As part of the IFPRI Egypt Seminar in partnership with the National Nutrition Committee: "the 100 million healthy lives initiative: Food availability, access and consumption patterns in Egypt"

1. What Factors Determine
Household Food Access and
Dietary Diversity?
Sikandra Kurdi
International Food Policy Research Institute
March 24, 2019

2. Food Security
Framework
 Availability
 Access
 Utilization

3. Household Food Access
“The ability to acquire sufficient quality and quantity of
food to meet all household members’ nutritional
requirements for productive lives”
(FANTA 2006)

4. Household Dietary Diversity as an Indicator
 Proxies for household economic access to food (not nutrient quality of diet)
 Number of food groups consumed by anyone in the household
 Highly dependent on the recall period used and local context: 24 hour
recall will have fewer food groups than 7 day recall
 12 food groups:
Cereals Meat
Potatoes Fish
Legumes Vegetables
Dairy Fruits
Eggs Oils and Fats
Condiments Sweets

5. Household Dietary Diversity as an Indicator
 In cross-country study, 1% increase in household dietary diversity is
associated with a 1% increase in per capita consumption and a 1.4%
increase in household caloric availability from non-staples (Hoddinott and
Yohannes, 2002)
 Individual country studies have found that a more diversified diet is
correlated with:
oCaloric and protein adequacy,
oPercentage of protein from animal sources
oHousehold income
oChild nutritional status and growth
(Ruel, 2002)

6. Why Care about Household Dietary Diversity?
 Household Dietary Diversity focuses on the availability of food at the
household level
 Individual level dietary diversity is an interaction between food availability
at the household level and behaviors within the household such as
distribution among family members and child feeding practices
 Individual level dietary diversity is strongly correlated with nutrient
adequacy of diet

7. What Factors Determine Household Food Access/ Dietary
Diversity?
 Household income and access to social safety net programs
 Absolute and relative food prices
 Consumption from own agricultural production
Also see these three factors when looking at agriculture-nutrition linkages at the household
level (Ruel and Alderman, 2013): Increased income, changes in relative food prices,
consumption from own production

8. Income and Household Food Access in Egypt

9. Income and consumption patterns- cross-sectional
• Vegetable consumption
(blue) increases with income;
• Legume consumption
(orange) flat or decreasing
with income
• Cereals (blue) and rice
(green and red) consumption
only increases slightly with
income
• Meat and fish consumption (blue)
increase sharply with income
• Milk and dairy consumption
(orange) increase sharply with
income
Figures from Ecker et. al, 2016, based on analysis of 2010-2011 HIECS

10. Income and consumption patterns- cross-sectional
Household Dietary Diversity Score by quintile
Poorest 20% 20-40% 40-60% 60-80% Richest 20%
8.7 9.7 10 10.3 10.6
less than 8 food groups 8 food groups 9 food groups 10 food groups 10-12 food groups
Cereals Cereals Cereals Cereals Cereals
Potatoes Potatoes Potatoes Potatoes Potatoes
Vegetables Vegetables Vegetables Vegetables Vegetables
Oils and fats Oils and fats Oils and fats Oils and fats Oils and fats
Sweets Sweets Sweets Sweets Sweets
Condiments Condiments Condiments Condiments Condiments
Legumes Legumes Legumes Legumes
Dairy products Dairy products Dairy products Dairy products
Fruits Fruits Fruits
Meat Meat Meat
Eggs

11. Income and consumption patterns: impact of cash transfers
 Since March 2015, the Government of Egypt has been providing monthly
cash transfers to poor households through the Takaful and Karama
program, Takaful is for poor families with children under 18
 Targeting is primarily based on proxy means test (PMT) methodology
oPMT score is calculated based on household characteristics, asset
ownership, and housing conditions
oHigher scores indicate higher predicted household expenditure
 Question: how does giving poor households cash change their access to
food?

12. Takaful and Karama Impact Evaluation
Regression Discontinuity
• Compares households
that are similar in every
way except for receiving
cash
• Unlike cross-sectional
analysis, shows causal
impact of increase in
income
Threshold
2500 3000 3500 4000 4500 5000 5500 6000
Consumption
Program
Impact
PMT Score

13. Household Food Consumption by Category
Grains, 173
Potatoes, 48
Vegetables,
179 Fruits, 52
Meat and
Poultry, 252
Eggs, 26
Fish, 26
Legumes, 58
Dairy, 72Oils and
Fats, 105
Sweets, 122
Other, 68
Outside, 70
Total food spending: 1252 EGP per month
(58% of all monthly spending)

14. Takaful Impacts on Food Consumption
Increased fruit by 25% (13 EGP )
Increased meat and poultry by 28% (70
EGP)
Total food spending: 1252 EGP per month
(58% of all monthly spending) Increased total food spending by 8.3% (101
EGP)
Average Transfer amount: 432 EGP
No impact on consumption of sweets
70
13
101
0 200 400 600 800 1000 1200 1400
Meat and Poultry
Fruits
Total Food
Household Spending per Month (EGP)
Average Spending Takaful Impact
Food consumption may be under-estimated because survey
length is shorter than HIECS (trade-off between accuracy
and completeness)
• Inflating to adjust for under-estimation suggests than food
spending increased by 152 EGP
• i.e. 35% of the transfer is spent on food
Figure from 2018 Impact Evaluation of Takaful and Karama Report

15. Household Dietary Diversity
 Cash transfer impacts for threshold households are on amount and
frequency of food consumed, rather than number of food groups
 Sample average HH Dietary Diversity Score is 9.5 (out of 12) for 7 days
 For poorer households in the program, transfers likely allowed households
to start to consume fruit and meat
less than 8 food groups 8 food groups 9 food groups 10 food groups than 10 food groups
7.8% 14.2% 22.6% 28.7% 26.7%
Cereals Cereals Cereals Cereals Cereals
Potatoes Potatoes Potatoes Potatoes Potatoes
Vegetables Vegetables Vegetables Vegetables Vegetables
Oils and fats Oils and fats Oils and fats Oils and fats Oils and fats
Sweets Sweets Sweets Sweets Sweets
Condiments Condiments Condiments Condiments Condiments
Legumes Legumes Legumes Legumes
Dairy products Dairy products Dairy products Dairy products
Fruits Fruits Fruits
Meat Meat Meat
Eggs

16. Qualitative Reports on Use of Cash Transfers
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
8
9
10
11
12
13
Food Chicken Meat Dairy and
eggs
Fruits Vegetables Grains and
legumes
NumberofthrehsoldHHs(of7)
NumberofultrapoorHHs(of13)
Ultra-poor (left-hand side) Threshold (right-hand side)
Figure from 2018 Impact Evaluation of Takaful and Karama Report

17. Qualitative Reports on Use of Cash Transfers
 “Our diet is now better because I have a source of income so I can get
what I want. Before that I didn’t used to buy things if I don’t have money”
 “I hadn’t bought chicken for some time, so I went out and got ten chicks to
raise and eventually eat”
 “The doctor said get bananas and milk, but I did not used to be able to buy
it. Then I started getting the transfer, so I buy it”
 “I get fruits. I also did not have the means to get them [my family] meat,
now I buy it for them. Every month on my way back from receiving the
transfers I get them a kilo of meat”

18. Relative Prices and Household Food Access in Egypt

19. Prices and Household Food Access
 Food subsidies decrease relative price of the subsidized food items
 Analysis of pre-2015 system (only bread, oil, rice, and sugar subsidized)
oAt similar income levels, ration card holders consume more cereals
and rice and less meat, fish, and dairy products
Figures from Ecker et. al, 2016, based on analysis of 2010-2011 HIECS

20. Agricultural Production and Household Food Access in
Egypt

21. Consumption from Own Production and Food Access
 Individual country studies have found that farm production diversity is
correlated with household food diversity in Ethiopia, Malawi, Zambia,
Indonesia, Kenya, and Nepal (Ruel 2013)
 However, the degree to which farm production diversity impacts household
food diversity depends on the market access: greater market access
reduces the correlation
oEgypt market access is relatively high compared to other countries
studies, so less likely to see a strong correlation
 From an IFPRI survey of farmers in Upper Egypt, on average only 20% of
food consumption is from own production and no evidence so far of
relationship between production diversity and dietary diversity

22. Key Points and Research Agenda Going Forwards
 Household food access is an important component of the complex framework leading to
nutrition outcomes
 In Egypt, we have strong evidence on the ability of increases in income to improve
household dietary quality on average
o More understanding is needed of the factors such as household decision-making
processes, food marketing, traditional foodways, and education that mediate the
relationship between income and dietary quality
 Theoretically and from cross-sectional findings we also know that relative prices matter
o Analysis needed of how household dietary diversity has been impacted by the
reforms in the ration card system
o Policy regarding pricing of food items for ration card holders should ideally be
informed by estimates of the price elasticity of demand and relative nutritional value
o Research to inform policy choice between continuation of subsidies vs. cash transfers
 Nutrition sensitive agricultural policy may also play a role, primarily in contexts with low
market access

23. References
 Breisinger, Clemens; Gilligan, Daniel; ElDidi, Hagar; El Enbaby, Hoda; Karachiwalla, Naureen; Kassim, Yumna;
Kurdi, Sikandra; Jilani, Amir Hamza; Thai, Giang; Goessinger, Karim-Yassin; Moataz, Yasmine; and Petesch,
Patti. 2018. Impact evaluation study for Egypt's Takaful and Karama cash transfer program: Synthesis report-
Summary of key findings form the quantitative and qualitative impact evaluation studies. MENA RP Working
Paper 16. Washington, DC and Cairo, Egypt: International Food Policy Research Institute (IFPRI).
 Ecker, Olivier; Al-Riffai, Perrihan; Breisinger, Clemens; and El-Batrawy, Rawia. 2016. Nutrition and economic
development: Exploring Egypt's exceptionalism and the role of food subsidies. Washington, D.C.: International
Food Policy Research Institute (IFPRI).
 Hoddinott, John and Yisehac Yohannes. Dietary Diversity as a Household Food Security Indicator. Food and
Nutrition Technical Assistance Project, Academy for Educational Development, Washington, D.C.2002.
 Ruel, Marie. “Is Dietary Diversity an Indicator of Food Security or Dietary Quality? A Review of Measurement
Issues and Research Needs” IFPRI FCND Discussion Paper 140, November 2002.
 Ruel, Marie T.; Quisumbing, Agnes R.; and Balagamwala, Mysbah. 2018. Nutrition-sensitive agriculture: What
have we learned so far? Global Food Security 17 (June 2018): 128-153.
 Swindale, Anne, and Paula Bilinsky. 2006. Household Dietary Diversity Score (HDDS) for Measurement of
Household Food Access: Indicator Guide (v.2). Washington, D.C.: FHI 360/FANTA.

24. For more information on past and future seminars
 http://egyptssp.ifpri.info/