Integrating agriculture, nutrition, health and HIV interventions: tools and program experience Ashley Aakesson, MA Nutrition Program Officer AIARD Annual Conference June 5, 2012 Photo: PATH/Evelyn Hockstein

PATH’s strategies for integration Create innovative solutions for integrating nutrition into agriculture, food security, and livelihoods programs; and vice versa. Design SBCC and social marketing strategies that support improved behaviors among individuals, households, and communities, across sectors Collaborate with private and public sector partners on market-led approaches to increasing access to inputs for good health and nutrition for the most vulnerable Develop innovative nutrition technologies, such as a non- invasive method for assessing vitamin A status Provide technical assistance to private-sector companies to develop and market low-cost, fortified foods and micronutrient supplements

IYCN Tools for Integrating Nutrition into Agriculture Projects Guiding questions What are the characteristics of agriculture interventions that improve food security and nutrition? What are the characteristics of interventions that have negative effects? Photo: PATH/Evelyn Hockstein

Solutions Include meaningful nutrition objectives in project design with activities supporting them. Protect nutritional considerations of vulnerable groups in the design of production and/or income-focused projects. Photo: PATH/Evelyn Hockstein

IYCN resources for integration

Positive food security impacts are more likely when projects… 1. Implement activities that generate employment. 2. Consider whether food insecure households are net sellers or net buyers when intervening in food prices. 3. Promote small-scale processing. 4. Support production of foods consumed by food insecure households. Photo: QFP/Mario DiBari

Positive nutritional impacts are more likely when projects… 1. Integrate nutrition counseling. 2. Incorporate home gardens. 3. Introduce micronutrient-rich crop varieties. 4. Ensure that vulnerable household members consume the foods produced. 5. Support agricultural tasks performed by women. 6. Improve health to ensure utilization of nutrients. Photos: PATH, PATH/Monique Berlier; Wendy Stone

PATH’s programmatic experience: examples UltraRice IYCN: tools for agriculture project planners and Ethiopia urban gardens project Mama SASHA project, Western Kenya Feed the Future Results Framework: Livestock Growth Program, Ethiopia

Ultra Rice Fortified food technology transfer, value chain development, and improved nutritional outcomes for women and children –Brazil, Dominican Republic, Burundi, India, Cambodia, and Vietnam Dual business model of working with the public sector while developing the private market –Brazil: commercialization; large miller and retail chain participation –Burundi and Cambodia: USDA supported school feeding programs –Vietnam: small scale fortification at village level with adapted hand mills

Urban Gardens Project in Ethiopia “IYCN has given us the soul for our program.”—Zalalem, AEW, Oromiya Trained AEWs on nutrition counseling, cooking demonstrations, referrals to nutrition services Baseline questions and formative research on nutrition (TIPS and recipe trials) Lessons: Agree on common goals at outset; involve government stakeholders Photo: PATH/Evelyn Hockstein

Mama SASHA project, Western Kenya 5-year project to provide evidence for the effectiveness of the approach Aims include increasing the consumption of Vitamin A-rich foods and use of antenatal care services. 10 month pilot: 75% of 823 women participating in the intervention areas received and redeemed vouchers for planting material. Women have an increased awareness of vitamin A-rich OFSP and value its benefits. Integrating health and agriculture to maximize the nutritional impact of orange- fleshed sweet potato

Lessons learned –Engaging men, the family landholders, is critical. –Coordinating the supply of sweetpotato planting material with demand from pregnant women requires clear roles and responsibilities among multiple actors. –Consistent training and frequent communication among stakeholders are key to reaching beneficiaries. Next steps: –Full implementation began April 2011 –Endline following on the baseline comparing intervention and control communities: MCHN and ag KAP; stunting, wasting, and vit A deficiency among the 6-23 mos; and mothers’ BMI 12 Mama SASHA project, Western Kenya

Feed the Future: Livestock Growth Program, Ethiopia Objective: Improved Smallholder Incomes and Nutritional Status –IR 1: Increased productivity & competitiveness of selected livestock value chains –IR2: Improved Enabling Environment for Livestock Value Chains –IR3: Improved quality and diversity of household diet through intake of livestock products Challenges in responding to the solicitation: –Geographic and demographic targeting –Models for production, processing, storage, distribution –Mechanisms for supportive supervision, M & E, and mid-course adjustments

Key challenges and lessons learned Partial overlap among objectives, targeted participants –How to develop value chains for domestic and export markets while also increasing access (geographic, economic, socio-cultural) to nutritious foods by vulnerable groups? –Trade offs involved in supporting marginalized groups, including women, to participate more fully in value chains. Who drives the decisions? Mutual awareness of basic sectoral concepts and terminology is invaluable –Cross-sector orientation tools and conceptual frameworks –Multidisciplinary teams; holistic and participatory project designs; and public/private partnerships generate new ways of seeing and solving the problems and creating possibilities

Thank you! Photo: PATH/Evelyn Hockstein Photo: © 2008 Monirul Alam, Courtesy of Photoshare