Recent Developments in Food and Nutrition Policies in Developing Countries: Relevance for Africa

Lawrence Haddad Institute of Development Studies UK

Lawrence Haddad, Institute of Development Studies 1

Outline
Why nutrition sensitive policies are vital How can the following be more nutrition sensitive? Evidence
Agriculture Womens Empowerment Social Protection Water and Sanitation

The need for data on nutrition sensitive financial flows

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Nutrition Sensitive Policies are Crucial for Undernutrition Reduction

11.6
Share (%) of reduction in child underweight attributed to underlying variables, 197095 (63
developing countries)

19.3

43

26.1

Health Environment National Food Availability Female Education Women's Status

Smith and Haddad 2000. IFPRI Research Report.

Lawrence Haddad, Institute of Development Studies

Effective nutrition action requires coherence and critical mass from all sectors

Direct Nutrition Interventions

Lawrence Haddad, Institute of Development Studies

Driven by: Leadership, Ideas, Institutions, Incentives

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Effective nutrition action requires coherence and critical mass from all sectors

Agriculture Focus on poverty reduction, Gender

Direct Nutrition Interventions

Lawrence Haddad, Institute of Development Studies

Driven by: Leadership, Ideas, Institutions, Incentives

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Effective nutrition action requires coherence and critical mass from all sectors

Agriculture Focus on poverty reduction, Gender

Social Protection Focus on health conditionalities

Direct Nutrition Interventions

Lawrence Haddad, Institute of Development Studies

Driven by: Leadership, Ideas, Institutions, Incentives

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Effective nutrition action requires coherence and critical mass from all sectors

Agriculture Focus on poverty reduction, Gender

Social Protection Focus on health conditionalities Womens empowerment Balance of upstream and downstream empowerment

Direct Nutrition Interventions

Lawrence Haddad, Institute of Development Studies

Driven by: Leadership, Ideas, Institutions, Incentives

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Effective nutrition action requires coherence and critical mass from all sectors

Agriculture Focus on poverty reduction, Gender

Social Protection Focus on health conditionalities

Direct Nutrition Interventions

Womens empowerment Balance of upstream and downstream Water andempowerment Sanitation Focus on nutrition status outcomes

Lawrence Haddad, Institute of Development Studies

Driven by: Leadership, Ideas, Institutions, Incentives

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Effective nutrition action requires coherence and critical mass from all sectors
Education Keep girls in secondary school to delay age at first pregnancy

Agriculture Focus on poverty reduction, Gender

Social Protection Focus on health conditionalities

Direct Nutrition Interventions

Health systems View nutrition as lower in hierarchyembed direct nutrition programmes

Womens empowerment Balance of upstream and downstream Water andempowerment Sanitation Focus on nutrition status outcomes

Lawrence Haddad, Institute of Development Studies

Driven by: Leadership, Ideas, Institutions, Incentives

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Effective nutrition action requires coherence and critical mass from all sectors

Agriculture Focus on poverty reduction, Gender

Social Protection Focus on health conditionalities

Direct Nutrition Interventions

Womens empowerment Balance of upstream and downstream Water andempowerment Sanitation Focus on nutrition status outcomes

Lawrence Haddad, Institute of Development Studies

Driven by: Leadership, Ideas, Institutions, Incentives

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Agriculture

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Pathways through which changes in agriculture affect health and nutrition

1. Improved household Income 2. Lower consumer food prices 3. New foods into diet 4. Changes in processing 5. Changes in agricultural work patterns 6. Labor devoted to agricultural production 7. Changes in power within the household

J. Hoddinott. 2011. 2020 Conference Paper 2 Agriculture, Health, and Nutrition: Toward Conceptualizing the Linkages

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interventions in reducing the prevalence of underweight and wasting compared to stunting can be explained at least in two ways. The interventions considered may be better suited to addressing short-term agricultural interventions that The nutrition impact of undernutrition rather than chronic undernutrition. An alternative explanation is that the studies assessed impact shortly are designed to have an impact on nutrition after the interventions had taken place and could therefore not capture long-term impact such as chronic undernutrition.
Table 3.5 Impact of interventions on nutritional status of children Study Stunting (height-forUnderweight age) (weight-for-age) Aiga et al. (2002) n.s ** Faber et al. (2002) n.s n.s Hoorweg et al. (2000) ** ** Makhotla and Hendriks (2004) n.s. n.s. Low et al. (2007) n.s. ** Olney et al. (2009) n.s. n.s. Schipani et al. (2002) n.s. n.s. Shmidt and Vorster (1995) n.s. n.s. Wasting (weight-forheight) n.s n.s. ** n.s. ** n.s n.s. n.s.

Note: in the second column, n.s. is not statistically significant, * is statistically significant at the 10% level, ** is significant at the 5% level, *** is significant at the 1% level

Overall these results provide little support to the hypothesis that agricultural interventions Cornelius A and undernutrition. systematic review of should not be interpreted Masset E, Haddad L,help reduce Isaza-Castro J (2011), A However, they agricultural interventions that aim to as evidence of the absence of impact. Lack of significance can be the result improve nutritional status of children. London: EPPI-Centre, Institute of Education, University of London. of absence of impact as well of absence of statistical power (Borenstein et al. 2009), and many of the studies reviewed were conducted over small samples of children. In empirical research it is
Lawrence Haddad, Institute of standard practice to set a null Development Studies

hypothesis stating, for

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Women famers are disadvantaged in access to inputs

Number of studies

Source: Peterman, Behrman and Quisumbing, 2010. IFPRI Discussion Paper 975
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Social Protection

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Social protection at a glance

HLPE, 2012. Social protection for food security. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security, Rome 2012.

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Safety Nets: an important part of the response to the food price crisis

HLPE, 2012. Social protection for food security. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security, Rome 2012. Lawrence Haddad, Institute of Development Studies 17

0.41

Impact of various Latin American conditional cash transfers on child height for age z score
0.23 0.16 0.13

0.32

Mexico, Nicaragua and Colombia have the largest cash transfers

Difference in difference results, except for Brazil (Bolsa Alimentacao)

0.02

0.01 0.01 -0.02

0.02 -0.02 -0.11

-0.04

Age in months
For Honduras, S=Supply side interventions, D=demand side and C=control J. L. Leroy, M. Ruel, E. Verhofstadt (2009) The impact of conditional cash Lawrence Haddad, Institute of transfer programmes. In Journal of Development Effectiveness 1 (2). Development Studies

-0.19

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Womens Empowerment

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Proportion of under 5 children who are underweight

Impact of womens status on child underweight rates

Womens decision making power

Source: Smith et. al. 2003, IFPRI Research Report 131
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So, where to target womens empowerment efforts for nutrition?

Nutrition Determinant Basic Underlying Immediate Eradicate discrimination Voting rights Equalise access to farm inputs Equal access to fortified foods Positive promote catch up in womens status Quotas in governance and decision making fora Target social protection to women Nutrition programmes targeted to young girls

No one size fits all answer -- depends on context, programmes and evidence
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Water, Sanitation and Hygiene

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Impact of water, sanitation and hygiene interventions

Figure 19b: Comparison of rigorous studies (Esrey et al., 1991 and current review)

Intervention

0.9

Relative risk

0.8 0.7 0.6 0.5 Multiple Hygiene Sanitation Intervention Water supply Water quality Esrey Current

Note: a risk ratio of 1 = no effect on diarrhea rates; lower scores represent stronger effects

Water, interventions were also found to A more supply Sanitation And Hygiene: Interventions And Diarrhoea;beSystematic effective than reported by Esrey et al. (1991 Lorna Fewtrell and John M. Colford, Jr. Lawrence Haddad, Institute of 23 gh ReviewBank.Meta-analysis.due to large reduction in July 2004. levels in one study and the contribution o this and cholera World was mainly Development Studies

But which sector to focus on? We need studies like this for African countries to guide efforts
BRAZIL Relative contribution (%) to the decline in child stunting between 1996 and 2007
Income 22,5%

Other Factors 36,7%

Maternal Schooling 24,6%

Health Care 10,4%

Source: Monteiro et al (2009). Causes for the decline in child undernutrition in Brazil, 1996-2007. Revi Sade Pb, 43 (1): 35-43.

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Financial Resource Flows

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Direct and Indirect spend on nutrition as % of ODA is tiny

Aid For Nutrition: Can investments to scale up nutrition actions be accurately tracked? ACF. Lawrence Haddad, Institute of 2012.
Development Studies

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Conclusions
Nutrition sensitive policies have much larger budgets than nutrition specific programmes If they can become nutrition sensitive their potential is enormous
agriculture, social protection, womens empowerment, water and sanitation

But it is not easy: technical, political, financial challenges Key task is to start auditing the nutrition sensitivity of different policies
Lawrence Haddad, Institute of Development Studies 27