A publication of The International Policy Centre for Inclusive Growth
Volume 18, Issue No. 1 • December 2020
Leveraging food systems for poverty and malnutrition reduction Policy in Focus is a regular publication of the International Policy Centre for Inclusive Growth (IPC-IG).
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7 Exploring synergies between poverty and malnutrition reduction efforts within the food systems transformation agenda
10 Nutrition-sensitive value chain development and its role in improving nutrition and transforming food systems
14 Understanding the potential of territorial markets to reduce poverty and promote healthy diets
19 The role of small- and medium-sized enterprises in addressing the malnutrition challenge: reflections from project implementation in Ghana, Kenya and Viet Nam
22 Taxes as a policy measure to promote healthy diets
26 Building a food safety culture in Bangladesh
30 Ending malnutrition in all its forms: social protection and the growing prevalence of overweight, obesity and diet-related non-communicable diseases
35 Social protection responses to COVID-19 in the Middle East and North Africa: the case of Egypt
39 Enhancing maternal nutrition through cash transfers: what does the evidence say?
43 Empowering women for poverty alleviation and improved nutrition outcomes: from anecdotes to evidence
46 The potential of policy and programmatic synergies for impacting poverty and nutrition outcomes through schools
49 The Inter-Agency Social Protection Assessment Tool for food security and nutrition: what it is, and how it was applied in Cambodia, the State of Palestine, and Paraguay
52 The potential role of geographical indications in promoting healthy diets and reducing rural poverty Editorial
Even though substantial progress has been achieved systems approach can offer opportunities to reduce both worldwide in reducing both poverty and malnutrition, poverty and malnutrition. The food systems approach much is yet to be done. There are signs that the progress places equal emphasis on both the supply and demand made in both dimensions has stalled in recent years. dimensions that are critical for ensuring healthier diets and better nutrition for poor and vulnerable groups. Suboptimal diets have become a major driver for overweight and obesity and associated non- This special issue of Policy in Focus is dedicated to communicable diseases such as diabetes, heart answering a crucial question: How can a food systems diseases and some types of cancers. Conflict and climate approach be used to design and implement policies vulnerability have been identified as major obstacles and investments that reach those most vulnerable to to reaching Sustainable Development Goal targets poverty, hunger, malnutrition and suboptimal diets? related to malnutrition, in all its forms, by 2030. In 2019, We hope that the contributions contained in this volume, economic downturns and slowdowns hindered efforts by leading academics and development practitioners, even further. More recently, the COVID-19 crisis has exploring the linkages between nutrition, food systems imposed even harsher conditions to countries. and poverty, can help food systems stakeholders and policymakers make inroads towards the promotion of food Poverty and malnutrition are inextricably linked, and security and nutrition and the reduction of rural poverty. therefore addressing one can help address the other. Given that most of the world’s extremely poor people and stunted children live primarily in rural areas and rely mostly on agriculture, an agriculture and food Ahmed Raza and Fábio Veras Soares
6 Exploring synergies between poverty and malnutrition reduction efforts within the food systems transformation agenda
Ahmed Raza1 and Fábio Veras Soares2 Similarly, the World Bank (2020) points people and stunted children live primarily out that progress towards poverty in rural areas and rely predominantly on Poverty and malnutrition remain critical reduction was slowing down even before agriculture (World Bank 2020; FAO et al. challenges for countries in their pursuit the COVID-19 crisis after an unprecedent 2019), an agriculture and food systems to achieve the Sustainable Development trend towards poverty reduction. approach offers an opportunity to reduce Goals (SDGs). Although considerable The extreme poverty rate fell on average both poverty and malnutrition. progress has been made in reducing by 1 percentage point per year between both poverty and malnutrition, much 1990 and 2015, but that reduction slowed The food systems approach places equal remains to be done, as lower levels of down to 0.5 percentage points between emphasis on both the supply and demand poverty and malnutrition are actually 2015 and 2017. At this pace, the SDG dimensions that are critical for ensuring much harder to bring down and require target 1.1 of bringing down extreme healthier diets and better nutrition for a broader and more coordinated set poverty to less than 3 per cent will not poor and vulnerable groups. On the supply of policies and programmes to tackle be reached by 2030. Overall, 689 million side, this entails working along the food them. In addition, there are signs that people lived in extreme poverty (9.2 per supply chain—the production, processing, the progress made in both dimensions cent of the global population) in 2017— storage and transportation of food—and has stalled in recent years. 52 million fewer than in 2015. However, making efforts to diversify food production, this process has been uneven, and the enhance the availability and affordability of The 2020 ‘State of Food Security and rural population has become even more nutritious foods and improve post-harvest Nutrition’ (SOFI) has shown that an over-represented among those living in management. On the demand side, this additional 60 million people have extreme poverty in this period so that, entails shaping consumer behaviour by been affected by hunger since 2014. in 2017, 80 per cent of the people living promoting nutrition education, raising Extrapolating this trend, it means that in extreme poverty resided in rural areas. consumer awareness and influencing food by 2030, 840 million people will be and nutrition labelling regulations, policies undernourished. There are still about Finally, estimates of the impacts of and programmes. 144 million children under the age of 5 COVID-19 on poverty using 2017 data as a who suffer from stunting, and over 38 baseline suggest that between 88 million The critical question, then, is how can million children under the age of 5 and and 115 million people have probably a food systems approach be leveraged 337 million children and adolescents fallen into extreme poverty due to the to design and implement coordinated between the ages of 5 and 16 are COVID-19 crisis, raising global poverty rates and coherent policies, programmes overweight (UNICEF, WHO, and World to 9.4 per cent and basically cancelling and investments that reach those most Bank 2020; NCD-RisC 2017). In addition, out the progress made between 2015 vulnerable to poverty, hunger, malnutrition suboptimal diets have become a major and 2017 (World Bank 2020). In addition and suboptimal diets. The answer to driver for overweight and obesity and to the immense task of fighting poverty this question will depend greatly on our associated non-communicable diseases and malnutrition in a context of conflict, ability to navigate the food system, as such as diabetes, heart diseases and climate change and economic slowdown, they are expansive and evolving rapidly. some types of cancers. The 2020 SOFI now the COVID-19 crisis has added a layer They comprise a range of activities, actors, also shows that 3 billion people around of complexity that will require strong institutions and enabling environment that the globe are unable to afford the responses at policy and programme are critical to the production, processing, cheapest forms of healthy diets and levels from national governments and marketing, consumption and disposal of thus rely on suboptimal diets. Conflict the international community. food (FAO 2013). and climate vulnerability have been identified since 2014 as major obstacles From a policy and programme This Special Issue aims to answer this to reaching SDG targets related perspective, poverty and malnutrition question by supporting policymakers to malnutrition by 2030 (SDG 2). are inextricably linked, meaning that and development practitioners to identify More recently, in 2019, economic addressing one can help address the other. conceptual, policy and programmatic slowdowns and downturns have further Reducing malnutrition is vital to tackle linkages between nutrition, food undermined the efforts to achieve these the key determinants of poverty, and systems and poverty. It will enable these targets. In 2020, the COVID-19 crisis has reducing poverty is a necessary condition stakeholders to build a common narrative emerged to make the situation even for improving nutrition. In addition, given on the role of food systems in promoting worse (FAO et al. 2020). that most of the world’s extremely poor nutrition and reducing rural poverty.
The International Policy Centre for Inclusive Growth | Policy in Focus 7 Despite their popularity, “ social protection schemes overwhelmingly focus on one form of malnutrition— i.e. undernutrition.
Photo: UNICEF Ethiopia/Ephrem Tamiru. Health extension worker assessing a child's nutritional status at Elala Health center, Fentale, Ethiopia 2020
Food supply chains play a critical role in sized enterprises (SMEs), as argued by to set up a food safety system in transforming agriculture and food systems Santacoloma and Anta in their article. resource-poor and populous contexts. towards better nutrition outcomes for They propose that the potential of SMEs nutritionally vulnerable groups (Raza to increase the incomes of actors engaged Consumers, citizens and households play et al. 2020). In their article, Garrett and in the food and agriculture sector and to a catalytic role in demanding healthy De La Pena present the effectiveness of reach vulnerable populations with healthy diets from food systems. In resource- adopting a nutrition-sensitive value chains foods has been largely untapped. poor and vulnerable settings, however, approach to navigate the complexity consumers face considerable challenges of food systems by selecting individual For most consumers, in both urban and in accessing and consuming better agricultural commodities with the rural areas, markets and retail outlets are diets. Social protection schemes that potential to both improve nutrition and the key sources of food. These markets integrate complementary activities in the raise incomes for farmers. To make their and retail outlets form part of the physical, agriculture, health, labour and sanitation case, they provide examples from large- economic, political and socio-cultural sectors are innovative poverty reduction scale investment projects implemented context—or food environment—in which measures that can address malnutrition by the International Fund for Agriculture consumers interact with food systems challenges. These schemes, which often Development (IFAD). (HLPE 2017). However, food environments include cash or in-kind transfers, have the in low- and middle-income countries tend potential to contribute to overcoming Small-scale producers are an essential part not to support nutritious foods and need the challenge outlined by the SOFI 2020 of different kinds of food systems: local, to be shaped so that they promote the report of making quality and diverse regional and global. According to some desirability and affordability of healthy diets affordable. estimates, small- and medium-scale farms diets. Shu Wen and colleagues explain how, contribute to over half of the world’s food to meet this objective, fiscal policies such Despite their popularity, social protection production (Herrero et al. 2017); however, as taxes on food items have the potential schemes overwhelmingly focus on one they often lack resources to compete in of promoting healthier consumption form of malnutrition—i.e. undernutrition. markets. In their article, Vicovaro, Puhac patterns and reducing social inequities Grinspun, Gyori and Rivera discuss the and Tartanac argue the need to consider related to health and nutrition. trends and determinants of the double the development of territorial markets burden of malnutrition and provide an and strong producer organisations to Food environments in low- and middle- overview of literature on the impact of enable small-scale producers—who often income countries are also characterised cash transfers and other social protection tend to be women—to produce and by poor food safety and quality standards, programmes on overnutrition—i.e. market diverse foods which can meet which are critical elements for achieving overweight and obesity. Whereas El- the dual goals. optimal nutrition. Effective food safety Enbaby and Breisinger take a regional systems are also central to maintaining view by analysing how social protection In addition to small-scale farmers, and adding value along the food value programmes have been employed to tackle the private sector is fundamental to chain and reducing the incidence of the effects of the COVID-19 pandemic in the ensuring the availability of and access to food-borne diseases. Sridhar Dharmapuri Middle East and North Africa. a diverse diet in low- and middle-income provides an overview of the political countries. The private sector in these commitment, institutional capacities Given that women’s empowerment and contexts comprises small and medium- and science-based processes needed gender equality are critical to improving
8 nutrition outcomes, integrated social synergies across sectors for long-term FAO, IFAD, UNICEF, WFP, and WHO. 2020. protection schemes that incorporate impact on poverty and malnutrition. The State of Food Security and Nutrition in the World 2020. Rome: Food and Agriculture gender considerations can ensure optimal Organization of the United Nations. maternal health and nutrition, thereby The monitoring and assessment of social promoting the well-being of the whole programmes for their impact on poverty Herrero, M. et al. 2017. “Farming and the geography of nutrient production for human household. In their article on gender- and malnutrition is an important aspect use: a transdisciplinary analysis.” Lancet Planetary responsive social protection, Gavrilovic, of meeting SDGs 1 and 2. In this regard, Health 1(1): e33–e42. Kajula and Tirivayi summarise existing assessment tools which not only assess the NCD-RisC. 2017. “Worldwide trends in body- evidence on gender-responsive cash effectiveness of policies and programmes mass index, underweight, overweight, and transfers to identity actions that work but also foster coherence and coordination obesity from 1975 to 2016: A pooled analysis of and areas which require further research. can be valuable. One such tool is the 2,416 population-based measurement studies in 128.9 million children, adolescents, and adults. Inter-Agency Social Protection Assessment NCD Risk Factor Collaboration (NCD-RisC).” Also highlighting the importance (ISPA) Tool for food security and nutrition, Lancet 390(10113): 2627–2642. of empowering women for poverty developed by the Food and Agriculture Olinto, P., K. Beegle, C. Sobrado, and H. Uematsu. alleviation and better diets, Maria Antonia Organization of the United Nations (FAO) 2013. “The State of the Poor: Where Are the Poor, Tuazon shares an example of good practice in collaboration with other development Where Is Extreme Poverty Harder to end and from Lao PDR. In her article, she attributes partners. Russell, Lorenzon, Perri, Khalidi What is the Current Profile of the World’s Poor.” Economic Premise Series, No. 125. Washington, the success of the project to strong and Louteiro explain their experience DC: World Bank. community involvement, multisectoral of implementing the ISPA Tool in three and stakeholder participation, targeting of different contexts: Paraguay, Cambodia. Raza, et al.2020. "Conceptual framework of food systems for children and adolescents." nutritionally vulnerable groups, situational and the West Bank and Gaza Strip. Global Food Security, Vol. 27, 100436. analysis and capacity development.
Consumers, citizens “and households play a catalytic role in demanding healthy diets from food systems.
Photo: Icaro Cooke Vieira/CIFOR. Changing diets in Kapuas Hulu, Indonesia, 2017
The International Policy Centre for Inclusive Growth | Policy in Focus 9 Nutrition-sensitive value chain development and its role in improving nutrition and transforming food systems
James Garrett 1 and Isabel de la Peña 2 only a reduction in consumption of fats, to ensuring that they support access to sugars and salt but also an increase in intake high-quality diets, produced and delivered Agriculture is the bedrock of food of more nutritious foods, such as whole in ways that are economically, socially systems. How people engage with food grains and fruits—could prevent one in five and environmentally sustainable (Global systems plays a critical role in shaping deaths globally (GBD 2017 Diet Collaborators Panel on Agriculture and Food Systems for their diets and provides the key link 2019). This is true even in rural areas. Small- Nutrition 2016; HLPE 2017). between agriculture, good health, scale producers, for instance, increasingly nutrition and the environment. rely on markets to feed their families, often Food systems are quite complex by abandoning local, traditional foods for diets nature, comprising production, storage, Food systems as they are today fail to deliver high in processed and packaged foods. processing, transportation, distribution the affordable, diverse, safe, healthy foods and marketing activities across multiple needed to address the world’s nutrition To improve nutrition, food systems must be commodities. Adding to complexity is the problems. Better diets—which entail not transformed from just supplying calories fact that one commodity can be the basis
FIGURE 1: The nutrition-sensitive value chain framework—strategies and examples of entry points
Nutrion problem
Constraints in food supply and demand
Increase supply Increase demand Upgrading of coordinaon and business models Product and process upgrading Funonal upgrading Enabling environment
Food Storage and Distribuon Trading and Preparaon Inputs and Promoon and producon processing transport markeng consumpon
Service provision
● Access to inputs: ● Access to technology ● Storage ● Rural road ● Contracng ● Promoonal seeds, ferlisers, ● Extension infrastructure connecvity agreements campaigns vaccines, etc. ● Capacity-building of ● Processing ● Distribution ● Multi-stakeholder producers organisations technologies channels VC platforms VC entry points
● Bioforficaon ● Diversificaon producon ● Safe storage ● Refrigerated ● Local market ● Social ● Cooking ● Micronutrient ● Integrated farming ● Nutrient- transport targeng markeng classes
s fertilisers (agriculture, livestock preserving ● Diversified ● Public ● Behaviour ● Recipe ● Nutrient-rich and fish) processing distribution purchasing change development varieties or ● Safe production ● Labour-saving channels programmes communication ● Hygienic food traditional practices processing ● Packaging in ● Consumer preparation varieties & ● Nutrition-sensitive ● Fortification small quantities food and ● Measures to NSVC entry point species extension ● Nutrition nutrition discourage labelling education food waste
ADD NUTRITION VALUE
Source: De la Peña, Garrett, and Gelli (2018). 02 10 Producers are most “interested in having a sustainable and profitable livelihood.
Photo: ACDI VOCA/David Osorio. Cocoa growers secure livelihoods through cocoa value chains, Colombia, 2013. for many different products, each with its production to consumption, to have a do no harm to, iv) women’s equality and own value chain (VC). positive impact on nutrition. empowerment; and v) the environment.
These commodities and their respective A nutrition-sensitive approach turns the Once commodities satisfying these VCs make up a food system. Governments usual process of VC development on its criteria have been identified, a and development partners frequently head by beginning with an analysis of the ‘nutrition lens’ can be applied to use a VC approach to design investments nutrition problem in the target population, analyse constraints and opportunities for increasing incomes of agricultural rather than starting with producers and in developing their respective VCs. producers, often poor smallholder farmers. considering market demand and income Depending on the constraints and These projects have traditionally focused generation potential. The characterisation opportunities identified, NSVC only on increasing economic returns for of the nutrition problem looks at the range development strategies can work to producers. Sometimes this approach of food systems the target population enhance the supply, demand or nutrition encourages specialisation in a single crop, interacts with and identifies excessive or value of the chosen food commodities. which can reduce agricultural biodiversity insufficient consumption of key foods Supply constraints may be related to and thus increase a producer’s vulnerability and reasons why, such as availability or availability, safety, food loss or waste. to climate change, price shocks, soil affordability. Specific food commodities Demand may be affected by cultural depletion and crop disease. can then be identified as having the beliefs, food preferences or limitations potential to address the nutrition problem in purchasing power. While supply and However, when implemented properly, and improve diet quality. Applying this demand strategies focus on improving VC development can shape food systems approach to multiple VCs can contribute the specific offer or consumption of the to be more nutrition-sensitive—that is, to transforming the entire food system. selected commodity, adding nutrition shape a food system to be economically, value means enhancing the nutrient environmentally and socially sustainable Of course, producers are most interested value of the commodity through, for and ensure that nutritious, diverse and in having a sustainable and profitable example, the choice of highly nutritious safe foods are accessible to consumers and livelihood. Food commodities selected varieties (such as biofortified crops), producers, thereby improving nutritional for VC development must, therefore, not nutrient-preserving processing or outcomes and diets. only improve nutrition but also make nutrition labelling, and can occur at business sense. To promote sustainable different points along the VC. By focusing on a particular food and inclusive food systems, gender and commodity, a VC approach can help economic, social and environmental Ultimately, a nutrition-sensitive unpack the otherwise overwhelming sustainability must also be considered. VC analysis aims to identify entry complexity of food systems. The nutrition- Commodities prioritised for NSVC points for investments at each stage sensitive value chain (NSVC) framework development should, therefore, have of the VC and improve nutrition by developed at the International Fund for the potential to: i) address the nutrition enhancing the availability, affordability, Agricultural Development (IFAD) (de la problem; ii) respond to market demand; diversity, nutritional quality, safety Peña, Garrett, and Gelli 2018) builds on iii) generate income, including helping and acceptability of nutritious foods. work by Gelli et al. (2015) and identifies to reduce production risk, especially Figure 1 pairs the strategies to the potential entry points, pathways and for small-scale producers and rural VC and identifies entry points and actions for developing a VC, from populations; and promote, and certainly potential interventions.
The International Policy Centre for Inclusive Growth | Policy in Focus 11 FIGURE 2: Steps of developing a NSVC, with comparison to the typical VC approach
STEPS 1 TO 4: DIAGNOSTICS VC NSVC STEP 1: Situaon analysis
Market analysis Nutrion situaon analysis
STEP 2: Commodity selecon
Addional selecon criteria Selecon criteria ● Nutrion-improvement potenal ● Market potenal Addional consideraons ● Income-generaon potenal ● Gender, climate and environment
STEP 3: Value chain analysis
● VC mapping of actors ● Nutrional value, food safety and food loss ● Opportunies for VC upgrading ● Demand: (i) from market and (ii) from target group
STEP 4: Intervenon opons
Addressing constraints in supply Addressing constraints in supply, demand and nurion value
Source: De la Peña and Garrett (2018).
Figure 2 summarises the steps described investment must meet the different governments and other stakeholders. above to develop a NSVC: (1) carry out a dimensions illustrated in the A multi-stakeholder consultation to nutrition situation analysis to understand NSVC framework, therefore strengthening discuss the benefits and trade-offs of the nutrition problem, (2) select a group food and nutrition security while certain commodity choices can ensure of commodities that respond to the also ensuring economic, social and buy-in among different VC actors and nutrition problem, but are also profitable environmental sustainability. local authorities. for producers, and promote, and certainly do no harm to, women’s status and the The Alliance of Bioversity International The selected VCs will then be analysed environment, (3) undertake a VC analysis and the International Center for Tropical through a multidimensional lens to with a nutrition lens, and (4) identify Agriculture will support PROINORTE in identify investments that can enhance intervention options (De la Peña and Garrett carrying out food systems analyses to demand and supply for nutritious foods or 2018).3 This process is detailed in IFAD’s identify which VCs to develop. This will add nutrition value. On the demand side, Nutrition-sensitive value chains: A guide for be done through a participatory regional the project will develop awareness-raising project design (De la Peña and Garrett 2018). consultation process in which VCs will campaigns for healthy and balanced diets be selected by the local population for at least 15,000 beneficiaries, as well as Case study: IFAD’s experience in and authorities. VC selection often promotional campaigns showcasing the promoting NSVCs as a way to transform needs to respond to the priorities of nutritional benefits of specific products. agri-food systems in Honduras A new IFAD-funded project in Honduras (Project for the Economic and Social Inclusion of Small Rural Producers in Northeast Honduras—PROINORTE) is BOX 1 adopting the NSVC approach. PROINORTE is a USD46.9 million project implemented Joyce Njoro, IFAD Lead Technical Specialist for Nutrition: by the Ministry of Agriculture and "At IFAD, value chains are increasingly being developed with clear attention to improved Livestock, which aims to increase incomes nutritional outcomes in a variety of ways: investing in a range of nutritious foods that and improve the nutrition of small rural contribute to dietary quality; leveraging the potential of markets and the private sector for nutrition; valuing the potential of neglected and underutilized species and wild edibles; producers, ultimately strengthening their empowering women and youth; strengthening climate resilience and environmental resilience. To do so, it adopts a territorial sustainability; and from the demand side, investing in nutrition education to promote sustainable food system approach to consumption of diversified and healthy diets." promoting VCs. The VCs selected for
12 BOX 2 “ Safe and Arnoud Hameleers, IFAD Country Director for Honduras: environmentally “A food system is only sustainable when you consider all aspects—economics as well as sustainable practices health and environmental and social sustainability. In Honduras, we have an extremely difficult situation with alarming levels of rural poverty, extreme exposure to climate change, will be promoted to violence, and high levels of obesity even in the rural areas. By starting with concerns about nutrition, through regional concertation we were able to find the balance between ensure production of generating income for smallholders and promoting sustainable food systems for nutrition. Through this approach we clearly identified costs and risks you would not otherwise identify diverse and safe foods. when focusing on economic benefits alone.”
On the supply side, safe and De la Peña, I., and J. Garrett. 2018. Nutrition- environmentally sustainable practices sensitive Value Chains: A guide for project design. Volumes I and II. Rome: International Fund for will be promoted to ensure production Agricultural Development. of diverse and safe foods. Storage and distribution activities will seek to reduce De la Peña, I., J. Garrett, and A. Gelli. 2018. “Nutrition-sensitive value chains from a food contamination, loss and waste. smallholder perspective: A framework for At least five processing centres will be project design.” IFAD Research Paper Series. Rome: devoted to producing healthy foods. At the International Fund for Agricultural Development. marketing stage, the project will develop GBD 2017 Diet Collaborators. 2019. “Health sustainable commercial alliances between effects of dietary risks in 195 countries, producers and buyers, with a particular 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.” The Lancet 393 focus on short VCs. Additionally, the school (10184): 1958–1972. meals programme—supported by the Gelli, A., C. Hawkes, J. Donovan, J. Harris, S.L. World Food Programme—will be one of Allen, A. De Brauw, S. Henson, N. Johnson, J. the key market outlets for the nutritious Garrett, and D. Ryckembusch. 2015. “Value produce of smallholder producers. Chains and Nutrition: A Framework to Support the Identification, Design, and Evaluation of Interventions.” IFPRI Discussion Paper, No. 01413. In conclusion, analysing VCs from a Washington, DC: International Food Policy nutrition perspective is a useful approach Research Institute. to help understand the complex food Global Panel on Agriculture and Food Systems systems in which we all operate. To shape for Nutrition. 2016. Food systems and diets: sustainable food systems to improve facing the challenges of the 21st century. London: Global Panel on Agriculture and Food Systems nutrition, the NSVC framework starts from for Nutrition. nutrition needs and identifies a selection of commodities to address dietary gaps. HLPE. 2017. Nutrition and food systems. A report by the High Level Panel of Experts on To most effectively contribute to improving Food Security and Nutrition of the Committee diet quality and poverty reduction in a on World Food Security. Rome: Committee on sustainable way, a programme would World Food Security. need to comprehensively tackle the food IFAD. 2018. Proyecto de inclusión económica system, intervening in a wide range of y social de pequeños productores rurales en la VCs. However, by using a framework región noreste de Honduras, PROINORTE. Informe principal y apéndices. Rome: International Fund that considers one VC at a time, the for Agricultural Development. identification of investment opportunities for a project is simplified. For each food commodity selected, the analysis can identify the specific VC actors in that chain 1. Senior Research Fellow at the Alliance of whose roles and motivations the project Bioversity and the International Center for needs to address, ensure sustainable Tropical Agriculture (CIAT). inclusion of small-scale producers and 2. Programme Officer in the Latin America and the Caribbean (LAC) Division of the International women, address issues of environmental Fund for Agricultural Development (IFAD). sustainability and identify appropriate 3. Further guidance on these steps is available policies and investments that will through the Food and Agriculture Organization transform the overall food system and of the United Nations e-learning course ‘Sustainable Food Value Chains for Nutrition’: enhance its capacity to deliver better
The International Policy Centre for Inclusive Growth | Policy in Focus 13 Understanding the potential of territorial markets to reduce poverty and promote healthy diets
Marcello Vicovaro, Ana Puhač territorial markets in ensuring inclusive and 736 million of whom live in extreme and Florence Tartanac 1 healthy food systems and thus advocate poverty (World Bank 2018). A large for more policy support to these markets. majority of poor people are smallholders Smallholder farmers are responsible The strong collaboration with producers’ and family farmers, who depend on for most of the food consumed in the organisations strengthens their capacities agriculture for their food and income world and most of the investments made to increase their bargaining power in (FAO 2017b). Despite limited assets and in agriculture (CFS 2016; FAO 2017a). market negotiations. capitalisation, in Asia and sub-Saharan Moreover, the vast majority of food Africa smallholders produce an estimated transactions occur in domestic markets— This article shows why and how territorial 80 per cent of the food that is consumed local and national (Murphy 2010). Thus, markets provide more benefits to small-scale (IFAD 2011), and the vast majority of food local and national markets are crucial farmers, particularly to poor farmers, and transactions occur in domestic markets not only to ensure smallholder farmers’ make healthy food accessible to different (Murphy 2010). Almost every smallholder access to markets and sustaining their consumers. Existing evidence (Aiyeko et farmer already produces and sells food on livelihoods but also for the food security al. 2005; Roesel and Grace 2015; Crush et markets. Hence, the issue is not market and nutrition of the territories in al. 2018) suggests that territorial markets access in general, but rather access to which they are embedded (FAO 2015). play an important role in ensuring inclusive inclusive and remunerative markets where The World Committee on Food Security and sustainable food systems for healthy smallholders can negotiate terms of access (CFS) has defined these markets as diets, and if policymakers want to transition and sell at a fair price, and where the ‘territorial markets’ and characterised them to these systems, they should pay more value of output is not only determined by based on a number of criteria (see Box 1). attention to territorial markets. volumes but also by other socio-cultural values and attributes that can foster more Despite increased awareness, limited Leveraging territorial markets to reduce inclusivity (CFS 2016). data are available on territorial markets,2 poverty and improve livelihoods which often results in public policies that Despite progress made in the last decades, Markets cannot be considered just as pay greater attention to global value over 2 billion people still live in poverty, formal agribusiness and value chains, chains while seldom supporting and incentivising territorial markets. For this reason, the CFS (2016) recommended to FAO and to the Rome-based agencies that BOX 1: Criteria to define territorial markets greater focus be placed on these markets by filling existing information gaps. To respond to the recommendation, y They are directly linked to local and/or national food systems (most products, producers, in 2017 the Food and Agriculture retailers and consumers are from the territory concerned). Organization of the United Nations (FAO), y They are more often characterised by horizontal relations (i.e. non-hierarchical) among together with the Civil Society Mechanism the various stakeholders in comparison to other markets. of the CFS, launched a participatory y They are inclusive and diverse in terms of their composition of stakeholders and products. process for the development of a methodology to gather information and y They have multiple economic, social, cultural and ecological functions in their respective data on territorial markets and to better territories, and are not only limited to food supply. understand their role within local and y They are most remunerative for smallholder farmers by providing them with greater national food systems (FAO forthcoming). bargaining power over prices. This methodology has been pilot tested y They contribute to structuring the territorial economy, creating wealth and redistributing by FAO and producers' organisations in it within the territory. three countries (Senegal, Burkina Faso y They can be formal, informal or a hybrid between the two. and Peru),3 with the aim of mapping and y collecting data on territorial markets. They can be located at different levels within territories (local, national or even cross-border). These data collection processes are intended to unveil the importance of Source: CFS (2016).
14 cooperative or a producers’ organisation, enables smallholder farmers greater opportunities for bargaining and advocacy, which can lead to enhanced prospects for fair market access (FAO 2018).
Role of territorial markets in shaping healthy diets Lately, there has been a surge in diet-related health problems, such as obesity, diabetes and heart disease. These problems are linked to increased consumption of ultra-processed, energy- dense foods with low nutritional value, and insufficient consumption of nutrient-rich foods, such as fresh vegetables and fruits.
Photo: UN Women/Ryan Brown. Woman selling bananas, Seychelles, 2017
TABLE 1: The most frequented food retail outlets and their influence on healthy diets in developing countries 4
Consumers Pros in terms of healthy diets Cons in terms of healthy diets Supermarkets Preferred by high-income and Exposure to several healthy food products, Exposure to high-calorie and well-educated households including non-traditional products that ultra-processed food items increase diet diversity Territorial markets Preferred by non-college-educated Mostly offer locally supplied foods, Food safety concerns due (e.g. open-air wet markets) households and large households including in-season vegetables and fruits, to poor infrastructure live poultry and fish Hawkers Preferred by low-income and Make foods widely available where the Low food quality, mostly less-educated large households, infrastructure is poor (including lack of ready-to-eat foods especially those with small children storage facilities at home) and where consumers have variable income flows
The International Policy Centre for Inclusive Growth | Policy in Focus 15 FIGURE 1: Characteristics of producers operating in four organic farmers’ markets in Bolivia
Retailers Formal educaon
8% 16% 8% Primary Women Upper secondary 14% Men Lower secondary 70% University 84%
Land Labour 2% 2% 2%
9% 23% Less than 1.99 Family Between 2 and 4.99 Both Between 5 and 19.99 Hired Between 20 and 100 87% 75%
Source: FAO and INRA (2016).
residents (ibid.). Thus, in many developing to productive resources, 87 per cent of the country is experiencing an increase countries territorial markets, both formal the producers have farmland of up to in adult overweight and obesity, while and informal, and hawkers continue to 2 hectares, and 75 per cent mainly both availability and consumption of fruits be the main choice of urban consumers use family labour. and vegetables are below recommended for purchasing and procuring food. quantities (Development Initiatives 2018). Additionally, a large proportion of these A total of 72 different products are sold at consumers have low disposable incomes, these farmers’ markets, especially potatoes, Concerning consumers, women make and their shopping patterns are tied to vegetables and cereals. In terms of food up 85 per cent of all buyers. An analysis low-value-added goods, with minimal groups (Figure 2), the most typical product into the monthly income of consumers’ processing and packaging (ibid.). Territorial groups sold at these farmers’ markets households6 revealed that 1 per cent of markets remain essential food retail outlets are vegetables, tubers and cereals. This households belong to the income bracket where households can access most locally figure is very relevant for Bolivia because with less than BOB1,000 (USD145) per produced foods, including in-season and nutritious foods, such as fresh vegetables and fruits (as shown in Table 1). FIGURE 2: Food groups sold in four organic farmers’ markets in Bolivia Evidence from Bolivia In a study conducted by FAO and the National Institute of Agricultural Research Other products 0.6% (INRA) in 2016, four organic farmers’ Flowers 0.6% 5 markets (a type of territorial market) were Honey and honey products 1.1% analysed to understand their functioning Processed produtcts 1.5% mechanisms as well as products and Dairy products 3.5% consumer characteristics. Smulants 0.2% Cereals 13.9% Results of the study show that Spices 0.9% short supply chains linked to the Fruits 3.0% four markets were dominated by Forage 3.2% family farmers, particularly women. Roots and tubers 17.6% Figure 1 shows that 84 per cent of market Vegetables 54.0% operators were women, with the majority of them having received only primary education. Concerning access Source: FAO and INRA (2016).
16 month, 25 per cent to the income bracket 2019b), interventions for reducing poverty, BOB1,000–3,000 (USD145–435), 48 per cent improving nutrition and promoting to the income bracket BOB3,000–5,000 healthy diets need inclusive and systemic (USD435–725), 19 per cent to the income approaches based on reliable data that bracket BOB5,000–10,000 (USD725–1,450), incorporate territorial markets, as they are and 5 per cent to the income bracket physical and social spaces at the core of with more than BOB10,000 (USD1,450) territorial food systems where production (see Figure 3). and consumption meet. Territorial markets can play an important role in ensuring Approximately 27 per cent of consumers inclusive and sustainable food systems, and households in the FAO study are living and if policymakers want to transition below or very close to the poverty line7,8— to these systems, they should pay more i.e. households with a monthly income of attention to these markets. less than BOB3,000. Abrahams, C. 2009. “Transforming the region: Evidence from these four organic farmers’ Supermarkets and the local food economy.” African Affairs 109(434): 115–134. markets in Bolivia shows that not only do these markets make healthy and nutritious Ayieko, M., D. Tschirley, and M. Mathenge. foods available, such as organic and 2005. “Fresh Fruit and Vegetable Consumption Patterns and Supply Chain Systems in Urban agroecological fresh fruits and vegetables— Kenya: Implications for Policy and Investment foods that are usually under-consumed in Priorities.” Working Paper, No. 16. Nairobi: national diets—but also that these markets Tegemeo Institute of Agricultural Policy and Development, Egerton University. are important retail outlets for households belonging to different income brackets, Callon, M., and F. Muniesa. 2005. “Peripheral including those living below the poverty line. Vision: Economic Markets as Calculative Collective Devices.” Organization Studies 26(8): 1229–1250.
Conclusion CFS. 2016. Connecting smallholders to markets. Smallholder agriculture is the main source Rome: Committee on Food Security. of income for the majority of the world’s Crush, J., N. Nickanor, and L. Kazembe. poor people who live in rural areas. Yet 2019. “Informal food deserts and territorial markets where the majority of household food insecurity in Windhoek, Namibia.” Sustainability 11(1): 37. these smallholders operate are neglected and do not receive adequate support, Development Initiatives. 2018. Global Nutrition limiting their contribution to food security Report: Shining a light to spur action on nutrition. Bristol, UK: Development Initiatives. and promotion of healthy diets. EAT-Lancet Commission. 2019. Food in the Anthropocene: the EAT-Lancet Commission on Since poverty and malnutrition are healthy diets from sustainable food systems multidimensional phenomena (FAO 393(10170): 447–492.
FIGURE 3: Income bracket of consumer households buying at four Smallholder organic farmers’ markets in Bolivia (expressed in bolivianos—BOB) agriculture“ is the main source of income for the
No fixed income majority of the world’s 25% Less than 1,000 poor people who live 2% 1,000 - 3,000 in rural areas. 48% 3,000 - 5,000 5% 1% 5,000 - 1,0000 19% More than 10,000
Source: FAO and INRA (2016).
The International Policy Centre for Inclusive Growth | Policy in Focus 17 Territorial markets can “play an important role in ensuring inclusive and sustainable food systems.
Photo: Dominic Chavez/World Bank. Members of an agriculture cooperative nurturing their fields of vegetables, Kieryaghin village, Burkina Faso, 2013
FAO. 2015. Food outlook 2015. Rome: Food and Del Pozo-Vergnes, E., and W. Vorley. 2015. Global Agriculture Organization of the United Nations. or local food chains? Uncovering the dilemmas in Senegal and Peru. London: International Institute FAO. 2017a. The state of food and agriculture. for Environment and Development. Rome: Food and Agriculture Organization of the United Nations. Reardon, T., D. Tschirley, M. Dolislager, J. Snyder, C. Hu, and S. White. 2014. Urbanization, Diet Change, FAO. 2017b. Supporting Family Farmers to reduce and Transformation of Food Supply Chains in Asia. rural poverty. Rome: Food and Agriculture Ann Arbor, MI: Global Center for Food Systems Organization of the United Nations. Transformation, Michigan State University.
FAO. 2018. Empowering People and Strengthening Roesel, K., and D. Grace (eds). 2015. Food safety Rural Organizations. Rome: Food and Agriculture and informal markets: animal products in sub- Organization of the United Nations. Saharan Africa. London: Routledge.
FAO. 2019a. Sustainable Healthy Diets: Guiding WHO. 2016. Global Report on Diabetes. Geneva: Principles. Rome: Food and Agriculture World Health Organization. Organization of the United Nations. World Bank. 2018. Poverty and Shared Prosperity FAO. 2019b. The State of Food Security and Nutrition 2018: Piecing Together the Poverty Puzzle. in the World 2019: Safeguarding Against economic Washington, DC: World Bank. slowdowns and downturns. Rome: Food and Agriculture Organization of the United Nations.
FAO. forthcoming. Mapping of territorial markets: 1. Food and Agriculture Organization of the a manual for data collection. Rome: Food and United Nations (FAO). Agriculture Organization of the United Nations. 2. Based on the CFS criteria, the main typologies of territorial markets are wet markets, FAO and INRA. 2016. Innovative Markets for neighbourhood food markets and farmers’ Sustainable Agriculture. Rome: Food and markets. Many other typologies can exist Agriculture Organization of the United Nations. though, depending on the context. 3. Conseil National de Concertation et de Hawkes, C., J. Harris, and S. Gillespie. 2017. Coopération des Ruraux (CNCR) in Senegal; “Changing diets: Urbanization and the nutrition Confédération Paysanne du Faso (CPF) in Burkina transition.” 2017 Global Food Policy Report, 34–41. Faso; and Asociación Nacional de Productores Washington, DC: International Food Policy Ecologicos (ANPE) and Terra Nuova in Peru. Research Institute. 4. Table 1 summarises results from different IFAD. 2011. Viewpoint: Smallholders can feed studies conducted in several developing the world. Rome: International Fund for countries (Meng et al. 2014; IDS 2015; Agricultural Development. Del Pozo-Vergnes and Vorley 2015). 5. Bio-Achocalla in La Paz, Bio-Tiqui and ECO Meng, T., W. Florkowski, D. Sarpong, M. Chinnan, Feria in Cochabamba, and Bio Tarija in Tarija. and A.V.A. Resurreccion. 2014. “Consumer’s Food Shopping Choice in Ghana: Supermarket 6. Considering a four-member household. or Traditional Outlets?” International Food and 7. According to the World Bank (2018), living on Agribusiness Management Review 17: 107–129. less than USD3.20 per day reflects the poverty line in lower-middle-income countries. Murphy, S. 2010. Changing perspectives: 8. Given that the average household size is four Smallscale farmers, markets and globalisation. members, USD3.20 per person per day means London and The Hague: International Institute USD12.80 per household per day, and USD384 for Environment and Development and Hivos. per household per month.
18 The role of small- and medium-sized enterprises in addressing the malnutrition challenge: reflections from project implementation in Ghana, Kenya and Viet Nam
Pilar Santacoloma and Manuel Anta1 What are SMEs? with landholdings of 2–100 ha, 5–100 ha or SMEs participate in all stages of food 5–20 ha (Lowder, Skoet, and Raney 2016). The immense malnutrition challenge of supply chains, including production (input today calls for a transformation of the food providers, technical, research and financial While there are many definitions of system, and a critical understanding of the institutions), processing, transportation, SMEs, what is commonly agreed is that driving forces and actors that can play a branding and packaging, and retailing, as entrepreneurship is a driving force behind role in promoting better diets and optimal key actors such as wholesalers, vendors, them. The European Commission defines it nutrition. Among the various forces and restaurants and traders (Demmler 2020). as follows: “Entrepreneurship is the mindset actors which comprise food systems, the However, there is no international and process to create and develop economic private sector is one of the most important. standard for defining SMEs, as the criteria activity by building risk-taking, creativity It is critical to enhancing access to and the for definition vary according to country and/or innovation with sound management, availability and affordability of safe, diverse contexts and sectors. Most commonly within a new or an existing organization” and nutritious foods. though, SMEs are defined according to (OECD 2006). Driven by entrepreneurship, the number of employees, capital assets, the contribution of SMEs to employment, A major proportion of private-sector turnover in the post-production stages, or growth and sustainable development is now entities in many countries are small the size of plots used during production. widely acknowledged. Their development and medium-sized enterprises (SMEs). For instance, in the European Union, can deepen the manufacturing sector and Although they are a major vehicle for the upper limit designating SMEs is 250 foster competitiveness, and can help achieve nutrition within food systems, they face employees (European Commission 2003). a more equitable distribution of the benefits many challenges to survive as a subsector, For low- and middle-income countries, the of economic growth, thereby helping not least due to being erroneously United Nations Industrial Development alleviate problems associated considered missing and broke (AGRA Organization (UNIDO) defines SMEs as with uneven income distribution 2019). This paper discusses the relevance those that have 5–99 employees, with (Boto and La Peccerella 2009). of SMEs in addressing the malnutrition small firms defined as those with 5–19 challenge, with illustrations from a field employees, and medium-sized firms In low- and middle-income countries, project on the development of SMEs led by as those with 20–99 employees. At the the available evidence suggests that SMEs the Food and Agriculture Organization of production stage, and depending on the have played a major role in the growth and the United Nations (FAO). context, SMEs are characterised as those development of all leading economies in
The immense malnutrition“ challenge of today calls for a transformation of the food system.
Photo: Cristina Aldehuela. A woman prepares green peppers to sell at this small stand in Agbogbloshie market. Ghana, 2016.
The International Policy Centre for Inclusive Growth | Policy in Focus 19 Asia and is the key sector in the agricultural and 90 per cent—in sub-Saharan Africa of demand from consumers upstream transformation in Africa (AGRA 2019). (Demmler 2020). It is at this stage of to farmers. In sub-Saharan Africa, food For example, we know that post-farm SMEs food systems where the availability, retailing is believed to generate about are the primary buyers of produce from affordability, diversity and safety of food 20 per cent of the total value of the small-scale farmers and are also suppliers are shaped. Further, it is estimated that agri-food sector (ibid.). of food for poor and vulnerable consumers almost 95 per cent of small-scale farmers (Demmler 2020). in Africa supply the SMEs involved in A critical question then is how SMEs, which processing directly or via small-scale produce, process and market shelf-stable The role of SMEs in nutrition wholesalers (AGRA 2019). The processing and nutrient-rich products, can make A rapid transformation is taking place stage—also mainly composed of SMEs use of wholesale and retail networks to in food systems worldwide, driven by in low- and middle-income countries— outsource their raw materials from small- rapid urbanisation, higher incomes, is fundamental to increasing food scale producers, market their products changing technology, increasing women’s quality and safety and reducing the effectively, make a profit and, at the same participation in wage employment, probability of contamination and losses time, reach low-income consumers. SMEs and trade liberalisation (FAO 2019). of nutrient content of fresh products. It is face serious challenges in this endeavour This transformation has placed heavy estimated that nearly a third of total food in terms of access to finance, quality of pressure on food systems to deliver safe, production is lost in production and post- supply, a skilled labour force, compliance diverse and nutritious foods (ibid.). production (HLPE 2014). Furthermore, with food quality and safety standards For instance, in African countries there processing helps to enhance shelf life, and infrastructural conditions (see Box 1). has been a rapid rise in the consumption increase palatability and convenience Maestre et al. (2017) note that another key of processed foods, which now represent of food and increase nutrient content challenge in the marketing of nutrient-rich 40–65 per cent of total urban and rural (Demmler 2020). It is estimated that foods is their credence characteristic—that food purchases (Tschirley et al. 2015). nearly 40 per cent of all agricultural is, their nutrient value is not observable Similarly, it is important to note the rise output is generated in the processing by consumers. Demand for these foods, in consumption of non-staple foods stage (AGRA 2019). Therefore, to support therefore, depends on distinctive labelling (meat, fish, milk, fruits, vegetables, lipids an inclusive agricultural transformation, of food quality and marketing. and roots/tubers, the latter mainly in the linkages between small-scale farmers West Africa), which form 50–70 per and SMEs engaged in processing need Up to now, most of the efforts to leverage cent of urban and rural diets in Africa to be fostered and strengthened the private sector to deliver better diets (AGRA 2019). through investment. have focused on incentivising large national and multinational companies. These developments have immense Similarly, the food retail stage—also The role of SMEs in nutrition has been less relevance for the SME sector, as they composed mostly of SMEs—is highly discussed, despite their importance in produce between 30 per cent and 65 per relevant for food security and nutrition, linking smallholder producers, markets and cent of all the food consumed globally, as it not only links food with consumers consumers in both rural and urban areas and even more—between 75 per cent but also because it is the transmitter (HLPE 2017).
BOX 1: Main constraints for SMEs delivering nutritious foods in Ghana
Under the project GLO/GCP/712/JPN, FAO undertook a ‘Net-Map’ manufactured machines used in production and the high duty costs workshop to identify bottlenecks and opportunities for supporting SMEs of imported ones. The third major challenge is a lack of workers with in delivering more nutritious products. The respondents interviewed the required skills, implying costly training and supervision costs are engaged in activities such as production, processing, and supply to accomplish given tasks. Lastly, marketing of their products also of raw materials. Commodities produced by the respondents included appeared to be a particular weakness. Some respondents mentioned mushrooms, peppers, tomatoes, maize, cassava, table eggs, poultry, that they do not provide any information about the quality of their including chicken and guinea fowl, sheep and goats. Most of the products to potential consumers, and only a few advertise using public respondents sell their commodities to urban dwellers, with a few also media outlets. selling to rural residents, suggesting a lack of service to rural consumers The project collaborates with the University of Ghana, the Association and, consequently, limited food environments. of Ghana Industries (AGI) and the National Board for Small Scale According to the respondents, financing from banks is their most Industries (NBSSI) to generate a capacity-building strategy for selected significant challenge. The reasons for this include: higher interest SMEs and raise awareness at the government level on the need to rates from banks; difficulty in accessing loans or high collateral support SMEs with specific incentives and policies. Similar activities requirements; banks requiring immediate repayment and perceiving are also being implemented in Viet Nam and Kenya in partnerships agriculture-related businesses as risky; and the unwillingness of banks with local universities. To reinforce these activities, an e-learning to lend money to SMEs due to poor repayment histories of some of course designed for policymakers, SME associations and development their counterparts. The second major challenge is the expensive and partners on leveraging the potential of SMEs to support nutrition- inconsistent supply of inputs, particularly the small capacity of locally sensitive food systems is under development.
Source: FAO and IFPRI (2020 forthcoming).
20 A rapid transformation “ is taking place in food systems worldwide, driven by rapid urbanisation, higher incomes, changing technology, increasing women’s participation in wage employment, and trade liberalisation.
Photo: Giulio Napolitano. Women filling jars with diverse and nutrient-rich foods. Swaziland, 2016.
Policy recommendations y Establish public nutrition awareness FAO and IFPRI. 2020 (forthcoming). Approaches for Leveraging Small and Medium Enterprises SMEs along the food supply chain have and education programmes on the to Improve Nutrition. Net-Map assessment of considerable potential to supply safe, importance of healthy diets for SMEs. actors and activities in Ghana. Rome: Food and diverse and nutritious food to most Agriculture Organization of the United Nations. y Provide training and mentoring populations but particularly to the most Herrero, M. et al. 2017. “Farming and vulnerable. However, several restrictions campaigns to SMEs on food safety the geography of nutrient production for need to be overcome for them to be able regulations and standards, and human use: a transdisciplinary analysis.” Lancet Planet Health 1(1): e33–e42. to reach their potential. The following designate specific credit lines policy recommendations are based on to support the upgrading of HLPE. 2014. Food losses and waste in the good practices from the FAO-led field infrastructure and equipment. context of sustainable food systems. Rome: programmes; they can support a vibrant Food and Agriculture Organization of the United Nations, 117. SME sector and their contribution to better diets: Lowder, S.K., J. Skoet, and T. Raney. 2016. AGRA. 2019. “The Hidden Middle: A Quiet “The number, size, and distribution of farms, smallholder farms, and family farms worldwide.” y Ease the barriers to doing business Revolution in the Private Sector Driving Agricultural Transformation.” Africa Agriculture World Development 1(87): 16–29. for SMEs along the food supply chain Status Report, Issue 7. Nairobi, Kenya: Alliance through infrastructure development, for a Green Revolution in Africa. Maestre, M., N. Poole, and S. Henson. 2017. “Assessing food value chain pathways, linkages such as building and improving roads, and impacts for better nutrition of vulnerable electrification and wholesale markets, Boto, I., and C. La Peccerella, 2012. “SMEs: Resources on the opportunities and groups.” Food Policy 68: 31–39. to enhance linkages between input challenges for SMEs in the agricultural sector suppliers, farmers, processors and of ACP countries.” Brussels Rural Development OECD. 2006. The SME financing gap. Vol. 1: Theory and Evidence. Paris: OECD Publishing.
The International Policy Centre for Inclusive Growth | Policy in Focus 21 Taxes as a policy measure to promote healthy diets
Shu Wen Ng, M. Arantxa Colchero, foods, especially most animal-sourced countries, as well as among low-income Juan Rivera and Barry Popkin1 foods and fortified infant cereals, were populations within countries (Cornelsen generally expensive in low-income et al. 2015). Setting the scene: Malnutrition and countries, while most non-cereal foods, the affordability of healthy food including sugar- and fat-rich foods, were To date, over 45 countries, cities or regions Addressing malnutrition involves relatively cheap in high-income countries within countries worldwide have instituted increasing financial and physical access (Headey and Alderman 2019). It was also taxes on SSBs, with a few also imposing to health-promoting, nutrient-rich and very telling that milk prices were found taxes on ultra-processed foods (UPFs) culturally appropriate foods, in addition to to be positively associated with stunting that exceed certain nutrient thresholds. educational efforts. This can be a challenge prevalence, while SSB prices are negatively Excise taxes have been adopted more in under-resourced locations and among associated with overweight prevalence. quickly on SSBs than on UPFs because those experiencing poverty and food SSBs clearly do not provide nutrients of insecurity. Under the current global threat Thus, the food systems transformation value, do not provide a feeling of satiation of COVID-19 and its associated immediate agenda needs to include policies aimed (thus resulting in excess consumption) and long-term economic, health and social at addressing affordability in the short and are associated with many diseases impacts, we are faced, more than ever, with term by creating incentives to promote (WHO 2016). More recent research the dire need to reform the food system. healthy diets and changing norms around provides strong support for the extremely the desirability of unhealthy foods detrimental health effects of UPFs One illustration of the troubled food compared to healthy options, in addition (Lawrence and Baker 2019; Vandevijvere system is the imbalance between the to complementary efforts regarding et al. 2019). Meanwhile, UPF sales and affordability of unhealthy foods and physical access to healthy foods and consumption are increasing very rapidly of healthy options. From 1990 to 2016 education over time. Taxation could help across most LMICs, forming a growing the affordability of sugar-sweetened support these efforts because it can serve share of the diets of very poor people and beverages (SSBs) increased in most low-, three functions. A well-designed policy now reaching infants and pre-schoolers middle- and high-income countries. can: 1) create financial disincentives for (Pries, Filteau, and Ferguson 2019; Pries This happened more rapidly in low- and consumers and producers regarding 2016). While SSBs represent about 2–7 per middle-income countries (LMICs) than unhealthy items; 2) generate tax revenue cent of food purchases and 4–10 per cent in high-income countries, largely due to support healthy food production of kcal/day, UPFs (which includes SSBs), to the higher rate of income growth in and diets among poor households; represent between 17 per cent and over 25 those countries rather than a decline and 3) send consistent messages to the per cent of purchases (15–60 per cent of in the real price of SSBs (Blecher et al. population on the importance of healthy kcal/day) depending on age group, gender 2017). Additionally, food price data from foods and diets. These effects are likely to and country. Therefore, it is also critical to 176 countries in 2011 show that healthy be larger in LMICs than in high-income adjust the prices of unhealthy UPFs relative to healthy foods.
In this article we provide examples of places where such taxes have been implemented, to illustrate how they can help with this goal and how they might be further improved. We then discuss future options that recent research suggests are needed in fiscal policy to truly improve diets and, subsequently, all nutrition-related non-communicable diseases (NCDs).
Mexico’s SSB and junk food taxes: A pioneer, but further action needed With some of the world’s highest prevalence of obesity and NCDs, Mexico introduced an excise tax of MXN1 per litre (a price increase of about 9–10 per cent Photo: Bart Verweij / World Bank. Nutritious meals, Laos, 2012
22 Evaluations of Mexico’s “ taxes have shown that they have helped reduce the purchase, manufacturing and sales of the taxed items, particularly among low-income Mexicans and those who were previously high consumers of these
Photo: Shu Wen Ng. Drinks stand in Mexico City, 2014. unhealthy products.
per cent ad valorem tax on non-essential larger package of interventions) have the foods with over 275 kcals per 100g (termed potential to prevent many new cases of a non-essential food tax) in 2014. This was NCDs, especially among those least able to one way to begin addressing the growing access treatment. imbalance between the prices of unhealthy foods and of healthy foods in the country, One major missed opportunity in particularly for lower-income households Mexico was the use of the tax revenue (Colchero et al. 2019). generated by the scheme. Early in the implementation phase, there were Evaluations of Mexico’s taxes have shown discussions and pushes by public health that they have helped reduce the purchase, advocates for some of the revenue to manufacturing and sales of the taxed be used to build potable water stations items, particularly among low-income in rural schools (especially where water Mexicans and those who were previously quality is poor) and to promote the local high consumers of these unhealthy production of healthier foods (economic products. This was the case for the taxes development). This did not occur, on both SSBs and non-essential foods however, and the revenue was instead (Colchero et al. 2016; Ng et al. 2018; Batis et directed towards the general budget, al. 2016). Meanwhile, purchases of untaxed with no specific earmarking. Although beverages (such as water) increased, and the use of revenues to cover general shifts in demand meant that employment government expenses helps to correct in the beverage and non-essential food some negative externalities of unhealthy sectors were not adversely impacted, as diets, it would be better to earmark their production portfolios appeared to those expenses to obesity prevention have shifted. This was also the case among efforts and to provide potable water to retailers (Guerrero-López, Molina, and marginalised communities. Educating Colchero 2017). Based on the findings on the public about the purpose of such SSB reductions alone, the predicted 10- taxes can help keep them relevant and year reductions in poor health outcomes enhance their health effect. include: 189,300 fewer cases of type 2 diabetes, 20,400 fewer incidents of strokes Chile’s SSB tax restructuring and food and myocardial infarctions, 18,900 fewer labelling and marketing regulations: deaths, global savings of around USD983 Early promise and opportunities for million (Sánchez-Romero et al. 2016), policy integration and enhancement and a 2.54 per cent reduction in obesity As part of a concerted obesity and NCD prevalence, with the largest reductions prevention effort, in October 2014, Chile found in populations with the lowest shifted its beverage tax structure from a income (Barrientos-Gutierrez et al. 2017). 13 per cent ad valorem tax to: no taxes on Thus, these taxes (particularly as part of a plain water and plain dairy-based drinks;
The International Policy Centre for Inclusive Growth | Policy in Focus 23 The current COVID-19 “pandemic has created considerable shocks around the world, with those in the informal sectors of the economy most immediately impacted.
Photo: Oxfam International. Children in Mexico, 2012
10 per cent on all non-alcoholic beverages Chile’s current 19 per cent value-added with sweeteners and under 6.25 g of tax on fruits and vegetables, would sugar; and 18 per cent on all non-alcoholic result in a net welfare gain and subsidy beverages with sweeteners and 6.25 g or transfer for the average household, with more of sugar. Due to the relatively small low-income households gaining more increase (plus 5 percentage points) and than high-income households (Caro decrease (minus 3 percentage points) in et al. 2020). Therefore, if Chile were to prices, evaluations of this tax restructuring integrate its tax policy with its labelling have shown that the price changes were and marketing policy, and further adjust muted (i.e. partially absorbed by suppliers), the relative prices of healthy foods by and purchase changes were consequently removing an existing tax, these measures small (Caro et al. 2018). In June 2016, Chile could lead to important equity- and began implementing ground-breaking health-promoting outcomes. food labelling and marketing regulations, including mandatory warnings when The way forward: Fiscal policies to products are ‘high’ in sugar, saturated fats, support healthy diets sodium or energy (products can have up to The current COVID-19 pandemic has four warning logos). Additionally, products created considerable shocks around with at least one warning logo were the world, with those in the informal not allowed to be marketed to children sectors of the economy most through any media (including digital) immediately impacted and thus facing or in schools. enormous, long-lasting and potentially generational consequences for their This provides a good opportunity overall well-being, including food to further policy integration efforts. and nutrition insecurity, educational Simulations of expanding the tax to attainment, and future earnings and include UPFs show that if Chile were to upward economic mobility. The health implement an unhealthy UPF tax, in line crisis also presents opportunities for with its food labelling and marketing change and to reassess how different regulations, household purchases of types of food and those who produce these items would fall dramatically. These them should be valued, as well as our substitutions could result in reductions in engagement with food. Fiscal policies nutrients of concern such as sugar (-5 g/ can help nudge this re-framing of our capita/day) and sodium (-23 mg/capita/ relationship with food by adjusting day), and calories (-42 kcals/capita/day), the prices of healthy foods relative which are linked with the most common to unhealthy foods, and they can be NCDs (Caro et al. 2017). Moreover, used as an income transfer approach simulations show that such an unhealthy to redistribute resources and address UPF tax, in addition to the removal of existing economic and health inequities.
24 At this critical time, increasing the Many more families and individuals Cornelsen, L., R. Green, R. Turner, A.D. Dangour, population’s ability to afford healthy around the world are facing economic B. Shankar, M. Mazzocchi et al. 2015. “What Happens to Patterns of Food Consumption foods—as opposed to just any type of uncertainties and constraints. The public when Food Prices Change? Evidence from A food—should be prioritised. This can be and private sectors and individuals must Systematic Review and Meta-Analysis of Food especially effective when targeting lower- work together to identify, develop and Price Elasticities Globally.” Health Economics income populations, because it can serve act on meaningful policies that can 24(12):1548-59. doi: 10.1002/hec.3107. a double purpose of addressing equity change the post-COVID-19 food system Guerrero-López, C.M., M. Molina, and M.A. concerns—particularly when paired with to better support healthy diets while Colchero. 2017. “Employment changes tax policies—and providing reinforcing addressing rising inequities. Creative associated with the introduction of taxes on messages about healthier food options fiscal policies, including taxes and sugar-sweetened beverages and nonessential energy-dense food in Mexico.” Preventive vs. unhealthy ones. These could include repurposing their revenue, can provide Medicine 105:S43-S9. regulating/restricting the marketing of part of the solution. unhealthy foods and beverages that may Headey, D.D., and H.H. Alderman. 2019. “The be gaining popularity due to their longer Relative Caloric Prices of Healthy and Unhealthy Foods Differ Systematically across Income average shelf life, and promoting healthier Levels and Continents.” The Journal of Nutrition options and how to store them safely Barrientos-Gutierrez, T., R. Zepeda-Tello, E.R. 149(11):2020-33. doi: 10.1093/jn/nxz158. Rodrigues, A. Colchero-Aragonés, R. Rojas- (e.g. freezing or canning). In many Martínez, E. Lazcano-Ponce et al. 2017. “Expected countries, cash transfers have been the population weight and diabetes impact of Lawrence, M.A., and P.I. Baker. 2019. “Ultra- processed food and adverse health outcomes.” primary tool used to bolster purchasing the 1-peso-per-litre tax to sugar sweetened beverages in Mexico.” PLOS ONE 12(5):e0176336. BMJ 365:l2289. doi: 10.1136/bmj.l2289. power. They typically target specific doi: 10.1371/journal.pone.0176336. subpopulations that need to meet Ng, S.W., J.A. Rivera, B.M. Popkin, and M.A. eligibility criteria (e.g. income and asset Batis, C., J.A. Rivera, B.M. Popkin, and L.S. Taillie. Colchero. 2018. “Did high sugar-sweetened beverage purchasers respond differently to the ownership, age or health condition). 2016. “First-year evaluation of Mexico’s tax on nonessential energy-dense foods: an observational excise tax on sugar-sweetened beverages in Efforts to aggressively supplement and study.” PLOS Medicine 13(7):e1002057. doi: 10.1371/ Mexico?” Public Health Nutrition 22(4):750-6. augment these programmes are needed. journal.pmed.1002057. PubMed Central PMCID: doi: 10.1017/S136898001800321X. PMC4933356. Pries, A.M., S. Filteau, and E.L. Ferguson. 2019. Using a system such as Chile’s, which Blecher, E., A.C. Liber, J.M. Drope, B. Nguyen, “Snack food and beverage consumption and identifies unhealthy UPFs and taxes them, and M. Stoklosa. 2017. “Global Trends in the young child nutrition in low- and middle-income and using the resulting funds to create Affordability of Sugar-Sweetened Beverages, countries: A systematic review.” Maternal & Child Nutrition 15(S4):e12729. doi: 10.1111/ food stamps or subsidies for low-income 1990-2016.” Preventing Chronic Disease 14:E37-E. doi: 10.5888/pcd14.160406. PubMed PMID: mcn.12729. households to obtain healthy food options 28472607. can be a progressive way to address Pries, A.M., S.L. Huffman, I. Adhikary, S.R. Upreti, the double burden of malnutrition2 and Caro, J.C., S.W. Ng, L.S. Taillie, and B.M. Popkin. S. Dhungel, M. Champeny et al. 2016. “High consumption of commercial food products build healthier food and eating norms. 2017. “Designing a tax to discourage unhealthy food and beverage purchases: The case of among children less than 24 months of age and This would create a multipurpose set Chile.” Food Policy 71:86–100. doi:
The International Policy Centre for Inclusive Growth | Policy in Focus 25 Building a food safety culture in Bangladesh
Sridhar Dharmapuri 1 points. Moreover, agricultural produce civil society more generally, in food safety is hard pressed to reach markets, as was particularly glaring in a country Food safety refers to all hazards—whether dedicated transport and storage are not of 160 million people and thousands of chronic or acute—that may make food easily available. This fuels the unethical well-functioning non-governmental injurious to the health of the consumer. and dangerous practice of adulteration organisations (NGOs). There is no food security without food and translates into food that is unsafe safety. Safe food is the product of an for consumption and the cause of Bangladesh is a development success effective food control system, which, in frequent illnesses, such as diarrhoea, story, for the most part. Its economy turn, is based on scientific principles and lowering productivity and impacting continues to grow at a very healthy rate, guidelines, addressing all sectors of the the economy in a major but subtler way. and its human development indicators food chain. This is particularly important The print, electronic and social media are among the best in South Asia. It was for developing countries as they seek to in Bangladesh are rife with incidents also one of the high achievers of the achieve improved food safety, quality and and news articles related to unsafe food Millennium Development Goals due nutrition, but it requires a high level of (Dhaka Tribune 2019; Daily Star 2019). to its notable progress in addressing political and policy commitment, as well Reports of export rejections and the hunger. Safe food is essential for ending as comprehensive capacity-building presence of contaminants in Bangladeshi hunger and all forms of malnutrition and (FAO and WHO 2003). products in other countries do the for promoting economic growth, which country’s image no favours (Emran, follows as a result of the population’s Bangladesh is one of the world’s most Taslim, and Taslim 2015). good health. Its progress towards the densely populated countries, with over Sustainable Development Goals (SDGs), 1,000 people per km2 (Ritchie 2019). A decade ago, food safety management most notably SDG 2 (“end hunger, achieve This places enormous pressure on actions carried out by authorities were food security and improved nutrition its limited natural resources and based almost solely on media reports, and promote sustainable agriculture”) infrastructure and across the farm-to- rather than on science and evidence. hinges crucially on ensuring food safety. fork chain. The arable land is being lost This was further compounded by a Moreover, as Bangladesh seeks to become to urbanisation and climate change. fragmentation of responsibilities for food a middle-income country, incorporating Awareness is low among producers and control across multiple ministries and good practices and standards for food supply chain actors regarding good agencies. The lack of involvement of the safety across agriculture and food chains hygiene practices, among others, leading private sector, particularly micro, small and will increase their attractiveness on the to contaminants—physical, chemical and medium-sized enterprises, including the international market and realise greater biological—entering the chain at various millions of street food vendors, as well as of values through trade, both domestic and
FIGURE 1: The BFSA structure
BEFORE AFTER
l e Enforcement and Compliance Monitoring s Ministry of Agricultur City and loca Ministry of Ministry of administaon Commerce Educaon Food Laboratory Networking Ministry of Food BSTI Consumer Affairs
Ministry of BAB BFSA Standard Seng and Quality Assurance k Ministry of Financ Ministry of Local Government Fisheries and Livestoc d Ministry of Health an Ministry of Industriee Risk Assessment and Communicaons Family Welfare s Industry associaons Corporate Services Consumer bodies
Laboratories
Source: Author’s elaboration.
26 Incorporating good“ practices and standards for food safety across agriculture and food chains will increase Bangladesh's attractiveness on the international market.
Photo: Danny McL. Bangladeshi man selling vegetables at market, London, United Kingdom, 2019
foreign. To this end, a science-based food Safety Network (BFSN), was founded. control system had to be established. It now has 5 founding and more than 20 associate members and has become the Food safety—everyone’s business BFSA’s main civil society organisation Against this backdrop and in light of partner, representing the ‘voice of the concerns being voiced by development people’ on food safety. The private parties partners and donors, the Food and that were directly linked to activities in Agriculture Organization of the United agricultural supply and value chains were Nations (FAO), with generous support co-opted into implementing food safety from the Kingdom of the Netherlands awareness and training programmes. and the United States Agency for Nationwide information, education and International Development (USAID) communications campaigns were carried instituted the two largest capacity- out. A multisectoral alliance across building projects ever on food safety government, the private sector and civil between 2012 and 2014, costing society was thus forged. The principle of a combined total of more than risk and risk management based on data USD20 million. and evidence was institutionalised.
These projects focused on strengthening Institutionalisation and the building blocks of food safety and national commitment enabling the technical workforce to At the institutional level, the projects enforce and implement food safety supported the formulation of the measures. They set up, operationalised Food Safety Act, 2013 and set up the and developed the corporate governance governance structure of the BFSA in 2015. structure of the Bangladesh Food Safety The BFSA started with a five-member Authority (BFSA), as mandated under board headed by a Chairperson. It has the Food Safety Act, 2013. Multisectoral now grown into an organisation with 22 collaboration between various line senior officials on deputation and 106 ministries (Agriculture, Fisheries and staff recruited through a competitive Livestock, Commerce, Industries, Local process, all fully funded from the Government, Home and Finance), government’s budget. The recruitment of agencies (Bangladesh Standards a further 371 officials is currently under and Testing Institution, Bangladesh way. The BFSA was assisted to organise Accreditation Board, National Board of itself into five divisions: enforcement and Revenue) and more than 35 technical compliance; food laboratory networking; institutions, including universities, standards-setting and quality assurance; laboratories and research centres, as communications and risk assessment; well as private entities were established. and corporate services. Memorandums A network of NGOs, the Bangladesh Food of Understanding were facilitated with
The International Policy Centre for Inclusive Growth | Policy in Focus 27 six food control authorities, including consumer affairs and one NGO. A five- year strategic plan envisioning ‘safe food for all to protect health and life’, in line with policies to strengthen transparency and accountability of all government institutions, was formulated and is currently being implemented. Seven regulations and three rules have been developed regarding key food safety priorities, such as hygiene, chemical contaminants, labelling and food additives. District-level food safety courts were set up under the Food Safety Act, and the project trained 70 magistrates to prosecute cases related to food safety.
Building the technical workforce Photo: Holly Holmes/WorldFish. Woman preparing vegetables, 2013
28 the project between trained farmers and Conclusion 1. Food and Agriculture Organization of the local and international buyers, mangoes Bangladesh is representative of the United Nations (FAO) Regional Office for Asia were sold directly through Walmart South Asian regional context, with a fast- and the Pacific. outlets in the UK. growing economy and a large aspirational 2. A solution including formaldehyde, often used as a food preservative. population. Placing the country on the Food safety can build path to sustaining food safety for all in and rebuild livelihoods the face of rapid urbanisation and climate Consumers in the city of Khulna, the change requires a sustained multisectoral Al Mamun, S.M., L. Kabir, M.M. Islam, S.K.M. Lubna, S. Islam, T.A.H.M. Akhter, and M.M. gateway to the Sunderbans delta in approach, which was demonstrated Hossain. 2017. “Molecular identification and south-west Bangladesh, now have access by the two projects described in this characterization of Salmonella species isolated to hygienic street food. In partnership article. They addressed critical areas from poultry value chains of Gazipur and Tangail districts of Bangladesh.” African Journal with the Khulna City Corporation (KCC), of an effective food control system, of Microbiology Research 11: 474–481. 500 street food vendors received new strengthening linkages between food street food carts, licensed by the KCC, safety measures, food and nutrition Daily Star. 2019. “Lead, bacteria in milk, curd.” Daily Star, 9 May.
Food safety is a fast-moving“ field, and constant improvement is essential.
Photo: WorldFish . Woman cleaning mola, a nutritious small fish in Jessore, Bangladesh
The International Policy Centre for Inclusive Growth | Policy in Focus 29 Ending malnutrition in all its forms: social protection and the growing prevalence of overweight, obesity and diet-related non-communicable diseases
Alejandro Grinspun,1 Mario Gyori 2 overnutrition: they can also be present Global aggregates hide asymmetries in and Rodrigo Rivera 3 in the same household (stunted children the prevalence of overweight and obesity living with overweight adults), and even between countries and specific population The double burden of malnutrition the same person over time: evidence groups. Overweight among adults is more A rapid shift in our diets has reconfigured shows that undernutrition early in life may pronounced in regions with higher levels the global nutrition profile in just one increase the risk of overweight and non- of per capita income. Adults in relatively generation. Child undernutrition has communicable diseases later. more prosperous areas are overweight reached its lowest level since 1990, more frequently than adults in lower- although it still persists, and progress Globally, there has been a rapid growth income regions, such as South Asia or has now stopped. At the same time, of overweight and obesity in recent sub-Saharan Africa (Figure 2). overweight and obesity in all age decades. Between 1975 and 2016, the groups show levels not seen previously. prevalence of overweight grew from Bodyweight disparities also manifest Today, the situation can be characterised 20 per cent to 39 per cent among adults, themselves by sex and geographic as a double burden of malnutrition: and from 4 per cent to 18 per cent among region. Overweight and obesity rates the coexistence of undernutrition— children and adolescents aged 5–19 years. are significantly higher among women stunting, wasting, underweight and Overweight in children under 5 years of than men, especially in low- and middle- micronutrient deficiencies—together age also increased, although more slowly. income countries, whereas obesity with overnutrition—overweight and Overall, roughly 30 per cent of the world’s is more frequent in men in high- obesity—and a host of diet-related population—2.4 billion people—are income countries (Jaacks et al. 2019). non-communicable diseases. overweight. Obesity, the most severe form The average Body Mass Index (BMI) of overweight, is increasing much faster. has been typically higher in urban than Development Initiatives (2020) estimates Since 1975, the prevalence of obesity in rural areas in most countries, especially that 124 countries out of a sample of 143 adults has tripled (Figure 1), and increased high-income, although accelerating are experiencing this double burden. more than eightfold in school-age children growth rates in rural BMI have Importantly, it is not only countries and and adolescents. At present, one in nine contributed to close this gap, close this communities that can experience the individuals of 5 years or older in the gap. Rural BMI has also been the main simultaneous presence of under- and world is obese. driver of the increase in total BMI in low- and in low- and middle-income countries over the last three decades (NCD Risk Factor Collaboration 2019). FIGURE 1: Prevalence of obesity among adults (18+ years), by per capita income and income group, 1975–2016 Determinants of overweight and obesity Overweight and obesity are primarily the result of an energy imbalance between 25 High income ) calories consumed and calories expended Upper middle income (WHO 2020a). Reasons for growing diet 20 Lower middle income Low income imbalances include the rapid changes in Global global, national and local food systems, 15 greater economic access to food, changing lifestyles that result in major reductions in 10 physical activity due to the introduction of activity-saving technologies, restrictions on 5 the availability of time for the preparation of
Prevalence of adult obesity (% traditional dishes, and even the increasing 0 share of food consumption through 1975 1980 1985 1990 1995 2000 2005 2010 // 2016 purchases rather than own production as countries become more urban (Popkin et al. Source: Author’s elaboration based on World Health Organization and World Bank data. 2020; Shekar and Popkin 2020).
30 FIGURE 2: Prevalence of overweight among adults (18+ years), A rapid shift in our by per-capita income and income group, 2012-2016 diets“ has reconfigured
80 Americas the global nutrition profile East Asia & Pacific Europe & Central Asia in just one generation. Middle East & North Africa 60 South Asia Sub-Saharan Africa
40 Prevalence of overweight
among adults (%), 2012-2016 20
1,0002,500 5,00010,00020,00040,00080,000150,000 GDP per capita, PPP (2017=100 internaonal US$) [Log scale], 2012-2016
Source: Author's elaboration based on WHO and WB data.
Food systems play an essential role in explain diet quality. FAO, IFAD, UNICEF, WFP in low- and lower-middle-income countries delivering affordable, safe and sustainable and WHO (2020) estimate that 3 billion (Williams et al. 2018). In the USA, being diets that, combined with other factors people in the world could not afford a black, female, young or having low income (living conditions, basic infrastructure healthy diet in 2017, as it cost almost five or educational attainment increases the risk and water and sanitation facilities, food times as much as a diet that would meet of obesity, and racial and class differences preferences and feeding practices, access minimum energy needs. have been associated with the risk of to health services), ultimately determine premature death (Lincoln et al. 2014). nutrition outcomes. Inequality in food access contributes to the disparities in overweight rates The potential role of social protection Over the past decades, however, observed between poor and wealthier in tackling the obesity epidemic food systems have undergone radical households. Recent evidence suggests While a large number of studies have transformations that have changed the that the prevalence of overweight shown that cash transfers can reduce way we access and consume food. and obesity progressively shifts from undernutrition,4 we know surprisingly There has been an exponential growth in affecting families at the top of the income little about their impact on overweight the availability of retail food, supermarket distribution to those at the bottom as the and obesity. This could be because penetration and the market power economy develops (Popkin et al. 2020;). many social assistance programmes of agribusinesses and food retailers, Data from low- and lower-middle-income prioritise lifting households out of extreme manufacturers and food service companies countries, mainly in sub-Saharan Africa poverty and protecting them from (Popkin et al. 2020). This, accompanied and South Asia, show that overweight food insecurity and hunger, rather than and sustained by aggressive branding and is predominantly linked to high-income addressing overnutrition. Brazil’s Bolsa marketing, has made cheap, ultra-processed households. By contrast, in upper-middle- Família, for instance, was at the core of the food widely available around the world. income economies such as China, Brazil government’s Zero Hunger strategy. and Mexico, overweight affects low- Growth in per capita income and income households more frequently. Overnutrition, however, is no longer variations in relative prices have also a concern merely for rich people, but transformed food patterns. Both Overweight and obesity impose substantial increasingly affects poor and vulnerable healthier and unhealthier foods become costs on societies, families and individuals. populations. Since social assistance more affordable as countries develop They are a major determinant for the programmes have been expanding in (Headey and Alderman 2019). This partly development of non-communicable many countries to cover larger numbers explains differences in food patterns diseases, including heart failure, type of poor and vulnerable households beyond between countries with varying levels of 2 diabetes and several types of cancer, those living in extreme poverty, the development. Access to nutritious foods which altogether are responsible for proportion of social assistance recipients such as milk, eggs, fruits and vegetables approximately 70 per cent of all deaths who are, or are at risk of being, overweight is usually more limited in low-income globally (WHO 2020b). The odds of or obese will almost inevitably increase. countries, whereas access to cheap, developing non-communicable disease Even at the outset of Bolsa Família in 2005, energy-dense but nutrient-poor foods is vary across population groups. The risk of overweight and obesity were already more frequent in middle- and high-income cardiovascular disease and cancer is higher as prevalent as undernutrition among countries. Food prices are also critical to among low-income households, especially programme beneficiaries.
The International Policy Centre for Inclusive Growth | Policy in Focus 31 FIGURE 3: Cash transfers and obesity—conceptual framework
Increase in overweight / obesity Decrease in overweight / obesity
Consume more Shi to processed Shi to healthier / of the same food/meals out less caloric food
Income Substuon Access to health Dedicated trainings effect effect and educaon on nutrion
Cash transfer Condions Cash +
Source: Authors’ elaboration based on the literature cited in this article.
Dispensing cash to poor households income boost provided by cash transfer sectional study of Bolsa Família that increases their purchasing power, programmes lowers the financial barriers found children in beneficiary households which will lead to both income effects5 that prevent households from accessing three times more likely to consume and substitution effects.6 The former social services, most notably health care junk food (Saldiva, Silva, and Saldiva predicts that households will consume and education. More frequent contact 2010), studies of Egypt’s Tamween food more of what they were already with health professionals and use of health subsidy scheme (Ecker et al. 2016) and consuming before, while the latter services can help in the early diagnosis and the US Supplemental Nutrition Assistance implies that households will substitute treatment of nutrition-related conditions. Program (Leung et al. 2013). the consumption of cheaper goods for At the same time, expanding access to more expensive ones. The income effect education might help caregivers and There is little evidence, however, that cash can be expected to lead to an increase in children of beneficiary households make transfers or other anti-poverty programmes the daily amount of calories consumed. more informed dietary choices, although have managed to address overnutrition Indeed, there is ample evidence showing there is limited evidence that it does. The among their participants. A recent study by that food consumption accounts for potential positive effects of greater access Levasseur (2019) found an overall decrease the largest share of expenditures that to health services and education could be in obesity related to Oportunidades, households around the world incur from reinforced if a cash transfer programme although it suggests that this decrease was the cash transfers they receive (Fiszbein incorporates conditionalities or strong caused not by the cash transfer but by the and Schady 2009). The substitution effect messaging around health and education. programme conditionalities, which included could incentivise households to switch training sessions (pláticas) focusing on from healthy to unhealthy food (e.g. Few studies have explicitly examined these healthy nutrition and young child feeding increasing consumption of fast food or links empirically. Fernald, Hou and Gertler practices. By contrast, Leroy et al. (2013)’s ultra-processed foods), help them afford (2008a; 2008b) show that participants of study of Mexico’s Programa de Apoyo a more balanced and healthy diet (e.g. Mexico’s Oportunidades had a significantly Alimentario, launched in 2003 to assist very switching from simple carbohydrates to lower BMI and prevalence of obesity than poor and vulnerable rural households who more protein sources, vegetables and non-participants, but the programme’s could not be reached by Oportunidades,7 fruit) or even increase expenditures on cash component led to higher BMI, higher found that both the food basket and cash non-food items. This will depend on a host prevalence of overweight and obesity, and transferred by the programme led to an of factors: dietary habits and preferences, higher levels of blood pressure. Likewise, increase in BMI even when accompanied the household’s initial income level, two studies on Colombia’s Familias en by nutritional training. This effect was time poverty, food prices, public Acción (Attanasio et al. 2005; Forde et al. higher among women who were already health education. 2012) found that this programme also obese at baseline. increased both BMI and the odds of being Apart from direct consumption effects, obese. A number of observational studies This limited evidence about the impacts there are a number of ways in which social have reached similar conclusions, but they of social protection on overweight and protection programmes, in particular cash need to be interpreted with caution, as obesity suggests that policymakers, transfers, can help address overnutrition they are not showing any causal effects programme designers and evaluators (see Figure 3). Evidence shows that the of cash transfers. These include a cross- have been slow to recognise the extent
32 to which overnutrition is affecting rising capacity of smallholder farmers, which systems and the increasing ubiquity numbers of poor people. Consequently, can help them diversify and enrich their of cheap, ultra-processed food and programmes around the world have diets by either consuming what they obesogenic food environments) While seldom made overnutrition a priority. harvest or procuring healthy foods in we need to learn more about how social The studies by Leroy et al. (2013) the market with the proceeds from the protection can promote better dietary and and Levasseur (2019) point to the crops they sell. However, there is no nutritional outcomes, broader changes in need for more research to identify empirical evidence yet on their impact on public policy and consumer awareness other contributing factors and how overweight and obesity. and behaviour will be needed too, if complementary nutrition sessions progress towards addressing overweight can effectively induce changes in dietary Social protection can clearly contribute and ending all forms of malnutrition is to habits, food use and feeding practices to create an environment that enables materialise in the near future. among beneficiaries of cash transfers. and promotes healthy diets by improving It is possible—and a matter for further physical and economic access to food. These schemes have already been shown research—that cash transfers are helping Attanasio, O., E. Battistin, E. Fitzsimons, and poor households gain greater access to to be a useful tool to reduce child and M. Vera-Hernandez. 2005. “How effective are food but falling short of providing them maternal undernutrition, but they may conditional cash transfers? Evidence from not be sufficiently well suited to address Colombia.” Institute for Fiscal Studies Briefing Note, with choices and the ability to afford No. 54. London: Institute for Fiscal Studies. healthy diets. We also need to know more the rising prevalence of overweight and about the long-term impacts of these obesity that is increasingly affecting not Development Initiatives. 2020. 2020 Global Nutrition Report: Action on equity to end programmes, particularly the generational just rich people but growing numbers malnutrition. Bristol, UK: Development Initiatives. impacts of investing in children’s health of poor households around the world. and education: the few existing studies do The design and implementation of Ecker, O., P. Al-Riffai, C. Breisinger, and R. El-Batrawy. 2016. Nutrition and economic not examine their effects on overweight existing programmes could be revisited development: Exploring Egypt’s exceptionalism and obesity (Molina Millán et al. 2019). so that they can simultaneously address and the role of food subsidies. Washington DC, the nutritional deficiencies for which International Food Policy Research Institute.
Fernald, L.C., X. Hou, and P.J. Gertler. 2008b. “Oportunidades program participation and body mass index, blood pressure, and self-reported health in Mexican adults.” Preventable Chronic Diseases 5(3): A81.
Fiszbein, A., and N. Schady. 2009. “Conditional Cash Transfers. Reducing Present and Future Poverty.” Washington, DC: World Bank.
Forde, I., T. Chandola, S. Garcia, M.G. Marmot, and O. Attanasio. 2012. “The impact of cash transfers to poor women in Colombia on BMI and obesity: prospective cohort study.” International Journal of Obesity 36(9): 1209–1214.
GBD 2017 Diet Collaborators. 2019. “Health effects of dietar y risks in 195 countries, 1990- 2017: a systematic analysis for the Global Burden of Disease Study 2017.” Lancet 393(10184): 1958–1972.
The International Policy Centre for Inclusive Growth | Policy in Focus 33 and M. Shekar. 2020. “Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships.” Obesity Reviews 21(11): 1–17.
Ruiz-Arranz, M., B. Davis, M. Stampini, P. Winters, and S. Handa. 2002. “More calories or more diversity? An econometric evaluation of the impact of the PROGRESA and PROCAMPO transfer programs on food security in rural Mexico.” ESA Working Paper, No. 02-09. Rome: Agricultural and Development Economics Division, Food and Agriculture Organization of the United Nations.
Saldiva, S.R.D.M., L.F.F. Silva, and P.H.N. Saldiva. 2010. “Avaliaca̧ õ antropometricá e consumo alimentar em criancaş menores de cinco anos residentes em um municipió da regiaõ do semiaridó nordestino Photo: World Food Programme. Food distribution to displaced children, Colombia, 2005
Shekar, M., and B. Popkin (eds). 2020. “Obesity: Gertler, P. 2004. “Do conditional cash transfers Leung, C.W., S.J. Blumenthal, E.E. Hoffnagle et al. Health and Economic Consequences of improve child health? Evidence from 2013. “Associations of food stamp participation an Impending Global Challenge.” Human PROGRESA’s control randomized experiment.” with dietary quality and obesity in children.” Development Perspectives Series. Washington, The American Economic Review 94(2): 336–341. Pediatrics 131: 463–472. DC: World Bank.
34 Social protection responses to COVID-19 in the Middle East and North Africa: the case of Egypt
Hoda El-Enbaby 1 and Clemens Breisinger 2 budget to food and energy subsidies Tunisia and Morocco. However, most have (Machado et al. 2018). Spending on made little progress, leading to continued Food subsidies and cash transfers social assistance is generally less than inadequate support for the bottom quintile in the Middle East and North Africa on subsidies in MENA, yet countries in of the population, while a large number A social protection system is most the region also have a wide range of of better-off households keep benefiting effective if, in addition to protecting poor social assistance schemes, including from social protection programmes people, it can also respond to shocks and cash transfers, contributory and non- (Jawad 2016; Loewe 2017). crises in an efficient and timely manner. contributory pensions, school feeding In a world impacted by COVID-19, social programmes and public works projects. Countries have taken several measures protection has once again moved to to respond to the pandemic. The most the centre of attention as an important Food subsidies are considered an important common response in the region has measure to shield the most vulnerable tool in ensuring access to food for poor been to introduce a new emergency cash people from adverse impacts. Across all people. For instance, they are essential transfer (IBC-SP and IPC-IG 2020). Several countries in the Middle East and North for ensuring a minimum caloric intake, countries have also expanded existing Africa (MENA) region, responses to the particularly during food price fluctuations cash transfer programmes, while others pandemic have included lockdowns, (Rahman 2016). Yet food subsidies have have topped up payments or done both, the closure of retail outlets and considerable shortcomings: even though among other measures (ibid.). In Jordan, restaurants, the shutdown of airports and they are usually more progressive than for instance, it was announced that the the halting of tourism and trade, among energy subsidies, they are mostly badly government had started registering others. Governments have been fighting targeted and suffer from leakages. households for a Bread Subsidy Cash the pandemic while trying to balance This is particularly the case since many Compensation Programme using the health and economic considerations. of the subsidies were first introduced as existing cash transfer programme forms, As economic losses can severely impact universal. In Jordan it is estimated that and had launched a temporary emergency the poorest households, social assistance is only 13 per cent of the subsidised bread is cash transfer programme to support crucial to protect their livelihoods. Recent consumed by the poorest households, while poor households affected by COVID-19. analysis estimated that an additional 140 12 per cent is consumed by the wealthier In-kind support is also being provided to million people could fall into extreme segments, and 25 per cent of subsidised vulnerable families through food parcels, poverty worldwide (according to the flour goes to the production of non- while the universal bread subsidy was World Bank’s USD1.90 per day poverty subsidised bread or other bakery products increased (Gentilini et al. 2020). line) as a result of the pandemic if no relief (Duwayri 2016). In Egypt, the leakages were actions are taken, such as fiscal stimulus or estimated at 28 per cent, when comparing Iraq also launched an assistance package expansions of social safety nets (Laborde, the difference between quantities supplied for the most vulnerable people, who Martin, and Vos 2020). Analysis from by government agencies and quantities have been affected by the curfew and Egypt suggests that poor people living consumed by households (Sdralevich et lockdown measures imposed, and started in rural areas may be hit especially hard al. 2014). These factors have prompted distributing food baskets to some poor by an expected reduction in remittances countries to consider reforming their households (ibid.). Tunisia introduced (Breisinger et al. 2020). food subsidy systems. a series of one-off cash transfers for households with family members in Therefore, now is a good time to assess National cash transfer programmes the informal sector and not covered by the current state of social protection in are not yet commonplace in MENA. any social assistance programme, those the region, to shed light on the potential Almost all countries have programmes covered in the social security system, those role of existing social protection that target specific groups of people hosting elderly individuals or people with programmes as response mechanisms (such as widows, people with disabilities, disabilities, and those fostering children to COVID-19. In this article we focus elderly people, orphans etc.), but in the without parental support. The country on (food) subsidies and cash transfer aftermath of the Arab Spring, governments also made progress in launching a unified programmes, as the majority of MENA have been trying to reform their social digital payment platform (ibid.). countries have food subsidy systems assistance schemes. Following the and/or cash transfers currently in place. successful examples of Latin America, Apart from the cash and in-kind transfers, Nearly three quarters of all countries some countries have introduced new cash some countries introduced other in the region allocated part of their transfers programmes, including Egypt, mechanisms to support the incomes
The International Policy Centre for Inclusive Growth | Policy in Focus 35 of households and businesses. In Tunisia, in 2015 as part of larger macroeconomic the same individual (e.g. having a stunted health insurance was maintained for all reforms. TKP was introduced to invest in child who is also obese). Ecker et al. (2016) workers, pension payments were topped human capital while mitigating the effects estimated that 22 per cent of children are up, contributory unemployment benefits of the economic reforms that the Egyptian stunted with an overweight mother, and were announced, and businesses were government was undertaking. It consists 21 per cent of children are both stunted allowed to waive their contributions to of two subprogrammes, as the name and overweight. the social security scheme. indicates; Takaful, which is a conditional cash transfer targeting poor households In 2019, nearly 73 million people benefited In Bahrain, the government decided with children, and Karama, which is an from the bread subsidy, and 64 million to cover utility bills for individuals and unconditional cash transfer targeting (with a total of 22.5 million cards) of Egypt’s businesses, and exempted households poor elderly people, people with 100 million citizens benefited from the from paying municipality fees on their first disabilities, and orphans. food ration cards (Egypt MSIT 2020). residence. The government is also paying The system has undergone several the salaries of private-sector employees Tamween plays an important role in reforms and innovations. It now has two for 3 months from the unemployment ensuring food security, and has benefited components: the Baladi bread and the fund, and paying 50 per cent of salaries of from restructuring. As Figure 1 shows, ration cards. Prior to the most recent wave Bahrainis in the most affected sectors for a the food subsidy still represents a larger of reforms, the ration card system used to further 3 months (ibid.). All these measures share of government spending in Egypt, cover a specific list of food items, most of are helping mitigate the effects of the covering more people than the cash which are calorie-rich, such as cooking oil, pandemic on those most vulnerable transfer programme. Tamween has sugar, rice and pasta. Households purchase and worst affected. had almost universal coverage since their subsidised food using a smart its inception. In 2011, subsidised food card, loaded with EGP50 per registered In the next section we highlight Egypt’s accounted for nearly a fifth of poor individual in the household, which can be experience as a successful example of households’ food expenditure, and allocated to either food or non-food items. introducing a national cash transfer subsidised Baladi bread accounted for Meanwhile, each beneficiary of the bread programme and how it is used as a 71 per cent of the bread they consumed. subsidy also receives a bread allowance of response to the pandemic. It has been estimated that a removal of five loaves of bread per day, at EGP0.05 per food subsidies could have pushed national loaf (Ecker et al. 2016; Kassim et al. 2018; From food to cash transfers— poverty estimates from 25.2 per cent to Al-Masry Al-Youm 2019). Currently, the two The case of Egypt 34 per cent in 2010-2011 (Breisinger et al. subsystems are interlinked, as beneficiaries Egypt has a long history of providing social 2013). Yet, in its previous structure—with are allowed to use their unspent Baladi assistance programmes, covering both the provision of only calorie-rich food— bread allowance for the consumption cash and in-kind transfers. Currently, it was shown that the subsidy system of a range of other products. the most important ones are Tamween has contributed to the prevalence of the (a food subsidy) and Takaful and Karama so-called double burden of malnutrition TKP has an increasingly important role (TKP, a cash transfer). Tamween dates back (Ecker et al. 2016). This refers to the co- within social protection in Egypt. With to the Second World War (Ramadan and existence of under- and over-nutrition good targeting, Takaful has succeeded in Thomas 2011), while TKP was introduced within a population, a household or even improving household consumption and welfare. Targeting for TKP is conducted using proxy means testing, and through geographical targeting, as the programme was first launched in the poorest districts FIGURE 1: Social spending as a share of government expenditure in the poorest governorates in Egypt. Beneficiary selection also includes other 20 exclusion factors. TKP beneficiaries are also 18 subject to recertification every 3 years, to 16 ensure their continued eligibility. A recent 14 study (Kurdi et al. 2018) that looked into 12 Takaful’s targeting, as the largest of the two 10 subprogrammes, revealed that more than 8 6 half of the applicants in the lowest income 4 quintile are rejected, while 13 per cent of applicants are in the highest quintile,
Government expenditure % 2 0 which is considered efficient relative to 5 7 8 other social programmes.
2013/14 2014/1 2015/16 2016/1 2017/1 2018/19 2019/20 Social security assistance (incl. T&K) Food Fuel Takaful’s impact on household spending is also comparable to other successful Source: Authors’ elaboration based on Egypt Ministry of Finance’s Financial Monthly Bulletins. conditional cash transfer programmes
36 FIGURE 2: Takaful’s impact on household spending compared Takaful’s impact on to other conditional cash transfer programmes “household spending
12 is also comparable to
10 other successful cash ) transfer programmes 8 worldwide, with 6 beneficiaries spending 4 8.4 per cent more than (percentage increase 2 non-beneficiaries. Impacts on household spending 0 Egypt (Takaful)BrazilColombiaHonduras Mexico
Source: Breisinger et al. (2018b).
worldwide (Figure 2), with beneficiaries cash distribution system. In addition, by the pandemic, adding people to spending 8.4 per cent more than non- the government is distributing a one-off social assistance schemes, increasing the beneficiaries. Takaful beneficiaries payment of EGP1,500 (USD96) in three transfer amounts of existing programmes, consume more food—particularly meat, tranches to support seasonal workers who distributing in-kind transfers and expanding poultry and fruits. This indicates that the lost their income due to the pandemic unemployment benefits. Some of the key transfer has helped households diversify (Ahram Online 2020; Gentilini et al. 2020). highlights of the response mechanisms their diets, which may have a positive Those funds are expected to cover 1.9 were leveraging existing databases and impact on their nutrition and on reducing million individuals, out of 4.4 million infrastructure, and the increasing use of the double burden of malnutrition. In applicants. The Employees Emergency technology and digital systems (IBC-SP and addition, the probability of a beneficiary Fund was also activated to cover the IPC-IG 2020). The success in responding to household living in poverty decreased by salaries of individuals in businesses such a crisis in a timely manner depends 11 per cent, for the group of beneficiary affected by the pandemic and the curfew, on the speed and efficiency of reaching the households with incomes near the such as the tourism sector (Gentilini et most vulnerable and those affected by the poverty line (Breisinger et al. 2018a). al. 2020). Furthermore, EGP50 million crisis. The pandemic should be taken as an The positive experiences from Takaful has been allocated to seasonal workers, opportunity for governments to continue have likely encouraged the government through a national fund supported by to improve the targeting and design of their to take further measures regarding the donations from Egyptian citizens (Moneim social assistance programmes, especially of targeting of Tamween, such as re-certifying 2020). In addition, the government used food subsidy programmes, and to consider existing beneficiaries and introducing its existing food subsidy network to make introducing more efficient cash transfers. stronger exclusion criteria. There are it obligatory for Tamween beneficiary also suggestions to remove 40 million households with four or fewer registered members to buy one mask per household, beneficiaries from the system (Enterprise Ahram Online. 2020. “Egypt to pay out the first Press 2019), and to move households to and to make it optional for households of three grants totalling EGP 1,500 for seasonal cash transfers. with three of fewer members. Having workers on Monday.” Ahram Online, 11 April. a large distribution network across the
The International Policy Centre for Inclusive Growth | Policy in Focus 37 The pandemic should“ be taken as an opportunity for governments to continue to improve the targeting and design of their social assistance programmes, especially of food subsidy programmes, and to consider introducing more
efficient cash transfers. Photo: Mona El Azzazy/Worldfish. Family eating lunch, Egypt, 2015
economy: Estimating the impacts of expected Egypt MSIT. 2020. “Sum of 2019 Research Institute Blog.
38 Enhancing maternal nutrition through cash transfers: what does the evidence say?
Maja Gavrilovic, Lusajo Kajula outcomes, including premature delivery, sensitive elements that are significant for and Juliana Nyasha Tirivayi 1 low infant birthweight and increased risks women’s nutritional status and broader of maternal and child mortality (Bhutta et al. well-being (FAO 2018). Women, in their Malnutrition remains a major health and 2013; WHO 2013). Caregivers can also affect role as caregiver, are often designated developmental challenge. Globally, an children’s nutrition indirectly through child- recipients of cash, and this may increase estimated one in three children under 5 care practices. Women may lack nutritional their resources for personal expenditure, years old are malnourished, 144 million of knowledge, sufficient time or decision- such as on food or health care. whom suffer from stunting (UNICEF, WHO, making power to care well for themselves Cash transfers may also use specific and World Bank 2020). Growth deficits and their children (WHO 2013; Debela behavioural features, such as in utero and poor nutrition in the first 2 et al. 2017). conditionalities, messaging or educational years of a child’s life are largely irreversible, nudges, to induce positive changes although there is evidence that growth can At the same time, women’s needs for in women’s care practices. These ‘cash catch up in childhood and adolescence2 energy, protein and micronutrients plus’ design elements aim to incentivise (Black et al. 2013; Fink and Rockers 2014). increase significantly during pregnancy women’s uptake of health and nutrition Women’s health and nutritional status and lactation. In many contexts, however, services (e.g. antenatal check-ups, during pregnancy and lactation is a women consume less than their minimum provision of supplements) and enhance critical determinant of children’s survival requirements and enjoy poor nutritional their nutritional knowledge regarding diets and growth outcomes in later life (WHO intake, due to several reasons, including and feeding practices, which ultimately 2013). Therefore, interventions that aim to poverty, unequal intra-household food contribute to the improvement of maternal improve children’s nutrition should also distribution and inadequate feeding and children’s health and nutritional status. prioritise maternal health and nutrition.3 and hygiene practices, resulting in micronutrient deficiencies and insufficient Ways in which cash transfers Cash transfers, particularly when designed weight gain during pregnancy (Peterman may impact maternal nutrition as ‘cash plus’ interventions,4 are viewed as et al. 2019). An estimated 469 million Cash transfer programmes have the a promising tool for addressing children’s women worldwide are anaemic, and at potential to address the multifaceted malnutrition (de Groot et al. 2017). Even least half of these cases are attributable to determinants of women’s nutrition in though cash transfers can affect women’s iron deficiencies, parasitic infections and three core ways.5 First, such programmes nutritional status, maternal nutrition inherited health disorders (WHO 2013). directly increase household income, which is often the least prioritised objective can be spent to buy or produce a greater in these programmes, and maternal The potential role of cash transfers quantity and better quality of food to nutrition outcomes are overlooked in in tackling maternal nutrition improve household food security (Davis impact evaluations (Bhutta et al. 2013; Both unconditional and conditional cash 2016). Providing cash to women directly WHO 2013). This article examines how transfer programmes have expanded may increase their bargaining power and maternal nutrition, and women’s nutrition rapidly in recent years as a key poverty control over household budgets, allowing more broadly, is considered in the design reduction strategy across the developing them to spend funds on their own food of cash transfer programmes, detailing world. Although they vary in coverage and health expenses, and improving the various mechanisms through which and design features, cash transfers nutritional intake (Armand et al. 2020; they can address key determinants of generally aim to improve household Owusu-Addo, Renzaho, and Smith 2018). maternal malnutrition, and highlighting poverty and food security, as well as the evidence of impact. the health, nutritional and educational Second, an increase in household status of children (Davis 2016). Some purchasing power can reduce financial The links between maternal incorporate specific objectives to improve barriers and opportunity costs (loss of and child nutrition child nutrition outcomes. For example, income due to health-seeking activities) The link between maternal and child child grant programmes typically cover that poor households face in accessing nutrition is well acknowledged in research the ‘window of opportunity’ for nutrition health services and improving their (Van der Bold, Quisumbing, and Gillespie interventions—targeting pregnant and living conditions (WHO 2013). Cash, 2013; UNICEF 2013). Mothers influence lactating mothers with a combination of particularly when designed with soft their children’s growth directly in utero health and nutrition services during the conditionalities, can improve women’s through their own nutritional and health first 1,000 days in a child’s life for maximum demand for, and uptake of, essential status. Maternal undernutrition during impact (de Groot et al. 2017). antenatal and postnatal care, while pregnancy, signified by short stature, complementary behavioural programming anaemia and low Body Mass Index (BMI), has While cash transfers often focus on may expose them to health and nutrition been associated with adverse pregnancy children, they may include gender- education and dietary advice. Household
The International Policy Centre for Inclusive Growth | Policy in Focus 39 improvements to water, sanitation and housing facilities may result in reduced labour burdens for pregnant and lactating women, improving their health and general quality of life.
Finally, improved maternal nutrition can emerge through increased resources for maternal care.6 By reducing household poverty-related stress, cash transfers may positively impact the mental and emotional states of caregivers and improve their agency, autonomy and status in the household, resulting in a more positive outlook on life and investments in self- care (e.g. food, health care, education, more time for leisure etc.) (Peterman et al. 2019). When a woman’s food and nutrient Photo: Dominic Chavez/World Bank. Mother comforts baby, Sierra Leone, 2015
40 On a positive note, evidence suggests that micronutrients and health insurance, as University Press.
The International Policy Centre for Inclusive Growth | Policy in Focus 41 Cash transfers, particularly“ through complementary programming, can play a significant role in addressing various determinants of maternal malnutrition.
Photo: Son of Groucho. Mother and child, Yucatan, Mexico, 2014
with a High Prevalence of Overweight in Rural WHO. 2013. Essential Nutrition Actions: Mexico.” The Journal of Nutrition 143(3): 378–383. improving maternal, newborn, infant and
Maffioli, E.E., and E. Field. 2019. “The Impact of Maternal Cash Transfers on Child Malnutrition in Myanmar.” New Haven, CT: Innovations for 1. UNICEF Office of Research–Innocenti, Policy Action. Social and Economic Policy Unit. Authors would like to thank Amber Peterman and Luisa Manley, J., S. Gitter, and V. Slavchevska. 2012. How Natali (Innocenti) for their very useful feedback Effective are Cash Transfer Programmes at Improving on draft versions of this article. Nutritional Status? A Rapid Evidence Assessment of 2. Stunting leads to impaired cognitive Programmes’ Effects on Anthropometric Outcomes. development, poor school performance, and London: EPPI-Centre, University of London. lower economic productivity in adulthood.
42 Empowering women for poverty alleviation and improved nutrition outcomes: from anecdotes to evidence
Maria Antonia Tuazon1 as the Lao Women’s Union and civil society for achieving positive nutrition outcomes organisations such as the Sustainable and, conversely, that improvements in In 2010 the Food and Agriculture Agriculture and Environment Development nutrition matter for gender equality. Organization of the United Nations (FAO), Association (SAEDA) and the Poverty As in other developing countries, women with funding from the Italian government, Reduction and Development Association in Lao PDR were at a disadvantage when implemented an 18-month pilot project (PORDEA). The project’s objective was to it comes to accessing assets (such as on capacity-building for food security and implement and validate a nutrition-in- planting materials and credit) and services better nutrition in Lao People’s Democratic development approach (i.e. nutritional (such as agricultural extension) that can Republic (PDR). At the time the project well-being of all people is a precondition help improve their nutritional status was carried out, chronic malnutrition in for the development of societies and is and that of their families, specifically the country stood at 40 per cent, with a key objective of progress in human young children. no observable decline over the previous development) and to document good 10 years. It was apparent that despite the practices that could then be integrated Project components government’s efforts, the country into existing interventions and scaled up. was still far from achieving its vision Targeting of food-insecure and of “a prosperous country, free from Gender disparities occur in many aspects nutritionally vulnerable groups malnutrition, food insecurity and of Laotian life, ranging from access to A major element of the nutrition-in- poverty” as stated in the National Nutrition education, employment, capital or credit, development project approach is the Strategy (Ministry of Public Health 2009). natural and productive resources and capacity development of various actors, services, to governance—all of which specifically women and smallholder In response to the nutrition challenge, can have consequences not only for farmers, in three provinces of Lao PDR: a holistic and integrated approach was individuals and their families but also Louangnamtha, Bolikhamxay and Sekong. developed that would bring various sectors for society in general. In recent decades, The three provinces represented and stakeholders together in a common there has been an increasing trend three different agro-ecological settings. platform. This led to the implementation towards encouraging greater women’s The project sites (from province to district of a multisectoral, multi-stakeholder participation in economic endeavours to villages) and beneficiaries were selected project led by the Ministry of Health with as well as in development activities. based on socio-economic, health and support from the Ministries of Agriculture nutrition indicators, complemented by and Education, the National Planning The focus on women stems from the some practical considerations, such as the Commission, mass organisations such recognition that gender equality matters willingness of community leaders to take part in the project.
A participatory situational analysis was conducted in all project areas and was triangulated with data from key informant interviews and focus group discussions, which allowed for a greater understanding of the causal factors determining undernutrition. It was found that across the three provinces, women lacked knowledge of proper care practices for infants and young children. Most of them had limited knowledge of posanakan,2 proper food selection and preparation and simple food-processing techniques. This was compounded by a lack of access to planting materials for the kitchen garden for which the women were responsible, while men had to look after Photo: Project ID GCP/LAO/016/ITA, Lao PDR, 2010. farms or work as hired farm labourers.
The International Policy Centre for Inclusive Growth | Policy in Focus 43 Employment or livelihood“ activities may ease household budget constraints by providing additional resources.
Photo: Project ID GCP/LAO/016/ITA, Lao PDR, 2010.
Low and seasonal income was repeatedly Lao and pictographs (to include illiterate mentioned as a factor affecting the lack women) were also developed. of dietary diversity and inadequate food intake. While the women expressed Given the evidence demonstrating an interest in engaging in livelihood that horticultural interventions can activities to augment the family budget, promote dietary diversity and improve they also stated that these activities could nutritional status, they were considered effectively limit the time allocated to important interventions in Lao PDR’s crucial aspects of family life and childcare. National Plan of Action for Nutrition Therefore, unless these competing tasks (Ministry of Public Health 2009). and responsibilities were reconciled, Hence, training on integrated kitchen women were reluctant to participate gardens targeted both men and women. in some of the training activities. Using a farmer-to-farmer approach, civil society organisations such as PORDEA Training of women and SEADA led the training on organic and smallholder farmers kitchen gardening, which promoted Employment or livelihood activities may planting a variety of vegetables and fruits ease household budget constraints by and raising small animals, such as poultry. providing additional resources. However, Organic kitchen gardens are a cashless employment can also effectively limit and self-sustaining way for families the time that might otherwise be spent to feed themselves, as they plant and on crucial inputs to household welfare, harvest every day once production starts. including childcare. Based on this, most mothers would not take part in marketing Initially, inputs such as seeds and small activities. In addition, with the observed animals were provided by the project. gender distribution of work in a typical Rollover schemes were also put in place Lao household, encouraging greater to ensure that all beneficiaries received participation of women in the labour animals, and community nurseries were force may create a void inside homes established to provide a steady supply of that needs to be somehow filled by planting materials. other members of the household or by market-based mechanisms. The District Agricultural Extension Office also provided technical support and, Using a participatory training needs together with the communities, developed assessment, a strategy was put in place seasonal food calendars, each specific to considering the needs of the targeted the three provinces, providing guidance on women. A series of needs-oriented which horticultural crops to grow and wild training activities on various topics foods such as edible insects, which can be was launched. Training materials in gathered from the forests.
44 Simple food-processing techniques The civil society organisations involved the Ministry of Public Health, convinced were also introduced. New recipes were in the project also included these of the positive outcomes of the project on developed, and existing ones components in their community-based nutrition, promoted the national adoption were improved through the introduction development activities in much the of the TIPs approach and recipes. of nutrient-rich ingredients (such as rice same way that the Lao Women’s Union noodles enriched with green and yellow introduced the recipes and TIPs to There was also the promise of vegetables). The Lao Women’s Union used other villages, thereby achieving the sustainability. The training laid the indigenous, locally available, cheap but necessary multiplier effect. Convinced foundation for integrating nutrition nutritious foods. For food processing, of the positive outcomes, the Ministry considerations and promoting women’s women’s groups were organised of Public Health eventually earmarked empowerment as part of the training according to proximity of houses and investments to sustain the gains from agenda of the LAO Women’s Union. interests and to facilitate the adoption the programme. Trained mothers trained other women of the Trials of Improved Practices (TIPs) in their village. Many started setting up methodology (FAO 2011). The training One of the programme’s key components their own small businesses to sell jams, built on women’s pre-existing knowledge was strong community engagement squash and morning glory chips in the and household cooking equipment they throughout the entire cycle. Training village, near schools and bus stations. already possessed. Additional cheap for both the kitchen gardens and food Due to the increased production of some and labour-saving cooking equipment processing was not only demand-driven vegetables, mothers also sold the surplus was provided to each group to teach but also later gained recognition as being production to nearby restaurants and mothers how to standardise recipes crucial for ensuring food security and markets. Incomes derived from sales were and to ensure the quality and safety promoting dietary diversity. then used to purchase cooking equipment, of finished products. Recipes for food enabling mothers to start their own processing were introduced based on At the end of the 18-month period, the small businesses. the seasonal food calendar developed. programme documented health, nutrition At the end of each training, mothers were and economic benefits. For example, in The lessons learned—including the taught simple costing procedures and Bolikhamxai alone, the variety of crops knowledge products developed in this to demonstrate the economic potential increased from 3 or 4 to around 16 programme—served as inputs for other of the skills acquired. The promise of varieties. Average vegetable production projects, including the integration of additional income eventually served as an increased from around 50 kg per family nutrition into Farmer Field Schools incentive for more women to learn simple to about 75 kg per family. The vast and the World Bank’s Community food processing. majority (85 per cent) of the households Nutrition Project. claimed to first consume the vegetables, Two types of training were held: especially for their children, and then sell training of trainers was conducted for the surplus. Poultry production increased, FAO. 2011. Trials of Improved Practices 5 days, while training of beneficiaries and, by the end of the programme, (TIPs). Guiding Notes for TIPs Trainers and lasted for up to 3 days. The trainers also each family had around 25 chickens Implementers. Phnom Penh, Cambodia: FAO Representative Office in Cambodia.
The International Policy Centre for Inclusive Growth | Policy in Focus 45 The potential of policy and programmatic synergies for impacting poverty and nutrition outcomes through schools1
Melissa Vargas, Luana Swensson and eliciting benefits to support their for different beneficiary groups,3 and and Diana Carter 2 livelihoods (HLPE 2013). efforts are often small-scale or fragmented. In addition, policy implementation, Poverty and malnutrition heavily undermine Governments around the world are multisectoral and multi-stakeholder sustainable development. Both conditions increasingly implementing approaches collaboration mechanisms and funding can affect each other in a cyclical manner based on complementary interventions in are often inadequate in institutionalising (World Bank 2006; Development Initiatives school policies and programmes to address effective initiatives. Greater coherence and 2017) and have multidimensional causes. some of these interconnected challenges, investment at various levels are required to Improving nutrition is critical for combating such as school-based food and nutrition bring such initiatives to scale (FAO 2019a). poverty, and in many cases addressing education programmes that go beyond poverty can bring some improvement school settings and combine activities at the As such, there is increasing demand from to nutrition outcomes. However, these food environment level (e.g. restricting sales governments for investment and context- relationships are complex and depend and marketing practices, setting nutrition sensitive guidance on implementing cost- on many other factors; therefore, no standards for school food, among others) to effective school-based and school-linked isolated intervention for addressing one drive behavior change. Many other examples policy and programmatic options that condition will be enough for the other, can be found in the Food and Agriculture can enhance food security and nutrition unless holistically and coherently tackling Organization of the United Nations (FAO) outcomes of schoolchildren, and at the the most important causal pathways. For School Food and Nutrition Framework same time support local food systems instance, while economic slowdowns and (see Box 1). One prominent approach is and economic inclusion and development downturns will affect undernourishment in home-grown school feeding (HGSF), which (as a strategy to support poverty reduction). a population, increasing household income can result not only in educational and will not be sufficient to improve nutritional food security gains for children but also in Based on scientific evidence and good status. On the other hand, in low- and lower- livelihood gains for smallholder farmers and practices from the field, the following policy middle-income countries, food-insecure local communities (FAO and WFP 2018). and programmatic options have been households are less likely to be overweight identified as key measures to foster synergies: or obese, while in upper-middle- and high- Despite the progress with HGSF and other income countries, those experiencing food multicomponent school programmes, y Using multi-level data analysis, insecurity are more likely to be overweight there are still key challenges that hinder modelling and visualisation to identify or obese (FAO et al. 2019). their effectiveness. Particularly, synergies specific gaps and attract opportune between food and agriculture, nutrition, and targeted investments for improving These issues have multiple manifestations health, education and social protection income generation and the supply spanning across vulnerable population are not being fully realised. Impact is not (in terms of productivity and prevention groups. Schoolchildren from poor usually assessed rigorously due to the of losses, value chain diversification and households are a vulnerable population cross-sectoral nature of the programmes market access) and demand (in terms of group, and they often suffer from at least and the complexity and methodological main dietary needs and food practices) one form of malnutrition, which has challenges of measuring various outcomes for nutritious school food. adverse effects on their health, school performance and ability to learn, thus reducing their future productivity and earning potential and, as a corollary, their BOX 1: FAO’s school food and nutrition approach country’s human capital (Walker et al. 2007; Bundy et al. 2017). Furthermore, As a direct response to the international call for improved nutrition and food systems, and in rural areas, many of these vulnerable in the context of the Second International Conference on Nutrition (ICN2) and the United households are headed by smallholder Nations Decade of Action on Nutrition (2015–2025), FAO has devised a holistic approach for farmers, who in turn are some of the most action in schools. The approach leverages and purposely creates complementarities between affected by both poverty and malnutrition, four main areas of work that are at the heart of the organisation’s mandate and capacity: (i) promoting a healthy school food environment and adequate and safe school food; partly because they often depend on self- (ii) integrating effective food and nutrition education throughout the whole school system; provisioning, are more vulnerable to crises (iii) stimulating inclusive procurement and value chains for school food; and (iv) creating an and shocks, and experience significant enabling political, legal, financial and institutional environment (FAO 2019b). challenges in gaining market access
46 y Developing or revising nutrition guidelines and standards for school BOX 2: The example of Ethiopia food through a multi-stakeholder process, considering production Currently, there are two ongoing HGSF programmes in Ethiopia: a pilot initiative established systems data, agricultural seasons, in 2012 and an emergency programme established in 2015. The latter was set up to supply food to selected drought-affected areas to curb drought-induced school dropouts. It currently agroecological zones, local cultures, covers 10 regions, benefiting around 1.8 million children. food habits and preferences, and Both programmes aim to support education outcomes, as well as agricultural criteria compatible with smallholder development and income generation, through the procurement of food from local production (FAO 2019c). smallholder cooperatives. Various initiatives are being implemented by the government—with the support of FAO y Promoting complementary measures and other partners—to strengthen these programmes. For example, a multisectoral committee (with members from the Ministry of Education, the Ministry of Agriculture, within social protection systems—for the public procurement authority, FAO and WFP, among others) was established to support the instance, linking social protection development of a conducive public procurement regulatory framework and the revision measures such as cash transfers, which of the related legislation and regional directives (see Swensson 2019). can support access to education for In the Southern Nations Nationalities and People’s Region an impact evaluation is being children by removing financial barriers undertaken to assess the benefits of the HGSF pilot initiative for small-scale producers accessing school market outlets. Furthermore, complementary activities to enhance the to school systems (uniforms, fees etc.), nutrition quality and safety of school meals are being carried out, including the development with school meals, which, in turn, of nutrition recommendations for the meal menus; the adaptation of the World Food can address other barriers, ensuring Programme’s Food Quality, Hygiene and Safety Guide for the local context; and the training access to food and—when available— of school staff and health services. nutrition education (Alderman 2015; Although still at a preliminary stage, these are relevant efforts towards strengthening the nexus between nutrition, agriculture and social protection through school-based programmes, Spray 2015). to improve poverty and nutrition outcomes. y Extending effective school-based food and nutrition education to the most vulnerable communities in y Aligning and complementing from production to preparation) combination with school, home school procurement policies with (FAO 2018; FAO and WFP 2018). and community garden programmes agricultural development initiatives (Tamiru et al. 2016; Marquis et al. 2018). to strengthen smallholder farmers’ y Assessing the public procurement capacity to organise themselves regulatory framework and y Channelling school food service into cooperatives or other forms identifying legal instruments employment opportunities to the of associations, produce and that can be developed, used or most vulnerable community members, commercialise their products and adapted to support school food combined with regular and well- meet required nutrition and food procurement from local smallholder designed nutrition and food safety safety standards (drawing on support farmers (see the example of Ethiopia training schemes (FAO and WFP 2018; from concerned authorities to help in Box 2), focusing on nutritious FAO et al. 2019; Drake et al. 2016). ensure the safety and quality of products (FAO and WFP 2018; school food along the supply chain, Swensson 2018; 2019). Conclusion To capitalise on and consolidate the options outlined in this article, we recommend developing a theory of change that highlights the evidence- based pathways to enact changes in nutrition and poverty outcomes, and outline possible risks and mitigation mechanisms. Nevertheless, key programmatic gaps still remain regarding the right mix of components for the best possible outcomes and the best way to manage trade-offs. Evidence gaps also remain on differential impacts of the various programmatic components (e.g. farmers’ access to school markets with and without capacity development and provision of inputs, and home/ community/school gardens with and Photo: Pep Bonet/NOOR for FAO. School cookers in Guatemala. without nutrition education).
The International Policy Centre for Inclusive Growth | Policy in Focus 47 From a policy and legal perspective, the adoption of a holistic approach is highly recommended to ensure policy coherence and to foster institutional coordination for effective action (Cruz 2020). Coherent legislative measures can target and protect those who are most vulnerable to food insecurity by defining clear legal entitlements for guaranteeing children’s access to food at school and providing poor people with effective grievance redressal mechanisms in case of violations. Furthermore, legislative obligations lay the foundations for the provision of adequate funding to support policy action to reduce poverty and malnutrition, while ensuring school-based programmatic continuity. In addition, policy and legislative frameworks Photo: Benedicte Kurzen/NOOR for FAO. Woman farmer in Senegal. should provide incentives for responsible private-sector engagement and foster multi-stakeholder mechanisms enabling the in Africa, No. 7. Rome: Food and Agriculture the implementation of home-grown school inclusive and participatory involvement of all Organization of the United Nations.
48 The Inter-Agency Social Protection Assessment Tool for food security and nutrition: what it is, and how it was applied in Cambodia, the State of Palestine, and Paraguay
Iean Russell,1 Flavia Lorenzon,2 PirroTomaso Organization of the United Nations were conducted with representatives of Perri,3 Raja Khalidi 4 and Ana C. Louteiro 5 (FAO and the German Cooperation provincial and local governments, school Agency (GIZ). After examining the committees, school directors, teachers, The main objective of the Inter-Agency prospects for applying the Tool to various cooks, parents, students and suppliers. Social Protection Assessment Tool for food social protection programmes, the security and nutrition (ISPA-FSN Tool)6 Home-Grown School Feeding Programme The assessment criteria were addressed is to support national and subnational (HGSF), a social protection programme using semi-structured questionnaires governments in assessing how social with demonstrated effects on FSN around during face-to-face interviews, focus group protection programmes can be harnessed the world (Vargas, Swensson, and Carter discussions and other formal discussions to improve food security and nutrition 2020—see page XX of this Special Issue), with the broad groupings of stakeholders. (FSN) outcomes. The Tool aims to identify was selected for piloting the tool. This Formal meetings of the Technical Working gaps and areas for further improvement choice was also supported by the Ministry Group for Social Protection and Food based on the right-to-food and the of Education, Youth and Sport and the Security and Nutrition and the Task Force right-to-social-protection approaches. World Food Programme. meetings served for both consultation and It assesses social protection programmes validation of results at the national level. against seven pre-established criteria: The HGSF provides children enrolled in The results of the assessment were brought (1) explicit FSN objectives and indicators; school with food that is mostly produced directly to the attention of policymakers. (2) inclusiveness and accessibility; and purchased locally. It links school (3) adequacy of benefits, duration, timing feeding to rural development, stimulating The direct participation of government and predictability; (4) responsiveness; local agricultural growth by purchasing staff in the collection and analysis of (5) inter-sectoral coherence in o food from local producers to supply school information meant that the process had perational and governance structures; kitchens, thereby contributing broadly to to conform to their thought processes, (6) sustainability; and (7) rights and dignity. positive FSN outcomes. practices and limited availability. Recognising the trade-off between After its development, the ISPA-FSN Tool In 2017 the HGSF was implemented in research quality and ownership and given was piloted in Paraguay, Cambodia and four provinces of Cambodia, covering 84 that the Task Force was officially appointed the State of Palestine. The pilots gathered primary schools and 17,218 students, of by CARD, it was preferable to employ stakeholders from across various sectors, whom 8,482 were girls. The timing of the methods more akin to ‘action research’. in particular food security, nutrition and pilot supported some critical decisions that Action research offers the advantages social protection, and identified design were being made about HGSF in Cambodia of developing insights into a situation and implementation features that have the during the assessment and contributed to particularly for the research team itself. potential to enhance the impact of social an internal review process. The programme For effective action research, the team is protection programmes on FSN. In doing so, has expanded substantially since. selected from those directly involved in it also raised awareness of food security and programme delivery, problem-solving and nutrition within the social protection sector. Implementation decision-making. Participants understand The ISPA-FSN was directed by a formal the results and can incorporate the Adapting the ISPA-FSN inter-ministerial Task Force established information directly in their work. Tool for Cambodia by CARD. The Task Force initially spent 2 days reviewing the guidelines and Main findings Background discussing the pre-established criteria. This Results showed that the HGSF programme The Council for Agricultural and Rural information was augmented by interviews was serving as an effective mechanism for Development (CARD) of the Royal with key informants, a desk review and linking social protection and FSN activities in Government of Cambodia conducted information collected in the field. The Cambodia. Areas for improvement identified the ISPA-FSN assessment in Cambodia field assessment involved 18 primary included strengthening measures to address jointly with the Food and Agriculture schools in three provinces. Interviews shocks affecting FSN and improving the
The International Policy Centre for Inclusive Growth | Policy in Focus 49 monitoring and evaluation mechanisms. activities, mainly through micro- and y Policy coherence sphere: There was Limited funding and capacity-building small enterprise development, to a lack of inter-sectoral coherence in were identified as key challenges for scaling provide employment and bridge their operational and governance structures, up. The sustainability of HGSF is limited by consumption and income poverty gaps. partially due to the absence of the commitment of the national budget, a formal agreement to support given the many competing needs for the different institutions working together. education sector. However, the HGSF model Implementation The formalisation of the cooperation is the government’s and the community’s The Palestine Economic Policy Research between the MoSD and the MoA preferred model for school feeding. Institute (MAS) was selected to undertake was recommended. the implementation of the ISPA-FSN Tool, Follow-up in close cooperation with senior officials y Programmatic support to DEEP: After the assessment, the government from the MoSD and the MoA. The Tool, This key programme proved to bear included HGSF in the framework for which lies firmly at the centre of Sustainable positive results when beneficiaries social assistance for Cambodia and Development Goal (SDG) 1 (“end poverty in happened to be working in agriculture. recognised the programme as the preferred all its forms everywhere”) and SDG 2 (“end One suggestion was to specifically model for school feeding in the country. hunger, achieve food security and improved target poor farmers and those in The government recognised the need nutrition and promote sustainable marginalised areas, in cooperation to allocate resources to deal with shocks agriculture”), saw the engagement of the with the MoA. and scale up the programme. Greater National Working Groups for SDG 1 and investment in training was made possible SDG 2, with the objective of bridging y Programmatic interventions should by a grant from the US Department of these interrelated goals by promoting be aligned with the National Agriculture to support further development. food security and nutrition-sensitive Investment Plan (NIP) for Food and social protection programmes. Nutrition Security and Sustainable Adapting the ISPA-FSN Tool Agriculture (FNSSA) 2020–2022 and the for the State of Palestine The implementation of the Tool in the State National Food and Nutrition Security of Palestine was based on a consultative Policy (NFNSP) 2030. Background process, which began with a preparatory Following a request from the Ministry of phase consisting of a desk review, Agriculture (MoA), in agreement with the familiarisation with the components of Follow-up Ministry of Social Development (MoSD), the tool by the National Working Groups, The NFNSP 2030 and the NIP for FNSSA and with support from the FAO Country and forming the ISPA-FSN Tool Task Force. 2020–2022, submitted by the MoA, as the Office and the FAO–European Union FIRST The desk review helped provide important institution in charge of meeting SDG 2 programme,7 the State of Palestine was background material that was then used commitments, to the Council of Ministers selected to pilot the implementation of the in an inception workshop. This workshop in November 2019, were endorsed in ISPA-FSN Tool in the first half of 2018. proved to be an important opportunity for October 2020. The endorsement of the members of the Task Force to familiarise NFNSP and the NIP is fully in line with Two programmes were analysed, which themselves with the methodology for the the ISPA-FSN recommendations were primarily managed by the MoSD: implementation of the Tool and fine-tune mentioned earlier. the related questionnaire. Through a y The Cash Transfer Programme: comprehensive review of the questionnaire, Further, the NFNSP and the NIP foresee The main poverty alleviation social the participants highlighted the need to the establishment of a National FSN protection programme in the State refine some of the components. Council at the inter-ministerial level to: of Palestine, established as a part of (a) coordinate NFNSP/NIP interventions; the social protection strategy in 2010 In the data collection phase, the tools used (b) oversee NFNSP implementation and and funded by the State of Palestine, were agreed with the Task Force, and a the achievement of results; and (c) provide as well as key donors such as the total of nine interviews were conducted, services (for example, the elaboration of European Union and the World Bank. in addition to focus groups discussions dossiers, supported by the SDG 2 Working It provides cash assistance every with local organisations belonging to Group as technical secretariat) for the 4 months to extremely poor and the FSN sector as well as beneficiaries of higher-level political deliberative body. vulnerable households. the two programmes. The findings were The NIP also includes dedicated priorities validated during a multi-stakeholder and investments for nutrition-sensitive y The Deprived Families Economic workshop, which included local and programming and socio-economic Empowerment Programme (DEEP): international organisations, where inclusion of poor and vulnerable people. A poverty alleviation scheme aimed participants discussed the way forward. at promoting livelihoods. It provides Adapting the ISPA-FSN an inclusive approach for targeting Main findings Tool for Paraguay vulnerable yet productive households The ISPA-FSN process resulted in a list of Following a request from Paraguay’s and engages their members in recommendations. Three main findings Ministry of Social Development (Ministerio sustainable income-generating were deemed the most relevant: de Desarollo Social—MDS), the ISPA-FSN
50 populations and to achieve the SDGs such that no one is left behind.
Conclusion Social protection systems play a crucial role in helping countries achieve better FSN outcomes. However, these systems can be effective when greater efforts are made to integrate FSN considerations into social protection and agricultural interventions. In this regards, the ISPA-FSN Tool can enable countries, as illustrated by pilots in Cambodia, the State of Palestine and Paraguay, to: (i) improve coherence at the policy level between food security, nutrition and social protection policies so that they can jointly address the consumption and production needs of poor rural households; Photo: Fani Llauradó/WorldFish Cambodia. Family having lunch, 2018
The International Policy Centre for Inclusive Growth | Policy in Focus 51 The potential role of geographical indications in promoting healthy diets and reducing rural poverty
Bin Liu 1 Some products (mostly food products higher in the GI foods examined than in but also other types such as handicrafts, their non-GI counterparts. This can be Nutrition has been put high on the leather etc.) have a long history of attributed to several factors linked to the development agenda through a series of production and are deeply linked to unique materials and processes used for high-level events and initiatives, including the culture, history and environment production and the natural environment the Second International Conference on of their place of origin. They possess of the geographical origins. Nutrition (ICN2) in 2014, the Sustainable characteristic qualities that result from Development Goals adopted by the United the interaction between the local people Because of the great potential in value Nations General Assembly in 2015, and and the environment, thus becoming addition to local products, GI has been the United Nations Decade of Action on inseparable from many elements that frequently suggested and applied as a Nutrition 2016–2025. belong only to that place. A number of tool for poverty alleviation, improving measures have been developed to protect the economic well-being of producers Nutrition challenges faced worldwide origin-linked, characteristic products. and their communities. Among the many are complex. Most countries are The most common modern-day practice successful stories around the world (Box burdened by multiple forms of is to associate the product with a 2), recent research demonstrates that the malnutrition: undernutrition, geographical indication (GI), which is adoption of GI has enhanced rice farmers’ micronutrient deficiencies, overweight treated as collective intellectual proper livelihoods and reduced rural poverty in or obesity, which may co-exist within rights (see Box 1). India and Thailand, using examples of the same country, household or basmati and jasmine rice (Jena et al. 2015). individual (CFS 2016). A population’s GI foods, being the best examples of Similar conclusions were also drawn in nutritional status is determined by traditional foods and successful products Albania for chestnut farmers (Bardhi and many factors, but most critically by their of traditional food systems, have great Kapaj 2017). diet, and there is unequivocal evidence potential to contribute to improved that the global malnutrition pandemic nutrition and combat non-communicable However, this impact should not be is caused by poor diets. Current diets diseases. However, nutrition has received automatically assumed and should be in many parts of the world are high in limited attention in the GI literature. An approached and assessed carefully, unhealthy foods such as ultra-processed upcoming report from the Food and because the GI process may contain food rich in sugar, salt and calories and Agriculture Organization of the United inherent conditions that actually impede low in nutritious foods such as nuts, fruits, Nations (FAO), 'The Nutrition and Health it (Bonanno, Sekine, and Feuer 2019). vegetables and legumes. These trends Potential of Geographical Indication Among the successful factors of GI’s are driven partly by rapid urbanisation, Foods', reviews the nutritional values potential in rural development, some increasing incomes and inadequate of several GI foods from Europe, Asia authors emphasise exogenous factors accessibility of nutritious foods. In and Africa—notably meats, fermented such as market access, marketing addition, food production for such diets products and rice. The study finds that channels, the cultural and economic is pushing the Earth’s environmental the contents of beneficial compounds role of the product in the local context systems beyond safe boundaries such as polyunsaturated fatty acids, and the structure of the supply chain (Willett et al. 2019). vitamins, minerals and flavonoids are (Pacciani et al. 2001).
The role of traditional foods, diets and food systems is mentioned in some important documents, such as the ICN2 Framework BOX 1: Definition of geographical indication for Action and Rome Declaration on Nutrition (FAO and WHO 2014b; 2014a). Moreover, the High Level Panel of Experts A GI is a symbol used on products that have a specific geographical origin and possess on Food Security and Nutrition (HLPE 2017) qualities or a reputation that are due to that origin. To function as a GI, a symbol must identify a product as originating in a given place. In addition, the qualities, characteristics or provided a good overview of the capacity reputation of the product should be essentially due to the place of origin. Since the qualities challenges of current food systems to depend on the geographical place of production, there is a clear link between the product provide nutritious foods, with chapters and its original place of production. specifically discussing traditional food systems and diets. Source: WIPO (2020).
52 BOX 2: Examples of positive economic impacts of GI processes “ Central to the A study analyses nine GI processes and confirms the existence of positive economic impacts, effectiveness of GI including Colombian coffee, Darjeeling tea (India), Futog cabbage (Serbia), Kona coffee (United States), Manchego cheese (Spain), Penja pepper (Cameroon), Taliouine saffron (Morocco), Tête development in de Moine cheese (Switzerland) and Vale dos Vinhedos wine (Brazil). The introduction of GI contributing to poverty leads to higher prices paid to growers and processors, improved product quality, an increase in the number of permanent jobs, and resilience against price fluctuations on the international reduction is to guarantee market. The major elements contributing to these impacts are: y specific characteristics linked to the geographical place of origin of the product; that the increased y effective collective decision-making by a strong producers’ organisation; profits of GI products y an effective marketing strategy at both the individual and collective levels flow to producers. of the GI value chain; and y support from the public sector.
Source: FAO (2018).
Central to the effectiveness of GI foods, thus enhancing the profits and HLPE. 2017. “Nutrition and Food Systems. development in contributing to poverty eventually benefiting producers, but A Report by The High Level Panel of Experts on Food Security and Nutrition.” HLPE Report, No. 12. reduction is to guarantee that the this aspect has not been thoroughly Rome: Food and Agriculture Organization of the increased profits of GI products flow to researched. The nutritional content of local United Nations.
The International Policy Centre for Inclusive Growth | Policy in Focus 53
The food systems approach places equal emphasis on both the supply and demand dimensions that are critical for ensuring healthier diets and better nutrition for poor and vulnerable groups.
Fábio Veras Soares and Ahmed Raza
Smallholder agriculture is the main source of income for the majority of the world’s poor people who live in rural areas.
Marcello Vicovaro, Ana Puhac and Florence Tartanac
The immense malnutrition challenge of today calls for a transformation of the food system.
Pilar Santacoloma and Manuel Anta
International Policy Centre for Inclusive Growth (IPC-IG)
SBS, Quadra 1, Bloco J, Ed. BNDES, 13º andar 70076-900 Brasília, DF - Brazil ISBN 978-92-5-133761-5 Telephone: +55 61 2105 5000 [email protected] www.ipcig.org
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