Helping countries improve nutrition outcomes through agriculture and food -

what have we learned? what next?

John McDermott, Director

CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

A4NH PHASE II RESULTS FRAMEWORK

IMPROVED FOOD AND NUTRITION SECURITY FOR HEALTH

IMPROVED NATURAL RESOURCE SYSTEMS AND

ECOSYSTEM SERVICES REDUCED POVERTY

EQUITY, CAPACITY AND ENABLING ENVIRONMENT

A4NH PHASE II RESULTS FRAMEWORK: IMPACT PATHWAYS AND KEY ACTORS

PROGRAM GOALS:

DEVELOPMENT PROGRAMS PATHWAY

• Agriculture, nutrition, and health program implementers (NGOs and governments)

AGRI-FOOD VALUE CHAINS PATHWAY

• Producers • Change agents • Consumers • Regulators

Agriculture-Nutrition Programs: What Have We Learned?

Where We Started: Key Findings from Ag-Nutrition Program Reviews 2001-2013

Evidence of impacts on nutrition is inconclusive:

Livelihoods, income, food security

Diet quality, women’s empowerment

Ag-nutrition programs have impacts on several underlying determinants of nutrition:

Likely due to weaknesses in design, targeting, implementation, evaluation

Except for vitamin A

Source: Ruel and Alderman, 2013

Project Portfolio (Selected Projects) Social protection Agriculture Health/WASH Gender Nutrition

Four countries w/WFP, (completed) X X X

Bangladesh w/WFP, (completed) X X X X

Burundi and Guatemala w/USAID (FANTA) X X ♀/kids X

Ethiopia w/Gov’t of Ethiopia (PSNP) X X x x x

Mali w/WFP and World Bank X X X X

Burkina Faso w/Helen Keller International (HKI), (completed)

X X X X

Zambia w/Concern Worldwide X X X X

Burkina Faso and Tanzania w/HKI X X X X

Bangladesh w/Gov’t of Bangladesh X X X X

India w/PRADAN (Professional Assistance for Development Action)

X X X X

Bangladesh, Ethiopia, and Vietnam w/FHI360 (Alive & Thrive)

X ♀/Kids X

Burkina Faso and Mali w/HKI X ♀/Kids X

GAAP I/II (multiple countries and partners) X ? X X

Nutrition-sensitive agricultural programs work !

Two recommendations: 1. Focus on improving access to and intake of high-quality diets for all household

members, rather than on reducing childhood stunting.

2. Carefully tailor programs to specific context, culture, economic and food environment factors (especially markets, nutrient gaps, and gender roles)

Updated Review of Agriculture-Nutrition Programs 2014-2017

Source: Ruel, Quisumbing, and Balagamwala, 2017

Gender Strategies in Agriculture-Nutrition Programs:

What Have We Learned?

Reach Benefit Empower Objective Include women in program activities

Objective Increase women’s well-being (e.g. food

security, income, health)

Objective Strengthen women’s ability to make and put

into action strategic life choices

Strategy Invite women as participants;

reduce barriers; implement quota

system for training events

Strategy Design project to consider gendered

needs, preferences, constraints to ensure

women benefit from activities

Strategy Enhance women’s decision making power in

households and communities; address key

areas of disempowerment

Indicators Number/proportion of women who

participate in a project activity:

attend training, join a group, receive

extension advice, etc.

Indicators Sex-disaggregated data for positive and

negative outcome indicators such as

productivity, income, assets, nutrition,

time use, etc.

Indicators Women’s decision making power over

agricultural production, income, household

food consumption; reduce

disempowerment outcomes: gender-based

violence, time burden, etc.

Source: Johnson et al., 2017

• Bangladesh had the lowest women’s empowerment scores out of 19 USAID Feed the Future countries at baseline in 2012

• Ministry of Agriculture worked with IFPRI to design, implement, and evaluate a pilot program to see what worked best:

• Reach Agricultural extension directed to men and women farmers

• Benefit Behavior change communication to improve nutrition knowledge

• Empower Gender sensitization of men and communities to support women in their productive and reproductive roles

• The project is now being piloted; endline results will be available next year and we will know which approach works best to improve food security.

Agriculture, Nutrition, and Gender Linkages (ANGeL)

Helping Countries Create Enabling Environments for Nutrition:

What Have We Learned?

Evidence: Enabling Environment for Nutrition

Transform Nutrition: By pushing nutrition higher up the political agenda – through strengthening the evidence base and engaging decisionmakers and program implementers in dialogue - this research consortium aims to stimulate more effective action to improve nutrition.

The Lancet 2013: Two of the four papers in this agenda-setting maternal and child health series led by A4NH researchers

Global Nutrition Report 2014-2017: A4NH researchers have contributed content and editorial guidance to this comprehensive analysis of undernutrition

POSHAN: By synthesizing, generating, and mobilizing nutrition evidence, POSHAN enables policymakers, program implementers, researchers, and other stakeholders to access the latest, best evidence to support effective decisions to improve maternal and child nutrition in India.

National Food Systems for Healthier Diets: What’s Next?

Food Systems for Healthier Diets Main objective: To understand how changes in food systems can lead to healthier diets and to identify and test entry points for interventions to make those changes

Diagnosis and foresight

Food systems innovations

Anchoring and scaling up

National Food System Transformation

Issues • Dietary Transition (balancing

healthy and unhealthy) difficult • Collaboration:

– Public – Private – Longer supply chains, multiple agents

• Appropriate Enabling / Anchoring – Realistic in national / regional context – Balanced / fewer distortions – Evolving roles – public and private

Food consumption patterns drive health risk

Dariush Mozaffarian Circulation. 2016;133:187-225

Agri-Food System Transformation and the Future of Agriculture: Ethiopia

• Food system and dietary indicators (AGP2, PSNP)

• Dietary gap and food system foresight analysis

• Food-based dietary guidelines

• Value chain innovations for nutrient-dense foods

• Enabling SMEs

• Food system capacity development for national partners (policy, technical)

a4nh.cgiar.org Photo: Photoshare/M. Hasan

References

Development Initiatives. 2017. Global Nutrition Report 2017: Nourishing the SDGs. Bristol, UK: Development Initiatives. FAO. 2012. The State of Food Insecurity in the World. Rome: Food and Agriculture Organization of the United Nations (FAO). Johnson, Nancy L., Mysbah Balagamwala, Crossley Pinkstaff, Sophie Theis, Ruth S. Meinzen-Dick, and Agnes R. Quisumbing. 2017. “How do agricultural development projects aim to empower women?: Insights from an analysis of project strategies.” IFPRI Discussion Paper 1609. Washington, D.C.: International Food Policy Research Institute (IFPRI). Leroy, Jef L., Deanna K. Olney, and Marie T. Ruel. 2016. “Evaluating nutrition-sensitive programs: challenges, methods, and opportunities.” In Achieving a nutrition revolution for Africa: The road to healthier diets and optimal nutrition. Covic, Namukolo and Hendriks, Sheryl L. (Eds.). Chapter 10. Pp. 130-146. Washington, D.C.: International Food Policy Research Institute (IFPRI). Ruel, Marie T., Agnes R. Quisumbing, and Mysbah Balagamwala. 2017. “Nutrition-sensitive agriculture: What have we learned and where do we go from here?” IFPRI Discussion Paper 1681. Washington, D.C.: International Food Policy Research Institute (IFPRI). Ruel, Marie T. and Harold Alderman. 2013. “Nutrition-Sensitive Interventions and Programmes: How Can They Help to Accelerate Progress in Improving Maternal and Child Nutrition?” The Lancet 382 (9891): 536–51. Webb, Patrick. 2013. “Impact pathways from agricultural research to improved nutrition and health: literature analysis and research priorities.” Rome: Food and Agriculture Organization of the United Nations and Geneva: World Health Organization.