Making African Agriculture and Food Systems Work for Nutrition: What Has Been Done, What Needs To Be Done? Stuart Gillespie (International Food Policy Research Institute) and Charlotte Dufour (UN Food and Agriculture Organization)

The challenge In Africa south of the Sahara, progress in reducing undernutrition has been lagging behind other regions. Majority of the nutritionally vulnerable population is dependent upon agriculture as a primary source of livelihood—for food, for employment and income. Agriculture has close links to both the direct causes of undernutrition (diets, feeding practices, and health) and the underlying factors (such as income; food security; education; access to water, sanitation, and hygiene; access to health services; and gender equity).

Ag sector has huge potential to drive down rates of malnutrition, yet this potential is not being realized. Agricultural growth may generate more gains for nutrition than gross domestic product (GDP) growth per se, but….. ….nutrition has historically not been a primary concern for agricultural policy makers—for whom aggregate staple crop production is the primary target.

Evidence gaps Lack of evidence that agricultural interventions are benefiting nutrition. Why? Poor design and implementation of interventions, which are not as nutrition-enhancing as they could be Limitations in terms of targeting (few interventions are targeted to the 1,000-day window within the human life cycle) Poor design of evaluations, which are seldom rigorous enough (in terms of sample size, valid comparison groups, and so on) to demonstrate impact

The opportunity The African Union Maputo Declaration on Agriculture and Food Security places strong emphasis on ensuring food and nutrition security. Three recent Malabo Declarations related to nutrition reinforce this commitment. Nutrition indicators incorporated in the CAADP Results Framework, and in partnership with IFPRI under ReSAKKS, countries supported to report their progress on nutrition commitments biennially. Many SUN Movement member countries active.

Conceptualizing links

Household assets and livelihoods Pathways from agriculture to nutrition National economic growth National nutrition outcomes Food prices Nutrition knowledge Household assets and livelihoods Food production Food expenditure Food consumption Nutrient intake Child nutrition outcomes Income (agricultural and non-agricultural) Health care expenditure Health status Non-food expenditure We will present each of the major pathways separately, followed by the evidence that exists for nutrition impact. Build this from outcomes back… 1. We are interested in child nutrition outcomes, and also maternal nutrition as a woman’s nutrition during pregnancy and lactation has a direct effect on her children 2. Both nutrient intake and health status has an immediate effect on nutrition outcomes, as seen in the UNICEF framework earlier 3. Underlying that, we have the food, health and care determinants of nutrition, seen before …should note that we are using ‘consumption’ meaning eating, not buying… 4. Decisions on household expenditure allocations to food and non-food (including health) are an important factor 5. Both income and food prices affect these decisions (note that income can be agricultural or non-agricultural) 6. A household’s own agricultural production can affect food prices, and directly affect food consumption in the household 7. One important consideration is the role of women in agriculture: Agricultural work can affect women’s decision-making power and control of resources; her time and resources for childcare and feeding; and her own energy expenditure and health. 8. Nutrition knowledge mediates many of the decisions made around food and feeding in the household. 9. Finally, the nutritional status of household members contributes to the overall health and productivity of the household and of the nation- this is not a one-way street! Sometime national economic growth has been considered a pathway from agriculture to nutrition. The following slide illustrates the relationship between GDP and nutrition. Mother’s nutrition outcomes Caring capacity & practices Female employment / resources Female energy expenditure Adapted from Gillespie et al. 2012 and Headey et al 2012

Conceptualizing the pathways between agriculture and nutrition Agriculture as a source of food Agriculture as a source of income: – how income from agriculture/non agriculture is spent on food and non food (other basic needs) Agricultural policy and food prices Gender dimensions Women’s employment, time and ability to manage young child care Women’s status, decision making power and control over resource allocation Women’s own health and nutritional status Agriculture is a key driver of poverty reduction but... Pathways to nutrition are diverse and interconnected Source: Gillespie et al., TANDI project

What is LANEA? Leveraging Agriculture for Nutrition in East Africa (LANEA) IFPRI/FAO initiative in Ethiopia, Kenya and Uganda To investigate the enabling environment in these countries and the opportunities and challenges related to enhancing the nutrition-sensitivity of agriculture. Enabling environment: “the wider political and policy processes which build and sustain momentum for the effective implementation of actions that reduce undernutrition” (Gillespie, Haddad, Menon, Nisbett, Mannar 2013)

What does an enabling environment look like? Framing, knowledge and evidence Politics and governance Capacity and financial resources Impact Three vital factors for creating momentum and converting it to impact: “Enabling environment” = the wider political and policy processes which build and sustain momentum for the effective implementation of actions that reduce undernutrition

Methods LANEA country studies took place in 2014 Structured review of evidence relating to agriculture- nutrition pathways for each country Key informant interviews with individuals working on nutrition and agriculture. Stakeholder workshops in each country to disseminate the findings and gain further perspectives and input on agriculture and nutrition linkages Country reports and policy briefs 

Number of studies in evidence reviews by pathways   Pathway Number of studies Ethiopia Kenya Uganda 1: Agriculture as a source of food 12 8 6 2: Agriculture as a source of income for food and non-food expenditure 3 2 3: Agriculture policy and food prices affecting food consumption 1 4: Women in agriculture and intra-household decision-making and resource allocation 4 5: Female employment in agriculture and child care and feeding 6: Women in agriculture and women’s nutritional and health status

Number of studies in evidence reviews by design Randomized controlled trials 2 Quasi-experimental studies 4 1 Observational studies using analytical methods such as multivariate regressions and econometric modelling 7 13 3 Observational descriptive studies Mixed method studies (involving quantitative & qualitative studies) Studies that do not clearly identify a design  

Emerging from the interviews and stakeholder consultations Key challenges Emerging from the interviews and stakeholder consultations

How do agricultural policymakers and other stakeholders perceive the issue of undernutrition, and its relationship to agri-food systems? Programmes and research need to be practical and well- adapted to the context. Ongoing engagement and interaction with the government is needed, so that communication is not just one-way, post-research outreach. Data availability is a major challenge. Pervasive data disconnect -- surveys rarely include both nutrition/health and food security/agricultural indicators, rendering it difficult to establish relationships. Improved data streams to link these types of indicators in national data collection, as well as quality and timeliness of data, could better inform understanding about agriculture-nutrition linkages, and also allow accountability.

What incentives and disincentives exist for decisions and actions to become more pro-nutrition? Focus within the agriculture sector has historically been on increasing production and productivity of cash crops as an engine of economic growth. Without clear and transparent systems of accountability for action, progress on nutrition will not happen. Accountability requires timely and appropriate information on how agriculture is affecting nutrition outcomes. Multisectoral and “invisible” nature of malnutrition represent challenges for holding policymakers and programme managers to account. Agriculture stakeholders cannot be held accountable for stunting, but diet diversity is a more useful indicator. Unless nutrition advocates understand the mindsets, motivations and the “language” of the sector, change will be elusive. Along with incentives to act, there is a need – through policy process/political economy-related research -- to identify the trade- offs and potential synergies of any change.

What type of capacity and financing is required to maximize the nutrition sensitivity of the agri-food system? Training and education needs to be strengthened with regard to agriculture’s linkages to nutrition. Leadership is a pivotal form of individual capacity, and is potentially transformational. Nutrition champions, policy entrepreneurs, and civil society activists at all levels need to be supported and encouraged.

In conclusion….. Leveraging agriculture for nutrition implies: creating and strengthening institutional and policy environments that enable agriculture to support nutrition and health goals making agricultural policy and practice more nutrition sensitive and therefore more effective in improving nutrition and health, and developing capacity and leadership to use evidence- informed decision making to enhance the impact of agriculture on nutrition and health.