p1.2. pathways to household nutrition in asia-pacific region
DESCRIPTION
Helen Keller InternationalTRANSCRIPT
Pathways to household nutrition
in Asia-Pacific Region
GCARD 2012
Punte del Este, Uruguay
Context: Renewed investments in agriculture, nutrition, gender equality
“
“Achieving gender equality… is also crucial for agricultural development and food security.” (FAO SOFA, 2011)
“Fighting malnutrition should be the top priority for policy makers and philanthropists.”
(Copenhagen Consensus 2012) “There is no greater engine for
driving growth…than investments in agriculture.” (GCARD Roadmap, 2010)
HKI’s nutrition priorities in Asia
Agriculture-based nutrition
Infant Young Child
Feeding
Vitamin A
Women’s nutrition and gender
Build the evidence base for agriculture-based nutrition approaches
Ensure lasting capacity to deliver effective nutrition services
Create a supportive environment to prevent and treat malnutrition
Develop replicable, scalable evidence-based models
HKI’s agriculture for nutrition model Goal: Increase production and consumption of micronutrient-rich foods.
Evolving toward child growth focus, but limited data on impact. Core components:
Institutional linkages (health, agriculture, livestock, markets) Community-based extension targeting poor smallholder women
(demo farms) Horticultural training (micronutrient-dense varieties) Poultry and livestock support (animal source foods and income) Nutrition BCC (IYCF, micronutrients, cooking, gender)
Consistent evidence: Improved dietary diversity Greater food security Increased income (in women’s control) Greater participation in decision-making (small decisions)
Ensuring lasting capacity to deliver nutrition services: Governance model, Nepal
Partners: Government Ministries of Health, Agriculture and Local Development, the Nepali Technical Assistance Group (NTAG) and NGOs.
National and district planning workshops to define objectives, areas for integration
Food Security and Nutrition Committees formed at District and VDC level
Health workers trained as demonstration farmers
Outcomes: Nutrition commitments
Demonstration farms integrated into government extension system at VDC level
District and VDC-level food security & nutrition working groups linked in Multi-sectoral Nutrition Plan (MNSP)
Recognition of synergies and potential between Agriculture, Health, Local Government
AAMA initiatives sustained beyond HKI withdrawal
Village Development Committee Funds Contributed to nutrition initiatives:
Kailali – VDC $9800 ENA training, seed distribution,
poultry distribution, vaccination, IYCF food demonstration
Batadi - VDC $2500 ENA / HFP training, seed
distribution, coop improvement, poultry vaccination, pol house construction
Bajura - VDC $36000
More than messages: Importance of integrated nutrition BCC strategies
• Grounded in formative research
• Has specific behavior objectives
• Uses multiple channels and methods
• Addresses gender + intra-household issues
• Uses adult learning principles (learning-by-doing, cooking demonstrations, games)
• Invests in facilitation and counseling skills
Grandmothers laugh at “ludo,” learn about breastfeeding-support
Child Growth in ENA Pilot Area
A M J J A S O N D J F M A M J J A S*Pre-intervention Period Training Period Post-Intervention
-1.30
-1.25
-1.20
-1.15
-1.10
-1.05
-1.00
-0.95
-0.90
-0.85
Average weight-for-age z-scores in pilot and non-pilot areas
Selected nearby areas Selected ENA pilot project area
All children in ENA unions
Investment in nutrition BCC skills accelerates child growth •Supplemental training and facilitation skills to existing MCHN program area•Trained TBAs, health volunteers, midwives•Used adult-learning, participatory tools•Improved counseling skills•Growth rates improved within six months of implementation
Source: Training Communities on Essential Nutrition Actions. HKI Bangladesh April 2010.
Developing an ag-nutrition-gender strategy
Strategy: “Let’s all care for each other.”
Problems Strong family support at birthBreastfeeding drops at three months, women return to fields; harvest-time workloads Grandmothers enforce food taboos, poor IYCF
Reposition breastfeeding as valuable labor and family investment
Build on fathers’ caring practices around childbirth
Seasonal calendars for family workload support sharing
Work with church, agriculture, health groups (whole family)
Use neighborhood committees to allocate harvest-season work, including breastfeeding support
Train iodized salt sellers on marketing, nutrition
Organize local, district, regional agriculture-nutrition fairs and competitions
Community strategy
Creating a supportive environment: Gender- transformative pathways
•
•Addressing intra-household power relations• Treating child feeding as valuable work and time investment•Engaging men, mothers-in-law in workload-sharing strategies
Holding integrated nutrition-agriculture community events
Treating women as farmers; men as carers; establishing role models
Building women’s market skills and providing supplemental support
Measuring gender-based violence and social norms
Challenge: Building the evidence baseA Systematic Review of Agricultural Interventions that Aim to
Improve Nutritional Status of Children found: “The studies reviewed report little or no impact on the impact of
agricultural interventions on the nutritional status of children. However, we attribute this to the lack of statistical power of the studies… rather than to the efficacy.” (Masset et al, 2011)
Methodological gaps in agriculture-for-nutrition studies: Absence of control groups Poor attention to determinants of participation, little
socioeconomic data Inconsistent metrics of income, consumption, nutritional
outcomes
Fish on Farms RCT, Cambodia
Partners: HKI, University British Columbia, WorldFish, Cambodian Ministry of Agriculture and Fisheries, IDRC
22-month, 3-arm RCT: Horticulture Horticulture + aquaculture Control group
Target population: 600 food insecure women with <2
children Indicators:
Anemia Vitamin A Anthropometry , BMI Dietary diversity Economic data and marketing practices Gender and decision-making Household livelihood strategies
Partnerships to build the evidence base and scalable models: What can agriculture research bring? Rigorous evaluation designs Food-systems thinking: integrated analysis of
care, production, income, markets Better understanding of consumption-income-
generation choices Building evidence of behavior-change
communication channels in agriculture; what are the appropriate channels and messages for the extension sector? How can we use market actors and create demand for nutritious crops and diets?
Technologies: For drudgery, efficient use of small plots, for processing and packaging foods
Using common nutrition indicators and outcomes
Establishing common, long-term gender-transformative goals for changes in agriculture sector (attitudes, norms, representation)