PANEL 6.3 USING AN AGRICULTURAL PLATFORM IN BURKINA FASO TO IMPROVE NUTRITION DURING THE FIRST 1,000 DAYS
DEANNA KELLY OLNEY, ANDREW DILLON, ABDOULAYE PEDEHOMBGA, MARCELLIN OUÉDRAOGO, AND MARIE RUEL I
ntegrating nutrition programs with agri- cultural programs has great potential to improve nutrition outcomes, but weaknesses in program targeting, design, and implemen- tation, as well as poor evaluation designs, have limited the evidence available on the actual impact of such programs. One type of integrated nutrition- agriculture program is homestead food production (HFP). The standard HFP model includes gardening and small animal produc- tion and a behavior-change communication strategy designed around the so-called essen- tial nutrition actions. It is typically targeted to vulnerable households with children under five years of age. In Burkina Faso an Enhanced Homestead Food Production (E-HFP) program was introduced by Helen Keller International (HKI) in 2010. Instead of targeting households with children under five, it targeted women with children 3–12 months of age to ensure that the program would directly benefit chil- dren within the “first 1,000 days” window of opportunity. The E-HFP also changed how the program was designed and implemented. Rather than just teaching mothers about nutrition, it modified the behavior-change
communication strategy to promote adoption of key nutrition practices. It also empow- ered women by providing education on best agriculture and nutrition practices, transfer- ring small agricultural assets and chickens to beneficiary women, and having village model farms led by beneficiary women (rather than male farmers living in the village). To address the issue of poor evaluation
designs, we designed a comprehensive eval- uation approach. It included a longitudinal cluster-randomized controlled trial (the first of its kind for an agriculture and nutrition program other than biofortification) as well as two rounds of qualitative process evaluation. Compared with people living in the control villages, children who were program benefi- ciaries showed increased dietary diversity and reduced prevalence of wasting, anemia, and diarrhea. Women who were program benefi- ciaries had increased intake of nutrient-rich foods and reduced prevalence of thinness. These positive changes were likely related to the positive impacts of the E-HFP program on intermediate outcomes observed along the primary program impact pathways. These intermediate outcomes included
• increases in women’s ownership of pro- ductive assets, including agricultural assets and small animals,
• increased production of nutrient-rich foods by women,
• improvements in women’s knowledge of key feeding and care practices for infants and young children,
• increased dietary diversity and consumption of nutrient-rich foods in households, and
• improvements in women’s status indica- tors, such as their ability to make decisions about purchases. This study is one of the first to employ
rigorous evaluation to provide convinc- ing evidence that using an agricultural platform can improve maternal and child nutrition (Olney et al. 2014). It shows that a well-designed, well-targeted, and well-implemented integrated agriculture and nutrition program, including a strong nutri- tion and health behavior-change communi- cation strategy and women’s empowerment activities, can have a significant and possibly long-lasting impact on the nutrition and health of mothers and children during the first 1,000 days.
they allocate spending. These allocations are driven not only by available resources, but by political choices.
HOW CAN PROGRAMS AND SPENDING ON UNDERLYING DETERMINANTS BE MADE MORE NUTRITION SENSITIVE?
As Ruel and Alderman noted (2013, 1), “Nutrition-sensitive interventions and programmes in agriculture, social safety nets, early child development, and education have enormous poten- tial to enhance the scale and effectiveness of nutrition-specific interventions.” The evidence base on which to achieve that po- tential is weak but growing stronger. Many organizations have put forward documents that propose good-practice guidelines to practitioners. Most of these proposed guidelines have been for agriculture, social protection, and health (see World Bank
2013 for an excellent summary), with none that we can find for education or water, sanitation, and hygiene.8
Table 6.3 summarizes the main guidelines for agriculture and social protection and health and makes some suggestions for water and sanitation and education.
The evidence base is still shaky but growing stronger. Panel
6.3 provides an excellent new example from Burkina Faso of an agricultural intervention designed to improve nutritional status. The intervention seems to be successful by targeting children during the first 1,000 days, focusing on changing specific nu- trition behaviors, and deliberately aiming to empower women within agriculture.
ACTIONS & ACCOUNTABILITY TO ACCELERATE THE WORLD’S PROGRESS ON NUTRITION
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