The process of developing a nutrition sensitive agriculture intervention a multi site experience

The process of developing a nutrition sensitive agriculture intervention a multi site experience tài liệu, giáo án, bài...

ORIGINAL PAPER

The process of developing a nutrition-sensitive agriculture

intervention: a multi-site experience

Peter R Berti1&Rachelle E Desrochers1&Hoi Pham Van2&An Lê Văn3

&

Tung Duc Ngo3&Ky Hoang The4&Nga Le Thi4&Prasit Wangpakapattanawong5,6

Received: 7 September 2015 / Accepted: 10 October 2016

# Springer Science+Business Media Dordrecht and International Society for Plant Pathology 2016

Abstract Nutrition-sensitive agriculture (NSA)

inter-ventions are of increasing interest to those working

in global health and nutrition However NSA is a

broad concept, and there are numerous candidate

NSA interventions that could be implemented in any

given setting While most agriculture interventions

can be made Bnutrition-sensitive^, there are few

guidelines for helping to decide what agriculture

com-ponent should be tried in an NSA intervention Based

on previous models, we developed a framework with

explicit questions about community factors

(agricul-tural production, diets, power and gender), project

factors (team capacity, budget, timelines) and external factors that helped our team of agriculture scientists, nutritionists and local officials identify NSA interven-tions that may be feasibly implemented with a reason-able chance of having positive agricultural and nutri-tional impacts We applied this framework to two set-tings in upland Vietnam, and one setting in upland Thailand From an initial list of nineteen interventions that have been tried elsewhere, or may reasonably be expected to be appropriate for NSA, five or six can-didate interventions were chosen per site Based on the criteria, three to four interventions were selected per site and are being implemented Poultry rearing and home gardening were selected in each site They and the other selected interventions, hold promise for capitalizing on underused agricultural potential to im-prove diets, while working with (or improving) existing gender relationships and power structures The process for identifying NSA interventions was thorough and identified reasonable candidates, but it was very time consuming Further efforts should fo-cus on streamlining the process, so that promising and appropriate NSA interventions can be identified quickly and reliably

Keywords Nutrition-sensitive agriculture Vietnam Thailand Food security

Introduction The potential and real contributions of agriculture to the health and nutrition of low and middle income country farmers is of increasing interest to develop-ment donors, practitioners and researchers through

Electronic supplementary material The online version of this article

(doi:10.1007/s12571-016-0625-3) contains supplementary material,

which is available to authorized users.

* Prasit Wangpakapattanawong

prasitwang@yahoo.com

1

HealthBridge, 1004-One Nicholas Street, Ottawa, Canada

2

Center for Agricultural Research and Ecological Studies, Vietnam

National University of Agriculture, Hanoi, Vietnam

3 Hue University of Agriculture and Forestry, 102 Phung Hung,

Hue, Vietnam

4

HealthBridge, Suite 202 & 203, E4 Building, Diplomatic

Compound, No 6 Dang Van Ngu Str., Dong Da Dist,

Hanoi, Vietnam

5

Department of Biology, Faculty of Science, Chiang Mai University,

Chiang Mai 50200, Thailand

6 World Agroforestry Centre (ICRAF) c/o Knowledge Support Center

for the Greater Mekong Sub-region (KSC-GMS), Faculty of Social

Sciences, Chiang Mai University, P.O Box 267, CMU Post Office,

Chiang Mai 50202, Thailand

DOI 10.1007/s12571-016-0625-3

what has been termed Bnutrition-sensitive agriculture^

(NSA) Instead of considering agriculture solely as an

economic activity, NSA is concerned with the broad

relationship between food production and the health

of the farmer and the farm family Their relationship

may be expressed in terms of pathways that lead from

agriculture to improved nutrition (Herforth and Harris

2014; Headey et al 2011; Kadiyala et al 2014)

These include: a household’s own crop and animal

production to consumption of its own produced food;

increased household income (through increased

pro-duction or beneficial agricultural policies) allowing

increased purchasing of food and/or health care;

ad-justment of women’s workload to allow for improved

child care and/or maternal nutritional status; and

im-proved women’s status and ability to control

alloca-tion of resources for food, health and care

These relationships are theoretical and the amount of

supporting evidence for each pathway is variable but

generally limited There were eight reviews of the

im-pact of agriculture interventions on nutrition outcomes

carried out between 2001 and 2013, summarized in

Webb and Kennedy (2014), but these reviews included

only as few as 13 and at most 52 separate studies, and

collectively they drew on about 100 separate studies

This is a small number of studies from which to draw

globally applicable lessons The studies cover different

agricultural foci in various climatic, topographic and

geopolitical environments, with various ethnic groups

and covering different age groups All the reviews

con-clude that more research is needed to better understand

the relationship between agricultural interventions and

nutrition and to be able to design NSA interventions

with a high probability of having a positive health

out-come Fortunately, much more research is ongoing now

– a recent review of the research landscape indicated

that there were 151 ongoing NSA studies (Turner

et al 2013), and probably many more that were not

captured in that review With all this interest, it is

worthwhile considering how to select a specific NSA

intervention to implement in a given situation

Guidelines from the FAO direct the user on aspects of

situation appraisal to plan NSA, to define program

ob-jectives, to select target groups, to choose interventions

and implementation modalities (FAO 2015)

The focus here is on the development of a framework

specifically for choosing which NSA(s) to trial In our

case, this meant choosing an agriculture intervention

that the agriculture scientists (HPV, ALV, PW, plus

oth-er local team memboth-ers) thought may be successful from

a production point of view, and the nutritionists (PRB,

NLT, plus other local team members) thought could be

made Bnutrition-sensitive^ and have a positive impact

on nutrition outcomes The authors represent teams from agriculture departments in two Vietnamese universities, and a biology department in a Thai university, as well

as scientists from a health-focused international NGO Funding from the International Development Research Centre (IDRC), Canada from March 2013 to February

2016 supported carrying out research on NSA interven-tions in three research sites (one for each of the univer-sity teams), but the specifics of the interventions were not pre-defined A preliminary step for the research teams was to decide which intervention, or interven-tions, should be trialled at each site The Vietnamese and Thai research teams did not have prior experience with explicit NSA interventions and some care was needed to select appropriate interventions to implement

at these sites

The purpose of the paper is to describe our methods

of determining suitable NSAs to test, and suggest ways forward for other researchers and programme designers

in a similar situation Based on previous models, we developed a framework with explicit questions about community factors (agricultural production, diets, local power structure and gender), project factors (team ca-pacity, budget, timelines) and external factors that helped our team of agriculture scientists, nutritionists and local officials identify NSA interventions that may feasibly be implemented with a reasonable chance of having positive agricultural and nutritional impacts Note that we did not carry out a comprehensive needs assessment to identify the single best strategy for poverty alleviation or health improvement – perhaps a water and sanitation intervention, or a maternal health services interven-tion would have a greater impact Rather, our research mandate was to identify and test NSA interventions and monitor the nutrition impact of the intervention, accepting that while there are risks in NSA interventions (Dury et al.2015), they can have positive health benefits when well done (Berti et al.2004; Webb and Kennedy2014)

Study setting Malnutrition (General Statistical Office of Vietnam

2011; National Statistical Office of Thailand 2013) and food security remain serious problems in both Vietnam (as determined using household food insecurity access score (Humphries et al 2015) or whether households produce enough staple crop (FAO 2004) and Thailand

as d etermine d by acc ess to a deq uate re sourc es (Isvilanonda and Bunyasiri 2009), particularly amongst ethnic minorities living in remote, upland areas (Government of Vietnam Socialist Republic 2005; Limnirankul et al 2015) The national prevalence of underweight and stunting is 11.7 % and 22.7 %,

respectively, in Vietnam and 9.2 % and 16.3 %,

respec-tively, in Thailand Rates in both countries are higher in

the poverty-stricken highland-minority communities

(General Statistical Office of Vietnam 2011; National

Statistical Office of Thailand 2013)

The current study was carried out in three locations:

Mae Chaem district of Chiang Mai province in northern

Thailand (with Lua and Karen ethnic groups), district of

Hue province in central Vietnam (with Cotu, Taoi, Paco,

Van Kieu and Kinh ethnic groups), and Yen Chau

dis-trict of Son La province in north Vietnam (with Kinh,

Thai, Kho Mu, and H’mong ethnic groups) (see Map 1)

Specific villages were selected based on accessibility by

the research team, perceived potential for change, and

representativeness of major ethnic groups The three

sites have broadly similar climates, with temperatures

hitting lows of 15 to 20 °C in December and highs of

25 to 35 °C in May through July, and the rainfalls

ranging from close to 0 mm in December to as much

as 250 to 300 mm in August in Yen Chau and Mae

C h a e m , o r 1 0 0 0 m m i n A L u o i i n O c t o b e r

Agriculture practiced in these communities is

predomi-nantly subsistence agriculture (or semi-subsistence in the

case of Yen Chau district in northern Vietnam with

60 % of farmers producing their own rice and nearly

all producing their own vegetables)

There is a need in all three locations to identify

long-term, sustainable solutions to increase local food

avail-ability in these vulnerable areas With existing high

rates of malnutrition, their food security is threatened

further by transitions taking place in the local farming

systems Traditionally, farmers in highland areas (more

than 600 m above sea level) have practiced Bshifting

agriculture^, also known as swidden or slash-and-burn

agriculture The burning of the trees by farmers provides

a nutrient-rich layer of ash that allows for a season or two of high levels of crop production Farmers would then move to new areas to repeat the cycle, while the burnt area was left to regenerate (Rambo and Cuc 1996; Wangpakapattanawonga et al.2010) There is now intense pressure to transition away from shifting agriculture in both Vietnam (where it is now illegal) and northern Thailand as alternative methods of farming are now being sought because there is insufficient land for the number of people farming to leave land fallow long enough to regenerate (Sikor and Nguyen 2011; Thomas et al 2004) There is tension between farmers’ needs for high levels of production in the short term, which makes increasing levels of agriculture inputs (especially synthetic pesticides and fertilizers) attractive

to the farmers, and the longer term degradation of the environment caused by this industrialization of agriculture (Dung et al.2008; Tuan et al.2014)

Methods Development of framework to guide selecting NSA

We developed a framework for assessing the Community, Project, and External factors listed in the introduction In or-der to develop the framework, we drew on existing descrip-tions of the pathways between agriculture and nutrition (Headey et al.2011; Herforth and Harris2014), and drew on our experience in previous community development projects, nutrition research, agriculture research, and integrated nutrition-agriculture research projects This led to the frame-work in Box 1, which consists of a series of questions for assessing the Community, Project, and External factors

Map 1 The three study sites, Mae Chaem, Yen Chau, and A Luoi are shown in orange on the right hand panel

Box 1 Factors taken into consideration when deciding on the

nature of nutrition-sensitive agriculture interventions

In choosing the NSA interventions, guided by the

frame-work in Box 1, the user can then select from a list of potential

interventions that have been shown in other settings to be

successful at improving nutrition outcomes, or that could be

reasoned to potentially improve nutrition A list of

interven-tions the authors considered is shown in Table1

Application of the framework to guide selecting NSA

Given budget and timing limitations, the site PIs (HPV, ALV,

PW) estimated they could test, at most, four interventions per

site In other words, they had sufficient time and resources to

introduce four distinct NSAs to participating communities,

provide adequate training and requisite materials for the

fam-ilies to start the intervention, and allow it to continue for at

least one growing season The application of the framework,

therefore, helped to reduce the candidate interventions from the 19 listed in Table1to only four

To collect the information required to answer the questions

in Box 1, we used qualitative and quantitative methods to conduct a situational assessment characterizing the nutritional situation, local farming practices and the relationships be-tween food production, availability and consumption, as well

as the conditioning factors (e.g gender dynamics, market in-frastructure, natural resources, including local wild foods) that promote (or impede) healthy diets Questions regarding Community Factors were answered through formative re-search involving household surveys, in-depth interviews and focus group discussions targeting different ethnic groups at the study sites External Factors were assessed through key informant interviews with district and sub-district/commune officials The project teams answered the questions about Project Factors

Data were collected during October 2013 and January

2014 Specifically:

(a) In household surveys: parents or caregivers of

chil-dren under 5 years old were randomly selected to

be interviewed using a standardized questionnaire;

(b) Individuals from surveyed households were

purpo-sively sampled to take part in in-depth interviews

to more fully characterize agricultural production

and opportunities at the household level;

(c) Focus group discussions were held with men and women

who had children under 5 years;

(d) Key informant interviews were conducted with

commune/sub-district leaders, agriculture staff,

healthcare staff and school nurses and with district

agri-culture and health officials

The focus of this paper is not the data gathering process and

quantitative results, but rather how the results were interpreted

and used, with respect to Box 1 Therefore, details of the

methods and the survey results are in the Supplementary

Materials section

The leaders of each of the three research sites used the

results of the data collection to answer the questions in Box

1 and to guide their preliminary selection of the NSAs to be

trialled Their results and preliminary NSA selections were

p r e s e n t e d t o l o c a l p a r t n e r s , a n d t h e n , t h r o u g h

teleconferencing, to all the authors The authors questioned the site leaders and asked them to defend their decisions, and when all the questions were satisfactorily addressed, the decisions on the NSA selections were endorsed

Research ethics review The research was approved by the Ethical Review Board for Biomedical Research, Hanoi School of Public Health, and Human Experimentation Committee Research Institute for Health Sciences, Chiang Mai University Permission was also granted by the community via the local community leaders Before conducting the interviews, the purpose of the data col-lection was explained to the respondents, the confidentiality of their responses was assured, and their informed and voluntary consent was sought Agreement to participate was granted orally (in Vietnam) or in writing (in Thailand)

Results Development of framework to guide selecting NSA Through a series of team meetings and discussions, the authors developed and refined the questions, leading to the framework shown in Box 1, including, as planned, questions related to community factors, project factors and external factors In the development of the framework we recognized that the process would work best if we split the process into two steps (1) Characterized the site in terms of agricultural production, and food and nutrition to identify basic needs and potentials, and considered project factors that would present limits or provide opportunities at each site Then the observations and interpre-tations would suggest a number of candidate interventions drawing from the options in Table1 (2) Assess the suitability

of each of the candidate interventions according to the various Community, Project, and External factors laid out in Box 1 Application of the framework to guide selecting NSA The first step of characterizing agricultural production, food and nutrition, and considering project factors suggested a number of possible interventions for each site (Box 2a, b and c) Five or six NSA interventions were considered in detail for each site, with 11 different interventions considered across the three sites For A Luoi, the site team chose the candidate interventions Poultry, Fishponds, Home gardens, Beans and inter-cropping, and Infant and child feeding For Yen Chau, they selected the candidate interventions Poultry, Pumpkins, Home gardens, Rice, School gardens, and Sloping land crop diversification For Mae Chaem, the site team chose the candidate interventions Poultry, Food preservation, Home gardening, Infant and child feeding, and Improving water

Table 1 Agriculture interventions we considered for testing in

integrated NSA interventions

Animal-source food production

and consumption

Horticulture

Large animal husbandry –

for meat and milk

Fruit trees (various types) Small animal husbandry

– for meat Home gardening of various vegetables

Poultry rearing – for

meat and eggs

Home gardening of pumpkins Fish farming School gardens of various vegetables

Insect farming Perennial vegetables

Field crops Market development

Rice (System of Rice

Intensification,

known as SRI)

Local markets for fruit, vegetables, meat and eggs, and preserved foods Legumes and intercropping Export markets

Infrastructure Behaviour

Improved irrigation system Time management changes to

reduce women’s workload Fish pond improvement Nutrition promotion and education

-aimed at breastfeeding practices, complementary feeding, young child feeding, diet of pregnant and breastfeeding women, or diet

of whole family Sloping land protection

systems In all cases, the candidate interventions were selected

because the local teams saw that they could meet the

production and nutrition needs within the time and resource constraints of the project

Box 2a Characteristics of A Luoi, in relation to Box 1

Box 2b Characteristics of Yen Chau, in relation to Box 1

Box 2c Characteristics of Mae Chaem, in relation to Box 1

Box 3a Evaluation of candidate interventions in A Luoi district

Box 3b Evaluation of candidate interventions in Yen Chau