The Integrated Horticulture and Nutrition Development Project illustrated the links between different horticulture components that prevent micronutrient malnutrition and promote food security, health and livelihoods. It demonstrated the effectiveness of household production in addressing undernutrition and micronutrient deficiencies in Bangladesh.
A nutrition strategy based on household production is more sustainable than external intervention in the form of supply of drugs and centralised fortification facilities outside the control and supervision of the beneficiaries. Strengthening it with institutional support should be a key government concern.
The project’s results can be the basis for future food-based initiatives in Bangladesh. However, considerable institutional strengthening and human resource development are needed to extend it to other areas. Further collaboration between the Ministry of Education and the Ministry of Agriculture and Fisheries is needed to upscale the school nutrition programme and ensure technical support to teaching staff.
A formal policy for food-based nutrition through integrated homestead systems production is needed in Bangladesh with coordination among the Ministries of Health, Education and Agriculture.
A school-based nutrition programme will benefit students and the wider community, resulting in social and economic development through improved productivity and quality of life. This requires harnessing of horticulture and nutrition resources at national, community and school level besides advocacy of school health and nutrition.
Horticultural production and diversification can benefit resource-poor rural farmers through targeted interventions to increase productivity and efficient marketing of food products and quality seeds. Also needed are effective extension services, credit availability for women farmers and more use of farm inputs like fertilizers and improved seeds.
The project demonstrated that a combination of technology and investment in people, especially nutrition and health education for men and women farmers can yield high rates of return. Incorporation of nutritional considerations in production policies and programmes can avoid some negative aspects of the new technologies.
Food diversification must increase the production of nutritious food rich in fat, protein and micronutrients such as beans, leafy, yellow and orange vegetables, root crops like yellow sweet potato, and fruits.
It is important to identify food purchasing and consumption trends in developing countries in view of the disparity in the quality and depth of information on production, distribution and consumption of fruits and vegetables.
Policy makers and planners must be aware how specific target groups perceive, obtain and consume fruits and vegetables. What may be appropriate for one consumer section may not be relevant for another. Identifying social groups at risk of under-consumption of fruits and vegetables and understanding the reasons for the risk, is essential for designing sound nutrition interventions.
Micronutrient-deficient diets are responsible for some of the world’s most widespread and debilitating nutritional disorders, including birth defects, mental and physical retardation, weakened immune systems, blindness and even death. Inadequate consumption of fruits and vegetables, a major reason for such micronutrient deficiencies,107 is estimated to cause about 31 percent of ischaemic heart diseases and 11 percent of strokes worldwide.108 Overall, it is estimated that that up to 2.7 million lives can be saved each year with increased fruit and vegetable consumption.
The FAO/WHO expert consultation on diet, nutrition and the prevention of chronic diseases recommended a daily intake of 400 g of fruits and vegetables (excluding potatoes and other starchy tubers) to prevent heart disease, cancer, diabetes and obesity. This can also prevent several diseases caused by micronutrient deficiency in developing countries.
A high-level international review of research findings on the link between fruit and vegetable consumption and cancer risk, coordinated by the WHO and the International Agency for Research on Cancer (IARC), concluded that eating fruits and vegetables may lower the risk of some cancers, particularly of the gastro-intestinal tract. According to IARC estimates, 5 to 12 percent of all cancers and 20 to 30 percent of cancers of the upper gastro-intestinal tract can be prevented with adequate consumption of fruits and vegetables.109
The project can be a catalyst linking horticultural innovation with household nutritional improvement, working in partnership with other stakeholders such as the government, NGOs and beneficiaries.
School-based nutrition programmes have an important role in promoting healthy eating habits. As diet also influences the learning potential, national education programmes must aim to ensure that children get adequate nutrition and health care to attend school with healthy minds and bodies.110
Schools also offer the most effective way of reaching out to large sections of society, including young people, school teachers and personnel, families and community members. Schools provide a setting to introduce the community to nutrition information and technologies, leading to community advocacy of nutrition improvement policies and services.111 Girls, in particular, benefit from good nutrition which is beneficial during later pregnancy, lactation and nourishment of children.
The school nutrition programme should emphasize harnessing of horticultural and nutrition resources at country, community and school level while assisting government advocacy of school health and nutrition. Advocacy is needed to influence government policy and ensure long-term sustainability of the initiative.
Discussion with various agriculture and nutrition stakeholders has shown the need to widen the school nutrition initiative and the MOE and MOA can initiate efforts to make practical nutrition education and school gardening activities a part of the regular school curriculum.
FAO’s technical projects on school gardening are linked to the global flagship partnership programme “Education for Rural People” (ERP) launched at the 2002 World Summit on Sustainable Development. These are expected to be part of the FAO/WHO joint initiative “Fruit and Vegetables for Health” to enhance fruit and vegetable consumption.
The school nutrition programme of the Integrated Horticulture and Nutrition Development Project should be part of the initiative by FAO and the UNESCO (United Nations Educational, Scientific and Cultural Organization) Institute of Education Planning which led to the 2004 publication of the school gardening book “Revisiting garden-based learning in basic education”.
The school nutrition programme, combined with the school garden programme can be integrated with wider curriculum development by the Ministry of Education and needs to be taken up as a priority by policy makers.
An extension of the project horizon would be useful in linking educational with nutrition programmes. It would increase donor interest in health and nutrition of school age children and adolescents, which are closely linked with women’s health and nutrition. Such a strategy would benefit the Government of Bangladesh in its planning of nutrition development projects that could be based on the findings of the IHNDP. A focus area for the IHNDP exit strategy should be influencing government policy through advocacy and the long-term sustainability of the school nutrition initiative.
The project has successfully raised awareness of the importance of nutrition education in all of HDTCs and a wide variety of vegetables is now being consumed as soups and pickles.112 A shift of practice in the use of vegetables, cooking and child feeding has also been manifest on various occasions.
While emphasis has been on horticultural production and access to vegetables has increased, the frequency of consumption of vegetables has also increased through learning and practice of new horticulture-based recipes in the project. Field observations and the findings of the community-based assessment underscore the need for regular follow-up so that the nutrition knowledge is put into practice.
There is a felt need to institutionalize the community-based nutrition education programme. Resource-poor farmers should be empowered with ownership of nutrition programmes combined with income generation activities. This, in turn will ensure sustainability of nutrition education at the rural level leading to qualitative changes in the life of farmers.
An important implication of the IHNDP’s nutrition component is the importance of food safety and hygiene. Food safety should be a component of DAE’s future horticulture-related programmes. The technologies promoted through the food preparation and processing activities for nutrition improvement should be further replicated.
There is a need for more data on the nutritional composition of cooked recipes. Food safety aspects related to fruits and vegetables, focusing on pesticide residues, related chemical contaminants like heavy metals (arsenic) and mycotoxins, and microbiological contaminants (bacteria and parasites) should be considered. This can have implications for the safety of horticultural produce in locations with high reported arsenic soil levels.
The lessons, nutritional (dietary) impact assessment and practical research outcomes of IHNDP can be used to strengthen food policy initiatives of relevant departments and sectors of the Ministry of Agriculture, Bangladesh. The project outcomes can be used by DAE to foster and support interaction among government entities as well as between them and relevant community organizations working to promote food and nutrition policies within the framework of national policies on agriculture, poverty reduction, health and population.
Food-based nutrition models for dietary diversification and horticultural production using the IHNDP experience to widen the food basket should be upscaled. Specifically, this can be for development of nutrition or micronutrient-based food policies, implementation of food safety and nutrition enhancement progammes. Issues related to access to food, its preparation and consumption within households in Bangladesh should be identified as these form an important basis for improved food policy decisions and change at the national level.
The community-based nutrition activities must be mainstreamed with other DAE development activities. An approach to food and nutrition security based on a homestead gardening system should also be considered beyond project areas, particularly for landless farmers. Horticultural cropping potential can be combined with rearing small animals, poultry and fish breeding for dietary improvement of marginal rural households.
The technical partners of the National Nutrition Programme (NNP) have requested IHNDP and FAO collaboration for initiating food-based nutrition programmes. This was discussed during the NNP workshop under the Health, Nutrition and Population Sector Programme (HNPSP). Specifically, requests have been made to integrate the food-based nutrition model and approach with the HNPSP.
107 FAO/WHO. 2003. Diet, nutrition and the prevention of chronic diseases. Report of the Joint WHO/FAO Expert Consultation. Geneva, World Health Organization.
108 WHO. 2002. World Health Report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization.
109 IARC. 2003. Handbook on fruit and vegetable consumption and cancer prevention. Washington, DC, International Agency for Research on Cancer.
110 NEGP. 1993. The national educational goals report: building a nation of learners. Washington, DC, National Education Goals Panel, US Department of Agriculture, Food and Nutrition Service, Nutrition and Technical Services Division.
111 WHO. 1996. Status of School Health. Geneva, World Health Organization.
112 Mid-term Mission Report, 2003, IHND Project, Dhaka.
