HKI s Homestead Food Production Program Model in Asia Workshop on Measuring Effects of Agriculture-Health Interventions Aminuzzaman Talukder, MPH Regional Food Security Advisor, Asia And Country Director, Cambodia Helen Keller International. Nutrition and Health Effects of Homestead Food Production program in Asia Presentation made to LCIRAH and IFPRI Workshop London May 12-13, 2011
Today s Presentation I. Case Study: HKI s Homestead Food Production program model and results to date II. Agricultural programs: Design issues relevant for nutrition outcomes III. Future Priorities
I: Case Study: HKI s Homestead Food Production (HFP) Program Model
Pilot Home Gardening Project initiated in Bangladesh Initiated the first pilot project in 1990 to improve dietary diversity and micronutrient status, particularly vitamin A Worked with 1000 marginal and landless families represented by women Based on the findings from the pilot project, eventually scaled up throughout the country to cover 210 sub-districts
Home Gardening: What did we learn? Increased availability of vitamin A and other MN rich foods and their consumption Talukder et al, Food Nutr Bull 2000;21:165-172 Diversification is important for increasing consumption and possibilities to increase varieties of food - Bloem et al, Eur J Clin Nutr 1996;50:s62-s67 Ensures year round availability - Talukder et al, Food Nutr Bull 2000;21:165-172 Increased family income and women s participation in decision making Bushamuka et al, Food Nutr Bull 2005;26:17-25
HKI expanded concept of Home Gardening to Homestead Food Production Study results showed lower bioefficacy of b-carotene from plant foods than previously assumed (West et al. 2002, J. Nutr. 132: 2920S 2926S) HKI added animal foods into foodbased programs to increase micronutrient intake among women and children (HKI Nutrition Bulletin Jan 2003, APRO)
HFP to date So far, HKI has worked in partnership with > 200 NGOs and GOs Cumulative coverage is more than 950,000 households and 5.5 million beneficiaries over 20 years of implementation Establish homestead food production practices through Village Model Farm (VMF) Women are primary farming beneficiaries Nutrition education component by incorporating a strong nutrition behavior change element based on the Essential Nutrition Actions (ENA) framework Countries: Bangladesh, Nepal, Cambodia & Philippines and 3 countries in Africa
HKI s HFP Program Model Objective of HKI s HFP model: Improve nutritional status of vulnerable members of low income households through home production of micronutrient (MN) rich foods including vegetable and fruit crops, small animals, poultry. First generation programs focused on micronutrient outcomes (esp. vitamin A and iron) via dietary diversity and not child growth Today our new E-HFP model has stronger focus on infant and young child feeding and behavior change (via Essential Nutrition Actions) with expectation for improvements in child growth
Intervention includes: Inputs support: improved breed of chicken, fish cultivars, horticultural inputs, poultry vaccines, animal fodder (e.g. napier grass) Training in farming and animal husbandry Training in Essential Nutrition Actions (ENA) and behavior change Establishment of links for marketing & resource access Partner engagement and contribution HKI:financial, training, materials, technical & managerial NGOs: personnel, operational Households: chicken; poultry & fish feed, poultry shed
Model for implementation of HKI s homestead food production program Village Model Farm (VMF) 15-20 VMF per district Farmer s Groups (Women s groups) 2-3 Groups per VMNPF Households (Women) 20 HHs per group Approximately 1,200 households per district
Village Model Farm
Village Model Farm
Type of homestead garden Traditional Improved Developed
Poultry and small animals
IEC/BCC materials for nutrition education and behavior change Posters and leaflets
Regarding HKI s HFP program in Bangladesh, IFPRI reports (2009): there is sufficient evidence to conclude that HFP is improving household food security, and in some cases nutrition and other intermediary outcomes IFPRI Evaluation under Millions Fed review: Improving diet quality and micronutrient nutrition: Homestead food production in Bangladesh by Iannotti, Lora; Cunningham, Kenda; Ruel, Marie. 2009. IFPRI Discussion Paper 928.
Child consumption/ # varieties Production and consumption of vegetables by type of garden (n=10,107), Bangladesh Production (kg) Crop diversity, production and consumption increased 7 6 5 4 3 2 1 Child consumption Number of varieties 60 Production in last 2 mo (kg) 50 40 30 20 10 0 None Traditional Improved Developed Garden type 0 Source: Talukder et al. Food Nutr Bull 2000;21:165-172
Prevalence of XN (%) Prevalence of nightblindness among underfives (12-59 mo) that had not received VAC by home garden and poultry ownership (n=4296) (Kiess et al, APHA abstract, 2003) 3.5 3 Night blindness decreased 2.5 2 1.5 1 0.5 0 No HG, No Poultry Poultry HG HG & Poultry
Evidence from Bangladesh that gardening reduces risk of vitamin A deficiency 1997-98 Bangladesh National Vitamin A Survey Among non-vac recipients, children living in households without garden are 2.2 times more likely to be night blind Proportion with low serum retinol lower among children living in households with a garden Prevalence of VA deficiency among women lower in households with garden Source: National VA survey report, IPHN/HKI Bangladesh 2000
Anemia prevalence among children aged 6-59 mo from program and control households in Bangladesh, Cambodia, Nepal and Philippines 90 80 70 60 50 40 30 20 10 0 64 66 65 78 70 72 70 64 65 57 59 45 50 43 Baseline 31 Endline 17 Target Control Target Control Target Control Target Control Bangladesh Nepal Cambodia Philippines Source: Talukder et al. FACTS Report 2010
Anemia prevalence among non-pregnant women from program and control HHs in Bangladesh, Cambodia and Nepal 70 60 50 40 51.4 51.6 45 51.9 58 42.9 60 62.9 51.8 50.8 51.5 40.8 30 20 10 Baseline Endline 0 Target Control Target Control Target Control Bangladesh Nepal Cambodia Source: Talukder et al. FACTS Report 2010
HH Commodities Main use of income earned bimonthly by selling garden produce and poultry & egg % of HH spending income from vegetable and fruits (US$6) on: % of HH spending income from egg and poultry (US$4.5) on: Food 77 61 HFP reinvestment 9 13 Saved 0 2 Clothing 3 9 Education 8 8 Medicine 0 1 Housing 0 6 Social activities 3 0 Source: Bangladesh, Cambodia, Nepal and Philippines HFP monitoring report
HFP Benefits Participating families were able to diversify their diets increasing consumption of micronutrient-rich foods, including poultry and fish generating income, also to be spent on foods thereby contributing to improved household food security and nutrition HFP empowers women through increased control over family production, income and decision making
II. Summing up: program design Most importantly need to ensure that all three key elements of FOOD, HEALTH and CARE are addressed Need to get agriculture and health to work handin-hand for better nutrition
HKI s HFP model showing the FOOD-CARE-HEALTH components Farmer s Groups FOOD (primarily women) HEALTH CARE 25
HKI s key program impact pathways to achieve objectives Increased year-round production & consumption of home New Enhanced-HFP Model: produced micronutrient-rich vegetables and fruits and animal source foods (increased dietary diversity) increases emphasis on Care and Health Increased household income from the sale of production that can be used to purchase nutritious foods & other necessities, especially that under control of participating women Improved child nutrition and health practices through nutrition education and links to local health services Improved child care and family welfare through the empowerment of participating women
III. Future priorities and Challenges
Future Priorities Re-tool HFP program model (based on program theory to intensify focus on achieving impact on child growth (enhanced-hfp) Address landless (ultra poor) and families with very small holdings Conduct research to un-pack the many black boxes to better understand program impact pathways especially those leading to improved nutritional status and to improve cost effectiveness (partnering with IFPRI)
Thank you!
Acknowledgements USAID, OFDA IFPRI European Union NOVIB Partner NGOs and GOs in Cambodia, Nepal, Bangladesh and the Philippines CIDA Monsanto NHF www.hki.org