Prioritizing Nutrition in Agriculture and Rural Development: Guiding Principles for Operational Investments, by A. Herforth, A., Jones and P. Pinstrup-Andersen, HNP Discussion Paper Series, World Bank. (Full Publication Available Here).
Agricultural and rural development provides a critically important opportunity for reducing malnutrition, partly because a large share of the malnourished resides in rural areas and partly because agriculture is the source of food and other ecological services for both rural and urban people. Many factors influence human nutrition and the impact of agricultural and rural development on human nutrition is not automatic and predetermined. Both undernutrition (stunting, underweight, wasting, and micronutrient malnutrition) and overnutrition (overweight and obesity) are costly for human and economic development, and both are influenced by agriculture and the food system.
Abundant evidence shows that when farmers are malnourished, they are less productive; improving the nutrition of rural populations will improve agricultural productivity. Putting a nutrition lens on an agricultural investment can also improve gender equity in that investment – an increasingly common goal of the agriculture sector – because it shifts focus toward the labor, income control, and time use of women. It can also improve ecological sustainability in cases where crop diversification contributes to both human and ecosystem health. In many instances, it is also good business to produce nutritious foods, since demand for high-value horticultural and animal source foods is rising in urban areas, and could rise further with improved education and incentives. Food security is regularly used as a justification for agricultural activities, and because food security rests on the access to nutritious diets, greater attention to nutrition impact will help ensure that many agricultural investments remain true to their rationale.
The purpose of this paper is to provide a set of guiding principles for incorporating nutrition goals into the design and implementation of agricultural and rural development projects, and to provide examples of current best-evidence options for operational investments. While many agricultural approaches to improve nutrition have shown promise, there is no one-size-fits-all silver bullet approach. To choose among operational approaches, assessing the context in which agricultural operations will occur is essential. Further, both concerted actions and policy coherence are needed to avoid unintended negative consequences on nutrition through agriculture policies and programs. Several principles are likely to be important in all or most cases for nutrition-sensitive agriculture, which can be adapted to individual contexts:
1. Incorporate nutritional concerns into the design and implementation of agricultural policies, projects and investments. The primary ways to achieve this principle are to include a nutrition objective as an explicit program or policy goal, and to measure nutrition-related outcomes. In measurement of impact, the highest priority should be given to measurement of determinants of nutrition most likely to be affected by agricultural projects, particularly household food consumption and diet (e.g. through indicators such as dietary diversity); indicators will vary with respect to the project activities and goals. If child nutritional status is the target for impact, it should also be measured through child anthropometry (e.g. height and weight measurements), given sufficient sample sizes, and attention to impact pathways for improving nutritional status.
2. Target nutritionally-vulnerable groups: Within the population, target the poorest households: the project or policy should be targeted to reach the most vulnerable group(s) involved in or affected by agricultural incomes and food prices, particularly smallholder farmers, landless laborers, and the urban poor. Investments can better reach vulnerable indigenous groups if they are modified appropriately. Within households, target women of childbearing age and young children. Agriculture has the potential to greatly contribute to child nutrition within the 1,000-day window between conception and age two, not only by ensuring consistent access to diverse diets, but also safeguarding environmental resources and the health of household members.
3. Invest in women: Women have a large role in the food security and nutrition in the household. Agricultural investments can strengthen women’s decision-making power and control of economic resources, for example though providing increased market opportunities for women’s crops, increased access to land rights and other productive resources, and supporting women’s income generation with facilitation of high-quality child care and time-saving technologies. Agricultural project planners are accustomed to assessing market price and agronomic characteristics when selecting crops to be included in projects; gender characteristics could also be included as a criterion.
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5. Protect health through water management, primarily through safeguards to minimize potential harm from water-borne diseases and chemical contamination of water and efforts to improve water use efficiency.
6. Design poverty-reduction strategies explicitly to benefit nutrition. At household level, the nutrition impact of household income can be enhanced through a focus on women and nutrition knowledge. At a larger scale, measured outcomes of agricultural growth should include food security and public health – considering the dual burden of undernutrition and obesity that is closely linked to the food system –in addition to productivity and economic growth. Poverty reduction, a primary goal of agriculture and rural development investments, can further become more nutrition-sensitive through pro-poor investments in services and infrastructure.
7. Create enabling environments for good nutrition through knowledge and incentives. Evidence has shown that incorporating nutrition education into agricultural investments helps to translate production and income gains into nutrition improvements. Some nutrition-relevant information is best communicated by agricultural extensionists or project staff. Efforts that involve the entire family in revaluing the importance of women’s time, resources and nutrition and the care of children have been shown as more likely to shift behaviors to benefit nutrition. Policies can support or undermine poverty reduction and nutritious diets, and are a much larger factor that can be leveraged to enable households to put nutrition knowledge into practice.
8. Seek opportunities to work across sectors. Multisectoral action is critical to reducing all causal factors of malnutrition. There may be opportunities within each program to interact with programs in other sectors working to improve nutrition: examples are through multisectoral planning and geographic overlap, establishing a national shared architecture for nutrition improvement, conducting joint nutritional impact assessments, and referring clients to other sector projects. Supporting multisectoral coordination, it is often necessary to increase the capacity of government ministry staff across sectors to understand and address malnutrition.
The principles put forth in this document underscore investments in people and systems that have the potential to transform underlying conditions and positively influence the multiple, proximal determinants of proper nutrition. Better information on impact and costs of specific approaches based on the above principles would be extremely helpful to inform better program design and best practice examples for scale-up. Research and evaluation priorities include tracking impact on multiple outcomes at once (such as diet, nutritional status, productivity and income); better designing studies to attribute impact to specific approaches; and collecting information on costs and cost-effectiveness.
Although there is an urgent need to strengthen the understanding of how agricultural policies, projects and investments can be designed and implemented to achieve nutrition goals, existing knowledge around the guiding principles in this document is sufficient to move ahead with designing nutrition-sensitive agricultural interventions. Rather than to rationalize inaction based on incomplete evidence on operational approaches, it would be sensible to base agricultural investments on principles of how agriculture can affect nutrition, strengthened by good evidence that well-planned investments are likely to reach at least targeted income and dietary outcomes. The next step is to put the principles outlined in this document into action, and to learn from the results.