HOMESTEAD FOOD

PRODUCTION: A MULTI-
SECTORAL INTERVENTION TO
ADDRESS MALNUTRITION

11 March, 2016
Overview of the content for this presentation.

• Section 1: Global Burden of Malnutrition

• Section 2: Nutrition‐sensitive Interventions

to Address Malnutrition

• Section 3: Homestead Food Production

• Section 4: Current Status of Homestead Food

Production in Indonesia
Key points for today’s discussion

• First key point

– Reducing the burden of malnutrition requires action at
many stages of a family’s life
• Second key point
– A multi‐sectoral approach is needed to reduce
malnutrition
• Third key point
– Building the self‐reliance of the household or
community to address malnutrition offers a potentially
sustainable approach to breaking the cycle.
GLOBAL BURDEN OF MALNUTRITION

4
 Progress Toward the Global WHA Targets*

Indicator Baseline year Baseline status Target for 2015

Stunting 2012 162 million 100 million 
(15% 
prevalence)
Anemia 2011 29% 15%
Low Birth  2008‐2012 15% 10%
Weight
Wasting 2012 8% <5%
Exclusive  2008‐2012 38% 50%
Breastfeeding

*2014 Global Nutrition Report
 Framework for actions to achieve optimum fetal and 
child nutrition and development*

*2014 Black Maternal and child undernutrition and overweight in low‐income and middle‐income countries
NUTRITION‐SENSITIVE INTERVENTIONS TO ADDRESS
MALNUTRITION

9
 Nutrition‐sensitive Interventions and Programs*

Interventions or programs that address

the underlying determinants of fetal and
child nutrition and development (food,
care, health) and incorporate specific
nutrition goals and actions.

Nutrition‐sensitive programs can serve as

delivery platforms for nutrition‐specific
interventions, potentially increasing their
scale, coverage and effectiveness.
*2013 Lancet
Nutrition‐sensitive interventions can include:

 Agriculture and food safety;

 Early child development;
 Women’s Empowerment;
 Schooling;
 Health and Family Planning Services;
 Social Safety Nets;
 Maternal Mental Health;
 Child Protection; and
 Water, Sanitation, and Hygiene.
 Key points to remember for food 
security and nutrition 

•The overall outcome for food 
security is the nutritional status of 
the population; and 
•All four key elements (availability, 
access, stability, and utilization of 
food) are important for achieving a 
good nutritional status. 
HOMESTEAD FOOD PRODUCTION

15
 HKI’s HFP Program Model 

Objective of HKI’s HFP model:   Improve the nutritional status 
of vulnerable members in low income households through 
home production of micronutrient (MN) rich foods including 
vegetable and fruit crops, small animals, and poultry.  

First generation programs focused on micronutrient outcomes 
(esp. vitamin A and iron) via dietary diversity

Second generation programs (e.g. HFP’s current programs) now 
also include improvement in child growth as an objective in 
addition to micronutrient status
 Program impact pathways to achieve objectives

• Increased  year‐round production & consumption of home 
produced micronutrient‐rich vegetables and fruits and animal 
source foods  (increased dietary diversity);
• Increased household income from the sale of produce that can 
be used to purchase nutritious foods & other necessities, 
especially that under control of participating women;
• Improved child nutrition and health practices through nutrition 
behavior change  (e.g. enhanced nutrition actions) and links to 
local health services; and
• Improved child care and family welfare through the 
empowerment of participating women.
 Conceptual framework of the relationship between household 
food production strategies and health and nutrition outcomes

Increased  Increased 
household  spending 
income on health
Improved 
Improved 
utilization  maternal 
of vitamins  and child 
Nutrient Increased  and 
Gender‐ health 
spending  minerals
sensitive  ‐rich  outcomes
agriculture 
on 
foods  nutritious 
training
sold foods

Improved 
Participation  Increased  Nutrient‐ Increased 
intake of  Improved 
production  rich foods  consumption 
in household  macro‐ and  maternal 
Agricultural  of nutrient‐
food  of  consumed  rich foods by 
micro‐ and child  
production  inputs nutrients by 
nutrient‐ by  women and  nutritional 
interventions women and  status
rich foods household children
children

Nutrition 
education

2012 Webb‐Girard: The effects of household food production strategies on the health and nutrition outcomes of women and young children.
 Characteristics of HKI’s HFP program model

 Utilizes existing community structures and systems to 
establish Demonstration Farms (DFs) who received 
agriculture support and nutrition education; 
 Integrates home gardening with small animal 
husbandry, poultry/fowl production and fish farming;
 Promotes  year round access of indigenous 
micronutrient‐rich crops and animal source foods, many 
of which are already being produced by households; and
 Improves on local farming practices to extent possible.
 Program Model Cascade

HKI
Demonstration Farm

Local  Members
Gov’t
NGOs
Head

Comm
Others
Leaders
 Targeted household and beneficiaries 

• Resource poor households:  land holding, not salaried, no 
sanitary latrine, no motor cycles, TV, electricity, no 
irrigation/power tiller; 
• Female‐headed household when possible; 
• Interested to participate in the program;
• One young child: A majority of the total households have  
one child < 5 or pregnant women; and
• Important: Households in the demonstration farm should 
not be far apart.  
 Intervention inputs:

• Input support:  seeds, seedlings and saplings, poultry (local 
breeds) or/and support for poultry sheds, poultry vaccines, 
fish cultivars, horticultural inputs, animal fodder, and 
gardening tools like water cane and pipes 
• Training in Essential Agriculture Techniques including animal 
husbandry at different levels – extension agents from NGOs, 
community health volunteers, village and subdistrict
government
• Training in Essential Nutrition Actions and behavior change at 
different levels – health staff from NGOs and government 
offices, health volunteers, and targeted women 
• Establish of links for marketing & resource access
• Important: Input support shouldn’t be 100% free of cost 
 Agriculture Training

Agriculture
• Year‐round vegetable and fruit
production;
• Seed, seedling and sapling
production;
• Integrated pest management;
• Organic fertilizer and pesticides; and
• Small scale irrigation
 Nutrition Training

Nutrition
• The Importance of Dietary Diversity;
• Undernutrition and its Causes;
• The Importance of Micronutrients;
• Hygiene Practices; and
• Infant and Young Child Feeding Practices.
 Nutrition Education

• Based on formative research;

• Nutrition training provided to health workers,
kaders, agriculture and animal husbandry
extension workers, and religious leaders;
• Uses IEC materials such as food cards, health
practice game boards, and a recipe book;
• Cooking demonstrations; and
• Nutrition education during religious
meetings.
 Animal Husbandry Training

• Chicken Rearing;
• Chicken Coop Construction;
• Chicken feeding;
• Chicken vaccination; and
• Catfish rearing.
Suaahara: Integrated Nutrition Project in Nepal 
(2012‐2016)
 Suaahara: Overview

Goal: Improve the nutritional status of women 
and children < 2 years

Result 4:
Result 1: Result 2: Result 3:
Coordination on 
Household  Use of quality  Consumption of 
nutrition 
nutrition, health  nutrition and  diverse and 
between 
and hygiene  health services by  nutritious food by 
government and 
behaviors  women and  women and their 
other actors 
improved children increased families increased 
strengthened
Suaahara’s intervention districts

Suaahara
A 5-year (2011-2016) multi-sector
nutrition project operating at scale in
25 districts and recently expanded to
additional 16 districts to reach over
625,000 households
 Suaahara components

Nutrition‐specific
• Essential Nutrition Actions
• Essential Hygiene Actions
Nutrition‐sensitive
• Homestead Food Production
• Maternal Newborn and Child 
Health Services
• Family Planning
• Water Sanitation and Hygiene

Cross‐cutting themes
• Social behavior change communication
• Nutrition Governance
• Gender and Social Inclusion
• Capacity Building
• Monitoring, Evaluation and Learning
 Suaahara: Implementation modality

National District (41) Community (>1900 VDCs) Households 

(~625,000)
Health workers

District authorities  FCHVs,  Health mothers 

and stakeholders groups
GON and  Social mobilizers and  Pregnant women,
Stakeholders local development  lactating women 
Partner NGOs and 0‐24 month 
structures
old children
Suaahara
District media WASH committees
Disadvantaged 
Ag/Livestock extension 
1,000‐day 
workers
To improve advocacy  households
leading to national 
policies, strategies,  Local media
guidelines and 
To strengthen service delivery 
investments in nutrition
systems for nutrition
To improve access to quality services To support community for 
improved family actions on 
nutrition
 Results from a Cluster Randomized Trial  for HFP in 
Nepal

Food Production, Household Income, and Food Security
Outcome Treatment Control
Had both home garden and 
poultry, % +18.3%* +6.0%*
Eggs produced from HFP, last 2 
months, count +21.8%* +10.0%*
Cash income ≥ Rs. 4,000, last 
month, % +26.4%* +13.8%*
Perception of food insecurity 
(HFIAS), last 30 days, % ‐26.1%* ‐9.1%*
Source: 2014 USAID Operations  *Differences between baseline and endline within the study group 
Research Brief were statistically significant at  P<0.05
 Results from a Cluster Randomized Trial for HFP in 
Nepal
Health Knowledge and Practices
Outcome Treatment Control
Nutrition knowledge, %
Eggs good for children 6–12 months old* +51.5%* +1.3%
Meat good for children 6–12 months old* +38.5%* +13.6%*
Women should eat more during pregnancy* +31.4%* +7.4%*
Complementary feeding for children 6–23 months 
old, %
Received minimum dietary diversity* +45.0%* +4.7%
Received minimum meal frequency* +12.6%* +4.2%*
Antenatal care, %
Received any antenatal care* +23.0%* +15.0%*
Attended ≥ 4 antenatal care visits* +34.9%* +18.6%*
Source: 2014 USAID Operations  *Differences between baseline and endline within the study group 
Research Brief were statistically significant at  P<0.05
 Results from a Cluster Randomized Trial for HFP in 
Nepal

Nutritional Status
Outcome Treatment Control
Underweight, women (BMI <18.5 
kg/m2), %* ‐1.6% +5.5%*
Anemia, women (Hgb <12 g/dL non‐
pregnant; Hgb <11 g/dLpregnant), %* +5.0%* +14.7%*
Stunting, children (ht‐for‐age z‐score 
<‐2 SD), % ‐2.6% ‐2.3%
Wasting, children (wt‐for‐height z‐
score <‐2 SD, % ‐0.1% ‐0.4%
Underweight, children (wt‐for‐age z‐
score <‐2 SD), %* ‐2.4% ‐7.4%*
Anemia, children (Hgb <11 g/dL), %* +2.6% +10.9%*
Source: 2014 USAID Operations  *Differences between baseline and endline within the study group 
Research Brief were statistically significant at  P<0.05
 An independent evaluation showed that the
HFP is sustainable*:

• Households continue with their garden

activities once the program support has
ended;
• Income earned from selling garden produce
was even higher than during project
participation; and
• Consumption patterns were still more diverse
in comparison with a control group.

*Source:  Bushamuka, V. N. et. al. FNB 2005
HOMESTEAD FOOD PRODUCTION IN INDONESIA

38
 Nutritional Status in Indonesia

Indicator Year Status Target 2015

Stunting* 2013 37% 32%

Anemia  2013 37.1%

(pregnant 
women)*
Low Birth  2013 11.1%
Weight*
Wasting* 2013 12.1%
Exclusive  2012** 42% 80%
Breastfeeding

*2013 Riskesdas; **2012 IDHS
 HKI’s Project Goals
• Improve the food security and nutrition conditions 
among vulnerable households in Timor Tengah 
Selatan (TTS) district, East Tenggara Timur (NTT) 
Province in eastern Indonesia. 
• Promote and facilitate improved household food 
security and nutrition through Homestead Food 
Production (HFP).
• Improve the capacity of households to produce 
year‐round micronutrient rich foods (fruits, 
vegetables, small animals (e.g. chickens, eggs) for 
their own consumption.
• Improve the nutritional practices and behaviours of 
those households.
“Before I mainly sold the vegetables I grew.  Now I feed my children  more 
of the vegetables that I grow  and they are gaining weight and getting 
healthier.”

Fin learned that  children need to 
consume various nutritious foods 
every day so they can be healthy.  
Fin received seeds for 12 
vegetables at the training that she 
could  plant in her home garden.  
Fin grew these  vegetables, but 
instead of selling all of her produce, 
she used the new vegetables to 
feed her children.  Fin did sell the 
surplus to her neighbors.  Her 
children now enjoy eating 
vegetables every day  because they 
get a variety. 
Where is NTT?
NTT Has the Highest Prevalence of Stunting in Indonesia
 Access to Health Services can be an Issue in the TTS 
district (Project Area) of NTT Province

35%

30%
Distance to Health Facility in Time*
25%

20%
NTT
15%
TTS
10%

5%

0%
31'‐60' >60'
*2007 Riskesdas Data
Target Phase 1 (2012) Phase 2 (2013‐ Total
2015)
Households (HH) 1,601 2,400 4,001

Demonstration 80 120 200

Farms (DF)
Current exposure 21 months (Feb 13‐ 10 months (Mar‐
time Dec 14) Dec 14)
Planned exposure 31 months (Feb 13‐ 18 months (Mar
time Sept 15) 14‐Sept 15)
Villages 74

Sub‐districts 17
Before participating in the 
Homestead Food 
Production project, 
Sancerina used to buy 
vegetables for consumption, 
but now she sells her 
surplus produce to the 
market. As she said, “Before 
I doubted (I could do this) 
since my homestead is full 
of trees, but HKI taught me 
how to cultivate vegetables 
using polybags”. 
 Results from Baseline (2012) in NTT

Food Production and Household Income
Outcome Baseline Endline
Planted orange/yellow fruits or 
vegetables in garden 48.9% ?
Planted green leafy vegetables in 
garden 35.5% ?
Percentage of farmers profiting 
from their garden 32.8% ?

Source: 2012 Baseline survey
 Results from Baseline (2012) in NTT

Health Knowledge and Practices
Outcome Baseline Endline
Complementary feeding 
for children 6–23 months 
old, %
Received minimum 
dietary diversity 11.8% ?
Received minimum meal 
frequency 87.9% ?

Source: 2012 Baseline survey
 Results from Baseline (2012) in NTT

Nutritional Status
Outcome Baseline Endline
Stunting, children (ht‐for‐age z‐score 
<‐2 SD), % 60.1% ?
Wasting, children (wt‐for‐height z‐
score <‐2 SD, % 11.8% ?
Underweight, children (wt‐for‐age z‐
score <‐2 SD), %* 44.3% ?
Anemia, children (Hgb <11 g/dL), %* 48.3% ?

Source: 2012 Baseline survey
 Change in Food Consumption Scores from 
baseline after 24 months of implementation
100%

80%

60%
Baseline
Sep‐13
Jan/Feb 14
Jul‐14
40%
Jan‐15

20%

0%
Poor Borderline Acceptable

Source: 2012 Baseline survey, 4 rounds of LQAS survey
Availability of expertise and land in Indonesia*

• In Indonesia, approximately 28% of men are agriculture 
workers;
• Ranges from 1% (Jakarta) to 53% (West Sulawesi)
• Approximately  13% of women are agriculture workers;
• Ranges from  <1% (Jakarta) to 40% (Papua); and
• Approximately 39% of households in Indonesia  own 
land usable for agriculture;
• Ranges from  9% (Jakarta) to 64% (Papua).

*Source:  2012 Indonesian DHS
 Strategy on Acceleration of Nutrition Improvement in technocratic 
draft of RPJMN Sub‐fields Health and Community Nutrition

1. Improvement nutrition surveillance, including monitoring of growth;
2. Improvement of access and quality of health care and nutrition package with a primary 
focus on first 1,000 days of life.
3. Increase promotion of community behavioral health, nutrition, sanitation, hygiene, and 
parenting;
4. Increase community involvement to improve nutrition, including through community‐
based health / UKBM (integrated service post / Posyandu and Early Childhood Education 
and Development / PAUD);
5. Strengthening the implementation and supervision of regulation and nutrition 
standards;
6. Development of food fortification;
7. Strengthening the cross‐sector role within the framework of specific interventions 
(health sector) and sensitive interventions (education, religion affair, agriculture, 
fisheries, livestock, family planning, social, industry, trade, communication and 
information, and infrastructure).
63
 Comparison between the Ministry of Agriculture’s Sustainable Food Reserve 
Garden Model (Kawasan Rumah Pangan Lestari/KRPL) and HKI’s Homestead 
Food Production Model

Component Ministry of  HKI

Agriculture
Improving food security through  Yes Yes
utilization of
the home garden
Increasing food diversity Yes Yes
Demonstration farms as a source of  Yes Yes
inputs
Group approach Yes, with 20 HHs Yes, with 20 HHs
per village per DF
Training Yes Yes
Focus Income Generation Nutrition and 
Income 
Generation 
 “Life has to be changed!”
“HKI [Helen Keller International], through 
its Homestead Food Production program in 
our village, has improved my family’s life 
because we now plant organic vegetables 
and raise poultry as well as catfish in our 
yard. Production of those vegetables, 
chicken and catfish is so good that I can 
sell some to the market and it has 
improved our economic condition while 
fulfilling the basic needs of my family…. I 
am sure the result of this activity will help 
me to provide enough
money to pay for my children’s school 
fees. I really hope that the government will 
continue supporting
this activity,”
 In Summary 

• Vulnerable households can:
• diversify their diet by increasing production 
and consumption of micronutrient‐rich foods, 
including poultry and fish
• generate income, also to be spent on foods 
• HFP has the potential to reduce micronutrient 
deficiencies;
• Considering its multiple benefits, HFP is an option 
to improve household food security, nutrition 
and livelihoods and contribute to achieving the 
MDGs. 
 THANK YOU.
“Alone we can do so little; together
we can do so much.” ‐Helen Keller pgupta@hki.org