A. Shifting from food security to nutrition security

The development of rural areas is very much linked to agricultural activities and food production, especially in areas where other income opportunities are lacking. Access to sufficient food has been a concern throughout the history – expressed as “food security”.

However, food security does not always lead to an improved nutritional situation. As a means to get a more explicit understanding and handle on those factors that are influencing and contributing to an improved nutrition, the concept of “nutrition security” has been emerging. Here, ‘utilization’ is a key feature, meaning that sufficient and adequate food is consumed and absorbed by the body – which, for instance, is not the case if sufficient food is available in the household, but is not given to all individuals or when people suffer from diarrhoea.

Nutrition sensitive agriculture is aiming at both food and nutrition security: “Food and nutrition security is achieved, if adequate food – in regard to quantity, quality, safety, socio-cultural acceptability – is constantly available and accessible for and satisfactorily utilized by all individuals of rural households.”

All in all, the concept of “nutrition security” implies a good understanding of the context-specific nutritional situation and how malnutrition can be overcome, also taking into account health-related factors (see figure below).

Source: adapted from UNICEF conceptual framework

B. Key strategic intervention areas

All projects that aim to improve nutrition security mainly through agriculture are nutrition sensitive agricultural projects. Concrete actions may not target directly the food production as such, but other underlying causes that somehow influence the level of malnutrition, or nutrition security, through different health and nutrition related aspects (see figure below).

Source: adapted from UNICEF conceptual framework

In projects in the scope of nutrition sensitive agriculture, the following intervention areas are most important:

• Introducing nutritious / nutrient dense foods (crops & animals) – Depending on consumption habits and the type of (unbalanced) diet, crops or animal foods are introduced that are especially ‘nutritious’ or rich in regard to the limiting nutrients. In most developing countries, ‘nutritious’ relates mainly to food sources high in iron, vitamin A, zinc and protein. In practice, foods rich in these nutrients are promoted, e.g. beans, fruits, vegetables, orange flesh sweet potato, plus animal productions (i.e. eggs, milk, meat).
  
  
• Promoting biodiversity and diet diversity – Another way to promote a better and more balanced nutrition is by fostering the diversity of production, and thus consumption. In this case, not a specific food is promoted, but a diversified production system and a diet which relies on more variety in terms of food items / ingredients, which altogether provide a wider range of nutrients. To explain which combination of foods give a balanced diet, food is normally categorized in food groups. Most common is the differentiation of food groups by content, based on three main categories: (a) energy rich food (“go food”), (b) protein rich food (“grow food”), and micronutrient rich food (“glow food”). Government institutions and NGOs commonly produce such education material featuring most relevant local food sources.
  
  
• Awareness creation and education for nutrition & health aspects (see also special section on ‘nutrition education and change’) – In many cases, agricultural projects have limited impact on nutrition because the food produced does not always lead to improved nutrition. Most nutritious food might be sold due to high market prices, and low quality food might be purchased. An important driver to change the diet and consumption habits is that people understand what nutritious food is and how it contributes to better health and body development. In this sense, increased awareness is an important element of education activities that generate knowledge and knowhow in regard to improved food preparation, ways to better preserve nutrients, and how to integrate such better practices in daily activities. As health and hygiene strongly impact the absorption rate of nutrients, also these aspects must be an integral part of such awareness creation and education efforts within nutrition sensitive agricultural projects.

C. Understanding the nutrition and health situation – methodologies & tools

In order to target well nutrition interventions, a good understanding of the nutritional situation and the diets involved is of primary importance. Many factors influence the nutritional situation, depending very much on the natural and socio-economic context, access to resources and services (especially health services), and cultural norms.

There are many different approaches and methodologies to assess the nutritional situation; yet most of these require extensive research and special expertise and may not be appropriate for nutrition sensitive agricultural projects. For these type of projects, a sound qualitative assessment is more useful to serve this purpose.

• As a first step, to sensitize oneself for understanding the context respectively the questions to be asked the Agriculture and Nutrition Context Assessment Tool Locator is valuable. This online tool also provides a good overview of the different methodologies that are available for a more detailed assessment of certain aspects. Reference document: Agriculture and Nutrition Context Assessment Tool Locator (USAID – Spring).
  
  

• In the field, multi-disciplinary stakeholder meetings are ideal to generate a good understanding about the nutritional situation in a certain location, and to complement and contrast the findings with other information that can be obtained locally, from NGOs or local government offices. Such stakeholder meetings also have the advantage to effectively involve the local population in an early step of the project, i.e. making local stakeholders become part of the project early on. Reference documents: FAO - Agreeing on causes of malnutrition for joint action – PDF & FAO - Agreeing on causes of malnutrition for joint action – E-Learning.
  
  

• As nutrition sensitive interventions aim to improve the quality of the diet, another method that may be helpful in an initial assessment is the Dietary Diversity Scoring (DDS). This qualitative tool assesses households’ or individuals’ variety of food consumed, as a proxy for nutrient adequacy of the diet. For that purpose, a questionnaire is used, where scoring and analysis of the information obtained is straightforward, based on a simple counting of food groups consumed over the preceding 24 hours. Important: DDS does not assess the food intake of individuals – but it gives a picture of the quality of the diet of the group which is assessed. Depending on the production context, the tool might be applied more than once to better cover seasonal differences. It also can serve as a monitoring tool, when being applied more than once for the same households during the project period. Reference document: FAO – Guidelines for measuring household and individual dietary diversity.
  
  

• In order to assess the target group’s nutrition-related knowledge, attitudes and practices, useful FAO guidelines exist for that purpose. A better understanding of the situation in this regard will help specifying the educational activities that are part of nutrition sensitive interventions. Reference document: FAO guidelines for assessing nutrition-related knowledge, attitudes and practices.
  
  

• Infants and young children are most at risk of malnutrition, as malnutrition impacts the development of affected persons in this age group during the rest of their lives. Assessing infant and young child feeding practices is key to better understand the nutritional situation to optimize project interventions. Reference documents: Indicators for assessing infant and young child feeding practices – Part I: Definitions & Indicators for assessing infant and young child feeding practices – Part II Measurement.
  
  
• The ultimate aim of nutrition sensitive interventions is to contribute to people’s optimal development based on good nutrition and health. Additional to assessing the diet, health professional tend to work with indicators that reveal information about the nutrition and health status of persons, especially children. Most common is the assessment of stunting, wasting, and underweight and overweight, based on calculated ratios that relate to a person’s age, height, and weight (see section ‘Nutrition ABC’). Furthermore, physical measurements (including blood samples) can be done to determine levels of micro-nutrient deficiencies. Yet, trained professionals are needed to make such kind of assessments, i.e. this cannot be done by lay persons. Reference document: Nutrition Assessment and Classification (NACS) – User’s Guide.
  
  
• Extensionists play a key role in not helping farmers to increase their yields but orient production such to positively impact nutrition. What can agricultural extension professionals do to support better nutrition? The Global Forum for Rural Advisory Services GFRAS has developed a special manual and support tools for extensionist to explicitly consider nutrition sensitive action in their work. Reference website: New NELK Plus Module on Nutrition-Sensitive Extension.

D. Considerations for project design and best practices

Projects that target to improve the nutritional situation through agricultural programmes require a careful intervention design. For such projects, FAO (2013) makes the following 10 recommendations:

1. Incorporate explicit nutrition objectives and indicators into the design, and track and mitigate potential harms.
   
   
2. Assess the context at the local level, to design appropriate activities to address the types and causes of malnutrition.
   
   
3. Target the vulnerable and improve equity through participation, access to resources and decent employment.
   
   
4. Collaborate with other sectors and programmes.
   
   
5. Maintain or improve the natural resource base. Manage water resources, reduce vector-borne illness and ensure sustainable, safe household water sources.
   
   
6. Empower women. Recognize the role of women in food security and nutrition improvement (as producers, actors in the value chain and as consumers/caretakers of their families).
   
   
7. Facilitate production diversification, and increase production of nutrient-dense crops and small-scale livestock.
   
   
8. Improve processing, storage and preservation to retain nutritional value and food safety, to reduce seasonality of food insecurity and post-harvest losses, and to make healthy foods convenient to prepare.
   
   
9. Expand market access for vulnerable groups, particularly for marketing nutritious foods.
   
   
10. Incorporate nutrition promotion and education that builds on existing local knowledge, attitudes and practices.
    
    

From an operation point of view, projects should be designed such that they involve all relevant local stakeholders as part of a facilitated participatory process that addresses both research and development activities. One critical success factor in such projects relates to the expertise / capacities of the person designing and facilitating such project, implying that the person is capable to structure and lead the process such that different type of actors (farmers, health specialists, agronomists, local authorities, teachers etc.) feel comfortable, participate actively, and develop trust among each other. The latter is key to foster the uptake of innovations that ultimately improve the nutritional situation of the stakeholders involved.