CHAPTER 3 - Process and Strategies for Incorporating Nutrition into Development Policies

J. Spaull

Policy-makers need to be aware of potential effects that various development policies can have on the poor and nutritionally vulnerable

Potential impact of development policies and programmes on nutrition

Incorporating nutrition strategies into agricultural and community development initiatives does not necessarily mean designing new programmes. It does, however, require that at all stages planners and/or managers ensure that the design and implementation of development policies and programmes are not detrimental to nutrition and that potential opportunities to improve nutrition are identified and exploited.

It must also be recalled that nutrition intervention programmes can be effective only as a temporary measure to cushion vulnerable groups while other means of incorporating these population groups into the mainstream development process are being devised and implemented.

Policy-makers concerned with protecting and improving nutritional status need to be aware of potential effects that various development policies and programmes can have, either directly or indirectly, on the poor and nutritionally vulnerable. This is important because nutrition has a strong link to development sectors, such as agriculture, health, education and rural development, and subsectors such as population and environmental issues.

Policies and programmes in agriculture

Agriculture has perhaps the most potential among development sectors to alleviate rural poverty and undernutrition in developing countries. Aside from improving the livelihood and nutritional status of households through increased food production and improved food security, policies in agriculture that incorporate nutrition considerations can also impact on nutritional status through income, food prices, food diversification and gender considerations. Hence nutrition can be greatly influenced by the design and selection of agriculture policies and programmes.

EMPLOYMENT OPPORTUNITIES FOR WOMEN

Often, the nutritionally vulnerable and undernourished are landless or have very small pieces of land and depend on wages earned from working on farms to purchase most of their food. This same principle applies to the invention or introduction of labour-saving technologies. Generally, in developing countries, the agriculture sector employs a large percentage of women as labourers (FAO, 1996d). Therefore:

When designing policies, caution should be exercised not to deprive people of income-earning opportunities: while some degree of mechanization will increase production and free women's time for family care activities, income earned from providing farm labour may be more important for vulnerable households.

A policy that is sensitive to women's role as caregivers could enhance nutritional status. For example, a policy that compels employers to allow breastfeeding breaks would have a positive impact on young child nutritional status and decrease morbidity and mortality rates.

CASH CROPPING

While cash cropping has the potential to improve nutritional status through improved productivity and increased income, it may impact negatively if it creates an imbalance or shift in the control of income between men and women. Women are more likely than men to spend their income on food for feeding their families. Hence, if women have control over some income, nutritional status is likely to be improved. Further, when people change from subsistence to cash cropping, they may need to purchase most of the food they consume. This presents a likelihood of replacing good-quality foods with less nutritious foods. Therefore:

It is advisable that, as a policy, strategies to monitor the effects of cash cropping programmes on the nutritional and social welfare of communities be appropriately integrated into programme activities.

Appropriate nutrition intervention programmes, such as nutrition education, should be incorporated into those programmes as well.

FOOD PRICES

Price is a major determinant of consumer choice in purchasing non-staple foods.

Therefore:

An initial assessment to review how these foods are processed, stored and marketed would be helpful.

Price fluctuations of foods consumed primarily by nutritionally vulnerable groups need to be closely monitored for affordability. When the need arises, targeted interventions that guarantee and protect access by the vulnerable to sufficient quantity and quality of food should be put in place.

Planners are also encouraged to assess the availability of commonly consumed foods whose prices vary with increase or decrease in supply, and determine how consumption of these foods is influenced by price changes and income levels.

It would also be helpful to review relevant food laws and regulations. Factors related to import and export policies, as well as to informal border trade, can have a great impact not only on diet and food availability, but also on the outcome of food pricing and subsidy policies.

FOOD DIVERSIFICATION

Indigenous foods and foods consumed by the poorest of the poor are often overlooked by agricultural research and extension programmes. As an example, in some countries, research and extension have promoted single staple foods to the exclusion of other local staples. In many cases, the excluded staples are resistant to adverse local weather conditions and are therefore dependable in terms of providing continuous food supply. Potentially, they can supplement major staples by providing food during hunger periods, when supplies of major staples have been depleted. In addition, in many countries, the food security situation has deteriorated because of the HIV/AIDS pandemic. The young productive age groups are killed by the disease, and food production is left for the very young and the old. Therefore:

Through agriculture policies, ministries of agriculture can be encouraged to improve the production and marketing of indigenous and low-cost foods through their extension programmes.

Policies that foster close collaboration between nutrition and agricultural research need to be developed. Foods consumed by the poor can be identified through nutrition research. In collaboration with research, the nutrient content of indigenous foods and foods consumed by the poor can be analyzed, in order to enhance the production and consumption of these foods.

In view of HIV/AIDS, when giving advice to affected farming families, it should be considered that family resources are usually depleted by medical care, and as such, farm inputs are unaffordable; available labour is often engaged in looking after the sick; therefore, crops that need less inputs and tending such as indigenous crops could be promoted.

Policies and programmes in other development sectors

HEALTH

Nutrition and health are inextricable. Without good health, good nutritional status cannot be achieved and when nutritional status is poor, good health will remain elusive. Most policies that impact on health will directly or indirectly impact on nutrition. However, in many developing countries, nutrition issues are often not prioritized in health institutions. Furthermore, nutrition units are usually given a lower status in the policy-making hierarchy of these institutions. In order for health programmes to benefit target groups maximally, nutrition considerations ought to be integrated in the planning, monitoring and evaluation of these programmes.

G. Diana

Indigenous food crops are nutritious and need less inputs than other crops; they are a good choice for farming families that are affected by HIV/AIDS

The HIV/AIDS pandemic has had a negative impact on the health status of many people in developing countries, particularly in sub-Saharan Africa. Health facilities in these countries have been stretched beyond their capacities. Nonetheless, it is important that health units to continue to educate the public about ways to prolong their lives and contribute in development activities.

Therefore, when developing health policies, the following should be considered:

Ensuring that nutrition is an integral part of health policies;

Enhancing the status of nutrition units to be on par with that of other programmes;

Including the training of nutrition personnel in health human resources development programmes;

Strengthening the nutrition component of the Primary Health Care programme, which is a strategy that has been adopted by many developing countries to increase health coverage and reach vulnerable population groups;

Making available nutrition and health information for People Living With Aids and those infected or affected by the disease;

Educating the public about the disease, and ways of preventing from infection;

Developing clear guidelines on breastfeeding for HIV-positive mothers.

EDUCATION

Education is the most effective single investment a country can make for good returns on economic growth and nutritional status (FAO/WHO, 1992a). The education of women in particular has a positive effect on family income, dietary intake, family environment and health. Universal primary education is probably the most equity-promoting development intervention since it raises the productivity and earning potential of all people, irrespective of their other assets. Sound education policies are therefore of primary importance in nation building, eradicating poverty and enhancing nutritional status.

The majority of people infected with the HIV/AIDS virus are young people in the prime of their productive lives. Hence, the HIV/AIDS scourge has had a devastating impact on the socio-economic development progress of many nations. Education has a crucial role to play in the control of the disease since many young people go through the system.

When developing policies, policy-makers in this sector need to ardently promote the following initiatives, taking into account national, local and individual household resources, as well as cultural values:

Compulsory universal primary education;

Institution of affordable school feeding programmes that can be supported with local resources;

Introducing nutrition as a subject in primary and secondary schools; and

Introducing the subject of sexuality in schools and colleges and providing lessons on HIV/AIDS.

MACRO-ECONOMIC POLICIES

Macro-economic policies can directly and indirectly impact on the socio-economic status of all population groups, and hence nutritional status.

Adequate infrastructure, such as good roads will enhance nutritional status through improved distribution of food, increased employment and low food prices

J. Isaac

For example, if macroeconomic policies do not support the agriculture sector, the impact on the rural poor is negative since they depend on agriculture for their livelihood; economic growth decreases; there are fewer employment opportunities; and income distribution is skewed against the poor, thereby affecting their nutritional status. In addition, macro-economic policies can impact negatively on nutritional status if there is reduced national expenditure on social services. A good example is the Structural Adjustment Programme that was promoted in many developing countries by the International Monetary Fund. This initiative resulted in the drastic reduction of expenditure on social services, such as health, and consequently on nutritional status. Therefore:

Policies need to be designed such that their negative impact on the economic and social lives of the poor is minimized. Alternatively, population groups that are most negatively affected need to be identified and targeted with compensatory programmes such as school or supplementary feeding programmes; subsidies or price moderation; and provision of health services.

Policies that lead to improvement of infrastructure such as roads, transportation and communication will enhance improvement of nutritional status through employment (particularly of unskilled labour), improved food distribution and decreased food prices.

Access to credit by poor households will enable them to increase their income through agriculture or self-employment. Policies that support financing or small-scale financing programmes also promote equity and are therefore encouraged. In low-income, food-deficit countries, population and environmental policies are essential for sustainable economic growth and improved nutritional status to be realized. In many cultures, population-related issues are sensitive and therefore such policies need to be developed and implemented within an acceptable cultural context.

Nutrition communication and advocacy

Nutrition advocacy draws attention to issues that can bring about nutrition improvement within the population. Strategies aim at influencing decision-making at the organizational, community, national and international levels. They can include lobbying, social marketing, information, education and communication, and community mobilization for action. Improving nutritional status requires sustained efforts over a long period of time, usually with a time horizon of 20 to 30 years.

The development and delivery of nutrition messages must be appropriate in order to be effective. The following suggestions are offered:

Deliver consistent messages to an audience through a variety of channels over an extended period of time.

Deliver the message by a source that the audience will find credible.

Create a message that the audience will understand.

Suggested message formats are listed in Box 9. Critical issues for nutrition promotion can be identified and communication plans developed to address these issues with primary and secondary audiences as shown in Box 10. It might be necessary to target specific groups and individuals as follows:

households, especially parents and child caregivers;

health professionals, both public and private;

older school children who could be involved in child-to-child activities to improve the nutrition of young children, and who can benefit from understanding their own nutrition situation;

members of civic organizations;

employers; and

district, provincial and national policy-makers and legislatures.

Policy mapping is a tool used to identify critical audiences. The first stage of policy mapping is to list key decision-makers, influential individuals and groups, also known as stakeholders. Ranking the stakeholders by importance is extremely helpful in planning a strategy. If there is some uncertainty regarding stakeholders, research may be required. Identifying stakeholders is a constant task for advocates.