Foro Global sobre Seguridad Alimentaria y Nutrición (Foro FSN)

Please find below an example submitted by Switzerland, responding to the call for examples and good practices on investments for healthy food systems.

With best regards,

Marlene Heeb

Programme Officer

Global Programme on Food Security

Department Global Cooperation

Federal Department of Foreign Affairs (EDA)

Swiss Agency for Development and Cooperation (SDC)

Proponent

Switzerland



Date/Timeframe and location

2015-2018, Zambia - Uganda



Main responsible entity

Swiss Agency for Development and Cooperation (SDC)



Nutrition context

Micronutrient deficiency is particularly prevalent in countries where diets consist heavily of starchy staples. Limited availability and accessibility of nutrient rich foods such as fruits and vegetables throughout the year and low recognition of the value and importance of a diverse diet for improved health reduces their consumption. High levels of malnutrition are also associated with high levels of gender inequality.  Among others, the distribution of nutrients within a household is often biased towards the male head of household and not favoring the household members most in need, i.e. children and lactating mothers.

Chronic and acute malnutrition affects over 200 million children under 5 years of age and more than two billion people suffer from micronutrient deficiency.

Zambia has one of the highest rates of stunting in the world with 40% among children under five. Micronutrient deficiencies among children are 54% for vitamin A, and 53% for Iron. In Uganda, 29% of the children under five are stunted, while 11% are underweight and 4% are wasted. Aside from the moral imperative with poor development and lost lives, the economic cost of malnutrition has been estimated to be as high as US$775 million between 2004 and 2013 in Zambia. In Uganda, the incentive to invest in nutrition is high. Every Dollar invested in nutrition result in economic benefits at least six times more.



Key characteristics of the food system(s) considered

In Uganda and Zambia, the food systems are diverse with both local (short) and long value chains, affected by seasonal variations, current consumer demand and cultural, regulatory, social and economic factors.

Zambia: About 60% of the Zambia population live in rural areas and depend on agriculture for livelihoods and food. However, Zambia is marked by relatively low agricultural productivity and diversification. Maize production predominates, and is the main cash and subsistence crop. The lack of crop diversity is reflected in dietary practices, which are predominantly staple cereal based with little diversity and hence is one of the main contributors to the high malnutrition rates. Some foods, e.g. fish are subject to seasonal availability and have begun to decline for a variety of socio-ecological pressures. Mono-cropping also affects the ecosystem, and climate change, reduced crop yields, livestock disease and reduced fish supply are adding to the challenges that communities face. The commercialization of small-scale agriculture, which dominates the rural economy, is an important element in Zambia’s economic growth strategy. Over 300,000 smallholders are linked to agribusinesses through more or less vertically integrated value chains, and the supply chain almost always incorporates intermediary traders. Although, there is a concern that commercialization may not benefit the smallholders, public private partnerships in extension, for example, could improve value chain and increase benefits going to smallholders. Additionally opportunities exist in the horticulture sector, offering an incentive for farmers to diversify and also providing these nutritious foods at an affordable price to poorer consumers.[1] In Chinsali and Isoka, where the investment is made, the food systems are ‘traditional’ (i.e. ‘low external input-intensive food systems’)[2] Crop yields and livestock productivity are generally low and if sold in local markets, commodities are relatively unprocessed. Agricultural production, commodity and food trading and processing takes place in small-scale operational units, which have little or no commercial linkages outside the local region. Typically, market relations are spot exchange, in which commodities are traded for immediate delivery. The majority of the food consumed comes from within the local area and consumption patterns are often seasonally dictated.

Uganda: In the Western region, where the investment is taking place, high rates of malnutrition persist and diets lack diversity, although the region is fertile with high agricultural production and potential for diversification. With stunting levels of 41% compared to 28% national average,  Tooro region has the highest levels of stunting for the under 5 in the entire country Growing pressures on farming households to sell nutritious produce for cash is a factor. Additionally increased cash cropping affects the soil and the gap between actual and potential yields is widening. The annual cost of environmental degradation, including agricultural driven encroachments, soil erosion and water pollution, is high. Over 73% of all households and the majority of the poor in Uganda depend directly on agriculture. Although there is more diversified food production in Uganda compared to Zambia, the diets are still mainly composed of cereals, starchy root crops and plantain, illustrating that the linkage between production, household food security and nutrition, particularly amongst vulnerable groups is complex. However, there is an opportunity to develop food system interventions which address the impact pathways to improved nutrition, including gender, and social and behavior change. This is relevant to Uganda where food systems are changing. For example rapid urbanization and improvements in roads and infrastructure are driving a massive growth in trade from the rural hinterlands to the capital [3]



Key characteristics of the investment made

The investment consist of a project aiming to improve food and nutrition security through the adoption of agro-biodiversity and dietary diversity at the intra household level.

It’s implemented in 4 districts in Uganda and Zambia: Kasese and Kyenjojo in Uganda and Chinsali and Isoka in Zambia. The Project has reached 4900 households in Zambia, a total of 25’480 people, and 12’310 households in Uganda, covering a total of 66’532 people.

The intervention model is based on four integrated pillars

1. Triggering demand: This is achieved through building capacities among local leaders and district level service providers for triggering and maintaining demand for intra household dietary diversity.
2. Behavioral change: Effective behavioral change communication nuanced to all varied target groups, such as pregnant and lactating women, is anchored in local practice and is community owned to ensure long-term sustainable behavior change in improved dietary diversity, nutrition and agro-biodiversity at intra household level
3. Diverse supply: Appropriate, affordable and diversified nutritious products are available at scale supported by locally-available and locally-managed inputs, extension services and market linkages
4. Governance: national multi-sectoral governance capacity for intra household dietary diversity and improved nutrition is strengthened through the establishment and/or strengthening of district level nutrition coordinating committees. The Right to Adequate Food is a human right and as governments are duty bearers for realisation of that right, the project anchors its work in local and national structures to ensure sustainable change and scalability to national level.

See also: https://www.youtube.com/watch?v=0j0PgN6u1FE



Key actors and stakeholders involved (including through south-south/triangular exchanges, if any)

National Partners:

• SUN Focal Point of the governments of Zambia and Uganda
• District Nutrition Coordinating Committees
• Health and Agricultural service providers (Village Health Teams, Extension Services, etc.)

International Partners

• SNV Netherlands Development Organization
• Wageningen University CDI
• Royal Tropical Institute KIT

​​​​​​​Key changes (intended and unintended) as a result of the investment/s

Outcome 1: Capacities among local leaders and district level service providers for triggering and maintaining demand for intra household dietary diversity at scale built.

At the start of the project, capacity amongst various district staff to create demand for nutrition at the village level was limited, but has significantly improved since and district staff has now the capacity to implement and upscale the approach as part of their own district plans.  Gender being a critical component of the project, triggering sessions addressed communities as a whole, involving men and women, elders, adolescents and children.

This provided a unique opportunity for men to become sensitised to the impact of malnutrition on their children. Often nutritional counselling involves only mothers when they take the children for growth monitoring visits at the local health centres.

Outcome 2: Effective behavioral change communication nuanced to all varied target groups, such as pregnant and lactating women, is anchored in local practice and results in improved dietary diversity, nutrition and agro biodiversity at intra household level

The triggering of the villages resulted in first tangible and measurable behaviour changes. The BCC campaigns reached the majority of households in the intervention area and the following results are observed after 1.5 years of intervention: 61% of the households from target population in Zambia and 78% in Uganda eat 3 meals a day. Dietary diversity has improved, from being largely staple cereal based.

Outcome 3: Appropriate, affordable and diversified nutritious products are available at scale supported by locally-available and locally-managed inputs, extension services and market linkages

In Zambia 48% of the targeted households and 72% in Uganda established gardens, producing various types of vegetables and other crops, like green Amaranthus, carrots, rape, black night shade, orange fleshed sweet potatoes, cow peas, cassava, maize, pumpkin leaves, beans, groundnuts cow peas. Local input system has also improved, producing its own seed for sale and extension services include nutrition dimensions in their service provision.

Outcome 4: national governance capacity for intra household dietary diversity and improved nutrition is strengthened

The establishment of two District Nutrition Coordinating committees, one in Zambia and Uganda each led to combined district nutrition plans whose implementation is well coordinated. Intersectoral coordination has greatly improved, with individual departments sharing resources, skills and monitoring district progress in a coordinated way. This has improved district performance and increased efficiency in implementation of activities.



Challenges faced

The multi- and inter-sectoral implementation of the approach at the district level was challenging and during the course of the project, it was recognized that another coordination layer was needed at the sub-district level i.e. A Hub level Nutrition coordination committees (HNCC). This created greater ownership and has made project implementation and monitoring very cost effective and sustainable.

Another finding is that effective community mapping and behavioural research is critical to identify all the factors involved in influencing positive behaviour change.



Lessons/Key messages

Increasing governance capacity and knowledge at local level has shown to be most effective for improving nutrition outcomes.

The creation of the multi-stakeholder partnerships (Nutrition Coordinating Committees) at the lowest governance level possible (sub-district vs District level) is crucial for ownership and successful service provision to improve nutrition.

To spark behaviour change among communities, triggering approaches proved very successful, as they make communities take a critical look at their behaviours related to production systems, consumption patterns, diets and nutrition and hygiene. This in turn leads to a realisation that malnutrition (stunting) is an issue, affecting the health and development of their children and locally available solutions are possible.