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Agriculture, Nutrition, Health
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AGRICULTURE, NUTRITION, HEALTH: HOW TO BRING MULTIPLE SECTORS TO WORK ON NUTRITIONAL GOALS
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We know that bio-fortification works. What is needed now is to build greater demand for bio-fortified crops within national nutrition programs. This will require addressing demand side constraints and policies that encourage the private sector to incorporate these nutritious crops in processed foods. —Dr. Akinwumi A. Adesina, President of the African Development Bank, 2015. Address to the 3rd Annual Meeting of the Global Panel on Agriculture and Food Systems for Nutrition
INTRODUCTION The linkages between agriculture, nutrition, and health have been on the development agenda recently, although how agriculture can contribute to nutritional outcomes is not new in development thinking (Pinstrup-Andersen, 2013). For example, the goal of the green revolution related to research and technology development, particularly in Asia, was to address the challenges of hunger many developing countries faced 50 years ago. This is a good example of addressing food insecurity and nutrition challenges through agricultural and crop improvements. While the green revolution technologies focused on macronutrients, such as calories and protein, the challenge of micronutrient deficiency or hidden hunger was grossly neglected by the green revolution approach to nutrition. This was one of the major criticisms of the introduction of high yielding rice and wheat crop varieties, which replaced other crops which had more micronutrients and resulted in reduced crop diversity, leading to a monoculture of rice and wheat. To offset such unintended but negative consequences, scientists have embarked on setting priorities for crop improvements in international agricultural research, considering nutrition as one of its goals almost 40 years ago (Pinstrup-Andersen et al., 1976). Several attempts to understand the role of food system improvements for their contribution to better nutritional outcomes have been documented elsewhere (Kataki and Babu, 2002). Other efforts to identify opportunities for integrating nutritional goals in farming systems have also been studied: the introduction of animal production and livestock ownership (Leroy and Frangello, 2007; Azzari et al., 2015) in rice-aquaculture systems (Rajasekaran and Whiteford, 1993; Murshed-e-Jahan et al., 2010); in agroforestry systems (Babu and Rajasekaran, 1991a; Babu and Rhoe, 2002); in growing algal supplements through biotechnological advances (Babu and Rajasekaran, 1991b); and in identifying and promoting indigenous plant species (Babu, 2001). The nutritional implications of the commercialization of agriculture have also been studied (Kennedy and Von Braun, 1987; Martin and Von Braun, 1989). Nutrition Economics. DOI: http://dx.doi.org/10.1016/B978-0-12-800878-2.00015-3 © 2017 Elsevier Inc. All rights reserved.
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Leveraging agricultural systems to contribute to nutrition has gained revived interest in the wake of the food crisis of 2007 2 08 when the food supply at the global level failed to meet the demand for food, and food prices kept rising (Pinstrup-Andersen, 2013; Webb and Kennedy, 2014; McDermott et al., 2015). In addition to the nutritional contribution through increasing the nutrient content of crops, modifying agricultural systems is seen as a source of income and enhanced nutrition, and further, it can open up women’s time spent in agriculture through technological choices. Agriculture and food production systems also affect nutrition through nutritional enhancement throughout the value chains, particularly in the context of high value crops. These opportunities, however, involve several sectors working together to achieve the nutritional goals. In this chapter we look at selected agriculture-based intervention opportunities in the context of multi-sectoral nutrition policy making and programming. We review the literature on agriculture 2 nutrition health linkages for their nutritional implications, and to identify new research areas.
CONCEPTUAL FRAMEWORK The conceptual framework presented in Chapter 3, A Conceptual Framework for Investing in Nutrition: Issues, Challenges, and Analytical Approaches, could be reformulated to identify the theoretical pathways through which agricultural interventions can affect nutritional outcomes. Fig. 15.1 builds on an earlier effort to connect agricultural factors to the nutritional outcomes in the early 1990s (Babu and Mthindi, 1994), and on the recent development to highlight the role of women in nutrition, both as producers and providers (Herforth et al., 2012; Webb and Kennedy, 2014; Kadiyala et al., 2015). To begin with, the efficacy of agriculture-based interventions depend crucially on several broad contexts in which the agro 2 ecological system functions. For example, the political system and the policy making environment will determine if agriculture-based interventions could be implemented on a large scale. The agro 2 ecological conditions that allow growing of specific crops, and natural resource constraints such as the availability of land and water, can define the production systems and their ability to diversify and substitute one enterprise for the other. Related to this is the challenge of land use rights and water use rights of landless and share cropping households. Socioeconomic factors such as the dominance of large-scale production systems surrounded by smallholders and landless laborers producing cash crops for the markets may not allow production of nutritious crops or diversification (Coates and Galante, 2015). In the context of policy, the price policies for inputs, such as fertilizer, and outputs will help or restrict diversification to nutritious crops. For example, in the case of India, the minimum support price given to rice and wheat—a food security oriented policy objective—severely affects the farmers’ ability to diversify to other nutritious crops, such as fruit and vegetables (Jones and Moffit, 2015). Market and price uncertainty, thus, can play a significant role in crop diversification toward nutritional objectives. When the markets function well for fruit and vegetables, farmers tend to produce for the market and may earn a better income, but whether this enhanced income results in
Land, environment/natural resources/research policies/strategies
Strategies/exchange for food/cash
Livestock production
Local/private food traders Resource use land, irrigation
Household food security Crop/food production/ diversity
Selling markets/output prices wages
Household income
Input availability (fertilizer, seed pesticides use)
Food availability in markets
Employment offfarm/non-farm Labor/ mechanization availability
Household characteristics/ gender role/empowerment
Buying market/food prices
Food safety/ food quality
Women in agriculture/other employment
Processing/ storage technology
Strategies exchange/wages wage in kind
Women’s role/child care, household chore energy expenditure
Gender, woman in agriculture, nutrition education, safety net policies/strategies
Non-food expenditures
Intra household allocation of food
Diets/diversity
Health, water, sanitation, care
Nutritional health status/household/ mother/women/ children
Food security, nutrition, health outcomes
Economic/agricultural development policies/strategies
Technology availability/adoption
Market, institution, infrastructure, trade policies/strategies
Multi-sectoral nutrition coordination
FIGURE 15.1 Agriculture 2 nutrition pathways: entry points for policy interventions. Based on Babu, S.C., Mthindi, G.B., 1994. Household food security and nutrition monitoring: the Malawi approach to development planning and policy interventions. Food Policy 19 (3), 272 284; Webb and Kennedy (2014); Kadiyala et al. (2014).
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improved nutritional outcomes is unclear, although studies have shown positive influences of such income increases (Murshed-e-Jahan et al., 2010). At the community level, the availability of land and the method of distribution among households will decide the success of agriculture-based nutrition interventions. For example, in the context of several African countries, the customary land tenure system does not allow long-term investments, such as allocation of land to aquaculture production. Increasingly, agricultural sector growth is seen as one of the pathways to achieving the goal of sustainably reducing poverty, malnutrition, and hunger. Yet the goals of the agricultural sector, such as improving the productivity of food production systems, enabling better processing and storage at the local levels, identifying and expanding the markets both local and external to translate production into income, require investment in agricultural research (Webb, 2013), market infrastructure, and in local storage facilities. Recently, researchers have began to stress the development of value chains, and their potential for employment generation and poverty reduction (PandyaLorch et al., 2014). From the nutritional perspective, the nutritional status of household members, particularly vulnerable groups, such as the women and children, depends on their improved access to higher quantities and qualities of food (Ruiz et al., 2015). In this context, dietary diversity plays an important role. Yet the farming systems relying on monocultures, such as the production of cereal crops, do not help much in improving the quality of diets. In addition, the consumption and use of nonfood factors such as clean water, sanitation, primary health care, and child care contribute to nutritional status. Access to and consumption of all these nonfood items are also influenced by the availability of income and resources, as well as the time and energy spent in obtaining them. This is particularly true for farming systems where women spend most to their time in the production of food and provision of nutrition (Balagamwala et al., 2015). Improving the investment in health and nutrition services, use of locally produced foods in the provision of nutritious diets, and improving nutritional behavior through education are key for nutrition to be transformed through agricultural systems (Webb and Block, 2012; Olney et al., 2015; Saaka and Larbi, 2015). Recently, food safety issues have been identified as part of providing quality food and nutrition (Leroy and Sununtnasuk, 2015). In the case of Africa, exposure to contaminants such as aflatoxin has been shown to affect the growth of infants (Turner et al., 2007). The new paradigm that connects agriculture to nutrition focuses on the three major pathways— food production; income from agriculture and nonagricultural sources used to obtain diverse foods, along with nonfood inputs such as clean water, sanitation, and health care for all members of the family, particularly the women and children; and the gender role in agriculture, particularly how women are empowered to control their time and money given their varied roles as producer, processor, marketer, and provider of food and nutrition (McDermott et al., 2015). Understanding the interlinkages between the agricultural factors and interventions and nutritional objectives, as depicted in Fig. 15.1, can help in the formulation of programs that are nutrition sensitive and nutrition driven. We explore this in the context of a multi-sector approach to agriculture nutrition programming. The policies related to broad agricultural development strategies are given on the left side of the figure, as they influence several factors that affect agricultural production, marketing, and consumption. From these broad agricultural strategies, it is possible to specify key subsector policies that can influence key variables. For example, the top left corner of the figure identifies policies related to land, irrigation, natural resources such as soil and water, and
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issues related to the environment and climate change. These policies, along with policies related to labor and other inputs can influence cropping patterns and the crop livestock mix. Policies that are related to market, infrastructure, and output price are given at the right top corner of the figure. They help in translating agricultural production into a meaningful income for the farming families. Further, they enhance added-value through provision of market infrastructure, such as cold storage, for better processing and marketing of the commodities. They also help in improving the quality of food commodities through regulatory policies and procedures. Trade policies have a high level of influence in determining food availability at the macro level, and also help in managing the fluctuation of prices in the global markets. The safety net policies and policies that affect gender relations and the empowerment of women are given at the bottom left corner of the figure. Finally, the multi-sectoral nature of policy making and program implementation is given in the right bottom corner of the figure. Collectively, these policies help in influencing the causal factors responsible for attaining food security and nutrition at the household and individual level. Using the conceptual framework developed above, we describe several emerging approaches to addressing nutritional challenges throughout the agriculture nutrition pathways.
DIETARY DIVERSITY Dietary diversity has been recognized for its contribution to balanced nutrition for long time. Yet the initial efforts to reduce hunger and prevent famine in the context of agricultural research focused on the major cereal crops such as rice and wheat. While focused investments on increasing the productivity of these crops resulted in solving hunger problems, particularly in several countries in Asia, it also brought vast areas of land under these crops into the form of monocultures. It has also eroded biodiversity and taken land away from the crops that were contributing to diverse diets in these societies. While the real prices of the cereal crops such as rice and wheat have come down and made these more accessible to the poor, the cost of foods which contribute micronutrients have increased over the years, resulting in reduced dietary diversity. Given that more than two billion people are now afflicted with micronutrient malnutrition, there is a need to increase dietary diversity and the diversity of crops produced by rural households. Several pathways exists to increase dietary diversity. To begin with, broad agricultural policies should take into consideration the need for diversified diets and their contribution to nutritional well-being. Policies that encourage monocultures of rice and wheat do not help in this context. Focused efforts are then needed to increase the diversity of crops, livestock, small ruminants, and aquaculture at the community level. Increasing the production of high value crops can improve the diversity of production at the farm level, but this does not guarantee the consumption of diverse diets. This will further require nutrition extension and nutrition education to guide farming households to expand the number of enterprises that can contribute to the increased availability of balanced nutrition at the household level. The role of home gardens and growing fruit and vegetables also helps in increasing diversity. Nutrition interventions such as school feeding programs (discussed in chapter: Economics of School Nutrition: An Application of Regression Discontinuity) could be designed in such a way that the food given to the students is purchased locally, and contains diverse dietary nutrients. The
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social safety net programs such as conditional cash transfers can further help in increasing the diversity of diets by introducing locally produced foods (see chapter: Nutritional Implications of Social Protection: Application of Panel Data Method). Improving value chins for the high value commodities, and ensuring these are also consumed by the producing households, can increase the diversity of food consumption (we expand on this below). Increasing the nutrient content of the food already grown through bio-fortification can increase the diversity of the diets (see section BioFortification). Nutritional education is a key intervention for increasing dietary diversity and nutrient intake. As people are used to eating a small number of foods that are traditionally grown and eaten by them, breaking cultural eating patterns and taboos requires nutritional education that helps in the behavioral change toward eating a wide variety of foods. In this context, revising the university curriculum to prepare frontline professionals in agriculture, nutrition, and social work is important. The curriculum has to go from the traditional single discipline to multidisciplinary to cover nutrition, agriculture, social work, home economics, and health (Babu et al., 2016). Finally, improving dietary diversity requires context specific interventions that take into account specific nutritional challenges faced by individuals and groups in the population. Agricultural interventions then need to take nutritional outcomes as explicit goals. Designing cropping patterns and the choice of crop varieties and technologies could then be analyzed for their nutritional contributions (see chapter: Designing a Decentralized Food System to Meet Nutrition Needs: An Optimization Approach for an example of such an approach). Designing such food production systems involves strengthening the capacity of the extension personnel. They must be trained in the monitoring and evaluation of the interventions to see how dietary diversity improves and contributes to improved nutritional status. This includes thorough knowledge about the indicators of dietary diversity and household access to food (Hoddinott and Yohannes, 2002). Increasing dietary diversity at the community level involves a multi-sectoral approach. Involvement of professionals from nutrition, agricultural extension, primary health care officials, and social welfare is required. This continues to be a challenge in developing countries and we discuss this further later in this chapter.
BIO-FORTIFICATION Bouis (2016) summarizes the latest status of bio-fortification as an agriculture-based nutrition intervention. Since the beginning of the green revolution period the development community has been focused on the role of agriculture and food production in improving the nutritional status of the population, particularly in developing countries. The initial investment in productivity increasing technologies, such as high yielding varieties of seeds that were generated through rice and wheat breeding, have contributed to the Asian green revolution. The birth of the Consultative Group on International Agricultural Research (CGIAR), supported by the multilateral and bilateral donors, more than 40 years ago resulted in several commodity-specific breakthroughs using agriculture to increase macronutrients, such as calories and protein, at the household level. Research by internal agricultural research centers continues to address the productivity of crops, plant protection, soil and water
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management, and sustainability issues related to climate change and land and forest management. Yet, as we mentioned in Chapter 2, Global Nutrition Challenges and Targets: A Development and Policy Perspective, more than two billion people are suffering from one or more micronutrient deficiencies that are essential to maintain healthy living. This has led to the increased nutritional focus of the international agricultural research system. A good example is the program for bio-fortification of crops, particularly those consumed by the poor. Bio-fortification is a process of increasing the nutrient content of crops through breeding varieties that are rich in micronutrients (Bouis, 2016). The process involves identifying crop varieties that contain high quantities of specific nutrients and minerals such as vitamin A or iron and through breeding, develop these varieties of crops that are consumed by a large number of people. Such crops include sweet potato, maize, beans, and millet. Several steps are involved in making bio-fortified crops available to meet the nutritional needs of the population (Boy, 2016). Confirmation is required that the crops and varieties from the breeding program have a sufficient amount of nutrients before they can be field tested. The varieties are then tested for their ability to retain the nutrient quality after different food processing methods commonly used by households. The next stage is to check that the consumption of these biofortified crops could add nutritional value, and reduce specific nutrient gaps by at least 25 50%. Further, the efficacy of the introduction of bio-fortified crops are tested to check if the specific micronutrient status is improved under controlled conditions. The bio-fortified crops are also tested for their effectiveness when introduced at a larger scale through market channels. The overall challenge in the context of the agricultural research involved in producing bio-fortified crops is that the yield levels cannot be sacrificed in the process of increasing micronutrient content (Lividini and Fiedler, 2015). Bio-fortification has now become an accepted strategy for making agriculture nutrition-sensitive (Bouis, 2016). Initial evaluations have shown that bio-fortified crops do improve the nutritional intake of those who produce and consume them. Bio-fortified crops are grown in some 30 countries and production is expanding. Evaluation studies have shown the benefits of bio-fortified crops. Yet several policy and program challenges remain (Bouis, 2016). Investment is needed from the governments of the countries for agricultural research. Current efforts to breed crops for micronutrients depend on external assistance, and it is working. In most countries, however, the researchers do not have resources committed to continuing such research after the donor funded projects come to a close. The breeding programs have to maintain the germplasms and continue to invest in breeding crops to maintain the quality and vigor of the crop varieties. Such long-term commitment can only come from the mainstreaming of bio-fortification research in the national systems of agricultural research. The commercialization of the crops that have been bio-fortified requires regulatory mechanisms that can engage the private sector in the production and multiplication of seed varieties. The yield and micronutrient content tradeoff is still an issue at the farmer field level, particularly those who grow the crops for commercial purposes, as they do not get increased prices for growing bio-fortified crops. Understanding the pathways through which bio-fortication affects nutritional outcomes, and using this tool as one of several interventions to address nutritional challenges requires context specific and multidisciplinary approaches as discussed below (Bouis, 2016; http://www.securenutrition.org/blog-entry/financing-scale-nutritious-staple-foodcrops#sthash.k7g4VUSP.dpuf).
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NUTRITION VALUE CHAINS As shown in the conceptual framework developed at the beginning of this chapter, one way to connect agricultural interventions to the nutritional status of the population is to increase the nutritive value of the commodity production chains. A recent review by Gelli et al. (2015) summarizes several issues, constraints, and challenges toward making value chains nutrition sensitive. Highvalue commodities such as fruit and vegetables, dairy products, milk, meat, and fish products, when produced by farming communities can help improve the nutritional content of the food consumed by the rural population. Thus, the interventions that introduce organized production of highvalue commodities aim at the dual goals of increasing the value of agricultural production by farm households, and at the same time focus on improving the nutritional outcomes of the household members, particularly the women and children. Development of commodity value chains helps in producing nutrient rich commodities, making such commodities available to the households that produce them, and through the marketing process making them accessible to households that can afford to buy them in the markets. Policy makers and program managers, however, face several policy and institutional constraints in making the traditional markets work for high value nutrient-rich commodities. For example, high value commodity market chains, when developed to meet food safety standards through investments in cold storage and other infrastructure, normally take the commodities away from the production site to urban markets. Then the challenge becomes the one, as in any intervention that introduces commercialization of agriculture—incomes generated through which may or may not result in better nutritional outcomes. Very little is known about how the development of the market chains directly or indirectly contributes to improvements in nutritional outcomes. They are trying to figure out which channel generates sufficient income to effectively impact nutrition becomes a challenge. Such policy dilemmas are common with any intervention that commercializes agriculture. From the policy and program design perspective, it is important to understand how farming households make choices between selling what they produce to make additional income, and their consumption to increase nutritional status. Income from the sale of high value commodities is needed for nutrition and nonnutrition expenditures, but the choices households make toward nutrition could be influenced by the nutritional education and behavioral change education that will be essential to get the full benefit of using nutritive value chains as nutrition interventions.
CONNECTING THE SECTORS THROUGH MULTI-SECTOR PROGRAMMING Enhancing the role of agriculture to meet nutritional objectives is the first step in the inter-sectoral approach to nutritional programming. In addition to agriculture, other sectors such as health, water, sanitation, and social welfare need to play their respective roles to meet nutritional objectives. While some level of coordination is possible at the planning and policy making level, the delivery of services that have nutritional objectives at the last mile level continues to be a challenge. A major question to policy makers and nutrition program managers is how one increases the nutritional impact by working with a group of professionals coming together from multiple sectors. While the agriculture sector has more proximity to the nutritional outcomes through the production
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of nutritious food and integrating nutritional objectives in the food system, other sectors such as water, sanitation, health, gender, and social welfare face more challenges in similar integration processes. Innovations in the policy and planning of multi-sector nutritional planning helps in better integration of nutritional goals in various sectors, and keeps them accountable for the nutritional outcomes. Such a process starts with the highest level of policy processes. Directives from the president’s office or parliamentary committees help in expressing their commitment and guiding the sectoral ministries to work together. Cross-sectoral integration has to be further followed up by vertical integration of goals and objectives through coordination and management of programs at the subregional and local levels. In each of the sectors, the stakeholders and key actors and players need to be sensitized about the nutritional objectives and outcomes. Consultations are needed among these players within each of the sectors, as well as joint meetings that bring together all the sectors for planning, setting priorities, designing implementation plans, monitoring and evaluation, and resource allocation. The development partners in each country have a key role to bring global knowledge to the table, as well as supporting such multi-sectoral approaches. It should however, be noted that multi-sectoral approaches do not succeed without a high level of sensitization and ownership of the nutrition goals by each of the sectors. In addition, the consultative processes could consume a lot of time and may not be appreciated. The current governance structures may not fully support such multiple sectors coming together for the common cause. Even within ministries, the coordination of nutritional activities becomes difficult if appropriate leadership capacity does not exist at different levels. Major challenges also exist in terms of allocation of resources by each of the sectors and the donors who support specific nutrition interventions through a particular ministry. For example, when one development donor supports a school nutrition program through the ministry of education, and the other donor supports a similar school feeding program through the ministry of social welfare, the coordination of programs, monitoring of efforts, and resource mobilization for nutrition becomes challenging. Further, the accountability for the nutritional outcomes and monitoring and tracking the program benefits also becomes cumbersome for the nutritional policy makers at the national level (Table 15.1).
Table 15.1 Making Agriculture and Food Systems More Nutrition Sensitive Incorporate explicit nutrition objectives and indicators into their design, and track and mitigate potential harms, while seeking synergies with economic, social, and environmental objectives. This however, has to happen at national level policy making, providing a process for the sectoral ministries such as food, agriculture, rural development, gender, and social welfare to take nutrition seriously. Currently only a few leaders in a couple of ministries take such a multi-sectoral view about nutrition. Assess the context at the local level, to design appropriate activities to address the types and causes of malnutrition, including chronic or acute under-nutrition, vitamin and mineral deficiencies, and obesity and chronic disease. Context assessment can include potential food resources, agro-ecology, seasonality of production and income, access to productive resources such as land, market opportunities, and infrastructure, gender dynamics and roles, opportunities for collaboration with other sectors or programmes, and local priorities. The challenge, however, is that such decentralized capacity hardly exists, even in countries where adequate capacity could be available at the national level. Local level context specific nutrition interventions require basic analytical capacity for identifying interventions, testing them for potential benefits, and scaling them up within the same agro(Continued)
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Table 15.1 Making Agriculture and Food Systems More Nutrition Sensitive Continued ecological zones. Such capacity does not exist in most countries affected by nutritional challenges. Investment in such capacity would then be a first step. Target the vulnerable and improve equity through participation, access to resources, and decent employment. Vulnerable groups include smallholders, women, youth, the landless, urban dwellers, and the unemployed. Targeting in the context of agriculture and food systems where most of the farmers face similar challenges is easier said than done. Yet, identifying vulnerable groups and designing specific programs that would help them to effectively use agricultural programs to address nutrition would be helpful. Collaborate and coordinate with other sectors (health, environment, social protection, labor, water and sanitation, education, energy) and programmes, through joint strategies with common goals, to address concurrently the multiple underlying causes of malnutrition. See the section on multi-sectoral coordination above. Such coordination requires leadership at all levels. Nutritional leadership is the most severe constraint in developing countries. Further multi-sectoral coordination requires well-articulated national directives. Maintain or improve the natural resource base (water, soil, air, climate, bio-diversity), critical to the livelihoods and resilience of vulnerable farmers and to sustainable food and nutrition security for all. Manage water resources in particular to reduce vector-borne illness, and to ensure sustainable, safe household water sources. This again in itself is a multi-sectoral activity covering ministries of agriculture, land, water resources, health, and forestry to mention a few. Again this has to be coordinated at the landscape level (Babu and Reidhead, 2000). Empower women by ensuring access to productive resources, income opportunities, extension services and information, credit, labor and time-saving technologies (including energy and water services), and supporting their voice in household and farming decisions. Equitable opportunities to earn and learn should be compatible with safe pregnancy and young child feeding. Agricultural policies and programs could specifically target women, giving incentives to participate in nutrition education and technology adoption for diet diversification. Facilitate production diversification, and increase production of nutrient-dense crops and small-scale livestock (e.g., horticultural products, legumes, livestock, and fish at a small scale, under-utilized crops, and bio-fortified crops). Diversified production systems are important to vulnerable producers to enable resilience to climate and price shocks, more diverse food consumption, reduction of seasonal food and income fluctuations, and greater and more gender-equitable income generation. This will again require the subsectors within agriculture to come together and organize a concerted effort, keeping nutrition as a common goal. Departments of crops, livestock, horticulture, fisheries, marketing, irrigation, and mechanization for example, may function within agriculture, but coordination needs revamping approaches to research, extension, and technology dissemination. The Indian Extension model called the Agricultural Technology Management Agency is an effort in this direction (Babu et al., 2015). Improve processing, storage, and preservation to retain nutritional value, shelf-life, and food safety, to reduce seasonality of food insecurity and post-harvest losses, and to make healthy foods convenient to prepare. Marketing infrastructure needs to be improved at all levels. Improvements in cold storage through solar electricity have shown some promise. Serious efforts are needed in this area. Connecting villages, towns, and urban centers through vegetable marketing can reduce the need for storage greatly. Expand markets and market access for vulnerable groups, particularly for marketing nutritious foods or products vulnerable groups have a comparative advantage in producing. This can include innovative promotion (such as marketing based on nutrient content), value addition, access to price information, and farmer associations. This again requires capacity and infrastructure to collect, analyze, and disseminate real time marketing data for the producers and consumers to get connected and discover the right prices. Incorporate nutrition promotion and education around food and sustainable food systems that builds on existing local knowledge, attitudes, and practices. Nutrition knowledge can enhance the impact of production and income in rural households, especially important for women and young children, and can increase demand for nutritious foods in the general population. While mass education through television and radio are the best approaches, personal communication with farmers by the farm home assistant and nutrition extension workers cannot be underestimated. From: FAO, 2015. Key Recommendations for Improving Nutrition through Agriculture and Food Systems. (Comments in italics added by the authors). Available at: www.fao.org/3/a-i4922e.pdf.
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CONCLUSIONS As the challenge of malnutrition continues to daunt the development community, the solutions for sustainable nutrition outcomes have to come from multidisciplinary approaches to solving the nutrition problems at all levels. Increase in income can enhance nutrition through provision of diverse foods through markets and trade, depending on a country’s level of development. But interventions that facilitate the production of nutritious food and consumption require multiple sectors working together. Recently, the development community has begun its quest for sustainable diets that could be produced with minimal disturbance to the food production and natural resource systems that support it. Such an approach needs to recognize the role of various ecosystems, and protect biodiversity. The food consumed by societies needs to come from sources that do not unduly burden natural resources such as land, water, and landscapes. In addition, the resilience of the food production systems that are vulnerable to natural disasters and to the phenomenon of cultural change has to be proactively improved. Agricultural systems play a key role in the provision of sustainable diets.
EXERCISES 1. Consider your study country that you have been working on in several exercises. Develop an agriculture-based nutritional strategy for the country taking into account the policy system, development partners operation, their programs, and the key features that help the country to effectively use agriculture as a pathway to nutrition. 2. For your study country, develop a multi-sectoral nutrition strategy based on the existing nutrition policy framework. What linkages are currently missing in the design and implementation of a multi-sectoral nutrition strategy?
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We know that bio-fortification works. What is needed now is to build greater demand for bio-fortified crops within national nutrition programs. This will require addressing demand side constraints and policies that encourage the private sector to incorporate these nutritious crops in processed foods. —Dr. Akinwumi A. Adesina, President of the African Development Bank, 2015. Address to the 3rd Annual Meeting of the Global Panel on Agriculture and Food Systems for Nutrition
INTRODUCTION The linkages between agriculture, nutrition, and health have been on the development agenda recently, although how agriculture can contribute to nutritional outcomes is not new in development thinking (Pinstrup-Andersen, 2013). For example, the goal of the green revolution related to research and technology development, particularly in Asia, was to address the challenges of hunger many developing countries faced 50 years ago. This is a good example of addressing food insecurity and nutrition challenges through agricultural and crop improvements. While the green revolution technologies focused on macronutrients, such as calories and protein, the challenge of micronutrient deficiency or hidden hunger was grossly neglected by the green revolution approach to nutrition. This was one of the major criticisms of the introduction of high yielding rice and wheat crop varieties, which replaced other crops which had more micronutrients and resulted in reduced crop diversity, leading to a monoculture of rice and wheat. To offset such unintended but negative consequences, scientists have embarked on setting priorities for crop improvements in international agricultural research, considering nutrition as one of its goals almost 40 years ago (Pinstrup-Andersen et al., 1976). Several attempts to understand the role of food system improvements for their contribution to better nutritional outcomes have been documented elsewhere (Kataki and Babu, 2002). Other efforts to identify opportunities for integrating nutritional goals in farming systems have also been studied: the introduction of animal production and livestock ownership (Leroy and Frangello, 2007; Azzari et al., 2015) in rice-aquaculture systems (Rajasekaran and Whiteford, 1993; Murshed-e-Jahan et al., 2010); in agroforestry systems (Babu and Rajasekaran, 1991a; Babu and Rhoe, 2002); in growing algal supplements through biotechnological advances (Babu and Rajasekaran, 1991b); and in identifying and promoting indigenous plant species (Babu, 2001). The nutritional implications of the commercialization of agriculture have also been studied (Kennedy and Von Braun, 1987; Martin and Von Braun, 1989). Nutrition Economics. DOI: http://dx.doi.org/10.1016/B978-0-12-800878-2.00015-3 © 2017 Elsevier Inc. All rights reserved.
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Leveraging agricultural systems to contribute to nutrition has gained revived interest in the wake of the food crisis of 2007 2 08 when the food supply at the global level failed to meet the demand for food, and food prices kept rising (Pinstrup-Andersen, 2013; Webb and Kennedy, 2014; McDermott et al., 2015). In addition to the nutritional contribution through increasing the nutrient content of crops, modifying agricultural systems is seen as a source of income and enhanced nutrition, and further, it can open up women’s time spent in agriculture through technological choices. Agriculture and food production systems also affect nutrition through nutritional enhancement throughout the value chains, particularly in the context of high value crops. These opportunities, however, involve several sectors working together to achieve the nutritional goals. In this chapter we look at selected agriculture-based intervention opportunities in the context of multi-sectoral nutrition policy making and programming. We review the literature on agriculture 2 nutrition health linkages for their nutritional implications, and to identify new research areas.
CONCEPTUAL FRAMEWORK The conceptual framework presented in Chapter 3, A Conceptual Framework for Investing in Nutrition: Issues, Challenges, and Analytical Approaches, could be reformulated to identify the theoretical pathways through which agricultural interventions can affect nutritional outcomes. Fig. 15.1 builds on an earlier effort to connect agricultural factors to the nutritional outcomes in the early 1990s (Babu and Mthindi, 1994), and on the recent development to highlight the role of women in nutrition, both as producers and providers (Herforth et al., 2012; Webb and Kennedy, 2014; Kadiyala et al., 2015). To begin with, the efficacy of agriculture-based interventions depend crucially on several broad contexts in which the agro 2 ecological system functions. For example, the political system and the policy making environment will determine if agriculture-based interventions could be implemented on a large scale. The agro 2 ecological conditions that allow growing of specific crops, and natural resource constraints such as the availability of land and water, can define the production systems and their ability to diversify and substitute one enterprise for the other. Related to this is the challenge of land use rights and water use rights of landless and share cropping households. Socioeconomic factors such as the dominance of large-scale production systems surrounded by smallholders and landless laborers producing cash crops for the markets may not allow production of nutritious crops or diversification (Coates and Galante, 2015). In the context of policy, the price policies for inputs, such as fertilizer, and outputs will help or restrict diversification to nutritious crops. For example, in the case of India, the minimum support price given to rice and wheat—a food security oriented policy objective—severely affects the farmers’ ability to diversify to other nutritious crops, such as fruit and vegetables (Jones and Moffit, 2015). Market and price uncertainty, thus, can play a significant role in crop diversification toward nutritional objectives. When the markets function well for fruit and vegetables, farmers tend to produce for the market and may earn a better income, but whether this enhanced income results in
Land, environment/natural resources/research policies/strategies
Strategies/exchange for food/cash
Livestock production
Local/private food traders Resource use land, irrigation
Household food security Crop/food production/ diversity
Selling markets/output prices wages
Household income
Input availability (fertilizer, seed pesticides use)
Food availability in markets
Employment offfarm/non-farm Labor/ mechanization availability
Household characteristics/ gender role/empowerment
Buying market/food prices
Food safety/ food quality
Women in agriculture/other employment
Processing/ storage technology
Strategies exchange/wages wage in kind
Women’s role/child care, household chore energy expenditure
Gender, woman in agriculture, nutrition education, safety net policies/strategies
Non-food expenditures
Intra household allocation of food
Diets/diversity
Health, water, sanitation, care
Nutritional health status/household/ mother/women/ children
Food security, nutrition, health outcomes
Economic/agricultural development policies/strategies
Technology availability/adoption
Market, institution, infrastructure, trade policies/strategies
Multi-sectoral nutrition coordination
FIGURE 15.1 Agriculture 2 nutrition pathways: entry points for policy interventions. Based on Babu, S.C., Mthindi, G.B., 1994. Household food security and nutrition monitoring: the Malawi approach to development planning and policy interventions. Food Policy 19 (3), 272 284; Webb and Kennedy (2014); Kadiyala et al. (2014).
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improved nutritional outcomes is unclear, although studies have shown positive influences of such income increases (Murshed-e-Jahan et al., 2010). At the community level, the availability of land and the method of distribution among households will decide the success of agriculture-based nutrition interventions. For example, in the context of several African countries, the customary land tenure system does not allow long-term investments, such as allocation of land to aquaculture production. Increasingly, agricultural sector growth is seen as one of the pathways to achieving the goal of sustainably reducing poverty, malnutrition, and hunger. Yet the goals of the agricultural sector, such as improving the productivity of food production systems, enabling better processing and storage at the local levels, identifying and expanding the markets both local and external to translate production into income, require investment in agricultural research (Webb, 2013), market infrastructure, and in local storage facilities. Recently, researchers have began to stress the development of value chains, and their potential for employment generation and poverty reduction (PandyaLorch et al., 2014). From the nutritional perspective, the nutritional status of household members, particularly vulnerable groups, such as the women and children, depends on their improved access to higher quantities and qualities of food (Ruiz et al., 2015). In this context, dietary diversity plays an important role. Yet the farming systems relying on monocultures, such as the production of cereal crops, do not help much in improving the quality of diets. In addition, the consumption and use of nonfood factors such as clean water, sanitation, primary health care, and child care contribute to nutritional status. Access to and consumption of all these nonfood items are also influenced by the availability of income and resources, as well as the time and energy spent in obtaining them. This is particularly true for farming systems where women spend most to their time in the production of food and provision of nutrition (Balagamwala et al., 2015). Improving the investment in health and nutrition services, use of locally produced foods in the provision of nutritious diets, and improving nutritional behavior through education are key for nutrition to be transformed through agricultural systems (Webb and Block, 2012; Olney et al., 2015; Saaka and Larbi, 2015). Recently, food safety issues have been identified as part of providing quality food and nutrition (Leroy and Sununtnasuk, 2015). In the case of Africa, exposure to contaminants such as aflatoxin has been shown to affect the growth of infants (Turner et al., 2007). The new paradigm that connects agriculture to nutrition focuses on the three major pathways— food production; income from agriculture and nonagricultural sources used to obtain diverse foods, along with nonfood inputs such as clean water, sanitation, and health care for all members of the family, particularly the women and children; and the gender role in agriculture, particularly how women are empowered to control their time and money given their varied roles as producer, processor, marketer, and provider of food and nutrition (McDermott et al., 2015). Understanding the interlinkages between the agricultural factors and interventions and nutritional objectives, as depicted in Fig. 15.1, can help in the formulation of programs that are nutrition sensitive and nutrition driven. We explore this in the context of a multi-sector approach to agriculture nutrition programming. The policies related to broad agricultural development strategies are given on the left side of the figure, as they influence several factors that affect agricultural production, marketing, and consumption. From these broad agricultural strategies, it is possible to specify key subsector policies that can influence key variables. For example, the top left corner of the figure identifies policies related to land, irrigation, natural resources such as soil and water, and
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issues related to the environment and climate change. These policies, along with policies related to labor and other inputs can influence cropping patterns and the crop livestock mix. Policies that are related to market, infrastructure, and output price are given at the right top corner of the figure. They help in translating agricultural production into a meaningful income for the farming families. Further, they enhance added-value through provision of market infrastructure, such as cold storage, for better processing and marketing of the commodities. They also help in improving the quality of food commodities through regulatory policies and procedures. Trade policies have a high level of influence in determining food availability at the macro level, and also help in managing the fluctuation of prices in the global markets. The safety net policies and policies that affect gender relations and the empowerment of women are given at the bottom left corner of the figure. Finally, the multi-sectoral nature of policy making and program implementation is given in the right bottom corner of the figure. Collectively, these policies help in influencing the causal factors responsible for attaining food security and nutrition at the household and individual level. Using the conceptual framework developed above, we describe several emerging approaches to addressing nutritional challenges throughout the agriculture nutrition pathways.
DIETARY DIVERSITY Dietary diversity has been recognized for its contribution to balanced nutrition for long time. Yet the initial efforts to reduce hunger and prevent famine in the context of agricultural research focused on the major cereal crops such as rice and wheat. While focused investments on increasing the productivity of these crops resulted in solving hunger problems, particularly in several countries in Asia, it also brought vast areas of land under these crops into the form of monocultures. It has also eroded biodiversity and taken land away from the crops that were contributing to diverse diets in these societies. While the real prices of the cereal crops such as rice and wheat have come down and made these more accessible to the poor, the cost of foods which contribute micronutrients have increased over the years, resulting in reduced dietary diversity. Given that more than two billion people are now afflicted with micronutrient malnutrition, there is a need to increase dietary diversity and the diversity of crops produced by rural households. Several pathways exists to increase dietary diversity. To begin with, broad agricultural policies should take into consideration the need for diversified diets and their contribution to nutritional well-being. Policies that encourage monocultures of rice and wheat do not help in this context. Focused efforts are then needed to increase the diversity of crops, livestock, small ruminants, and aquaculture at the community level. Increasing the production of high value crops can improve the diversity of production at the farm level, but this does not guarantee the consumption of diverse diets. This will further require nutrition extension and nutrition education to guide farming households to expand the number of enterprises that can contribute to the increased availability of balanced nutrition at the household level. The role of home gardens and growing fruit and vegetables also helps in increasing diversity. Nutrition interventions such as school feeding programs (discussed in chapter: Economics of School Nutrition: An Application of Regression Discontinuity) could be designed in such a way that the food given to the students is purchased locally, and contains diverse dietary nutrients. The
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social safety net programs such as conditional cash transfers can further help in increasing the diversity of diets by introducing locally produced foods (see chapter: Nutritional Implications of Social Protection: Application of Panel Data Method). Improving value chins for the high value commodities, and ensuring these are also consumed by the producing households, can increase the diversity of food consumption (we expand on this below). Increasing the nutrient content of the food already grown through bio-fortification can increase the diversity of the diets (see section BioFortification). Nutritional education is a key intervention for increasing dietary diversity and nutrient intake. As people are used to eating a small number of foods that are traditionally grown and eaten by them, breaking cultural eating patterns and taboos requires nutritional education that helps in the behavioral change toward eating a wide variety of foods. In this context, revising the university curriculum to prepare frontline professionals in agriculture, nutrition, and social work is important. The curriculum has to go from the traditional single discipline to multidisciplinary to cover nutrition, agriculture, social work, home economics, and health (Babu et al., 2016). Finally, improving dietary diversity requires context specific interventions that take into account specific nutritional challenges faced by individuals and groups in the population. Agricultural interventions then need to take nutritional outcomes as explicit goals. Designing cropping patterns and the choice of crop varieties and technologies could then be analyzed for their nutritional contributions (see chapter: Designing a Decentralized Food System to Meet Nutrition Needs: An Optimization Approach for an example of such an approach). Designing such food production systems involves strengthening the capacity of the extension personnel. They must be trained in the monitoring and evaluation of the interventions to see how dietary diversity improves and contributes to improved nutritional status. This includes thorough knowledge about the indicators of dietary diversity and household access to food (Hoddinott and Yohannes, 2002). Increasing dietary diversity at the community level involves a multi-sectoral approach. Involvement of professionals from nutrition, agricultural extension, primary health care officials, and social welfare is required. This continues to be a challenge in developing countries and we discuss this further later in this chapter.
BIO-FORTIFICATION Bouis (2016) summarizes the latest status of bio-fortification as an agriculture-based nutrition intervention. Since the beginning of the green revolution period the development community has been focused on the role of agriculture and food production in improving the nutritional status of the population, particularly in developing countries. The initial investment in productivity increasing technologies, such as high yielding varieties of seeds that were generated through rice and wheat breeding, have contributed to the Asian green revolution. The birth of the Consultative Group on International Agricultural Research (CGIAR), supported by the multilateral and bilateral donors, more than 40 years ago resulted in several commodity-specific breakthroughs using agriculture to increase macronutrients, such as calories and protein, at the household level. Research by internal agricultural research centers continues to address the productivity of crops, plant protection, soil and water
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management, and sustainability issues related to climate change and land and forest management. Yet, as we mentioned in Chapter 2, Global Nutrition Challenges and Targets: A Development and Policy Perspective, more than two billion people are suffering from one or more micronutrient deficiencies that are essential to maintain healthy living. This has led to the increased nutritional focus of the international agricultural research system. A good example is the program for bio-fortification of crops, particularly those consumed by the poor. Bio-fortification is a process of increasing the nutrient content of crops through breeding varieties that are rich in micronutrients (Bouis, 2016). The process involves identifying crop varieties that contain high quantities of specific nutrients and minerals such as vitamin A or iron and through breeding, develop these varieties of crops that are consumed by a large number of people. Such crops include sweet potato, maize, beans, and millet. Several steps are involved in making bio-fortified crops available to meet the nutritional needs of the population (Boy, 2016). Confirmation is required that the crops and varieties from the breeding program have a sufficient amount of nutrients before they can be field tested. The varieties are then tested for their ability to retain the nutrient quality after different food processing methods commonly used by households. The next stage is to check that the consumption of these biofortified crops could add nutritional value, and reduce specific nutrient gaps by at least 25 50%. Further, the efficacy of the introduction of bio-fortified crops are tested to check if the specific micronutrient status is improved under controlled conditions. The bio-fortified crops are also tested for their effectiveness when introduced at a larger scale through market channels. The overall challenge in the context of the agricultural research involved in producing bio-fortified crops is that the yield levels cannot be sacrificed in the process of increasing micronutrient content (Lividini and Fiedler, 2015). Bio-fortification has now become an accepted strategy for making agriculture nutrition-sensitive (Bouis, 2016). Initial evaluations have shown that bio-fortified crops do improve the nutritional intake of those who produce and consume them. Bio-fortified crops are grown in some 30 countries and production is expanding. Evaluation studies have shown the benefits of bio-fortified crops. Yet several policy and program challenges remain (Bouis, 2016). Investment is needed from the governments of the countries for agricultural research. Current efforts to breed crops for micronutrients depend on external assistance, and it is working. In most countries, however, the researchers do not have resources committed to continuing such research after the donor funded projects come to a close. The breeding programs have to maintain the germplasms and continue to invest in breeding crops to maintain the quality and vigor of the crop varieties. Such long-term commitment can only come from the mainstreaming of bio-fortification research in the national systems of agricultural research. The commercialization of the crops that have been bio-fortified requires regulatory mechanisms that can engage the private sector in the production and multiplication of seed varieties. The yield and micronutrient content tradeoff is still an issue at the farmer field level, particularly those who grow the crops for commercial purposes, as they do not get increased prices for growing bio-fortified crops. Understanding the pathways through which bio-fortication affects nutritional outcomes, and using this tool as one of several interventions to address nutritional challenges requires context specific and multidisciplinary approaches as discussed below (Bouis, 2016; http://www.securenutrition.org/blog-entry/financing-scale-nutritious-staple-foodcrops#sthash.k7g4VUSP.dpuf).
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NUTRITION VALUE CHAINS As shown in the conceptual framework developed at the beginning of this chapter, one way to connect agricultural interventions to the nutritional status of the population is to increase the nutritive value of the commodity production chains. A recent review by Gelli et al. (2015) summarizes several issues, constraints, and challenges toward making value chains nutrition sensitive. Highvalue commodities such as fruit and vegetables, dairy products, milk, meat, and fish products, when produced by farming communities can help improve the nutritional content of the food consumed by the rural population. Thus, the interventions that introduce organized production of highvalue commodities aim at the dual goals of increasing the value of agricultural production by farm households, and at the same time focus on improving the nutritional outcomes of the household members, particularly the women and children. Development of commodity value chains helps in producing nutrient rich commodities, making such commodities available to the households that produce them, and through the marketing process making them accessible to households that can afford to buy them in the markets. Policy makers and program managers, however, face several policy and institutional constraints in making the traditional markets work for high value nutrient-rich commodities. For example, high value commodity market chains, when developed to meet food safety standards through investments in cold storage and other infrastructure, normally take the commodities away from the production site to urban markets. Then the challenge becomes the one, as in any intervention that introduces commercialization of agriculture—incomes generated through which may or may not result in better nutritional outcomes. Very little is known about how the development of the market chains directly or indirectly contributes to improvements in nutritional outcomes. They are trying to figure out which channel generates sufficient income to effectively impact nutrition becomes a challenge. Such policy dilemmas are common with any intervention that commercializes agriculture. From the policy and program design perspective, it is important to understand how farming households make choices between selling what they produce to make additional income, and their consumption to increase nutritional status. Income from the sale of high value commodities is needed for nutrition and nonnutrition expenditures, but the choices households make toward nutrition could be influenced by the nutritional education and behavioral change education that will be essential to get the full benefit of using nutritive value chains as nutrition interventions.
CONNECTING THE SECTORS THROUGH MULTI-SECTOR PROGRAMMING Enhancing the role of agriculture to meet nutritional objectives is the first step in the inter-sectoral approach to nutritional programming. In addition to agriculture, other sectors such as health, water, sanitation, and social welfare need to play their respective roles to meet nutritional objectives. While some level of coordination is possible at the planning and policy making level, the delivery of services that have nutritional objectives at the last mile level continues to be a challenge. A major question to policy makers and nutrition program managers is how one increases the nutritional impact by working with a group of professionals coming together from multiple sectors. While the agriculture sector has more proximity to the nutritional outcomes through the production
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of nutritious food and integrating nutritional objectives in the food system, other sectors such as water, sanitation, health, gender, and social welfare face more challenges in similar integration processes. Innovations in the policy and planning of multi-sector nutritional planning helps in better integration of nutritional goals in various sectors, and keeps them accountable for the nutritional outcomes. Such a process starts with the highest level of policy processes. Directives from the president’s office or parliamentary committees help in expressing their commitment and guiding the sectoral ministries to work together. Cross-sectoral integration has to be further followed up by vertical integration of goals and objectives through coordination and management of programs at the subregional and local levels. In each of the sectors, the stakeholders and key actors and players need to be sensitized about the nutritional objectives and outcomes. Consultations are needed among these players within each of the sectors, as well as joint meetings that bring together all the sectors for planning, setting priorities, designing implementation plans, monitoring and evaluation, and resource allocation. The development partners in each country have a key role to bring global knowledge to the table, as well as supporting such multi-sectoral approaches. It should however, be noted that multi-sectoral approaches do not succeed without a high level of sensitization and ownership of the nutrition goals by each of the sectors. In addition, the consultative processes could consume a lot of time and may not be appreciated. The current governance structures may not fully support such multiple sectors coming together for the common cause. Even within ministries, the coordination of nutritional activities becomes difficult if appropriate leadership capacity does not exist at different levels. Major challenges also exist in terms of allocation of resources by each of the sectors and the donors who support specific nutrition interventions through a particular ministry. For example, when one development donor supports a school nutrition program through the ministry of education, and the other donor supports a similar school feeding program through the ministry of social welfare, the coordination of programs, monitoring of efforts, and resource mobilization for nutrition becomes challenging. Further, the accountability for the nutritional outcomes and monitoring and tracking the program benefits also becomes cumbersome for the nutritional policy makers at the national level (Table 15.1).
Table 15.1 Making Agriculture and Food Systems More Nutrition Sensitive Incorporate explicit nutrition objectives and indicators into their design, and track and mitigate potential harms, while seeking synergies with economic, social, and environmental objectives. This however, has to happen at national level policy making, providing a process for the sectoral ministries such as food, agriculture, rural development, gender, and social welfare to take nutrition seriously. Currently only a few leaders in a couple of ministries take such a multi-sectoral view about nutrition. Assess the context at the local level, to design appropriate activities to address the types and causes of malnutrition, including chronic or acute under-nutrition, vitamin and mineral deficiencies, and obesity and chronic disease. Context assessment can include potential food resources, agro-ecology, seasonality of production and income, access to productive resources such as land, market opportunities, and infrastructure, gender dynamics and roles, opportunities for collaboration with other sectors or programmes, and local priorities. The challenge, however, is that such decentralized capacity hardly exists, even in countries where adequate capacity could be available at the national level. Local level context specific nutrition interventions require basic analytical capacity for identifying interventions, testing them for potential benefits, and scaling them up within the same agro(Continued)
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Table 15.1 Making Agriculture and Food Systems More Nutrition Sensitive Continued ecological zones. Such capacity does not exist in most countries affected by nutritional challenges. Investment in such capacity would then be a first step. Target the vulnerable and improve equity through participation, access to resources, and decent employment. Vulnerable groups include smallholders, women, youth, the landless, urban dwellers, and the unemployed. Targeting in the context of agriculture and food systems where most of the farmers face similar challenges is easier said than done. Yet, identifying vulnerable groups and designing specific programs that would help them to effectively use agricultural programs to address nutrition would be helpful. Collaborate and coordinate with other sectors (health, environment, social protection, labor, water and sanitation, education, energy) and programmes, through joint strategies with common goals, to address concurrently the multiple underlying causes of malnutrition. See the section on multi-sectoral coordination above. Such coordination requires leadership at all levels. Nutritional leadership is the most severe constraint in developing countries. Further multi-sectoral coordination requires well-articulated national directives. Maintain or improve the natural resource base (water, soil, air, climate, bio-diversity), critical to the livelihoods and resilience of vulnerable farmers and to sustainable food and nutrition security for all. Manage water resources in particular to reduce vector-borne illness, and to ensure sustainable, safe household water sources. This again in itself is a multi-sectoral activity covering ministries of agriculture, land, water resources, health, and forestry to mention a few. Again this has to be coordinated at the landscape level (Babu and Reidhead, 2000). Empower women by ensuring access to productive resources, income opportunities, extension services and information, credit, labor and time-saving technologies (including energy and water services), and supporting their voice in household and farming decisions. Equitable opportunities to earn and learn should be compatible with safe pregnancy and young child feeding. Agricultural policies and programs could specifically target women, giving incentives to participate in nutrition education and technology adoption for diet diversification. Facilitate production diversification, and increase production of nutrient-dense crops and small-scale livestock (e.g., horticultural products, legumes, livestock, and fish at a small scale, under-utilized crops, and bio-fortified crops). Diversified production systems are important to vulnerable producers to enable resilience to climate and price shocks, more diverse food consumption, reduction of seasonal food and income fluctuations, and greater and more gender-equitable income generation. This will again require the subsectors within agriculture to come together and organize a concerted effort, keeping nutrition as a common goal. Departments of crops, livestock, horticulture, fisheries, marketing, irrigation, and mechanization for example, may function within agriculture, but coordination needs revamping approaches to research, extension, and technology dissemination. The Indian Extension model called the Agricultural Technology Management Agency is an effort in this direction (Babu et al., 2015). Improve processing, storage, and preservation to retain nutritional value, shelf-life, and food safety, to reduce seasonality of food insecurity and post-harvest losses, and to make healthy foods convenient to prepare. Marketing infrastructure needs to be improved at all levels. Improvements in cold storage through solar electricity have shown some promise. Serious efforts are needed in this area. Connecting villages, towns, and urban centers through vegetable marketing can reduce the need for storage greatly. Expand markets and market access for vulnerable groups, particularly for marketing nutritious foods or products vulnerable groups have a comparative advantage in producing. This can include innovative promotion (such as marketing based on nutrient content), value addition, access to price information, and farmer associations. This again requires capacity and infrastructure to collect, analyze, and disseminate real time marketing data for the producers and consumers to get connected and discover the right prices. Incorporate nutrition promotion and education around food and sustainable food systems that builds on existing local knowledge, attitudes, and practices. Nutrition knowledge can enhance the impact of production and income in rural households, especially important for women and young children, and can increase demand for nutritious foods in the general population. While mass education through television and radio are the best approaches, personal communication with farmers by the farm home assistant and nutrition extension workers cannot be underestimated. From: FAO, 2015. Key Recommendations for Improving Nutrition through Agriculture and Food Systems. (Comments in italics added by the authors). Available at: www.fao.org/3/a-i4922e.pdf.
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CONCLUSIONS As the challenge of malnutrition continues to daunt the development community, the solutions for sustainable nutrition outcomes have to come from multidisciplinary approaches to solving the nutrition problems at all levels. Increase in income can enhance nutrition through provision of diverse foods through markets and trade, depending on a country’s level of development. But interventions that facilitate the production of nutritious food and consumption require multiple sectors working together. Recently, the development community has begun its quest for sustainable diets that could be produced with minimal disturbance to the food production and natural resource systems that support it. Such an approach needs to recognize the role of various ecosystems, and protect biodiversity. The food consumed by societies needs to come from sources that do not unduly burden natural resources such as land, water, and landscapes. In addition, the resilience of the food production systems that are vulnerable to natural disasters and to the phenomenon of cultural change has to be proactively improved. Agricultural systems play a key role in the provision of sustainable diets.
EXERCISES 1. Consider your study country that you have been working on in several exercises. Develop an agriculture-based nutritional strategy for the country taking into account the policy system, development partners operation, their programs, and the key features that help the country to effectively use agriculture as a pathway to nutrition. 2. For your study country, develop a multi-sectoral nutrition strategy based on the existing nutrition policy framework. What linkages are currently missing in the design and implementation of a multi-sectoral nutrition strategy?