ricu ture Public Disclosure Authorized 45363a+.. - ion m .* .'-'%! . rathway, Synergies and Outcomes u Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized From Agriculture to Nutrition: Pathways, Synergies and Outcomes THE WORLD BANK AGRICULTURE AND RURAL DEVELOPMENT DEPARTMENT O 2007 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 Telephone 202-473-1000 Internet www.worldbank.org/rural E-mail ardOworldbank.org All rights reserved. This volume is a product of the staff of the International Bank for Reconstruction and Development/The World Bank. The findings, interpretations, and conclusions expressed in this paper do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accu- racy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable law. The International Bank for Reconstruction and Development/ The World Bank encourages dissemination of its work and will normally grant permission to reproduce portions of the work promptly. For permission to photocopy or reprint any part of this work, please send a request with complete information to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA, telephone 978-750-8400, fax 978-750-4470, http:/ /www.copyright.com/. All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA, fax 202-522-2422, e-mail pubrightsOworldbank.org. Cover photos by World Bank staff members: vegetable produce at a Guatemalan market by Curt Carnemark; Senegalese girl carrying cassava leaves by Lianqin Wang; mother in BangIadesh feeding her child a food supplement by Shehzad Noorani. ACRONYMS AND ABBREVIATIONS vii ACKNOWLEDGMENTS ix EXECUTIVE SUMMARY xi World Food Security And Nutrition Situation 2 Structure of the Report 7 Determinants of Human Nutrition and the Pathways Linking Agriculture and Nutrition 9 Pathways Linking Agriculture to Nutrition 12 The Impact of Agriculture Interventions on Nutrition Outcomes 15 The Nutritional Impacts of Agricultural Interventions 16 Gender Outcomes of Agricultural Interventions 30 Lessons Learned 31 Orange-Fleshed Sweet Potato Production and Vitamin A Deficiency in Mozambique 33 Legume Systems and Child Nutrition in Malawi 36 Integrating Homestead Gardening and Primary Health Care Activities in South Africa 38 Homestead Gardening for Fruits, Vegetables, and Livestock in Asia 39 Lessons from the Four Case Studies 42 iv Contents The Changing Context of Agriculture and Nutrition Linkages 43 Agricultural Policy 43 Agricultural Technology 47 Food Marketing Systems 50 Food Consumption Patterns 53 Conclusions 56 1 Institutional Frameworks for Action in the Agriculture Sector to Address Undernutrition 59 Institutional Barriers to Coordinated Action in Nutrition 60 Resource Allocation and Planning 61 Sector Mandates and Priorities 61 Unique Sectoral Worldviews 62 Constrained Capacity for Nutritional Analysis 63 Institutional Mechanisms to Enable Agriculturists to Address Undernutrition 63 Conclusions 67 0 Lessons Learned and Next Steps 69 APPENDIX 7 3 BIBLIOGRAPHY 75 Figures 1 Estimated Prevalence of Stunted Preschool Children 1980-2005 4 2 Estimated Prevalence of Underweight Preschool Children 1980-2005 5 3 Overweight and Obesity among Women 45-59 Years of Age, by WHO Region 6 4 Estimated Prevalence of Overweight Preschool Children (O/O) 7 5 Conceptual Framework of the Determinants of IUutritional Status 10 7 Changes in Food Production per Capita over Ttme 48 6 Potential Impact of Technological Changes on Food Production and Consumption 48 Contents v Boxes 1 Messages from Publications on Agriculture and Nutrition, 1970s-2000s 11 2 lntroducing Orange-Fleshed Sweet Potato in Rural Mozambique 34 2 lntroducing Orange-Fleshed Sweet Potato in Rural Mozambique, Cont. 35 3 Legume Systems in Malawi: Building on Local Knowledge, lmprovi ng Nutrition 37 Trade Liberalization and Food Availability: Synthesis of Cases in South Asia 4 6 Trade Liberalization and Food Availability: Synthesis of Cases in South Asia, Cont. 47 Decline in Consumption of Pulses in India: The Effect of Technology and Domestic Policies 49 Situating Nutrition Administratively within the Public Sector 60 The Institutional Study under the Agriculture-Nutrition Advantage Project 6 1 Nutrition and Sectorwide Approaches to Planning 62 Home Economists as Agricultural Extension Agents 66 Tables 1 Prevalence and Number of Undernourished People in Developing Countries 1990-2003 3 2 Key Results from Selected Studies of Agricultural Commercialization 17 3 Summary of the Evaluation Findings of Horticultural and Nutrition Projects 2 1 4 Summary of Intervention Studies on Impacts of Animal Source Food Interventions on Nutrition-Related Outcomes 25 5 Potential Effects of the Changing Context on Pathways Linking Agriculture and Nutrition 44 6 Annual Average Growth in Retail Sales of Packaged Foods, 1996-2002 51 7 the Growth of Modern Retail in Developing Countries 52 8 Composition of Global Agricultural Food Exports (% of value) 53 9 Average Annual Growth in Global per Capita Consumption ofvarious Food Items (%) 54 10 Average Annual Share of Arable and Permanent Land Used for Harvest (%) 5 5 11 Worldwide Annual Average Growth in Food Production (%) 56 Acronyms and Abbreviations AVRDC Asian Vegetable Research and Development Center BMI body mass index CDD community-driven development FA0 Food and Agriculture Organization (United Nations) FRT Farmer Research Team HACCP Hazard analysis critical control point HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome HKI Helen Keller International TDRC International Development Research Center IFPRI International Food Policy Research Institute NGO nongovernmental organization OECD Organization for Economic Co-operation and Development OFSP orange-fleshed sweet potato SETSAN Technical Secretariat for Food Security and Nutrition (Mozambique) SFHC Soils, Food and Health Communities Study (Malawi) SWAP sectorwide approach TANA The Agriculture-Nutrition Advantage Project UNESCO United Nations Educational, Scientific and Cultural Organization UNICEF United Nations Children's Fund USAID United States Agency for International Development VITAA Vitamin A for Africa VITAL Vitamin A Field Support Project WFSP white-fleshed sweet potato WHO World Health Organization WTO World Trade Organization This report was prepared by a multi-institutional and interdiscipli- nary team from the International Food Policy Research Institute (IFPRI)and the World Bank (WB). The key contributors were Corinna Hawkes, Marie Ruel, Mary Arimond, Zeina Sifri, Todd Benson, Devesh Roy, and Noora-Lisa Aberman (IFPRI), Peter Berti (HealthBridge, Canada), Jef Leroy (National Institute of Public Health, Mexico), Edward Frongillo (University of South Carolina), Nwanze Okidegbe, Lynn Brown, Gunnar Larson, and Chris Delgado (World Bank). The task team would like to extend their thanks to the project ad- visors Nicolas Minot (IFPRI) and Peter Berti (HealthBridge), as well as to Michelle Adato, Damiana Astudillo, Bonnie McClafferty,and Ginette Mignot. The report's content editor was Gumar Larson (World Bank, Agriculture and Rural Development). Peer reviewers included Meera Shekar, James Garrett, Harold Alderman (World Bank), Beatrice Rogers (Tufts University), and Bruce Cogill (UNICEF). The task team thanks Sushma Ganguly (retired), Mark Cackler (Sector Manager and Acting Director of World Bank Agriculture and Rural Development), and the ARD Management Committee for their support and guidance. The team acknowledges Lisa Li Xi Lau for her support in the logistics and production of the report. Executive Summary INTRODUCTION In a world of food abundance, millions of people suffer from poor nu- trition. In some parts of the world, the poor have inadequate access to energy from food to meet their energy requirements. In these loca- tions, food shortage is often a seasonal phenomenon and micronutri- ents are also generally lacking in the diet. Elsewhere, there is a stable supply of energy but the poor have monotonous diets lacking in es- sential micronutrients. In other places a "nutrition transition" is under way in which the poor and other consumers enjoy sufficient access to energy, and indeed often consume excessive amounts, but the quality of their diets is unhealthy owing to a combination of fac- tors relating to nutrition and lifestyle. Excessive consumption com- bined with more sedentary lifestyles, often associated with urbanization, contributes to an increasing incidence of obesity and chronic disease such as diabetes in countries still plagued by under- nutrition. A combination of these nutritional problems adversely af- fects about 2 billion people worldwide. The relationship between agriculture and human nutrition is far more complex than the relationship between food production and food consumption or the economic relationship between food supply and food demand. Increased food production