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

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Vietnam

2010 2014

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Ethiopia

2010 2014

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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

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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

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EVIDENCE-BASED BEST BETS

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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