全球粮食安全与营养论坛 (FSN论坛)

POST 1  PROBLEMS

Many thanks for opening this subject on the FSN Forum. Of course gender issues are critical, but as a food educator I’d like to focus mainly on nutrition, in particular the needs for different kinds of food knowledge, motivation, action and training. Since it is rather long, I have divided it into two posts.

THE NITTY-GRITTY 

There is so much talk about what AEAS could or should do, that it is good to hear about what is actually being done and how it has turned out:  for example Helvetas on the “hard fight going on in the marketplace to catch the attention of consumers” and the need for a broad alliance of stakeholders to raise consumer awareness;  Harvest Plus on getting local agents to promote and sell biofortified foods (the Tupperware approach?);  Amtul Waris on approaches to engage children;  Dick Tinsley on what poor people can do for themselves, and what services cash-strapped governments can pay for;  George Bazayo of Tree Aid, Burkina Faso and Mahtab Bamji  of the Dangoria Charitable Trust describing and evaluating integrated small farming projects with a nutrition education component; and Kenneth Oulu’s experience of promoting “women’s crops” in Tanzania. 

They are all discussing problems and pathways, all involving some form of food education or learning, by whatever name.  I’d like to add my own point of view based on my field experience and reading.

PROBLEMS   

Overburdened?

Contributors mention several challenges to AEAS taking action on nutrition (also brought out in the GFRAS study by Fanzo [1]),such as lack of resources/ time/ transport/ training/coordination with other services; social and structural barriers and institutional barriers (e.g. gender attitudes, land ownership, the traditional AEAS focus on staples and productivity.  It is generally felt that the AEAS (a) have enough on their plates, (b) may not see nutrition as a priority, or indeed as their business, and (c) could do with official guidelines about what to do.

Indeed, don’t they have some justification? There seems to be a  general expectation that it’s the job of the extension services to compensate for low levels of food literacy in the population.  Imagine how much malnutrition, stunting and obesity would be averted if children left school with some understanding of and practice in cooking, feeding babies, growing  fresh vegetables, eating healthily, shopping wisely, protecting themselves against dangerous foods, adapting to change, recognizing and resisting misleading food advertising, and bringing up their children to do the same.  These skills are part of the Right to Food. There is a general absence of effective food and nutrition education in schools, in public education (the media,  public information sites, community programs [2]) and in social protection schemes. [3]  I was heartened to read the proposals for comprehensive school food and nutrition education (SFNE) from contributors. This was also a recommendation of the ICN2 conference.

 

Limitations and motivations  

There are also some inherent limitations on what AEAS can achieve for nutrition, which can affect the motivation of all concerned - farmers, households, AEAS and their ministries.

  • Diet and health  Nutrition impact depends not only on diet, but also on general health, for which AEAS are not directly responsible:  the best of nutrition interventions can be undermined by malaria, helminth infections or diarrhoeal diseases, or just lack of exercise.  So (for example) it will always be hard to promise convincingly that more spinach will make you stronger, or to see the effects.
  • Cash or consumption?  There is an inherent conflict of interest between cash income and improved home consumption. Poor people need to make money immediately, says Paul Rigterink, and many others have pointed out the  permanent motivational gap between present cash in the hand and the uncertain promise of future better health.[4]  The tension exists not only for farmers and households, but also for AEAS and MoAs, who pride themselves on increasing rural prosperity.
  • The partial picture   AEAS are not in a position to deal with the whole household food situation; they deal with what people grow for food, not with what they buy.  For any given context, this raises the question of where the main nutritional threats to health come from – is it homegrown dietary monotony, or the empty calories in bought food, or both?  The Dangoria Charitable Trust project evaluation asked what foods farmers buy with the money they get from selling the foods they produce.  We should also  ask farmers whether they prefer buy or growing.  Growing means extra time and effort in the garden and kitchen.  Buying can be cheaper, more convenient, tastier, quicker, sometimes more prestigious,   and above all time-saving (women don’t want anything which takes more time, says Aklilu Nigussie).  Social marketing experts would say this choice is a no-brainer.

If global reviews have difficulty establishing reliable pathways from agriculture to improved nutrition,[5]  how can ordinary households see the benefits and urgency of producing and consuming differently?   Unlike harvests and market prices, nutrition outcomes have low visibility and  many people do not think of varied vegetables or fewer soda drinks as concrete steps towards prosperity. Action for good nutrition is moved by attitudes and conviction as much as by reason.  This has consequences for the approach.  With resistance from established habits and social norms, competition from cash and convenience, and not a lot of clearly attributable outcomes, good information and sage advice are generally not enough to get people eating better.

 

POST 2     TRAINING

WHAT WORKS AND WHAT DOESN’T

If Ministries of Agriculture and the AEAS do want to take nutrition and diet into their sights, we know quite a lot about what works and what does not.  Here are some of the ideas.

  • More of the same - increased productivity/better harvests/agricultural training 

It is often recommended is that AEAS improve what they are already doing, with more personnel, more women, more resources, better seeds, better technology etc.  Of course this will improve food security, but we can’t assume that improving supply will reshape food consumption patterns.  On their own, supply-side interventions have a patchy impact on nutrition.  Like rising household income or increased GDP, they tend to  perpetuate and reinforce existing dietary patterns, or to improve them within the frame of what consumers already see as good (e.g. more meat).  So I would risk the thought that if AEAS are to improve nutrition, they will need to go a little beyond what they are already doing.

  • Imparting nutrition knowledge

Some knowledge of food and nutrition is certainly a must.  Nutrition awareness and perception do look like an obvious part of the professional repertoire for people who advise on what to grow and how to grow it, and whose mandate is to safeguard farmers’ interests and welfare.   It is frequently suggested therefore that AEAS acquire and “disseminate information” about good nutrition. However knowledge alone is not enough for either AEAS or their clients. It is well attested[6] that it is a necessary but not sufficient condition for changing food practices (as we also know from personal experience).  AEAS may like to test this for themselves by giving nutrition information and checking how far it is heeded.

  • Behavioural  messages

Specific messages about what to do, shaped for particular audiences, are the mainstay of behavior change interventions, and are more successful than general information. It’s often proposed that AEAS should act as ancillary messengers in “delivering” dietary messages (face-to-face communications have been found very effective in promoting change). This however is only part of a multi-faceted intervention[7] and may limit the role of AEAS and not make much use of their special expertise and local knowledge.

  • Integrated agricultural interventions 

Increasingly favoured are packages which mix experience and practice in growing and preparing foods with some knowledge of food and diet, and practice in changing habits, and which call on local experience and family/ group/ community support.  Contributors have given interesting examples of how agricultural, marketing and nutrition knowhow are directly put into practice.  Such packages have the potential to make full use of AEAS’ working skills and experience.  However these are usually independently funded projects with specific targets and target groups. Can such approaches be promoted in the regular extension services, with their limited resources, manpower and time?

TRAINING

If AEAS are willing to take an interest in improving local diet and nutrition,  then it seems that programs of action (and related training and guidelines) should aim at being economical in time and resources;  should be practical, productive and rewarding;  should make use of existing knowledge and skills and build easily into normative work patterns;  should “breed” support wherever possible, and develop capacity in the AEAS.   Effective national and ministerial policy, intersectoral coordination and easy access to accurate information can of course make everything much easier.

In the curriculum 

We would surely expect local food experts to be primed to make health connections between what’s grown and what’s consumed, know what common foods are good for, recognize poor diet and see how locally grown crops could improve it.  It cannot be ethical to keep nutrition knowhow out of the agriculture curriculum.  Two relatively inexpensive and feasible strategies are:

  • Nutrition across the pre-service curriculum   Review the whole pre-service agriculture curriculum in collaboration with its subject lecturers, integrating nutrition links and mini-activities wherever appropriate and making sure that nutrition is included in a small way in several official subject examinations.  This builds student awareness incrementally, and also creates better-informed subject teachers (there is nothing so educational as marking exam papers and grading projects).
  • Self-study course in food and nutrition   Develop, adopt or adapt a short tutored self-teaching course in food and nutrition for both pre-service and in-service, adaptable for other services so that all are on the same page.  Keep it online, where it can be updated and downloaded or printed for local use.   The content should cover not only the basics of food and nutrition, but also local issues, national diets, national nutrition programs, approaches and best practices, and a number of exercises involving direct observation, finding information resources, exploring people’s opinions etc. The course can be done first by supervisors/lecturers, who then become facilitators for groups of students or workers in their own workplaces. (For best results, spread it over at least 10 weeks, with 5 tutorials, and a final test.)

In the field

Finally, on the-job learning, which is more important than any other training. 

Field training programs  should parallel the new job dimension. They should aim to generate small observable improvements in local food practices; build community initiative and capacity in undertaking them; get support from health and education services; train up AEAS teams in the art of instigating, monitoring, assessing, recording and recycling the process; and get some recognition for achievement from both communities and ministries. Ideally they are slow, systematic and incremental, and result in a capable, skilled and motivated workforce which can operate independently. The training period (a year?) can be guided by ministerial protocols and some basic materials.

I am sticking my neck out here!  Such programs, if well organized, work fine in other kinds of professional work which are not so different from agricultural extension (e.g. teacher training, medical internships, social work, counselling), but I have never seen them in an AEAS service.

Is it feasible?  Has it been done?

 

[1]Fanzo, Jessica, Q. Marshall, J. Wong, R. I. Merchan, M.I. Jaber, A. Souza, N. Verjee .

The integration of nutrition into extension and advisory services  2013.  G-fras.org and World Bank Secure Nutrition.  www.g-fras.org  Global forum for rural advisory services

http://www.fsnnetwork.org/sites/default/files/gfras_nutrition_report.pdf

[2] The American community nutrition education program for low-income groups, EFNEP, covers many of these skills, and shows good results in its annual evaluation.   

[3] Social protection programs are currently beginning to discover the very large supplementary impact of a food and nutrition education component. See Akhter et al. 2016 Which form of safety net transfer is most beneficial?  Impacts on income, food security and child nutrition. IFPRI.  http://www.slideserve.com/maine/akhter-ahmed-john-hoddinott-wahid-quabili-shalini-roy-fiona-shaba-and-esha-sraboni

[4] For example, Banerjee and Duflo  Economist blog April 2011 Why people don’t take simple low-hanging fruit options to protect their health.  http://www.economist.com/blogs/freeexchange/2011/04/banerjee_and_duflo_…; They make the same point in their classic study Poor Economics 2012.

[5]  A great chorus of review literature makes the point that agricultural programs may have  great potential for improving nutrition but there is “little empirical evidence on the role of agriculture and other nutrition-sensitive sectors on nutrition” (HLPE of SCN 2016, draft report) or understanding of how to achieve the potential (Thompson and Amoroso 2010).  See also Hodge et al. 2016, Fiorella et al. 2016 review, Yosef et al 2015 re Bangladesh, Webb 2013b), Masset et al. 2011, Hawkes et al. 2012). 

[6]See e.g. Contento et al. (1995) The effectiveness of nutrition education and implications for nutrition education policy, programs and research: a review of research. Journal of Nutrition Education, 27(6), 355–364.   Most behaviour change theory supports this finding.

[7] Researching, developing, trialling and disseminating behaviour change messages is a big job, so the AEAS role in behaviour change interventions is generally taken to be as extra support.