audit no. P/24/082/LRZ
The NIK audit shows that the promotion of healthy lifestyle, including proper diet, should result from coordinated and wide-scale efforts. NIK also highlights the necessity of greater care in the quality of meals offered to children. They should not only be balanced and tasty but also aesthetically served to encourage the youngest ones to eat and help shape healthy eating habits. It is also important to educate people on consequences of inadequate nutrition which often leads to obesity and also to promote measures to reduce food waste. In many European countries, such as Sweden, Norway, Finland, Denmark, France, Spain and Italy, local and seasonal products are used as part of institutional nutrition for children.
Poland still lacks a full-fledged, nationwide plan for overweight and obesity prevention, although such institutions as NIK have repeatedly underlined an urgent need for its implementation. Previous audits of NIK on obesity treatment and prevention in children, youth and adults indicated that despite system solutions, their efficiency and implementation are often insufficient.
The audit covered: the Ministry of Health, the Ministry of National Education, the Chief Sanitary Inspectorate, the National Institute of Public Health, the National Research Institute, nurseries, kindergartens, school and kindergarten complexes, primary and secondary schools.
Key audit findings
In the audited period, relevant ministers did recognise needs related to healthy nutrition but they failed to solve the existing problems in a complex manner, e.g. by shaping a coherent public policy. They also did not ensure adequate financing mechanisms and failed to properly supervise this area.
Both the Minister of Health and the Minister of Education took legislative measures to implement healthy nutrition in Poland. The Minister of Health e.g. developed regulations limiting the consumption of drinks containing sweeteners, caffeine or taurine. Besides, since September 2022 primary schools have been obliged to offer hot meals to children. The Minister of Education failed to verify, though, how educational facilities implemented laws on healthy nutrition, food waste prevention and provision of hot meals to students. At the same time, the Minister of Health did not include comprehensive measures forming a consistent state policy on healthy nutrition in the draft of the National Health Programme for 2021–2025.
The Minister of Health improperly supervised the Chief Sanitary Inspector in terms of assessing education and health activity carried out by schools and other educational facilities, higher schools and the mass media. This posed a risk of spreading false information related to nutrition, especially in Internet and social media.
In the audited period, Minister of Health earmarked nearly PLN 21 million in total for activities promoting and implementing healthy nutrition as part of the National Health Programmes.
Quality of meals for children
The obligation to provide meals to children applies to nurseries, kindergartens and primary schools. Not all of the audited facilities properly planned or organised issues related to preparing and serving hot meals to children staying there. Out of 25 audited schools and kindergartens, hot meals were served in 21 of them. In most cases the facilities prepared and served them in their own kitchen and canteen (13 facilities). In four others catering services were provided and in yet two others two kitchen services were rendered by other entities being part of the education system. In 18 of 21 audited facilities, where children were offered hot meals, information was gathered about their special nutrition requirements (usually due to food intolerances). In most cases those students received meals consistent with such requirements.
In the audited primary schools, the percentage of children interested in school meals ranged from 12% to 78%. In principle, the meal rate was agreed upon with the management authority. It varied and was increased in the audited period. It ranged from PLN 3 for lunch in a primary school to PLN 21 for all-day meals in a nursery. In general, low food rates did not facilitate sourcing products and preparing quality school meals.
In the facilities which had their own kitchens, meals were usually prepared from products delivered by external providers. In case of the facilities using catering services, only two in eight facilities referred to the quality of meals in the agreements as well as penalties and withdrawal from the agreement in case of default. Six facilities did not fully protect their interests in this area. According to NIK the agreements with providers should secure 100% of the facilities’ interests and hence provide adequate nutrition to children.
Of 21 audited entities in which hot meals were served only in three a dietician was hired who was mainly responsible for arranging menus. In two others services of an external dietician or a nutrition-educated person were used. In other entities the person responsible for creating menus usually was a school nutrition specialist, less often a cook. Persons preparing meals in 14 facilities equipped with a kitchen often had a degree not related to nutrition.
In 20 facilities a 10-days menu did not meet specified requirements. None of five audited nurseries met the guidelines set out in the Recommendations for little children’s nutrition. Fruits and vegetables were served in small quantities or not at all while portions of milk or milk products were too small. At the same time, the servings of bread, potatoes, meat and deli meat were too big. Fat and high-processed meat products (e.g. sausages), sweetened milk products and sweet drinks were given to children.
In each of 21 facilities, which had the menu controlled, information on the menu was provided to children and their parents. In as many as eight, though, discrepancies were found between planned versus served meals. Additionally, in three facilities, despite obligation, information about allergens was not provided.
Older children also could buy snacks and drinks in school shops run in every third school or vending machines located in 12 facilities. In half of the audited schools, food sellers were not obliged to make sure the products on offer complied with the requirements set out in the Ordinance on institutional nutrition for children and youth. Children had the opportunity to buy products which did not meet specific requirements as there were no inspections and the supervision of the sale of food products in schools was insufficient. Inspections carried out by the State Sanitary Inspectorate in those schools at NIK’s request revealed irregularities in the assortment available for students. First of all, the products contained too much sugar, fat and salt. Only in five schools students were given access to food which complied with the Ordinance requirements.
Unlimited access to drinking water was provided in all entities (except one). In every sixth audited facility (those were secondary schools) water was available and fit to drink but only from water taps in toilets. Besides, students were not informed if water was fit to drink or not.
A common problem in nurseries was the organisation of meals not adjusted to the model specified in the Recommendations for little children’s nutrition. In half of the audited entities the food serving forms did not meet the nutrition guidelines and the time or place for meal consumption were insufficient for all students using school meals. Not all facilities provided proper sanitation and hygiene conditions. The irregularities found by the State Sanitary Inspectorate were mainly related to rooms where meals were prepared and stored. Issues included the lack of proper ventilation, no protection against insects, equipment corrosion and improper storage of products.
Nurseries, kindergartens and primary schools running their own kitchen took efforts to reduce food waste. None of the audited facilities kept waste statistics, though. When meals were delivered by catering companies, the interest in the quantities of wasted food was even lower and food waste prevention principles were not widely promoted among children.
Health education was formally in place in the audited facilities but its level and effectiveness differed. Diagnoses of needs to implement healthy nutrition were superficial, often based on talks with parents and observation of children, without any formal documentation.
NIK notices a range of good practices in the audited area. At the same time, NIK underlines that they were mainly of local nature and chiefly based on individual initiatives. That is why, the system of measures supporting healthy nutrition still requires improvements in terms of its effectiveness, consistency and monitoring, despite the legislative, educational and promotion activities. More detailed and measurable objectives have to be set, and also coordination of activities at the national and local levels needs to be improved. Also, effective evaluation tools should be implemented to assess the real impact of activities taken on bettering the citizens’ eating habits.
Recommendations
To the Minister of Health, Minister of Education, Minister of Family, Labour and Social Policy to:
- develop and execute a full-fledged action plan to promote and implement healthy nutrition, and in particular to include adequate indicators there, enabling their reliable and ongoing monitoring and evaluation;
- define goals for tasks carried out as part of national health programmes, serving education aimed at promoting and implementing healthy nutrition and monitoring them by means of planned indicators in a way to focus activities on the achievement of effects planned;
- introduce minimal rates for meals served in nurseries, kindergartens and schools;
- take efforts to provide free and unlimited access to drinking water in nurseries, kindergartens and schools in compliance with sanitary conditions for its consumption.
To the Minister of Health to:
- ensure effective supervision over the implementation of tasks related to healthy nutrition, as set out in the Act on the State Sanitary Inspectorate, performed by the Chief Sanitary Inspector;
- complete works on the ordinance defining requirements for institutional nutrition, including standardised nutrition in hospitals by defining nutrition norms for patients, considering dietary needs in various conditions and supporting healthy nutrition, in line with the National Health Programme for 2021–2025 and the National Oncology Strategy for 2020–2030.
To the Minister of Education to:
take legislative measures to further specify the Education Law Act to eliminate unequal treatment of students eating school meals in terms of fees paid.
To the Chief Sanitary Inspector to:
- plan education and health activity conducted on internet websites and in social media to specify objectives and measurable criteria to enable evaluation,
- develop measurable criteria to evaluate the performance level of the objectives of programmes: “Keep fit!” and “Where do eco-products come from?” and evaluate the effects achieved,
- plan activities, in particular in form of programmes, to shape proper health attitudes and behaviours in terms of healthy nutrition, addressed to adults, including seniors.
To directors of nurseries, kindergartens and schools to:
- ensure nutrition organisation in line with existing needs, in compliance with requirements defined by the law and internal regulations,
- include clauses in agreements guaranteeing the provision of good-quality ready-to-eat meals and products, as well as to make sure school shops and vending machines offer only products consistent with the requirements of the Ordinance on institutional nutrition for children and youth,
- make sure the portion sizes, the energy value of meals served, as well as the number of product groups comply with the demand for relevant age groups defined in the Nutrition norms and indicated in the Recommendations for little children’s nutrition or defined in the Recommendations for schools and kindergartens,
- properly inform children and their parents about the ingredients of meals on the menu, including allergens,
- monitor the quantity of wasted food in order to implement changes to minimise food waste.
