Do good, but above all do no harm Tom Schaetzel Infant & Young Child Nutrition (IYCN) Project Maximizing Nutritional Benefits of Agricultural Interventions

The Infant & Young Child Nutrition Project USAID Global Health Bureau flagship project on infant and young child nutrition. Aims to prevent malnutrition for mothers and children during the critical time from pregnancy until two years of age. Led by PATH in collaboration with CARE, The Manoff Group, and University Research Co., LLC. Photo: PATH/Evelyn Hockstein

Why IYCN Project and Agriculture? Protect nutritionally vulnerable groups. Ensure interventions promote improved nutrition. Avoid working at cross purposes. Build capacity among our staff to advise on agriculture and nutrition. Photo: PATH/Nicole Racine

A New Era for Agricultural Development Source: Farming First

A New Era InitiativeFunding L’Aquila Food Security Initiative (AFSI) $22 billion over 3 years Global Agriculture and Food Security Programme (GAFSP) $900 million over 3 years (so far) Cereal Systems Initiative for South Asia (CSISA) $30 million Feed the Future (FTF)$3.5 billion (more expected from private sector) Source: Farming First

Does Increased Agricultural Production Improve Nutrition? “…one of the most persistent of misperceptions…about technology and economics…is the idea that as long as production is rising, any problems of consumption will sort themselves out.” Pacey and Payne, 1985 Photo: © 2008 Monirul Alam, Courtesy of Photoshare

Does Increased Income Improve Nutrition? Not everything can be bought… “Income is a rather dubious indicator of the opportunity of being well nourished….” (Drèze and Sen, 1989) Health Education Clean Water Gender Equality Photos: PATH

Problem There are trade offs and complementarities between production/employment goals and meeting nutritional goals which should be taken into account…when making program decisions. (USAID, 1982) How can we maximize the complementarities? How can we minimize the tradeoffs?

Review of Experience What are the characteristics of agriculture interventions that: –Improve food security? –Improve nutrition? What are the characteristics of interventions that have negative effects?

Negative Food Security Impact Increase un- or under-employment among population groups already un- or under-employed. Increase food prices when vulnerable households are net purchasers. Reduce food prices when vulnerable households are net sellers. Shift cultivation to cash crops when the shift decreases labor utilization.

Positive Food Security Impact is More Likely When Promoting… Agricultural tasks normally performed by women. Small-scale processing. Food disproportionately consumed by food insecure households. Photo: QFP/Mario DiBari

Positive Nutrition Impacts are More Likely When… Vulnerable households regularly consume the food commodity being produced. The intervention includes explicit nutrition counseling. The intervention includes home gardens. The project introduces micronutrient-rich crop varieties.

Positive Nutrition Impacts are More Likely When… They are designed to benefit or protect more nutritionally vulnerable populations at project inception. Photo: PATH

Solutions Include meaningful nutrition objectives in project design (with activities supporting them). Protect nutritional considerations in the design of production/income projects. Photo: QFP/Mario DiBari

Introducing Meaningful Nutrition Objectives Many agricultural projects already include “nutrition” objectives… What are meaningful objectives? –Who is vulnerable? –Who is already worst off? –What is likely to change? –What are the intermediate steps to improved nutritional status?

Incorporating a Nutrition Objective State the objective. Specify a population already suffering from high malnutrition prevalence. Group should be likely to be affected by the agricultural intervention. SMART: specific, measurable, attainable, relevant and time-bound. Choose appropriate indicators (nutrition-related).

Supporting Objectives with Activities Reduce stunting (chronic malnutrition) –Treating acute malnutrition will have little impact. Reduce wasting –May need sanitation, improved health care in order to show impact. Reduce underweight among women –May need to incorporate family planning, women’s workload.

Designing Activities Include nutrition programming expertise on design team “Nutrition Program Design Assistant”

Avoiding Negative Impacts: the Nutritional Impact Assessment Tool Similar to environmental and gender impact assessments. Designed for agriculture program planners to consider nutrition impacts on vulnerable groups.

How does it work? Step 1 Define population groups at risk. Step 2 Describe nutrition situation. Step 3 Create implementation alternatives. Step 4 Estimate likely outcomes. Step 5 Modify as needed. Step 6 Assess and select alternatives. Step 7 Design mitigation plan. Step 8 Develop review plan.

Step 1: Define Population Groups Likely At-risk Functional groups likely to be at risk may include: –Small landowning households. –Households selling labor. –Female-headed households. –Socially-excluded households (ethnicity, caste, occupation). –Households with chronically ill head.

Step 2: Describe Nutrition Situation for At-risk Population Groups Obtain (disaggregated) data on any of the following for children < 2 (or under 5) and for reproductive-age girls and women. –Caloric intake (nutrient intake if possible). –Dietary diversity. –Nutritional status (anthropometric). –Vitamin A and iron status (or intake). Identify groups with highest risk.

Step 3: Create Implementation Alternatives Create at least two alternative implementation options for meeting the stated project objectives. Original plan: Increase household income by expanding tobacco production. Alternative 1: Increase household income by expanding maize production Alternative 2: Increase household income by introducing ponds and small-scale fisheries

Step 4: Estimate Likely Outcomes for High Risk Groups According to Alternatives Do the vulnerable groups consume the commodities? What impact will the intervention have on food prices? Are vulnerable households net sellers, or net purchasers? What will be the impact on women’s time? Women’s labor and income? What will be the impact on vulnerable children’s diet?

Step 5: Modify Plans as Needed If estimate that substantial negative impact is likely for a vulnerable group… –modify project design (or accept alternative) –repeat impact assessment. Otherwise proceed to next step.

Step 6: Assess Alternatives and Justify Selection Rank all approaches based on impact score. If the selected approach ranks lower than an alternative justify the decision for keeping it. The final approach adopted does not necessarily need to be the one that would produce the best nutritional impact.

Step 7: Mitigation Plans Prepare a mitigation plan to be implemented if negative impacts occur. –Specify activities –Specify “trigger” points for modifying project. –Describe budgetary adjustments. Define the process for monitoring nutritional impacts over the course of the project –Indicators –Data collection plan

Step 8: NIA Review Plan Process for review, including timeline and the groups and/or individuals to conduct the review. Ensures a realistic assessment.

Moving forward Avoid assumptions that production or income increases automatically improve nutrition Focus attention on nutritionally vulnerable groups. Help us test/use the Nutritional Impact Assessment Tool. Contact us for technical assistance.

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