Re: Nutrition-enhancing agriculture and food systems

Dr. Terri Ballard FAO, Italy

There has been a lot of discussion on-line and in workshops over the past few years about appropriate metrics for measuring the impact of nutrition-enhancing agriculture on nutrition.  Two recent systematic reviews have concluded that the evidence is not yet available to say that agricultural interventions reduce child malnutrition, and that better methodology is needed, including the use of randomized controlled trials ( Ruel MT, Alderman H and the Maternal and Child Nutrition Study Group. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet 2013. published online June 6.

In my opinion, if we continue to expect individual agricultural projects of often limited coverage and short life spans to evaluate their impact on reducing child malnutrition, we will never understand the true contribution of agriculture towards improving nutrition overall, and will still be searching for convincing evidence that these approaches are better than the “magic bullet” medical approaches to malnutrition. 

I would like to suggest that we are looking at the wrong set of impact indicators. By focusing on reduction in child malnutrition through the use of anthropometric measurement, we are setting ourselves up for failure.  As stated by Per Pinstrup-Anderson in his comment published in the recent Lancet Series, pathways through which food systems can affect nutrition are well known (Per Pinstrup-Anderson. Nutrition-sensitive food systems: from rhetoric to action. Lancet 2013. published online June 6. doi:10.1016/S0140-6736(13)61053-3).  While these pathways, such as homestead production, livelihood enhancement, women’s empowerment, improved market access of healthy foods, infrastructure, etc., can have a considerable impact on nutrition, it is not appropriate to hold agriculture-nutrition interventions accountable for reducing stunting or other multi-causal nutrition outcomes. A better way may be to  measure the contribution that different interventions make at different points along the food system on improving diets and reducing nutritional problems.  This is done through the selection of appropriate outcome indicators that are relevant to the projects being evaluated and then putting the evidence together in a way that focuses on the larger picture – improvement of nutrition of the population.  

There is a vast literature on large scale effectiveness evaluations in the health field that could serve as a model for understanding how and how much nutrition-enhancing agriculture achieves towards improving nutrition. (Bryce J, Victora CG; Ten methodological lessons from the multi-country evaluation of integrated Management of Childhood Illness. Health Policy Plan. 2005 Dec;20 Suppl 1:i94-i105. Victora CG, Black RE, Boerma JT, Bryce J. Measuring impact in the Millennium Development Goal era and beyond: a new approach to large-scale effectiveness evaluations. Lancet 2011; 377: 85-95.)