Assessing influencing factors in the school

food environment using Photovoice in Addis

Ababa, Ethiopia

Ursula Trübswasser1, Elise Talsma1, Megan Loeffen1,

Kaleab Baye2, Selamawit Ekubay2, Edith Feskens1

1Wageningen University and Research, 2Addis Ababa University

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

Addis Ababa 2010

Addis Ababa 2018

Hypothesis

www.annualreviews.org Creating Healthy Food Environments C-1

Figure 1

An ecological framework depicting the multiple influences on what people eat.

Macro-level

environments

(sectors)

Physical

environments

(settings)

Social

environment

(networks)

Individual

factors

(personal)

Home

Work sites

School,

after school

Child care

Neighborhoods

and communities

Restaurants and

fast food outlets

Supermarkets

Convenience and

corner stores

Cognitions

(e.g., attitudes,

preferences,

knowledge,

values)

Skills and

behaviors

Lifestyle

Biological (e.g.,

genes, gender,

age)

Demographics

(e.g., income,

race/ethnicity)

Access

Availability

Barriers

Opportunities

Outcome

expectations

Motivations

Self-efficacy

Societal and

cultural norms and

values

Food and

beverage industry

Food marketing

and media

Food and

agriculture policies

Economic systems

Food production

and distribution

systems

Government and

political structures

and policies

Food assistance

programs

Health care

systems

Land use and

transportation

Practices

Legislative,

regulatory, or

policy actions

Family

Friends

Peers

Role modeling

Social support

Social norms

Behavioral

capability

Story.qxd 02/14/2008 08:17 PM Page C-1

Ann

u. R

ev.

Pu

bli

c H

ealt

h 2

00

8.2

9:2

53-2

72

. D

ow

nlo

aded

fro

m w

ww

.ann

ual

rev

iew

s.o

rg A

cces

s pro

vid

ed b

y 2

13

.55

.77.1

94 o

n 0

4/0

3/1

8.

For

per

sonal

use

on

ly.

Story M, Kaphingst KM, Robinson-O’Brien R et al. (2008) Creating healthy food and eating environments: policy and environmental approaches. AnnuRev Public Health 29, 253–272.

Methods

Public school in Addis Ababa • 15 students 15-19 years• Owned smart phone• Boys and girls

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

Assessment of objective food environment

• Food and drink advertising• Availability of certain foods

in 60 food outlets• Photos of 138 kiosks

Photovoice: Assessment of perceived food environment

Students’ participation in the research

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

Analysis of qualitative information

• Codebook based on hypothesis• Analyzed photographs• Analyzed interviews and

discussion transcripts• Identified themes• Conducted word/code counts

is associated with

is part of

is a is a

is associated with

create awareness

It can make people realize that there are also good and hygienic markets that they can find fruits.

It relates to me in that I really love and enjoy eating fruits. My favorite fruits is banana. Moreov…

It will make people realize that their life/health should be a priority, that they should not buy co…

type of food outlet

area deprivation

outlet sanitation and hygiene

neighbourhood sanitation and hygiene

ban certain food outlets

Because the women selling the coffee has nowhere else to do it that is appropriate.

Mekoyah-Not looking down on jobs-IMG_20181111_234732.jpg

available food outlets

Mekoyah-FruitsIMG_20181128_153541.jpg

that they should not buy coffee from a place like this just because the price is cheaper.

food price

hope for healthier food

ignorance

affordable outlets

Coffee is being sold to customers in such a dirty setting/area.

limited livelihood options

I also used to sell injera on the street to make a living sometime in the past.

regulating food outlets

I see a lady who is selling Injera on the street.

hardship

I hope that these women will get a safe and appropriate place to sell their goods and change their l…

To win her daily bread. Earn some income to support herself and her family

I hope that in the future we will have even better fruit markets in our neighborhood.

It can teach them that anyone can make it only takes time, patience and hard work to get to where we…

hope people will eat more healthy

I hope to see these people given a safe and clean place to sell their goods and better materials to…

It actually disgusts me.

Mekoyah-Business-IMG_20181111_234631.jpg

Different types of fruits and vegies are be sold at the market. Many people had gathered in the are…

Mekoyah-Dirty place-IMG_20181124_111628.jpg

She is striving with whatever she has to earn a living.

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

Themes emerging from the study

1.Individual factors: “not rotten” = healthy

2.Social factors: “we have no say”

3.Physical factors: “it disgusts me”

4.Macro factors: “we go for cheap stuff”

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

1. “not rotten” = healthy

2. “we have no say”

“my mom cooks everything for me.” – Student 07

“We have no say in what we eat or want to eat. ““Our moms forces us to eat the food we don’t even like to eat…”“you can choose what to eat when you move out and live in your house”

Solutions “…if our moms could ask us for our food preference”“….teaching our parents whatever knowledge we have”

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

3. “it disgusts me”

“We use garlic in our day to day diet. If there’s no water available when we prepare food we might just peel the garlic and use it without washing it”

Solutions

“ I hope that these vendors would be removed and stopped from selling such bananas”

“I hope that these types of food become available in packed forms...”

“I love Banana I really love it. Whenever I go to buy there I see things which I don’t like and I return back without buying bananas” – Student 16

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

4. “we go for cheap stuff”

“Usually cheap foods are unhealthy. Healthy foods are expensive…we go for cheap stuff sold on the streets. Had both healthy and unhealthy food the same price we wouldn’t buy cheap food we would have options.”- Student 10

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

If you had 10 Birr what would you buy?

0

2

4

6

8

10

12

14

SSB or candy Fruit Fried streetfood

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

What is available, visible, advertised?

0

10

20

30

40

50

60

70

80

90

Dark greenleafy

vegetables

VitA rich FV Vegetable Fruit SSB-Candy

Available Visible Advertised

Sugar-sweetened beverages/Candy

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

“We were free”

“Expressing our feelings

without stress”

“it was fun”

“I learned a lot of things while

having fun”

“The way we could

participate”

“It made me think and give

more attention to things”

“It helped me improve my

food choice”

“Working together”“Discuss freely”

“It is easier to describe things

using pictures than talking”

“I like the unity”

“It helped me look deeper

in my living environment”

“Learned about basic

research skills”

“I was happy since I can

describe my living situation

through these pictures”

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

Thank you

Ursula.trubswasser@wur.nl

Thank you to Agriculture for

Nutrition and Health fir

funding this study

PROJECT NOTE 01 | JANUARY 1 2015

Ethiopia

A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015

The CGIAR Research Program (CRP) on Agriculture for Nutri-

tion and Health (A4NH) responds to the global challenge of im-

proving food security, nutrition, and health. CGIAR has a long leg-

acy of building global food security, but ensuring consumers can

access enough healthy, affordable, and safe food requires a per-

spective that encompasses far more than agricultural productiv-

ity.

In August 2015, A4NH submitted a pre-proposal for a second, six-

year phase of the program to begin in 2017. A full proposal will

be submitted in March 2016 for approval. This brief describes

what A4NH is building on in Ethiopia for its second phase.

FEATURED A4NH PROJECTS BY FLAGSHIP

FLAGSHIP 1: BIOFORTIFICATION

Biofortification builds on the strong track record of the Har-

vestPlus program. During Phase I of A4NH, HarvestPlus transi-

tioned from development to delivery phase. During Phase II, the

flagship will deliver outcomes at scale (reaching 20 million farm

households by 2020) and conduct research to fill key evidence

gaps and to learn lessons from delivery for future research and

scaling. As part of building an enabling environment for biofortifi-

cation in the future, the flagship will engage in policy analysis and

advocacy at national and international levels and build capacity

of key research and development partners to mainstream biofor-

tification in their research and programming.

In 2015, HarvestPlus expanded its activities to Ethiopia, including

it as one of the nine target countries.

Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-

work (NQAEN)

Led by the International Potato Center (CIP) and funded by A4NH,

HarvestPlus, and the International Center for Tropical Agriculture

(CIAT), the NQAEN aims to build and strengthen capacities to en-

able researchers in different target regions worldwide to conduct

accurate and cost-effective assessment of micronutrient content

of sweet potato and potato, to guarantee food safety of bioforti-

fied clones by keeping low levels of antinutrients in target envi-

ronments, to contribute to building evidence that minerals of bio-

fortified sweet potato and potato clones and their products are

bioavailable for the human body, and that phenolics in sweet po-

tato and potato have a health promoting role.

FLAGSHIP 2: FOOD SAFETY

The flagship on Food Safety conducts targeted research on

specific food safety issues as well as by generating evidence on

what approaches are likely to work and how an enabling environ-

ment for innovative approaches to food safety can be achieved

and sustained in informal markets. The high priority food safety

issues for Phase II are biological contamination of perishable

products and aflatoxins in staple crops. The flagship will scale-up

successfully piloted solutions alongside rigorous monitoring and

impact evaluations to increase understanding of the incentives,

capacity, and enabling policy environment required for successful

delivery at scale. At the same time, it will continue to generate

evidence on food safety risks, and their assessment, communica-

tion, and management. In close collaboration with the CRPs cov-

ering livestock, fish, and grain legumes, this flagship will reach

tens of millions of consumers, millions of farmers, and thousands

of market agents working in priority countries in Africa and Asia.

Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-

icated to Ethiopia

Led by the International Livestock Research Center (ILRI) and

funded by A4NH, this project aims to assess the level of aflatoxin

contamination in dairy value chains in Ethiopia, identify research

gaps in aflatoxin research, and provide evidence, risk assess-

ments and best-bet interventions for policy makers.

Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank

Additional slides

Number of photographs in the course of

the pilot487 PhotosPhotos students took

Selection during interview

Photos to discuss in one FGD

92 Photos

45 Photos

Select in one FGD for all 3 research questions

3 Photos

x 2 FGD 7-8 PhotosSelected photos for every

research question

analyzed

Main findings – adolescents’ diets

0

2

4

6

8

10

12

14

16

18

Recommendations

Availability of healthy foods at school through canteen/mobile sellers

Advertising of unhealthy foods not on the school property

School canteen guidelines and covered eating area: involve students

Giving students a platform and involving parents

Water supply and soap at toilets

Nutrition education in the school: safe ≠ healthy

Study conducted

in April 2019

Public school

Private school

Assessed:- External school food

environment (outlets, advertising)

- Internal school food environment (food provision, curriculum, awareness…)