A4NH value-for-money proposition

Research proposition In low-income countries, most people are linked to agriculture, which has important direct and indirect benefits and risks for nutrition and health.

A4NH is positioned to support agriculture research to achieve the following:

• Improve diets of the malnourished (particularly women and children) through more nutritious foods in value chains and by increasing micronutrients in staples through biofortification;

• Leverage agricultural and rural development programs and policies that improve income and empower women and link to actions in health, social protection, and other sectors for better nutrition and health impacts; and

• Mitigate health risks associated with the intensification of agriculture and food systems.

Two areas for planned short-to-medium term impact at scale:

• Increase adoption and consumption of biofortified food staples that provide iron, zinc and vitamin A to 25 million in 2018.

• By 2018, portfolio of tools and approaches for NGO, governments, and development banks, to help plan and implement integrated programs for improved efficiency, effectiveness, and impact.

*Adapted from Gillespie, Harris, & Kadiyala, 2012

Pictures

Thoughts from our partners… “Combining agriculture, nutrition, and health care interventions can reduce stunting and improve women’s lives. Our partnership with A4NH will enable us to develop and implement better programs by sharing knowledge, experience, and evidence for improved nutrition and health in developing countries." — Dr. Kaosar Afsana, Director, Health, Nutrition & Population, BRAC “An innovative science-based marriage of nutrition and agriculture will significantly contribute to overcoming the extensive malnutrition now prevalent in most developing countries. We are happy that IFPRI and other CGIAR institutions will participate in the LANSA Program. Our aim is to help small farm families overcome major nutrient deficiencies in their diets by teaching them how to apply agricultural remedies to nutritional maladies. The work done under A4NH will be of immense help in converting every family farm into a biofortified farm.” —Professor M. S. Swaminathan, Founder and Chairman, MS Swaminathan Research Foundation “Through our partnership with A4NH we were able to expand the “food basket” approach to biofortify the main staple crops that form the diets of vulnerable populations in Latin America and the Caribbean and then share these technologies worldwide.” — Marilia Nutti, Manager, Latin America & Caribbean, Embrapa Food Technology

This document is licensed for use under a Creative Commons Attribution – Non commercial-Share Alike 3.0 Unported License Photo credits: (L) UNICEF/Benedicte Kurzen, (C/R) Flickr: Neil Palmer/CIAT

October 2013

Lessons Using agriculture as a pathway for improving nutrition and health makes sense in low-income countries where agriculture is often the largest sector and central to the livelihoods of the poor. To achieve sustainable impacts at scale, A4NH faces two key challenges.

Cross-sectoral collaboration between agriculture and public health

In our theories of change, we assume that agriculture is essential for improving diet quality. The challenge is leveraging contributions from different sectors which requires a shared understanding of evidence on what is working and why. We must improve evaluation methods that provide evidence on the contribution of agricultural interventions and develop methods for assessing models of cross-sectoral collaboration.

Agriculture’s potential contribution to healthier food systems

For greater impact and reach, agricultural research must contribute to the evolution of food systems. This requires coordination with private sector actors, such as food processing companies, business schools, and public-private partnerships. It also requires clear understanding of how far market-based solutions will contribute to better and safer diets for the poor, particularly in the first ‘1000 days.’

RESULTS: Impact & Scale 1. Integrated Programs and Policies: Influencing an international agenda

for nutrition-sensitive interventions • Challenge paper selected as most cost-effective approach to addressing hunger and malnutrition at 2012

Copenhagen Consensus (Hoddinott et al. 2012)

• 2013 Lancet nutrition series – A4NH researchers from International Food Policy Research Institute (IFPRI) took lead on 2 of 4 papers:

• Research on nutrition-sensitive interventions (led by M.Ruel and H.Alderman)

• Research on enabling nutrition impacts (led by S.Gillespie, with L. Haddad and others)

• Tackling the Agriculture-Nutrition Disconnect in India (TANDI) project demonstrates critical role of gender empowerment to enhance nutrition progress and informs7 pathways for agriculture’s influence on nutritional outcomes in Lancet series, 3 of which are explicitly gendered.

(See asterisks in Nutrition Pathways).

2. Biofortification: HarvestPlus moving from development to delivery • 12 biofortifed staples for vitamin-A , iron, and zinc developed and assessed for bio-availability and

nutritional efficacy. (See table)

• Cost effectiveness studies compare cash, food, and vouchers for nutrition. Biofortification found to be "highly cost effective,"

estimated cost: $10 per disability-adjusted life year saved.

• Ex-ante assessments of impact pathways and adoption at scale for biofortification in 8 target countries—

from 500,000 people in 2013 to 25 million in 2018.

3. Food safety: Key lessons to accelerate better health for the poor and link them to emerging food markets

• Knowledge, tools and capacity for reducing food safety risks to improved informal and emerging food markets in Africa

• DFID-funded study on prioritization of zoonotic disease risks in Africa and Asia, International Livestock Research Institute (ILRI)

• Series of 19 policy briefs on managing aflatoxins produced by IFPRI as part of 2020 Vision Initiative on key emerging food policy issues

Key contacts John McDermott: Director, A4NH- J.McDermott@cgiar.org Laurian Unnevehr: Theme Leader on Value Chains for Enhanced Nutrition- L.Unnevehr@cgiar.org Howarth Bouis: Theme Leader on Biofortification- H.Bouis@cgiar.org Delia Grace: Theme Leader on Agriculture-Associated Diseases- D.Grace@cgiar.org Marie Ruel: Theme Leader on Integrated Programs and Policies- M.Ruel@cgiar.org Nancy Johnson: Evaluation Coordinator, A4NH - N.Johnson@cgiar.org

For more information visit our website: a4nh.cgiar.org

Gender Gender is central to A4NH research on nutrition and health outcomes and it is being integrated into the development of the A4NH impact pathways and theories of change, across the research portfolio.

Key results from recent gender research:

• Three pathways for agriculture’s influence on nutritional outcomes found to be explicitly gendered: women’s time, workload, and control of resources. (See Nutrition Pathways)

• A4NH is working with the CRP on Policies, Institutions, and Markets to explore the usefulness of the Women’s Empowerment in Agriculture Index (WEAI)—a tool jointly developed by USAID, IFPRI, and OPHI—for analyzing nutritional outcomes.

• Studies found that agricultural programs with demonstrated impacts on diet quality and nutritional status were those which also integrated gender and considered women’s multiple roles as caregivers, farmers and value chain actors.

• Data from different countries and value chains shows that women and men are differentially exposed to food safety risks and causes of zoonotic diseases.

Opportunities 1. Scale integrated programs for improving the nutrition and health impacts from agriculture.

• Ex-ante studies (modeled after biofortification assessments) being developed to scale up integrated programs.

• Support African Union-CAADP (Comprehensive African Agricultural Development Program) process for including nutrition in country investment plans with governments, FAO and NGO partners.

• Leverage funds for agriculture through partnerships with the International Fund for Agricultural Development (IFAD) and the World Bank.

• Build on the Scaling up Nutrition (SUN) movement, which has a total of 42 countries signed up and committed to enhancing nutrition-sensitivity of agricultural policy and programming.

2. Scale food safety research based on strong demand in Asia and urban areas of Africa.

• Work with public-private initiatives to understand reach of commercial food safety systems, and focus A4NH work on connecting poor producers and consumers to commercial markets, particularly for perishable nutrient-rich foods (with Livestock and Fish CRP and the World Vegetable Center).

• Coordinate integration of various interventions to reduce mycotoxin exposure and health and market risks (with Maize and Grain Legume CRPs).

3. Better targeting of agriculture programs for improved nutrition and health for women, children, and poor communities.

• Emphasize foods for first ‘1000 days,’ including complementary foods.

• Matching agriculture-nutrition education, gender empowerment, and social protection opportunities with needs of malnourished and vulnerable target groups.

Country Achievements : crop & nutrition

Nigeria Three Vitamin-A cassava varieties released in 2011, multiplied, and disseminated to farmers beginning in 2013; Two hybrids of vitamin-A maize released in 2012. Bioavailability studies published in 2009 and 2010; efficacy study underway in 2013.

Rwanda Five varieties of high-iron bean released in 2012; these and earlier fast track varieties disseminated to farmers 2011-present. Bioavailability study published in 2012; efficacy study completed in 2013. Preliminary analysis shows promising results.

Uganda Vitamin-A OFSP disseminated from 2007-present; high iron bean disseminated 2011-present. Efficacy evidence published in 2012.

Mozambique Vitamin-A OFSP disseminated 2007-2009 (delivery continues under CIP).

Zambia Three varieties of vitamin-A maize released in 2012 and disseminated beginning in 2013. Efficacy studies completed in 2013.

India High-zinc wheat commercialized in 2013 (high-zinc rice to follow in 2014/15). Wheat bioavailability study published in 2009; efficacy studies started in 2013. High-iron pearl millet commercialized in 2012 and released in 2013. Efficacy study completed in 2013; results are expected to be published by the end of 2013.

Bangladesh Two high-zinc rice varieties released in 2013. Bioavailability study completed in 2013; efficacy study planned for 2014.

DRC Vitamin-A cassava disseminated to farmers in 2013 (multiplication since 2011); high iron bean disseminated from 2011-present.

Pakistan High-zinc wheat to be released in 2015.

Nutrition Pathways