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Achieving the Malabo Commitments: Harnessing Agriculture for Improved Nutrition
University of California – Davis, Africa Rising Speakers Series
October 5, 2016
© 2014 Bill & Melinda Gates Foundation
NUTRITION
Reflections on getting to SDG2
45% of deaths of children under age 5 are attributable to undernutrition
Millions more children suffer permanent physical & cognitive impairments as a result of undernutrition– reducing their productivity and earnings as adults.
THE PROBLEM
Sources: Black, et. al., “Maternal and child undernutrition and overweight in low-income and middle-income countries,” The Lancet, 2013; Bill & Melinda Gates Foundation analysis conducted in partnership with John Hopkins School of Public Health
No. of deaths120K+
60-120K
20-60K
10-20K
0-10K
Estimated nutrition-attributable deaths in 2014
The consequences
The problem
The direct causes
Underlying causes
THE PROBLEM: A LOOK AT UNDERNUTRITION’S CAUSES AND CONSEQUENCESUndernutrition is a complex problem with serious consequences
Food Systems play an essential role
• Prior reviews of agriculture/nutrition linkages underscored dearth of information “more reviews of the literature than original studies”
• Past five years have seen a major acceleration of research in agriculture-nutrition linkages
• Costing of food systems interventions remains a major constraint
GETTING SERIOUS ABOUT SENSITIVE
We define food systems as the production, marketing, transformation, and purchase of food, and the consumer practices, resources, and institutions involved in these processes.
WHAT IS A FOOD SYSTEM?
www.glopan.org
© Bill & Melinda Gates Foundation | 6
WHY FOOD SYSTEMS MATTERIn Africa:
The poor spend more than 60% of their income on food
Starchy staples dominate diets Low consumption of nutrient-
rich foods, particularly those from animal sources
Contaminated food is prevalent Undernutrition has bigger
impacts on rural poor than those in urban areas (though urban areas still affected)
Rising rates of overnutrition
020406080100
Bangladesh
2010 2014
020406080100
Vietnam
2010 2014
020406080100
Ethiopia
2010 2014
020406080100
Grains,roots, andtubers
Legumesand nuts
Dairyproducts
Flesh foods Eggs Vitamin Arich fruits
andvegetables
Other fruitsand
vegetables
Ethiopia
2010 2014
0
20
40
60
80
100
Grains, roots,and tubers
Legumes andnuts
Dairy products Flesh foods Eggs Vitamin A richfruits andvegetables
Other fruitsand vegetables
Bangladesh
2010 2014
0
20
40
60
80
100
Grains,roots, andtubers
Legumesand nuts
Dairyproducts
Flesh foods Eggs Vitamin Arich fruits
andvegetables
Other fruitsand
vegetables
Vietnam
2010 2014
%
%
Changes in Infant & Young Child Feeding Practices (Alive & Thrive: 2010‐2014)
Changes in Previous Day Consumption of Food Groups (Alive & Thrive: 2010‐2014)
© Bill & Melinda Gates Foundation | 8
AFRICAN COMMITMENTS TO AGRICULTURE, FOOD SYSTEMS & NUTRITION
Comprehensive African Agriculture Development Program: Launched in 2005
Malabo Declaration: 2014
MALABO COMMITMENTS - 2014
9© Bill & Melinda Gates Foundation |
Nutrition: • Commitment to bringing down stunting to
10% and wasting to 5% by 2025 • Focusing on the first 1000 Days as the only
window of opportunity during which permanent and irreversible physical and mental damage would be avoided
• Positioning this goal as a high-level objective in national development plans and strategies
Agriculture: • Uphold 10% public spending target for
Agriculture• Commitment to ending hunger by 2025• At least double productivity
|
AFRICA: GREAT COMMITMENTS BUT GROWING PROBLEM
Source: Global Nutrition Report 2016
Household agricultural production has direct and important linkages with dietary patterns and nutrition of individual household members, including women and children.
1. Focus on smallholder women farmers2. Incorporate nutrition behavior change communication3. Fortification: staple food fortification and biofortification4. Production diversity, especially with a focus on ownership and production of
small livestock and poultry5. Increase market access
Gero Carletto, Marie Ruel, Paul Winters & Alberto Zezza (2015) Farm-level Pathways to Improved Nutritional Status, The Journal of Development Studies
|11
EVIDENCE-BASED BEST BETS
|
EVIDENCE-BASED PATHWAYS
There are four main pathways through which agriculture can influence nutrition at a household level:
1. Own consumption2. Income for food3. Income for health4. Women’s empowerment
EVIDENCE GAPS—KEY REMAINING QUESTIONSHow can agricultural interventions be designed to improve nutritional outcomes for individuals in farm families and communitiesas a whole? How do we take into account the multiple roles of women and support agriculture to take those roles into account? What is the effect of agricultural labor on women and children’s health and nutrition? How can we effectively increase demand for nutrient‐rich foods and strengthen markets for more diverse and affordable food? What are the most appropriate indicators to measure progress? What is the true extent of food loss and what interventions are most promising to address loss in nutrient‐rich foods?
What are the best—and most cost‐effective—delivery mechanisms through which agriculture can affect nutrition? Which entry points along the agricultural value chain have the greatest potential impact for improving women and child’s
nutrition? What are the best delivery mechanisms for educating farming households about nutrition? What are the quantifiable linkages and leakages in the agriculture‐nutrition pathways?
What are the best bets from a policy perspective? What are the impacts of agriculture policies on consumers, including the effects of price, food expenditures, and food
consumption? How can agricultural growth and nutrition be more tightly connected?
What role does food safety have in nutrition and health? Does aflatoxin cause stunting? What other food safety challenges are most important from a nutrition perspective?
CHALLENGES TO REACHING MALABO COMMITMENTS• Conflation and Confusion
• Nutrition governance and positioning:• Effective coordination mechanisms• Strategic information use and active learning• Africa and National Accountability
• Human resources for nutrition:• Front-line workers• Specialized workforce
• Accessing financial resources:• Domestic resources• Navigating complicated donor environment• Evidence-based prioritization
• Need to show success
Providing agriculture sector the capacity to address nutrition
Adjusting extension systems to meet needs of small-holder women farmers
Holding the agriculture sector accountable for nutrition-related outcomes
Identifying and implementing appropriate nutrition-sensitive policies
Scaling up best bet interventions
Prioritizing and financing interventions that are most cost-effective
In agriculture’s domain: Nutritious food production and supply Seasonal fluctuations in food accessibility Affordability of nutritious foods End‐user demand Consumption of nutritious foods Safety of food supply Women’s empowerment in agriculture
Not solely in agriculture’s domain: Child anthropometry (stunting and wasting) Maternal nutritional status Anemia
Not in agriculture’s domain: Exclusive breastfeeding Low birth weight Access to safe water and improved
sanitation Access to health care services
FOOD SYSTEMS CHALLENGES
ENVISAGING A FOOD SYSTEM FIT FOR AFRICA’S FUTURE
“Will our generation’s
legacy be more than a series of
broken promises.”
- Nelson Mandela