Innovation Frontiers

for Agriculture-Nutrition Linkages

Patrick Webb
Director of Feed the Future
Nutrition Innovation Lab - Asia
AAAS Chicago
February 2014
1

Main messages
1. Undernutrition remains a major challenge
to science,
not just to politics.
2. Study of the politics of nutrition is a neglected
domain
(understanding process of policy
implementation,
policymaker motivation, commitment to
collaboration
across sectors, willingness to act, capacity to
act
2
researchable questions).

Today, >160 million children stunted

(short for age)
Stunting underpins almost 20% child deaths globally
Severely stunted child c.5 times more likely to die of
diarrhea

If we change nothing,
127 million children still stunted in
2025.

Frontier research on policy processes

and program implementation
Analysis of how policies are put into practice
is still in its infancy. (Gilson and Raphaely 2008).
Gillespie et al (2013): We call for more
research on what defines enabling
environments for nutrition. We also call for
more systematic ways to capture [lessons
from] policy and programme operations.
4

Source: WHO (2013) Global Nutrition Policy Review

5

Source: Swart et al. (2008) Nutrition: Primary Health Care Perspective (Du

Map of Nepal research

sites 2012-15
21 sites, stratified random sample;
panel data (4,500 children); birth
cohort; linked to aflatoxin, gut
microbiome work.

Mountain sites
Hill sites
Valley sites

32 Questions posed to the >700

policymakers/implementers:

Incentives for collaboration

What incentives exist for x-sector collaborati
What hurdles are there to effective collabora
Perceptions/attitudes
Are beneficiaries able to express own needs?
Main frustrations in doing more for nutrition
Knowledge/training
Knowledge of national nutrition policy/strat
Had training in nutrition
Effectiveness/resources
Financial or administrative hurdles to action
Rewards to working within/across sectors
8

Nepal research
Level

Institution/Individual

National

Policy makers, donors, international nongovernmental organizations (NGOs),

academics

Regional

District

Regional Administrator, Ministries of Health,

Agriculture, Livestock, Education, Local
Development, Water Supply,
Departments of Health, Agriculture,
Livestock, Education, Local Development,
Social Development, implementing NGOs

N=
708
26
29
278

79

Ilaka

Offices of Health, Agriculture, Livestock,

Education, Local Development

Village
Developme
nt
Committee

VDC Secretaries of Health, Agriculture,

Livestock, Education, implementing NGOs

Ward

FCHV, Representative Ward Citizen Forum,

Representative MG, Representative
9
Source: Survey data 2013
Cooperative/Groups

97
199

Perceptions of causes of malnutrition varies by

governance level
Disea
Low
Poor
Lack of
se
food
breastfeedi educati
producti
ng
on
on
practices
Region
District

55%
42%

56%
48%

0
5%

90%
94%

Sub-District
Village
cluster

47%
45%

44%
49%

10%
9%

96%
93%

Ward

42%

40%

14%

86%
10

Source: Survey data 2013

Do you feel that your department is sufficiently

consulted on nutrition problems and solutions?

Region
District
Sub-District
Village
cluster
Ward
Mean

Yes
38%
42%
48%
38%

No
62%
58%
52%
62%

52%

48%

43%

57%

11
Source: Survey data 2013

Major constraints to effective nutrition action

Lack
Political
Time
Resources interferen burden
ce
Region

66%

35%

3%

District

48%

12%

2%

Sub-District

53%

8%

4%

Village
Cluster

43%

16%

16%

Ward

38%

2%

19%

Mean

47%

12%

5%
12

Source: Survey data 2013

Responses also vary by sector

Are your own colleagues sufficiently trained to
work across sectors on nutrition actions?

Yes
Yes, but
need
refreshers
No
p=0.000

Local
Agriculture
Water NonDevelopm Health and
Educatio Supply Gover
ent
Ministr Livestock n
Ministr nmen
Ministry
y
Ministries Ministry y
t

33% 59%
34%
50% 65% 70%
21%
46%

22%
20%

27%
39%

24%
26%

23%
12%

11%
20%

Source: Survey data 2013

13

Surprises

Own colleagues
adequately trained for
role?
Own department able
to respond to
expressed needs?
Awareness of nutrition
programming in your
region?
Knowledge of national
nutrition policy/strategy?

Mountai Hills Valleys

ns 45%
49%
36%
37%

35%

11%

96%

79%

76%

9%

3%

3%

Source: Survey data 2013

14

Governance Quality (GQ) Score

Commitment to Action [16 points]
Incentives for collaboration [8 points]
Perceptions/attitudes
[8 points]
Capacity to Act
[16 points]
Knowledge/training
[8 points]
Effectiveness/resources
[8 points]
32 points total possible per respondent (N=708)

15

>37%
Stunting

<36.9%

<16 GQ score

>16.1

>50% households
growing <5 crops

Preliminary findings/conclusions
Good governance matters for nutrition! Wellknown at national level; first quantified approach
at sub-national level.
Directions of causality must be explored. What
drives what? Key to targeting capacity-building
and incentives.
New tools needed to assess commitment and
capacity gaps that can make or break national
policies and programs. Same tools can apply to
implementing agriculture or health actions.
18

Many collaborators
(Asia and Africa):

Quality of Nutrition Governance Scores by Sector

Mean

Agriculture
Health
Education
Local development
Livestock
Administration
Water Supply Department
Womens Development
Committees
Commerce & industry

15.73
17.73
15.53
15.09
15.93
15.65
15.38
15.07

Standar
d
deviati
on
1.42
1.18
1.56
1.16
1.38
1.27
1.33
1.48

14.78

0.94

21

Source: Survey data 2013

>25% Low

<24%

BMI
<16 Governance
>16.1

Governance
Score

Stunting prevalence

What programs should be implemented?

Distric
Region t
Ilaka VDC

Ward

Income/poverty
Education

28%
90%

49%
87%

39%
87%

46%
94%

43%
92%

Agriculture
Improved intersectoral
coordination

59%

49%

48%

43%

21%

34%

32%

24%

12%

24%

Source: Survey data 2013

24

25
Source: Lancet series 2013

Effective
governanc
e of
policies
and
programs

Sanitatio
n,
hygiene Mycotoxins
,
cytokines,
Environmental
etc.
enteropathy (gut
microbiota; shared
pathogens)

26

Source: Adapted from Pinstrup-Andersen (2011) Logical Framework Linking Food Systems with Health

Higher calorie intake has improved nutrition and health

CGIAR (1996) Annual Report 1995-96

Merely producing more food does not

ensure food security or improved nutrition.
(Herforth (2012) World Bank)

Agriculture interventions do not always

contribute to positive nutritional outcomes.
(FAO 2012)

Percent of respondents answering yes

90
80
70
60
50
40
30
20
10
0

Your dept able Your dept has

to respond
ability to collaborate
to need?
more across sectors?

28

Incentives to collaborate across sectors

Support
Shared ownership of
goals
Mandatory
mechanism
Training
Shared resources
Allowance/fiscal
benefits
No incentive
Don't know

SubRegional District district

%
%
%
p value
13.8
7.2
7.6
0.449
20.7

33.8

24.1

0.119

17.2
13.8
62.1

41.0
15.8
51.1

15.2
10.1
50.6

0.000
0.444
0.515

55.2
3.4
0

20.9
1.8
0

17.7
0.000
25.3
0.000
Source:
Survey data
2013
1.3
0.143
29

31
Source: Lancet series 2013

Perceptions of underlying causes of malnutrition

Mountain
sites

Hill
sites

Valley
sites

Disease

51%

43%

35%

Lack of food

51%

54%

33%

Poor breastfeeding

16%

9%

2%

Lack of education

88%

93%

97%

Source: Survey data 2013

32

3 main messages
Undernutrition remains a major challenge
to science.
Wrong on 3 counts.
We know what to do, lets just do it!
1. Dozen evidence-based nutrition-specific
interventions
but even
90% coverage
only
New
research frontiers
lie inat
neglected
spaces.
resolves
20% child stunting.
Some
are biological
mechanisms:
suggestive key roles in nutrition for water-borne
2. Agriculture
is big part
of solution
pathogens,
diet-borne
toxins,
and but more
food/income harms.
not enough. Neglected frontiers of
environmental
research may yield more for nutrition than a
focusare
on yields
biofortification.
Some
policyorbased:
understanding
political motivation, commitment to action,
3. Good efficacy
butquestions
very littlein their33
capacity
to act --evidence
researchable