1

An Analysis of Malnutrition in Rural Zambia and the “Realigning Agriculture to Improve Nutrition” (RAIN) Project

Vanessa Young - 1001616655

GLOBAL PUBLIC HEALTH CHL 5700H Assignment #3

Submitted to Suzanne Jackson April 4, 2014

Introduction

Zambia is a beautiful country in southern Africa with a thriving agricultural industry; however,

beneath the plentiful harvest lies a hidden story of malnutrition. That is why Concern Worldwide

has developed an intervention which integrates agriculture, nutrition, and women’s empowerment

with the aim of reducing the harmful effects of stunting in children in rural Zambia. A secondary yet

ambitious goal is to identify a replicable pathway to success which can be scaled up for countries

around the world (Concern Worldwide and IFPRI, 2011a). This paper will first discuss malnutrition in

Zambia as viewed through the Labonte and Torgerson (2005) framework of globalization and

health. Next, the RAIN project will be summarized, and its stakeholder relationships and evaluation

plan will be described and critically analyzed.

Zambia’s Malnutrition within a Global Health Framework

A person’s health – and, by extension, their nutrition – does not develop in isolation; it is affected

by a web of interacting factors at the household, community, domestic, global, and superordinate

levels. A global framework such as that of Labonte and Torgerson (2005) helps to delineate these

influences and demonstrate how they interact to produce health outcomes. For this paper, the

health outcome of focus is stunted growth directly caused by malnutrition among the people in

Mumbwa district, Central province, Zambia.

Health outcomes

Malnutrition triggers a third of all child deaths globally each year (UNICEF, 2013). Not only does this

cause physical damage, but its ripple effects extend also into the mental and social realms, affecting

individuals and societies alike. Poorly nourished people develop poor health and work performance,

and in this way malnutrition drains national resources while undermining investments in education

and health (FAO, 2004). Nutritional well-being of a population is of utmost importance – and indeed

2

a precondition – for any nation's development while simultaneously reflecting the efficiency of

national resource allocation (FAO, 2004). The consequences exist not only in the present but,

indeed, can extend for generations.

A large proportion of Zambia’s population suffers from the effects of malnutrition. Current

measures indicate that 45% of children are moderately or severely stunted, although wasting

affects only 5% of children (UNICEF, 2014) – the causes of which often begin long before the child is

even born. Mothers who received poor nutrition during pre-conception, pregnancy, and lactation

are more likely to have children who are stunted, have developmental problems and weaker

immune systems. These disadvantages translate into overall higher mortality rates and therefore

unreached potential and economic losses on a macro level (WHO, 2013). Also, undernutrition and

other health conditions have reciprocally-influential relationships. For example, tuberculosis,

malaria, and HIV can both bring about, and be precipitated by, malnutrition (UNICEF, 2013).

Currently in Zambia, 11% percent of babies are born underweight (UNICEF, 2014), indicating

maternal malnutrition.

Stunting is a form of chronic malnutrition which occurs over time, caused by poor food quality, poor

feeding practices, and/or frequent infections, leaving children short for their age (UNICEF, 2009). It

can also result in diminished cognitive and physical development leading to poor performance in

school and reduced productivity as adults, resulting in lower earnings. Furthermore, children who

experience stunting are subject to higher risk of infections and disease compared with those who

were not stunted (UNICEF, 2013). Stunting is of particular concern among younger children because

once a child reaches the age of two, it is largely irreversible (WHO, 2013) and its lasting effects put

children at a disadvantage for the rest of their lives. Tackling undernutrition has a wider scope than

just trying to reduce an indicator such as stunting. Adequately addressing this issue improves

communities, restores potential, and breaks this damaging, destructive cycle.

Household Contexts

At the household level in Zambia, several factors such as dietary patterns, infant feeding practices,

and the role of women influence nutrition outcomes. One of the biggest nutritional needs in this

3

area is dietary diversity. Although agriculture is the dominant industry, there is little variety in

commodities; maize and cotton account for the majority of farmland. Naturally, this affects what is

consumed at the household level and therefore has repercussions for nutritional status. A baseline

survey for the RAIN project conducted in 2011 captured current eating patterns and showed that

although almost no households experienced hunger, diets were monotonous overall and

dominated by maize. Only about half of households had consumed iron-rich food such as meat, fish,

poultry, or eggs within the past month (Concern Worldwide and IFPRI, 2011b). These results

highlight the fact that while there is generally enough food in rural Zambia (i.e., people have access

to sufficient amounts of calories), there is a lack of dietary variety which leads to micronutrient

deficiencies.

The same baseline survey also recorded feeding practices in Mumbwa district. Virtually all infants

were breastfed until 8 months, and many into their second year. However, exclusive breastfeeding

was rare and low-diversity complementary foods along with water began to displace breastmilk for

many as early as a couple months of age (Concern Worldwide and IFPRI, 2011b). Such practices can

be detrimental to the proper growth of a child which is why the WHO recommends exclusive

breastfeeding to 6 months (and continued breastfeeding with appropriate complementary feeding

until the age of 2 and beyond) (WHO, 2015). Although there is an assumption that harmful practices

in infant feeding such as these which contribute to stunting can be modified through education,

data from the RAIN study suggests there is a more complex situation. According to the baseline

survey, although a majority of mothers knew what they should be feeding their children, inability to

access the right foods and competing time demands between caring for children and agricultural

work made the implementation of this knowledge difficult (Concern Worldwide and IFPRI, 2011b).

Many of the nutrition-influencing determinants at the household level are tied to traditional gender

roles. In rural Zambia – and many other African and Asian countries – in addition to being

responsible for producing food for their families, women carry out a significant amount of daily

domestic labor and often engage in piece-work to help make ends meet (Kent and MacRae, 2010).

Taking care of children is also an added constraint on time; these responsibilities all compete with

and reduce the amount of work that can be achieved on the family farm (Kent and MacRae, 2010).

One Zambian woman, in an interview on this topic explained this daily struggle: “The problem is

4

that I cannot cultivate a big portion of land [because]… I have to do piecework so I can feed my

family. I don’t eat enough so I don’t have enough energy for my land” (Kent and MacRae, 2010). It is

not difficult to see the relationships between women’s work, food, and nutrition. Women play the

role of both food producers and food providers at the household level therefore addressing their

needs is critical in addressing food insecurity (Kent and MacRae, 2010).

Traditional gender roles heavily affect household operation in Zambia, even influencing food

allocation patterns. Women – even if pregnant – prioritize the food needs of men and children

above their own. In taking smaller meals for herself, the woman’s nutrition status is hindered

(particularly when food is scarce), which in turn reduces the energy the woman has to spend on

cultivating crops (Kent and MacRae, 2010). Access to contraceptives, another gendered

determinant of health among Zambian women, is 41% (UNICEF, 2014). The resulting fertility rate is

5.7 births per woman (UNICEF, 2014) which translates into a large number of dependants for each

woman to feed, and a significant amount of time spent being pregnant, breastfeeding, and caring

for infants. Consequently, time spent cultivating food is further reduced. This may explain why

female heads of households cultivate smaller pieces of land compared to male heads of households

(Mofya-Mukuka, 2014b), and earn less than half than that of males as measured by average per

capita income among smallholder households (Sitko, 2014).

Community and Domestic Contexts

As community and domestic influences affecting nutritional outcomes in rural Zambia are

intertwined, they will be discussed here together. Zambia, a former British colony named Northern

Rhodesia, has been one of the most politically stable countries in southern Africa since gaining

independence in 1964 (Irish Aid, n.d.). The largest catalyst for its economic development has been

in mining its large reserves of high-quality copper (CIA, 2014; SCIAF, 2007), although as in many

industries, heavy reliance upon natural resources comes with both a blessing and a curse. In the

case of mining, the migration of labor to meet industry demand (both within Zambia and

throughout southern Africa) has resulted in high urbanization and a weak rural lobby (Scott, 2002).

As for agriculture, several issues will be highlighted below.

5

Although droughts, fluctuating copper prices, and business corruption have been obstacles to

development, Zambia’s economy has grown at a rate of more than 6% GDP per year since 2005

(some reasons for this will be expanded upon later). Economic growth in Zambia, however, is not

translating into poverty reduction. According to Mofya-Mukuka (2014a), for every 1% increase in

per capita GDP, the associated decline in rural poverty is a mere 0.25%. One reason for this is that

residents in rural areas rely heavily on agriculture for their livelihoods, yet there are market-

distorting agricultural policies hindering economic growth (CIA, 2014) which will be discussed

shortly.

Agriculture is a mainstay for a large segment of Zambian population, constituting 85% of the labor

force (CIA, 2014). Almost two thirds of the nation’s land is held by smallholder farmer families who

work to produce crops via low-technology rain-fed hoe cultivation (IFPRI, 2014a). Zambia’s small-

scale farmers have long depended on seed and fertilizer subsidies to produce maize. In the 1970’s

and 80’s, several innovations to improve the maize seed in Zambia were put in place in which state-

owned companies sold improved seed and fertilizer at reduced prices. This system and

accompanying government subsidies were later dismantled however, due to their fiscal burden

along with pressure from the International Monetary Fund as a part of structural adjustment

programs (SAPs) in the late 80s and early 90s (Smale and Birol, 2013).

Later, concerns over food security led to the reinstatement of farming subsidies in 2002 in the form

of the Farmer Input Support Program (FISP). The FISP is an initiative of the Zambian government as

a part of the poverty reduction strategy to reach food production goals (Burke, Jayne, and Sitko,

2012). The FISP provides seeds and fertilizers to farmers at heavily subsidized prices, accounting for

approximately three quarters of the Zambian government’s current agricultural budget (Burke,

Jayne, and Sitko, 2012). These subsidies remain controversial, though (Smale and Birol, 2013); the

FISP has been criticized for concurrently setting the goal of increasing total national maize

production to help keep up with urban consumption. This results in larger (wealthier) farm owners

receiving more of the benefits since they are thought to produce more marketable surplus than

smaller farms (Burke, Jayne, and Sitko, 2012; Mason, Jayne, and Mofya-Mukuka, 2013). As there is

little benefit for the rural poor, the FISP therefore has minimal impact on poverty reduction (Mofya-

Mukuka, 2014a).

6

There is another strike against the rural farmer. Due to more than half of Zambia’s land being

covered by water or allocated as national parks, game management areas, and commercial

farmland (Natural Resources Consultative Forum, 2008; Zambia Tourism, 2015), many smallholder

farms are constrained. A quarter of households in Central province have less than half an hectare of

land to cultivate, and an average of 50% of smallholders say there’s no land available to expand

(Mofya-Mukuka, 2014a; Scott, 2002). This constraint is not unrelated to the fact that 78% of

smallholder farming households live below the $1.25 per person per day poverty line (Mason,

Jayne, and Mofya-Mukuka, 2013).

Another topic of relevance to this project is the gendered organizing of farming in Zambia. Land

allocation practices, as influenced by post-colonial development in which large areas were declared

as state land, favored men. In other areas however, where fishing was a main industry, women took

the dominant role in agriculture since fishing was seen as a male activity (Meinzen-Dick et al.,

2012). Gender inequality proves to be a deeply-entrenched barrier in Zambian society, however, as

women face difficulties in obtaining external services and support for agriculture (Kent and MacRae,

2010). Men outnumber women 2:1 for receiving assistance from the Fertiliser Support Programme

(Republic of Zambia, 2011a), for example, despite women carrying out the majority of physical

labor on smallholder farms.

Despite these challenges, the Zambian government has shown consistent commitment to

addressing malnutrition. In 1967 the National Food and Nutrition Act mandated the newly-

established National Food and Nutrition Commission (NFNC, within the Ministry of Health) to

promote food and nutrition activities and advise the government on these issues (Harris and

Drimie, 2012). More recently, the government, realizing the value of crop diversification for its

beneficial impacts on food security, has begun to promote high-nutrient crops (IFPRI, 2014a;

Mofya-Mukuka, 2014b). In 2004 following several droughts, the Zambian Ministry of Agriculture

and Cooperatives implemented a program for this purpose. Moving away from maize-only farming

towards incorporating other options such as cassava, cashews, soy beans, sunflowers, and sweet

potatoes could improve food security and nutrition status of smallholder household by not only

mitigating the risks of weather-, pest-, or disease- induced failure of mono-crops, but also providing

variety in diets (IFPRI, 2014a).

7

And finally, the 2010 joining of Zambia with the Scaling Up Nutrition (SUN) initiative (SUN, 2014)

also demonstrates a renewed commitment to nutrition in the government agenda. While there are

many improvements to be made, (programs remain underfunded and more intersectoral consensus

must be reached (Taylor, 2012)), the momentum built from Zambia’s involvement in SUN makes the

RAIN project a less foreign ideas to the Zambian government. And just as the sun and rain are a

winning combination for successful agriculture, so these projects can work in tandem, building

synergy to ultimately to rid the country of food insecurity.

Global Contexts

At the global level, international market fluctuations, the signing of treaties, and donor aid with

stipulated conditions have in various ways influenced the Zambian economy, government spending

patterns, and individual economic access to food. To begin, world events such as the global financial

crisis, geopolitical conflicts, or natural disasters (particularly in oil-producing countries) can

influence international markets (Caracciolo, Depalo, and Macias, 2014). As Zambia’s national

budget depends significantly upon donor support, downturns in the global economy can have

detrimental effects through public sector job losses and cuts in public services (Masiye, Chama,

Chitah, and Jonsson, 2010). This affects not only the national economy, but trickles down to the

individual level as well, tightening family budgets and worsening poverty.

International food commodity market prices are also subject to volatility and directly impact food

prices at the local level. Considering that two thirds of household income is spent on food in

developing countries, higher global food prices over the past few years have measurably reduced

the purchasing power of the average Zambian (Caracciolo, Depalo, and Macias, 2014). Also, when

commodity prices are high, investors’ risk tolerance decreases. In Zambia over the past two

decades, almost two thirds of the international grain trading companies exited the country, citing

unpredictability of the Zambian government as a main reason (Caracciolo, Depalo, and Macias,

2014). Global trade, while often economically beneficial, is certainly not a static construct and can

worsen food insecurity at times.

8

International cooperation can also have beneficial effects. The 54-country African Union (of which

Zambia is a member) recently made a commitment to the Malabo Declaration which aims to triple

intra-African agricultural trade and end hunger by 2025. One of the actionable pledges in the

declaration is for each government to allot at least 10% of their public expenditure to agriculture

(Mofya-Mukuka, 2014a). While this is no doubt easier for some countries to achieve than others,

the solidarity in action is certainly a source of momentum upon which individual countries such as

Zambia can build. Other actions at the national level will be discussed later.

Economic reform in Zambia begun in 1983 with a structural adjustment package supported by the

IMF and World Bank (OSDBA, 1996). The goal of the SAP in Zambia was to transform economic

policies and correct imbalances caused by “economic mismanagement and … misguided

development strategies” (OSDBA, 1996); significant changes were made in a number of sectors.

Progress was seen in agriculture by liberalizing production and trade which ultimately led to

improvements in exchange and interest rates (OSDBA, 1996). However, the corresponding

reduction of spending on public services such as health, education, and water sanitation in the

decade that followed caused living conditions in Zambia to deteriorate (Masiye, Chama, Chitah, and

Jonsson, 2010). It became clear that the SAP was a donor-driven reformulation of spending which

came with conditionalities not controlled by the Zambian government, and therefore not

appropriate in the local context. Any benefit to Zambian citizens certainly didn’t extend to rural

communities or the poor in general (Scott, 2002).

A discussion of global-level influences in Zambia would not be complete without including the

international pressure placed on the Zambian government to privatize copper mines in the 90’s

(CIA, 2014). Opinions are divided over its benefit despite the fact that copper mining currently

comprises 70% of total export earnings (Irish Aid, n.d.). Some see privatization as having spurred

economic growth through increased foreign investment which boosted copper output; others see

privatization as having undermined development. The government’s decision was largely swayed by

the World Bank and IMF which repeatedly attached privatization as a condition to several loan and

debt-relief packages (SCIAF, 2007). While there were clear benefits such as profits channeled back

to the government through taxation, the revenue has been relatively small (about a 3% royalty rate)

compared to that generated by private mines in other resource-rich countries (as high as 10-30%)

9

(SCIAF, 2007). In a country with such high levels of poverty and malnutrition, this missed income

from Zambian-owned resources could have been spent on social services, infrastructure, and health

care to improve the standard of living and nutrition.

Superordinate Contexts

Zambia is a landlocked country naturally endowed with vast amounts of fertile land, water, and a

favorable climate for agricultural production (Mofya-Mukuka, 2014a), although sometimes prone to

flash flooding and prolonged droughts (Caracciolo, Depalo, and Macias, 2014). Maize is one of the

country’s top agricultural exports (along with sugar, tobacco, and cotton) and a ubiquitous dietary

staple (FAO, 2011). Zambia has a rapidly-growing population of 14.5 million (WHO, 2014; World

Bank, 2015), with about 60% of its residents living in rural areas (CIA, 2014). The Mumbwa district,

about 150km west of Lusaka, Zambia’s capital, constitutes 25% of Central province and contains a

reported population of 218,328 (Republic of Zambia, 2011b). In 2010, the population growth rate in

Central province was 2.3%, and even greater at 3.2% in Mumbwa district (Republic of Zambia,

2011b). Population growth presents food supply challenges on top of the fact that much of Zambia

still struggles under the weight of poverty. In 2010, over 80% of the rural population was living on

less than $1/day (WHO, 2014; Mofya-Mukuka, 2014a). Poverty and hunger are inextricably linked as

each worsens the other (their combination into one Millennium Development Goal may be seen to

signify their close relationship (United Nations, 2014)).

Additionally there is a heavy HIV/AIDS burden (Mofya-Mukuka, 2014a) in Zambia with a prevalence

rate of 12.5% among those 15-49 years of age (UNAIDS, 2013). The burden of this disease not only

affects those suffering from it (being both a contributing cause and indirect effect of malnutrition),

but a high prevalence of HIV/AIDS also influences food insecurity by reducing productivity across

sectors – including public administration – and therefore brings damaging socio-economic effects

(Scott, 2002). The quality and duration of the average life becomes significantly diminished; life

expectancy at 55 for females and 58 for males, resulting in almost half the population being under

the age of 15, and 90% under the age of 45 (UNICEF, 2014; Republic of Zambia, 2014). This bottom-

heavy population pyramid means a smaller number of working adults are supporting a larger

10

number of dependents and, unfortunately, is one of the reasons that 28% of Zambian children are

involved in child labor, mostly in agriculture (United States Department of Labor, 2013).

RAIN Project Summary

From household to superordinate levels, the influencers described above interact to produce an

unfortunate recipe for malnutrition in rural Zambia. Addressing this complex issue, then, requires a

multi-faceted and multi-industry approach. That is precisely what the RAIN project, an initiative

headed by Concern Worldwide, aims to do through an intervention focused on empowering rural

smallholder families through agriculture and nutrition education to improve feeding practices and

ultimately prevent malnutrition in the form of stunting (Concern Worldwide and IFPRI, 2011a). As

discussed above, women in Zambia play a vital role in nourishing families and it is therefore

imperative to focus on them in working to improve nutrition. The ultimate goal of the five-year

project (running from 2011-2015) is to develop a sustainable, successful model for improving

nutrition through empowering women in agriculture that can be scaled-up and replicated in other

regions of Zambia and in other countries (Concern Worldwide and IFPRI, 2011a).

The RAIN project was implemented in four wards of Zambia’s Mumbwa district, Central province

with two similar wards (outside of but adjacent to Mumbwa) selected as controls for comparison. A

total of 3 480 households with children under the age of two and/or pregnant women

(approximately 20 500 people) were selected for inclusion. Priority was given to extremely poor

households. Of the people in the intervention area, half were assigned to receive health and

agricultural programs, while the other half were assigned to receive agricultural programs alone

(Concern Worldwide and IFPRI, 2011a).

The RAIN project is multi-faceted, with several unique yet complementary components aligned to

ultimately meet the common goal of improving nutrition. The most obvious component,

agriculture, involves small-scale gardening of vegetables and fruits along with small-animal

husbandry (CONCERN Worldwide and IFPRI, 2011a). Groups of 15-20 women at a time are trained

in nutrition and farming by community health workers and smallholder model farmers (SMFs;

11

usually women), respectively. Inputs such as seed and fertilizers are provided at the beginning of

the program which farmers use to generate their own outputs, forming a hub of production with

linkages to markets facilitated as production increases (although the first priority is household

consumption) (CONCERN Worldwide and IFPRI, 2011a).

Another component is nutrition and health activities working together to improve infant and young

child feeding practices. The emphasis is on a child’s first 1000 days (from conception until their

second birthday), and volunteers from the community are trained in nutrition and healthy meal

preparation to provide support to mothers in their villages. Linkages are also made to the

healthcare system (including helping reduce mother-to-child HIV transmission) (CONCERN

Worldwide and IFPRI, 2011a). Women’s empowerment activities are also included in the RAIN

project based on a needs assessment conducted by Women for Chang (CONCERN Worldwide and

IFPRI, 2011a), although no details of this component were accessible.

Stakeholder Involvement and Interactions

One of the most innovative elements of this program is that although traditionally nutrition issues

such as stunting are addressed separately by different sectors with different methods and agendas,

RAIN takes a multi-sectoral approach, recognizing the complexity of malnutrition. RAIN was

designed by Concern Worldwide and The International Food Policy Research Institute (IFPRI), with

Concern leading the implementation along with Zambian partners, and IFPRI playing the role of

technical support and evaluation (Concern Worldwide and IFPRI, 2011a). It is not just run through

health or agriculture alone, but is a partnership seeking to integrate activities within the Ministry of

Agriculture and the Ministry of Health to achieve more effective and sustainable outcomes

(CONCERN Worldwide and IFPRI, 2011a).

Concern Worldwide is Ireland’s largest international humanitarian agency and focuses on issues of

health, education, livelihood, HIV/AIDS, as well as disaster response. It has been operating for 40

years, aiming to eliminate extreme poverty through partnering with and enabling “the very poorest

people” in 25 of the poorest countries around the world, with a focus on gender equality. Their

12

philosophy is aligned with the best practices of using local knowledge, resources, and opportunities

for self-development to help transform lives; in this way, Concern’s work is quite different from

much global health work in the past which has sought to use non-local (often Westernized) ideas

and models for intervention. They also aim to influence local, national, and international policies for

the reduction of extreme poverty (Concern Worldwide, n.d.)

The IFPRI joined the RAIN project in an impact assessment and evaluation capacity (Concern

Worldwide, n.d.). Founded in 1975, IFPRI is a group of researchers collaborating with practitioners,

policymakers, NGO’s, and the private sector to provide country-specific evidence for developing

sustainable research-based policy solutions to end hunger and malnutrition. Some of IFPRI’s priority

areas include sustainable food production, promoting healthy food systems, and transforming

agriculture, incorporating a gender theme cutting across all areas. IFPRI is a member of the CGIAR

Consortium, a global food security research group (IFPRI, n.d.).

A major funder of the RAIN project is the Kerry Group which has donated 1.25 million of the overall

RAIN budget of 3.7 million Euros. The Kerry Group is an international food ingredients company

based in Ireland with divisions in agribusiness, product development, and marketing. As a part of its

sustainability program, Kerry Group supports sustainable development, committing to partnering

with international organizations to help alleviate hunger in developing countries (Kerry Group, n.d.).

Concern has worked with Kerry Group in the past – most notably in 2007 by launching a review the

effectiveness of food assistance programs among those affected by HIV in Uganda and Zambia

(Concern Worldwide, n.d.). Additional funders of the RAIN project include Irish Aid, the Irish

government’s program for overseas development as a part of their foreign policy in fighting global

poverty, along with the Bank of Ireland (Irish Aid, n.d.). There is no indication that these funding

partners had input into the design of RAIN or had conditions attached to their donations. If they

did, however, it could call into question some of the motives behind the interventions, particularly

if modifications were made at the request of a for-profit organization such as Kerry Group.

In order to facilitate sustainability and local ownership of this project, RAIN has several

implementing partners in Zambia, although their specific roles and contributions to the project are

not outlined in any reasonably accessible information. First, a natural fit – the Ministry of

13

Agriculture and Livestock (MAL) is a partner working at the national, regional, and community levels

with a vision to promote development the agricultural sector in a way that is efficient, sustainable,

and which assures food security (Harris and Drimie, 2012). MAL advocates a food-based approach

to improving nutrition and rural livelihoods, although their main focus is on cereal crops with

limited vegetable production. This arm of government provides extension services by educating

farmers on storage and preservation methods as well as nutrition (Harris and Drimie, 2012;

CONCERN Worldwide and IFPRI, 2011a).

Another government-level partner is the Ministry of Health (MOH) which participates in the RAIN

project through their National Food and Nutrition Commission (NFNC), mandated by parliament in

1967 to advise government on matters concerning food and nutrition. NCFC’s mission is to provide

leadership on these matters in order to achieve optimal nutrition status of the people of Zambia

(NFNC, 2015). The MAL and the MOH are ideal stakeholders in the RAIN project because potential

exists (pending significant evaluation results) to use the RAIN model to organize future government

strategies and funds. Also, because there is currently minimal coordination between agriculture and

health sectors in Zambia when it comes to nutrition (CONCERN Worldwide and IFPRI, 2012), having

them linked through this project could facilitate longer-term collaboration.

At the community level, RAIN partners with the NGO Women for Change, whose mandate is to

build community capacities in rural areas especially among women and children, and ultimately to

achieve sustainable development and eradicate poverty. Women for Change collaborates with civic,

political, and other organizations to advocate for improvements in law and policies for the

promotion of women’s rights. Most importantly, Women for Change views traditional leaders as

key players and works with them to increase involvement in governance and bring about changes in

behavior and attitudes in the country (Zambia Land Alliance, 2015). A description of the role of this

NGO in the RAIN project could not be found. It would be beneficial to see Women for Change given

significant opportunities for input and collaboration on the RAIN project as they could draw on their

experience and connections within the community, and will also likely continue to operate in

Mumbwa long after the RAIN project has concluded.

14

Evaluation and Critical Analysis

The RAIN project has a significant built-in monitoring and evaluation component. The goal is not

only to discover the impact of RAIN on maternal and child nutrition, but also to understand how

this project can be effectively delivered in other regions after gaining an understanding of the

critical pathways to impact (Concern Worldwide and IFPRI, 2011a). The outcomes of the project

will be measured by comparing the impact of the two intervention groups (agriculture-and-health

versus agriculture-only) on stunting among children two years and older. A baseline survey was

conducted in June-August 2011, and will be compared with results collected in the same season in

2015. The survey captures such data as child health, child nutrition, infant feeding practices, dietary

diversity, and use of available agriculture services (Concern Worldwide and IFPRI, 2011b).

Primary evaluation outcomes include achieving program implementation; for example,

establishment of smallholder farms and women’s groups, and having agriculture and health training

conducted. Other outcomes are focused on developing relationships between farmers and markets,

production of and year-round access to diversified plant and animal food sources at the household

level, and improved practices of infant feeding and gender equality. These outcomes are predicted

to lead to increased household food security, greater decision-making power for women, and

improved nutrition status of women and children. The ultimate desired outcome is one of improved

policies to reduce the prevalence of undernutrition (Concern Worldwide and IFPRI, 2011a).

As with any research or intervention design there is room for improvement. The RAIN project

methodology indicates that the poorest households in Mumbwa were selected for intervention

groups, but there is no specific inclusion criteria listed. Not knowing who was doing the choosing or

how it was done leaves the reader questioning if there may have been some selection bias. For

example, it is possible that selection favored families who were already open to the idea of gender

equality, who already had begun crop diversification, or who had more social linkages or support in

the community.

Assuming the evaluation results demonstrate that the RAIN model is successful and there is

sufficient support to replicate it in other areas of Zambia, continuous relationships with the

15

Zambian government could be maintained provided Zambian ownership is strategically increased.

However, there is no outlined plan for continued engagement across sectors within the Zambian

government, particularly if the project is not scaled up. Another unclear element is how progress

will be sustained among the people of Mumbwa district and how they will continue being

supported once the final evaluation data is collected and the project concludes later in 2015.

Stripping away assumptions is important in any critical analysis, and in this case there exists a

question of whether empowerment in agriculture necessarily translates into a better life for women

and children. There is a complex interplay of influences that may be at work but have not been

captured in this intervention. As an example, one potential problem with investing in women’s

agriculture, as Kent and MacRae (2010) point out, is that it may be inadvertently discouraging their

pursuit of opportunities to be successful in livelihoods outside of farming.

Research is being done to explore these relationships. The “Women’s Empowerment in Agriculture

Index” (WEAI), developed in by IFPRI, Oxford Poverty and Human Development Initiative, and

USAID’s Feed the Future, is a survey-based tool tracking the dimensions of production, resources,

income, leadership, and time for the purpose of comprehensively measuring women’s

empowerment and inclusion in the agricultural sector in relation to men (IFPRI, 2014b). The Index’s

founders have piloted it in several countries and found that correlation between women’s

empowerment and nutritional outcomes of women and their children are highly context-

dependent.

In Nepal, for example, the results of WEAI show that women’s autonomy in production is associated

with dietary diversity as well as children’s nutrition outcomes. Yet in Ghana, women’s

empowerment in agriculture is more strongly associated with infant and young child feeding

behaviors but only weakly with children’s nutrition status. And in Bangladesh, women’s

empowerment correlated with household dietary diversity, but other things such as parental

education were stronger predictors of child nutritional status. Indeed, often nutritional status is

affected by factors far beyond the woman’s control (IFPRI, 2014b). It would be useful to apply WEAI

to the rural Zambian context, exploring how results align with the RAIN project.

16

Although the RAIN project targets gender equality and women’s empowerment at the household

level, there are also many health-influencing factors at the individual level that it does not

encompass. Long-term education and literacy rates, for example, are low among rural Zambians,

and even worse for women; only about half of females are literate compared with 72% of males

(CIA, 2014). Access to contraceptives, as mentioned above, can have a dramatic impact upon the

health of a woman and her family, as can access to and uptake of health services throughout the

lifespan.

At the community level, prevailing attitudes about gender equality and the rights of women within

society greatly affect a woman’s empowerment. One glaring example here is child marriage. Zambia

has one of the highest rates of child marriage in the world, with 42% of girls married before the age

of 18 (UNICEF Global Databases, 2014). This is not only a human rights issue, but also a health issue.

A girl’s well-being is compromised by early pregnancy, interruption of education, and potential

social isolation, all of which have damaging effects on her career opportunities. It must be

examined whether interventions in agriculture and nutrition alone, without simultaneous (and

equally funded) efforts to combat this harmful practice, will meaningfully improve lives in the long

run.

At the domestic level, land allocation and usage laws, public debt, and government capacity all

affect the system in which women live, and therefore affect woman and child health. Government

expenditure on health care and education in Zambia is quite low (CIA, 2014). If long-term,

sustainable improvements are to be made in the rates of stunting among Zambian children, so too

do long-term, sustainable changes need to be made in the spending patterns and priorities of

governments. Admittedly, this is anything but a straightforward path, but one that must be traveled

if poverty and malnutrition are to be addressed and eventually eliminated.

Moving to the global level, although this project is exceptionally well-planned and carefully

constructed to avoid some of the common pitfalls of international development work in nutrition

(such as mono-sectored leadership, short-sightedness, and imposing solutions upon others), it is

impossible to ignore the fact that the project seems to be entirely designed by and funded through

non-Zambian parties. While consultation with national stakeholders did take place, it is likely that

17

ownership and sustainability of this project could be improved with a greater amount of input and

staffing from local leadership. The issue of data accessibility and ownership also arises here. If this

project and attached data is protectively ‘owned’ by funders, the people of Mumbwa and future

Zambian researchers may not have direct, open access to it for the further benefit of the Zambian

people.

Finally, the superordinate level. Aside from natural endowments which cannot be altered, some

issues at this level must be addressed along with the targeting of nutrition outcomes. Poverty and

the burden of HIV/AIDS are examples; improving agriculture and feeding behaviors can only go so

far without their simultaneous reduction. Zambia’s skewed age-demographic structure, on the

other hand, is a superordinate factor that is not directly alterable through interventions, but will

gradually improve and resolve as Zambia moves towards development. Such long-term

improvements will depend upon projects like RAIN to build upon each other and, like links in a

chain, each contribute to a whole that is greater than the sum of the parts.

Conclusion

Overall, there is a myriad physical, behavioral, socio-cultural, political, and historical factors that

interact to contribute to the high rates of stunting in Zambia. The RAIN project is an innovative

intervention targeting malnutrition which holds potential for great impact, and results of this study

could indeed set a new standard for intersectoral collaboration when targeting malnutrition in

similar contexts. The designers of the RAIN project have made an extensive effort to learn from the

shortfalls of traditional nutrition interventions and have developed strong evaluation

methodologies for this project. While there remains some questions about sustainability once the

project is completed, the work done to enhance the status and abilities of women in agriculture are

valuable. Conceivably this project will translate into a replicable model for nutrition-with-

agriculture interventions that can be scaled up for long-lasting health, social, and political impacts.

18

References

Burke WJ, Jayne TS, and Sitko NJ. (2012). Can the FISP More Effectively Achieve Food Production and Poverty Reduction Goals? Retrieved from: http://fsg.afre.msu.edu/zambia/ps_51.pdf

Central Intelligence Agency (CIA). (2014). Zambia. [The World Factbook]. https://www.cia.gov/library/publications/the-world-factbook/geos/za.html

Caracciolo F, Depalo D, and Macias JB. (2014). Food Price Changes and Poverty in Zambia: An empirical assessment using household microdata. Journal of International Development (26):492–507.

Concern Worldwide. (n.d.). About Concern. Retrieved from: https://www.concern.net/about

Concern Worldwide and the International Food Policy Research Institute (IFPRI). (2011a). Realigning Agriculture to Improve Nutrition: RAIN Project – Rationale, Model & Implementation in Mumbwa District. [RAIN Project Brief No. 1]. Retrieved from: https://www.Concern.net/sites/default/files/media/page/rain_brief_no_1_nov_2011_1.pdf

Concern Worldwide and the International Food Policy Research Institute (IFPRI). (2011b). Realigning

Agriculture to Improve Nutrition: RAIN Project – Impact Evaluation: Methods and Baseline Results. [RAIN Project Brief No. 2]. Retrieved from: https://www.Concern.net/sites/default/files/media/page/rain_brief_no_2_nov_2011_0.pdf

Concern Worldwide and the International Food Policy Research Institute (IFPRI). (2012). Realigning

Agriculture to Improve Nutrition: RAIN Project – Intersectoral Coordination and Alignment for Nutrition. [RAIN Project Brief No. 3]. Retrieved from: https://www.Concern.net/sites/default/files/media/page/rain_brief_no.3_sep_2012.pdf

Concern Worldwide and the International Food Policy Research Institute (IFPRI). (2014). Realigning

Agriculture to Improve Nutrition: RAIN Project – The importance of gender in agriculture for nutrion. [RAIN Project Brief No. 4]. Retrieved from: https://www.Concern.net/sites/default/files/media/page/rain_briefing_no_4_dec_2013_final_0.pdf

Connect Africa. (2009). Rural Communication Network Trial Project: Mumbwa District, Central Zambia.

Retrieved from: http://www.connectafrica.net/pdfs/Zambia%20Report_Final_ABF%20August_2009.pdf

Food and Agriculture Organization of the United Nations (FAO). (2004). Incorporating Nutrition

Considerations into Development Policies and Programmes. Retrieved from: http://www.fao.org/docrep/007/y5343e/y5343e00.htm#Contents

Food and Agricultural Organization of the United Nations (FAO). (2011). Top Exports – Zambia - 2011.

Retrieved from: http://faostat.fao.org/desktopdefault.aspx?pageid=342&lang=en&country=251 Harris, J and Drimie, S. (2012). Toward an Integrated Approach for Addressing Malnutrition in Zambia:

19

A Literature Review and Institutional Analysis. [IFPRI Discussion Paper]. Retrieved from: http://www.ifpri.org/sites/default/files/publications/ifpridp01200.pdf

International Food Policy Research Institute (IFPRI). (n.d.). About Us. Retrieved from:

http://www.ifpri.org/ourwork/about International Food Policy Research Institute (IFPRI). (2014a). The determinants and extent of crop

diversification among smallholder farmers. [Working Paper 05]. Retreived from: http://www.ifpri.org/sites/default/files/publications/masspwp5.pdf

International Food Policy Research Institute (IFPRI). (2014b). Women’s Empowerment in Agriculture

Index. Retrieved from: http://www.ifpri.org/book-9075/ourwork/program/weai-resource-center Irish Aid. (n.d.). Ireland's commitment to a world without poverty and hunger. Retrieved from:

https://www.irishaid.ie/ Kent R. and MacRae M. (2010). Agricultural livelihoods and nutrition – exploring the links with women

in Zambia. Gender & Development. 18 (3):387-409. Kerry Group. (n.d.). Key Sustainability Programme 2012-2015. Retrieved from:

http://www.kerrygroup.com/sustainability/sustainability-programme/

Labonte, R. and Torgerson, R. (2005). Interrogating globalization, health and development: Towards a comprehensive framework for research, policy and political action. Critical Public Health. 15(2): 157–179.

Mason NM, Jayne TS, Mofya-Mukuka R. (2013). Zambia’s input subsidy programs. Agricultural

Economics. 44: 613–628. Masiye F, Chama C, Chitah C, and Jonsson D. (2010). Determinants of Child Nutritional Status in

Zambia: An Analysis of a National Survey. Zambia Social Science Journal. 1(1):29-42. Mofya-Mukuka, R. (2014a). Reflecting on the Hunger Situation in Zambia. Retrieved from:

http://fsg.afre.msu.edu/zambia/Mofya_Mukuka_IAPRI_hunger.pdf

Mofya-Mukuka, R. (2014b) Transforming Agriculture Towards a Food and Nutrition Secure Zambia. [PowerPoint presentation]. Retrieved from: http://fsg.afre.msu.edu/zambia/Transforming_Agriculture_Towards_a_Food_Secure_Zambia.pdf

Meinzen-Dick R, van Koppen B., Behrman J, Karelina Z, Akamandisa V, Hope L, and Wielgosz B. (2012).

Putting Gender on the Map: Methods for Mapping Gendered Farm Management Systems in Sub-Saharan Africa. http://www.ifpri.org/sites/default/files/publications/ifpridp01153.pdf

National Food and Nutrition Commission of Zambia (NFNC). (2015). About National Food and Nutrition

Commission of Zambia. Retrieved from: https://www.facebook.com/pages/National-Food-and-

20

Nutrition-Commission-of-Zambia/446462708766664?sk=info&tab=page_info Natural Resources Consultative Forum. (2008). The Impact of Wildlife Management Policies on

Communities and Conservation in Game Management Areas in Zambia. Retrieved from: http://fsg.afre.msu.edu/zambia/Impact_of_Willdife_Mgt_Policies_on_Communities_and_Conservation.pdf

Office of Sustainable Development Bureau for Africa (OSDBA). (1996). Policy Reform and Structural

Adjustment in Zambia With Emphasis on Agriculture and Trade. [Technical paper no. 35]. Retrieved from: http://www.eldis.org/vfile/upload/1/document/0708/doc4533.pdf

Republic of Zambia. (2011a). 2010 Gender Status Report. Retrieved from:

http://www.mgcd.gov.zm/images/publications/MGCD%20Gender%20Status%20Report_Zambia.pdf

Republic of Zambia. (2011b). Zambia 2010 Census of Population and Housing. Retrieved from:

http://unstats.un.org/unsd/demographic/sources/census/2010_phc/Zambia/PreliminaryReport.pdf Republic of Zambia. (2014). Budget Address by the Minister of Finance.

http://www.mofnp.gov.zm/jdownloads/National%20Budgets/Budget%20Speeches/2015-budget-speech.pdf

Scaling Up Nutrition (SUN). (2014). Zambia. Retrieved from: http://scalingupnutrition.org/sun-

countries/zambia Scott, G. (2002). Zambia: structural adjustment, rural livelihoods and sustainable development.

Development Southern Africa. 19(3). Scottish Catholic International Aid Fund (SCIAF). (2007). Undermining Development? Copper Mining in

Zambia. Retrieved from: http://www.actsa.org/Pictures/UpImages/pdf/Undermining%20development%20report.pdf

Sitko, N. (2014). Agricultural Policy and Food Prices in Zambia. Retrieved from:

http://fsg.afre.msu.edu/zambia/Sitko_Ag_policy_and_food_prices.pdf

Smale, M. and Birol, E. (2013). Smallholder Demand for Maize Hybrids and Selective Seed Subsidies in Zambia. [HarvestPlus Working Paper]. Retrieved from http://www.ifpri.org/sites/default/files/publications/harvestpluswp_9.pdf

Taylor, L. (2012). A Second Chance: Focusing Zambia's Nutrition Sector in the Context of Political

Change. Retrieved from: http://r4d.dfid.gov.uk/PDF/Outputs/Malnutrition/DFID_ANG_Zambia_Report_Final.pdf

UNAIDS. (2013). Zaambia. Retrieved from:

http://www.unaids.org/en/regionscountries/countries/zambia

21

UNICEF. (2009). Chronic Malnutrition: Stunting. Retrieved from:

http://www.unicef.org/nutrition/training/2.3/20.html UNICEF. (2013). Zambia. Retrieved from: http://www.unicef.org/infobycountry/zambia_statistics.html UNICEF Global Databases. (2014). Child Marriage. Retrieved from: http://data.unicef.org/child-

protection/child-marriage United Nations. (2014). The Millennium Development Goals Report. Retrieved from:

http://www.un.org/millenniumgoals/2014%20MDG%20report/MDG%202014%20English%20web.pdf

United States Department of Labor. (2013). Zambia. Retrieved from:

http://www.dol.gov/ilab/reports/child-labor/zambia.htm World Bank. (2015). Zambia. Retrieved from: http://data.worldbank.org/country/zambia World Health Organization (WHO). (2015). Breastfeeding. Retrieved from:

www.who.int/topics/breastfeeding/en/ World Health Organization (WHO). (2013). Informal Consultation with Member States and UN Agencies

on A Proposed Set of Indicators for the Global Monitoring Framework for Maternal, Infant and Young Child Nutrition. Retrieved from: http://www.who.int/nutrition/events/2013_informalconsultation_WHO_MIYCN_Stunting_presentation.pdf

World Health Organization (WHO). (2014). Zambia statistics summary (2002 – present). Retrieved

from: http://apps.who.int/gho/data/node.country.country-ZMB Zambia Land Alliance. (2015). Women for Change. Retrieved from:

http://www.zla.org.zm/2014/07/women-for-change-wfc/ Zambia Tourism. (2015). Safaris in Zambia. Retrieved from: http://www.zambiatourism.com/safaris