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P1.2. Pathways to household nutrition in Asia-Pacific region


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Helen Keller International

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P1.2. Pathways to household nutrition in Asia-Pacific region

  1. 1. Pathways to household nutrition in Asia-Pacific Region GCARD 2012 Punte del Este, Uruguay
  2. 2. Context: Renewed investments inagriculture, nutrition, gender equality“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.” “Achieving gender equality… (GCARD Roadmap, 2010) is also crucial for agricultural development and food security.” (FAO SOFA, 2011)
  3. 3. HKI’s nutrition priorities in AsiaEnsure lasting capacity to Agriculture-baseddeliver effective nutrition nutritionservicesCreate a supportiveenvironment to prevent Women’sand treat malnutrition nutrition Infant and Young gender ChildDevelop Feedingreplicable, scalableevidence-based modelsBuild the evidence basefor agriculture-based Vitamin Anutrition approaches
  4. 4. 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)
  5. 5. 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
  6. 6. Outcomes: Nutrition commitments Demonstration farms Village Development Committee Funds integrated into government Contributed to nutrition initiatives: extension system at VDC level  Kailali – VDC $9800 District and VDC-level food  ENA training, seed distribution, security & nutrition working poultry distribution, vaccination, groups linked in Multi- IYCF food demonstration sectoral Nutrition Plan (MNSP)  Batadi - VDC $2500 Recognition of synergies  ENA / HFP training, seed and potential between distribution, coop improvement, Agriculture, Health, Local poultry vaccination, pol house Government construction  Bajura - VDC $36000 AAMA initiatives sustained beyond HKI withdrawal
  7. 7. More than messages: Importance of integratednutrition BCC strategies•Grounded in formativeresearch• Has specific behaviorobjectives• Uses multiple channelsand methods• Addresses gender +intra-household issues•Uses adult learningprinciples (learning-by-doing, cookingdemonstrations, games)•Invests in facilitation Grandmothers laugh at “ludo,” learn about breastfeeding-and counseling skills support
  8. 8. Investment innutrition BCC skills Child Growth in ENA Pilot Areaaccelerates child Average weight-for-age z-scores in pilot and non-pilot areasgrowth -0.85•Supplemental training -0.90and facilitation skills to -0.95existing MCHN program -1.00area -1.05•Trained TBAs, health -1.10volunteers, midwives -1.15•Used adult-learning, -1.20participatory tools -1.25•Improved counseling -1.30 A M J J A S O N D J F M A M J J A S*skills Pre-intervention Period Training Period Post-Intervention•Growth rates improvedwithin six months of Selected nearby areas Selected ENA pilot project area All children in ENA unionsimplementationSource: Training Communities on Essential Nutrition Actions. HKI Bangladesh April 2010.
  9. 9. Developing an ag-nutrition-gender strategy
  10. 10. Strategy: “Let’s all care for each other.”Problems Community strategyStrong family support at birth  Reposition breastfeeding as valuable labor and familyBreastfeeding drops at three months, women investmentreturn to fields; harvest-time workloads  Build on fathers’ caring practices Grandmothers enforce food taboos, poor IYCF 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
  11. 11. Creating a supportive environment: Gender- transformativepathways•Addressing intra-household powerrelations• Treating child feeding as valuablework and time investment•Engaging men, mothers-in-law inworkload-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
  12. 12. 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
  13. 13. 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
  14. 14. Partnerships to build the evidence base and scalablemodels: 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)