After decades of investment programmes in agriculture and rural development, 2 billion people still suffer from undernutrition. How can we make sure these investments have a greater impact in reducing this number?
Where are we now?
The numbers speak loud and clear. Nearly half of the world’s population is malnourished; 2 billion people are estimated to be undernourished while 1.5 billion are considered to be ‘over-nourished’ or overweight. According to the FAO, “Micronutrient deficiencies (‘hidden hunger’) still affect over 30 percent of the world’s population, causing increased morbidity and mortality, impaired cognitive development and reduced learning ability and productivity, reduced work capacity in populations due to high rates of illness and disability, and tragic loss of human potential. Overcoming micronutrient malnutrition is a precondition for ensuring development” 1. Rates are fluctuating, with some areas showing rapid decline but the sustained cost of malnutrition to societies is colossal today and will remain so for generations to come. After decades of development assistance, we must question whether and which investments are effective, equitable, or detrimental in reducing these numbers. Certainly, it is time to acknowledge that not any investment in agriculture, rural development or community development will necessarily lead to improved nutrition. Increased productivity, crop yields and/or incomes do not directly reduce malnutrition. We need to rethink current investment schemes, so as to catalyse a sustainable reduction in malnutrition but we still have a long way to understand impact pathways from investment to nutrition outcomes. The time is particularly opportune now that high-level political commitment to tackle nutrition is growing, especially in the wake of the International Conference on Nutrition (November 19-21 FAO, Rome).
So where to invest and how?
The 2013 Lancet Maternal and Child Nutrition Series made a sweeping statement, that even if ten proven effective nutrition-specific (mainly health) interventions were to be scaled up and reach 90% coverage, costing approximately US $9.6 billion per year, stunting rates (a crude indicator to measure undernutrition) would only decrease by 20% 2. Instead, investing in ‘nutrition-sensitive’ programmes and interventions is required to tackle the root causes of undernutrition. This demands collaborative efforts between agriculture, welfare, water sanitation and hygiene, health and family planning, and education ministries and sectors. Our food system today is intensely complex so effective action requires a thorough understanding of the context and of the implications of various types of interventions for nutrition. This is also highlighted in The Broker’s articles, What about nutrition security and The emphasis on technical fixes is misleading.
Panel 1: Definition of nutrition-specific and nutrition-sensitive interventions and programmes 3
Nutrition-specific interventions and programmes
- Interventions or programmes that address the immediate determinants of fetal and child nutrition and development-adequate food and nutrient intake, feeding, caregiving and parenting practices, and low burden of infectious diseases
- Examples: adolescent, preconception, and maternal health and nutrition; maternal dietary or micronutrient supplementation; promotion of optimum breastfeeding; complementary feeding and responsive feeding practices and simulation; dietary supplementation; diversification and micronutrient supplementation or fortification for children; treatment of severe acute malnutrition; disease prevention and management; nutrition in emergencies
Nutrition-sensitive interventions and programmes
- Interventions or programmes that address the underlying determinants of fetal and child nutrition and development – food security; adequate caregiving resources at the maternal, household and community levels; and access to health services and a safe and hygienic environment – and incorporate specific nutrition goals and actions
- Nutrition-sensitive programmes can serve as delivery platforms for nutrition-specific interventions, potentially increasing their scale, coverage, and effectiveness
- Examples: agriculture and food security; social safety nets; early child development; maternal mental health; women’s empowerment; child protection; schooling; water, sanitation, and hygiene; health and family planning services
So where to start?
First, we need to figure out what types of investments are most effective. We need to collect evidence on how certain types of agriculture and rural development investments can contribute to reducing hunger and undernutrition so as to inform evidenced-based policy-making and investment programming.
In July 2014, the International Fund for Agricultural Development (IFAD) and the Food and Agriculture Organization of the UN (FAO) jointly organized a workshop to address this need. It was clear that nutrition can and must be integrated into agricultural and rural investment programmes promoted by the two organizations. Nonetheless, impact pathways are insufficiently understood and it remains unclear how investments can contribute, especially in tackling the double burden of malnutrition (under and over-nutrition). Both agencies have historically advocated a comprehensive food-based approach to nutrition rather than a single nutrient (health sector) approach, but working out which concrete channels lead to an effective and sustainable reduction in malnutrition remains to be further explored and documented.
The overall conclusion of this workshop was that sound and well-designed investments can help harness agriculture and rural development potential in nourishing people by placing food, people and environmental sustainability back at the centre of the food system and of the programmes that countries put in place. Making sure that improved nutrition is the final aim of a proposed intervention is the most powerful way to ensure that these interventions effectively improve nutrition through well identified impact pathways. In the past, too many investment interventions exclusively aimed to increase farm productivity, propagate crop and livestock technologies, reduce poverty or increase market surpluses. When developing an investment project, this shift in focus requires: (1) understanding the causes of malnutrition, which are specific to every country and situation. In other words, there is no universal recipe; (2) establishing synergies and improving on what has been done before, and working with affected people to understand the core dynamics and potential for change; (3) assessing and documenting past interventions that “worked” and understanding the conditions under which they can be upscaled through large-scale investments; (4) putting in place simple nutrition indicators that are monitored during implementation so as to assess the effectiveness of these interventions and take corrective measures.
Concretely, what are nutrition-sensitive investments?
There are various entry points for agricultural or rural development programs to improve nutrition. As solutions are specific to each country or situation, there is a crucial need to understand the context and particular causes of malnutrition. Practically, nutrition can be integrated from the start or retrofitted into existing projects and programs by, for example:
- Diversifying crops and expanding integrated home-gardening to facilitate availability of foods for a diversified diet;
- Investing in nutrient-dense agricultural production and/or (bio-)fortification to improve availability of lacking micro-nutrients;
- Ensuring that agricultural research and extension also aim to improve nutrition by diversifying variety development, research on more effective farming systems, moving away from mono-cropping, etc.;
- Improving (and shortening) value chains to support local producers and facilitate accessibility of fresh foods to consumers;
- Focusing attention on the most nutrition-insecure such as the poor, women and children who are particularly vulnerable to micro-nutrient deficiencies and simultaneously often unable to access resources necessary to secure sufficient nutrient intake;
- Establishing school feeding programs that source locally-produced foods and engage with farmers;
- Preserving and processing foods to bridge lean seasons (decrease food insecurity) and preserve nutrients;
- Introducing or expanding nutrition education programs and behaviour change communication to ensure good consumption practices;
- Safeguarding indigenous foods and crops and making use of underutilized crops considering the nutritional needs and preferences of local populations;
- Seeking joint action between agricultural, health and education sectors to support populations suffering from malnutrition.
An increasing number of countries are coming forward to commit to improving the nutrition status of their population, for instance by adhering to the Scaling Up Nutrition Movement and by engaging in the International Conference on Nutrition 2 in November 2014. They can shape their investments, building on evidence and learning from other’s experiences. It is the duty of international organizations like financing institutions (IFAD, the World Bank, regional banks...) and specialized organizations (FAO, UNICEF, WHO, WFP and many others) to capture and share lessons learned and join hands to provide the necessary support that crosses their mandates and the sectors they cover. Some countries and regions have already integrated nutrition into their agricultural strategies; now we need to ensure that investments are aligned to effectively reduce undernutrition.
All views expressed in this piece are those of the authors and do not necessarily represent the views of the UN Food and Agriculture Organization.
1 Food and Agriculture Organization of the United Nations (FAO) (2012) The State of Food Insecurity in the World 2012: Economic growth is necessary but not sufficient to accelerate reduction of hunger and malnutrition. Headquarters, Rome: IFAD, WFP, FAO, FAO.
4 UN (2011) Scaling Up Nutrition. Progress report from countries and their partners in the Movement to Scale Up Nutrition. NewYork.
5 Shekar M, Ruel-Bergeron J, Herforth A. (2013) Module A. Introduction. In: Improving nutrition through multisectoral approaches. Washington, DC, International Bank for Reconstruction and Development, International Development Association of The World Bank.
Photo credit main picture: Sifting grain. India / Ray Witlin, World Bank Photo Collection via Flickr