Country Policy Analysis

Nutrition Impact of Agriculture and Food Systems

Malawi

August 2013 (First Draft) March 2014 (Final)

UN System Standing Committee on Nutrition country study for the second International Conference on Nutrition

2 | P a g e

Foreword This case study was authored by Anne-Marie B Mayer, with contributions from Nynke Kampstra

for Q sort method. This document has gone under two levels of review and feedback and is in

the final stages of national endorsement.

3 | P a g e

Table of Contents

Executive Summary ............................................................................................ 5

Acknowledgements .......................................................................................... 13

Acronyms .......................................................................................................... 14

Purpose of Study and Research ......................................................................... 16

1. Introduction .............................................................................................. 18

1.1 Background ................................................................................................................ 18

1.2 Situation analysis ......................................................................................................... 1

2. Methods ..................................................................................................... 9

2.1 Literature sources ........................................................................................................ 9

2.2 Policy Analysis ............................................................................................................ 10

2.3 Country visit to Malawi .............................................................................................. 10

2.4 Interviews and group discussion ................................................................................ 10

2.5 Project visits: .............................................................................................................. 11

2.6 Q-Sort method for assessing opinions ....................................................................... 12

3. Findings ..................................................................................................... 13

3.1 Stakeholder perception of the causes of undernutrition .......................................... 13

3.2 Agriculture history & policies ..................................................................................... 14

3.3 Main objectives of the policies .................................................................................. 16

3.4 Agriculture and Dietary Diversification in policies and strategies ............................. 19

3.5 Priorities in the current national nutrition policy and action plans. ......................... 22

3.6 Review of terminology and concepts used in Malawi related to food and nutrition

security ....................................................................................................................... 25

3.7 Analysis of the nutrition-sensitivity of the specified food and agriculture policies

and frameworks: Policy mapping for 10 dimensions of nutrition sensitivity ............ 26

3.8 Impact pathways key impacts and where the policies fit into the IFPRI pathways

model and the UNICEF causes of Child Undernutrition model ................................. 28

3.9 How the stated policies impact nutrition outcomes (directly and/or indirectly)

(undernutrition, micronutrient deficiencies, and dietary diversity) of different

population groups ...................................................................................................... 29

3.10 National data trends on Agriculture and Dietary Diversification .............................. 30

3.11 Summary points on financing .................................................................................... 32

3.12 Commitments to Nutrition Centred Agriculture in Malawi ....................................... 32

3.13 Policy Implementation ............................................................................................... 35

4 | P a g e

3.14 Example 1 Agriculture and Health extension systems for implementation of the

ASWAp and NNPSP at District and Community Levels .............................................. 36

3.15 Example 2: Legume production and utilisation in Kasungu District ........................ 39

3.16 Example 3: School Health and Nutrition Strategy .................................................... 41

3.17 Example 4 Model Village Approach Concept (GOM DAES 2000) ............................. 42

3.18 Conclusions from the examples: ................................................................................ 43

3.19 Stakeholders’ views on implementation of nutrition centred agriculture ................ 43

3.20 M & E systems (as described in key policies & strategies) ........................................ 49

3.21 Q-Sort Results ............................................................................................................ 50

3.22 Final appraisal of nutritional value of analysed action .............................................. 53

3.23 Achievements ............................................................................................................. 53

3.24 Opportunities ............................................................................................................. 53

3.25 Conclusions ................................................................................................................ 57

4. Annexes .................................................................................................... 58

4.1 Schedule and people met .......................................................................................... 58

4.2 Timeline of the consultancy ....................................................................................... 63

4.3 Terms of Reference .................................................................................................... 64

4.4 Q Methodology Exercise ............................................................................................ 70

4.5 References.................................................................................................................. 95

5 | P a g e

Executive Summary

1. BACKGROUND TO THE CASE STUDY

1.1. Objectives were to:

review how food and agricultural policies are having or are intended to have an impact

on nutrition through food systems in Malawi;

to contribute to the advancement of the discussion on improving agriculture for

nutrition;

to prepare for the ICN2 International Conference on Nutrition in 2014.

1.2. Specific Objectives were to:

review the current food and nutrition situation in Malawi;

review key policies;

identify potential points of impact on the food and nutrition system;

describe policy processes how they support the Nutrition-Agriculture links;

review implementation of key policies; to review impact or potential impact of policies /

strategies/ actions on nutrition.

The example of agricultural diversification and dietary diversification will be used to

illustrate the links between agriculture and nutrition for this case study.

2. INTRODUCTION:

Malawi is one of the poorest countries in the world and this poverty is accompanied by

poor nutrition statistics. However improvements are apparent and Malawi is on track to

meet its MDG target for underweight. Stunting has also improved: a reduction in child

stunting between 2004 (53%) and 2010 (47%). Malawi could be described as in ‘early’

stage of Nutrition-transition with half as many underweight as overweight adult women

(8.8, 17.1% respectively). Maize is the main staple crop in Malawi (80% of cropped area)

and is central to the food culture with 60% dietary energy intake. Agricultural diversity is

poor with half farmers growing just one crop in the worst district. Underlying causes of

under-nutrition in Malawi include food insecurity, poor caring practices and health

environment and basic causes cross all sectors and include issues related to agriculture,

health, gender, economics, environment and policy.

By comparing agriculture, food security, nutrition and hunger reports some questions

emerge:

What has contributed to the improvements in nutrition?

There is an assumption that increasing maize production will improve food security, but

what is the relationship between increased maize production and nutrition security?

What is the relationship between agricultural diversification and diet quality?

6 | P a g e

3. METHODS:

The assignment was carried out from the end of March 2013 to August 2013. It started

with ‘Meeting of Minds’ in Geneva in which ‘nutrition sensitive’ development was

discussed with a group of experts. The ToR was developed between the UNSCN, the

Government of Malawi’s Office of the President and Cabinet, key UN staff in Malawi and

the consultant. The assignment was carried out with Nynke Kampstra, a student from

Wageningen University who worked on Q sort methodology for qualitative assessment of

opinions of stakeholders on ‘nutrition sensitive’ agriculture.

The following policies were reviewed for ‘nutrition sensitivity’ by reference to the ‘Guiding

Principles for improvement of nutrition through agriculture’. Malawi Growth and

Development Strategy II 2011-2016; Economic Recovery Plan; Presidential Initiative on

Legumes; Presidential initiative on small stock production; National Agricultural Policy;

Malawi Agriculture Sector Wide Approach; Food Security Policy; National Nutrition Policy;

Strategic Plan NNPSP; National SUN Nutrition Education and Communication Strategy.

A visit to Malawi was undertaken in May/June 2013. During this time interviews were

conducted by the consultant (ABM) in Lilongwe with stakeholders from the Malawi

Government ministries of Health, Agriculture and Education and also District staff. UN

agencies, donors, NGOs and the Private sector, followed by trips to 3 of the 28 districts:

Zomba, Mangochi and Kasungu.

4. FINDINGS

4.1. Policy analysis

Since 1994, Malawi has developed policy documents addressing agricultural development

and emphasizing poverty reduction and food insecurity. Agriculture and Nutrition policies

developed together from 2004 then split to develop separately in 2006 and 2007, although

the topic of diversification of both agriculture and diet has drawn together initiatives from

both sectors and there is a joint monitoring system for some of the indicators.

Most of the policies reviewed had an overarching aim to improve economic

performance and reduce poverty in Malawi. The NNPSP aims to ‘achieve human

capital development and economic growth and prosperity through a better nourished

population’. Therefore nutrition is seen as a means to improve economic development.

For the majority of the policies nutrition is not specifically mentioned as a high level

priority and therefore, although nutrition is included it is not afforded high priority. In an

environment of enormous constraints on funding, nutrition actions can easily be side

lined or even dropped altogether.

Food security is a high level aim for the National Agricultural Policy and the Food

Security Policy only.

7 | P a g e

The Scaling up Nutrition (SUN) Nutrition Education Communication Strategy (NECS) is

focused on prevention of stunting and is aligned to a national campaign ‘1000 special

Days’ with outreach to many different sectors of the population. Priorities of the NNPSP

include food-related interventions such as: the promotion of access to nutritious meals

for school children, food safety and quality and nutrition-related non-communicable

diseases, recognizing that these have become a small but nevertheless growing public

health problem. Promotion of access to diverse foods is also included and the

coordination, advocacy and capacity for strengthening an enabling environment for

nutrition mainstreaming with a central coordinating body within the DNHA. The

ASWAp priority areas correspond to CAADP pillars 1-4; of particular relevance to this

case study is Pillar 3 (Increasing food supply and reducing hunger) which relates to the

first ASWAp focus area (Food Security and Risk Management) which includes i) Maize

self sufficiency ii) diversification of food production for improved nutrition with focus on

crops, livestock and fisheries and iii) risk management for food stability at National level.

Hence high level support and agreement was reached to prioritise agricultural diversity

for nutrition objectives.

4.2. ‘Nutrition Centred Agriculture’

The concept of ‘Nutrition-sensitive Agriculture’ has not been introduced into the language

of the policies in Malawi nor is it a popular term; alternatives could be ‘nutrition driven’,

‘nutrition focused’, ‘nutrition centred’. This report will utilize Nutrition Centred Agriculture.

Taken as a whole the policies match up to most of the nutrition dimensions as outlined

in the ‘Guiding Principles’.

Malawi has worked on gender mainstreaming and cross sectoral working so these

features appear in most policies. ‘Targeting the vulnerable’ is also widely reflected in

the policies.

Increasing food production and diversified food production is featured widely in all but

the Economic Recovery Plan.

Nutrition objectives and indicators are built into the ASWAp but not the Food Security

Policy. The Economic Recovery Plan has no nutrition objectives.

Post harvest issues – storage, processing and marketing of nutrient rich foods is an

area that is not widely covered in policies. In Malawi the number one priority is maize

and this takes precedence over other crops in post harvest policies. The policies that

do mention processing, either of maize or other crops do not include processing for

nutrient retention. This is a large potential area to improve nutrient content of foods and

is so far an under-emphasised area for policy.

Environmental sustainability, natural resource management is included in most policies,

apart from the Economic Recovery Plan and Presidential Initiative on Legumes. In

Malawi economic recovery is seen as something apart from building nutrition and

natural resources.

8 | P a g e

4.3. Nutrition impact:

With present evidence it is difficult to determine what has contributed to improvements in

nutrition and how and where successes occurred. Data on trends are available for

agricultural production for limited foods from the food groups, but not consistently for

consumption and neither are linked to anthropometric data collection. Some NGOs report

positive impacts on Nutrition, for example the MICAH project showed reductions in

stunting and anaemia with data available. The Millennium Villages also report reduction in

stunting, although data were not available.

4.4. Funding:

Agricultural diversification is written into agricultural policies but the funding commitment is

not strong from Malawi’s own resources. At this time it is not possible to be clear about

budgets allocated to nutrition centred agriculture. The present ASWAp includes

diversification of agriculture and diets but this is not prioritised in comparison to production

of maize.

Maize self sufficiency is allocated 39 percent of the budget with 78% of the budget from

local resources and donors pledging an extra 11%

Sustainable water management is given 23% of the budget

Diversification and nutrition are allocated 10% of the budget. However, only 5% is

allocated from local resources; donors pledged 49% thus leaving a funding gap of 46%.

Other allocations are less than 10%.

4.5. Policy Implementation:

Programme and project reports, monitoring and evaluation reports, budget allocations,

human resource deployment and impact studies were not available for the case study, so

the approach was taken to review programmes and projects that illustrate implementation

of the policies using field visits and interviews with stakeholders. Projects and

programmes and indigenous systems that emphasise agricultural and dietary diversity are

used as examples of Nutrition-Centred Agriculture. The examples are:

1) Agriculture and Health Extension Systems for implementation of the ASWAp and NNPSP at

District and Community Levels

2) Legume production and utilisation in Kasungu District;

3) School Health and Nutrition Strategy

4) Model Village Approach Concept.

The examples illustrate the ways in which government and NGOs are working together

with Civil Society and the private sector to improve agriculture and dietary diversity. The

policies and strategies provide a framework for programme implementation and to support

farmers. They show that although documentation is sparse, a wide range of programmes

and other actions are being implemented in Malawi – many of which might not be visible in

9 | P a g e

peer reviewed journals. Stakeholders shared views on what has facilitated and what has

challenged implementation.

Supportive: Advocacy on nutrition, donor support, the SUN movement, the formation

of the DNHA, new Behaviour Change Communication (BCC approaches, the Care

group model for delivery of BCC were amongst the facilitating factors.

Challenges: Capacity and support for field operations, coordination and clarity on

responsibilities at national and district and community level, lack of nutrition priority or

mainstreaming in agriculture strategies. Logistical difficulties were highlighted at the

district level, such as lack of fuel and vehicles to reach communities; insufficient staff;

coordination, sustainability and competing interests of NGOs.

4.6. Policy processes and alignments:

The formation of the DNHA within the OPC has enabled Nutrition actions to be

coordinated through one office that reports straight to the President. National Nutrition

Committee (NNC) with 7 Technical Working Groups (TWGs) 1 for Nutritionists in the

different sectors is coordinated by DNHA and includes development partners, academia

and sector ministries. The TWGs cover Micronutrients, School Health and Nutrition,

Nutrition Care Treatment and Support, IYCF, Integrated Food and Nutrition Surveillance,

Targeted Nutrition Programmes and Nutrition Education & Research. The SUN framework

is also setting up national coordination mechanisms at National and District levels. At the

District level District Nutrition Coordinating Committee (DNCC) operate under the District

Executive Committee. A district level SUN task force is also planned. It is not clear how

these structures will work in practice. At community level various traditional structures,

such as Village Development Committees and newer structures such as CLAN

(Community Leaders for Action on Nutrition) and other groups act as a focus for training

and coordination.

4.7. Key commitments

Key Commitments to Nutrition in Malawi are the SUN Movement ; the MGDS is strong on

Nutrition commitment, Malawi has made strong commitments to Nutrition in the ‘Nutrition

for Growth’ conference in June 2013, London including the commitment to nutrition

strategies with agriculture, increased financing and extra support at District and

Community levels for nutrition. There was a commitment by the GoM to increase the

nutrition budget from 1-2% to 3.3%. Support for Nutrition Improvement Component (SNIC)

project has the objective to increase access to and utilization of selected services known

to contribute to the reduction of child stunting, maternal and child anaemia. The

international Hunger and Nutrition Commitment Index (HANCI) scores Malawi second

globally on commitment to Nutrition.

1 In January 2014 OPC DNHA led a review of the TWGs which is now if its final stages. There are 5 TWGs proposed

and possible adjustments to be made to other committees, groups and task forces: NNC, Nutrition Development Partners, DONUTS, and SUN Task Force

10 | P a g e

5. OPPORTUNITIES

5.1. Documentation and learning:

Impact data for nutrition and dietary data are priorities for development of strong evidence

of nutrition-centred agriculture. With greater attention to good impact evaluations, it would

be possible to show how well policies, programmes and actions are working in Malawi.

Strong evidence would be useful for donors, but perhaps more importantly show what

strategies are working and where improvement is needed to achieve impact. For nutrition-

centred agriculture this is particularly important because the evidence internationally is

sparse so it is also not possible to draw on international evidence to support policies and

programmes. This means locally produced evidence is all the more valuable – both

nationally and internationally. It would be useful to have regular reports available on

Coverage of programmes. Lessons-learnt and impact of programmes need to be

documented, published and disseminated to enable real learning to result from the

experiences of implementation.

5.2. Poverty reduction:

In a country such as Malawi, an effective way to address nutrition is always going to be

targeting small and marginal farmers for support. What is clear is that small farmers will be

the route to agriculture and poverty reduction. When small farmers are more secure in the

knowledge that staple foods are sufficient, diversification will be more acceptable.

Therefore MPRS and other strategies are going to be key to nutrition improvement.

5.3. Sustainable approaches to agriculture and food security:

Food security is commonly interpreted as ‘maize security’; there is an opportunity to re-

orient food security to include diverse food production and to meet all nutritional needs

using the Malawi food groups. Agro-ecological agriculture offers promising decentralised

sustainable and empowering approaches to diversified food and nutrition security. These

approaches would gradually reduce the need to subsidise agricultural inputs when soil

fertility and local sources of fertility are established. Indigenous knowledge, crops, cooking

and processing methods and systems of organisation in communities offer good

opportunities to improve nutrition. There is little mention of ways to ensure nutritional

quality of foods other than through fortification and biofortification using plant breeding in

policies, and this is limiting opportunities. There is considerable opportunity to improve

nutrient content of foods through agronomic approaches and through reduction in losses

on processing and through diversification to naturally high nutrient content foods.

Research and development of this area would provide sustainable ways to improve

dietary micronutrient intake.

5.4. Value Chains approach:

The ‘Value Chains for Nutrition’ approach to nutritious crops in Malawi is beginning to

grow and will help to support each stage from ‘farm to fork’. Post-harvest processing,

storage and safety of foods other than maize is not strong in the policies and appears to

have fallen between the cracks of the sectors to some extent. With the high proportion of

food lost to spoilage and waste, this topic would merit receiving attention alongside

11 | P a g e

strategies to improve agricultural production. Contamination with mycotoxins is an

important food security issue for Malawians. Greater focus on Aflatoxin control would be

an opportunity to improve food safety in Malawi.

5.5. Seed Systems:

One important obstacle to production of diverse foods is lack of seed availability. A

stronger focus on promotion of local, indigenous seed multiplication (from all food groups)

would help support production of diverse foods.

5.6. Coordination and alignment of policies and actions:

The District local government offices offer a good opportunity for coordination of work in

Nutrition. Coordination of the meetings could be carried out or supported by an

administrative role rather than by a Nutrition Officer to allow this function to happen in the

absence of a key staff. The mapping and coordination exercise of the ‘Support for

Nutrition Improvement in Malawi’ project will help with coordination and implementation of

nutrition actions. Sector wide approaches are necessary and need to be carried through

from policy to strategy to action. A Nutrition and Agriculture Sector Wide Approach and

Strategy might be appropriate to address the difficult task of coordinating these sectors.

5.7. Funding and Capacity for implementation:

With the clear interest in nutrition at this time, local capacity building could be an area for

development assistance (NGOs and international organizations) to concentrate their

efforts. There is an opportunity to increase funding for Nutrition in Malawi; this will be

facilitated by drawing up clear plans for nutrition-centred agriculture with support from

SUN and evidence of impact on nutrition.

6. CONCLUSIONS

6.1. Malawi has prioritised nutrition in its policies

The dimensions of nutrition-centred agriculture laid out in current guidelines have been

largely adhered to in policies. Post-harvest issues for nutrition are the exception and do

not appear strongly in policies for nutrition impact. Both agriculture and dietary

diversification however are often included. It is less clear what is actually happening at the

community level and how well implementation is working.

6.2. Coordination & Capacity

Coordination between sectors and between government, NGOs, the private sector and

communities is often cited by stakeholders as limiting implementation; as is capacity for

implementation.

6.3. Promising Practices

The case study has taken a set of examples to show that certainly good programmes are

being implemented, although to what extent is not known. Examples of indigenous

practices and new innovations in agro-ecological agriculture exist in Malawi alongside

subsidised input mono-crop farming.

12 | P a g e

6.4. Evidence

It is important to gather evidence soon to understand what models offer the best impacts

for food and nutrition security, so that Malawi can invest in cost effective programmes to

improve nutrition.

6.5. Good Nutrition for all – avoid triple burden of malnutrition

It is also important for Malawi to avoid falling into the ‘triple burden of malnutrition’ where

under-weight/stunted growth co-exists with overweight/non-communicable diseases and

micro-nutrient deficiencies, independent of weight status. This burden is experienced by

many countries and Malawi should introduce clear strategies to prevent this.

13 | P a g e

Acknowledgements

I wish to thank Nynke Kampstra for her contribution to the literature review and the Q sort analysis. Lina Mahy and the staff at SCN. For their support whilst in Malawi- Edith Mkawa (DNHA), Jean Chilemba, (DNHA) Blessings Muwalo,(DNHA) Mzondwase Agnes Mgomezulu (MoAFS DAES), Dr. Susan Kambale (WHO), and Stacia Nordin (FAO). To all the interviewees and support staff of the Malawi government, NGOs and UN agencies and donors for their time and interest in the study. To Flemish Aid for funding the Case Study.

14 | P a g e

Acronyms

Acronym Abbreviations

ADD Agriculture Development Division

ADP Agriculture Development Programme

AEDO Agriculture Extension Development Officer

AIDS Acquired Immunodeficiency Syndrome

ASWAp Agriculture Sector Wide Approach

BCC Behaviour Change Communication

BFHI Baby Friendly Hospital Initiative

BMI Body mass index

CAADP Comprehensive Africa Agriculture Development Programme

CBO Community Based Organization

CGIAR Consultative Group on International Agricultural Research

CHD Child Health Days

CIDA Canadian International Development Agency

CMAM Community Managed Acute Malnutrition

CRS Catholic Relief Services

CTC Community Therapeutic Care

DAESS District Agricultural Extension Services

DEC District Executive Committee

DHS Demographic and Health Survey

DCAFS Donor Committee for Agriculture and Food Security

DFID Department for International Development (UK)

DNCC District Nutrition Coordination Committee

DNHA Department of Nutrition, HIV and AIDS

DoNutS Donor Nutrition Support Group

DoDMA Department of Disaster Management Affairs

EBF Exclusive Breastfeeding

ENA Essential Nutrition Actions

EPA Extension Planning Area

ERP Economic Recovery Programme

EU European Union

FAO Food and Agriculture Organization of the United Nations

Acronym Abbreviations

FAOSTAT FAO Statistical Databases

FCS food consumption scores

FEWS-Net Famine Early Warning System Network

FICA Flemish International Cooperation Agency

FIDP Farm Income Diversification Programme

FNSIS Food and Nutrition Security Information Systems

FISP Farm Input Subsidy Program

FIVIMS Food and Security Vulnerability Information and Mapping System

GoM Government of Malawi

HANCI Hunger and Nutrition Commitment Index

Hb Haemoglobin

HIV Human Immunodeficiency Virus

IA Irish Aid

ICN2 International Conference on Nutrition II

ICRAF International Centre for Research in Agro-forestry

ICRISAT International Crops Research Institute for the Semi-Arid Tropics

IDS International Development Studies

IEC Information Education and Communication

IHS3 Third Integrated Household Survey, 2011

IFPRI International Food Policy Research Institute

IFSN Improved Food Security and Nutrition

IMCI Integrated Management of Childhood Illnesses

INVC Integrating Nutrition with Value Chains

IRLADP Irrigation Rural Livelihood Agriculture Development Project

ITN Insecticide Treated Net

M&E Monitoring and Evaluation

MDG Millennium Development Goals

MDHS Malawi Demographic and Health Survey

MGDS Malawi Growth and Development Strategy

MICAH Micronutrient and Health

15 | P a g e

Acronym Abbreviations

MoAFS Ministry of Agriculture and Food Security

MoE Ministry of Education

MoEPD Ministry of Economic Planning and Development

MoGCCD Ministry of Gender, Child Development and Community Development

MoH Ministry of Health

MoIWD Ministry of Irrigation and Water Development

MoLGRD Ministry of Local Government and Rural Development

MPRS Malawi Poverty Reduction Strategy

MVAC Malawi Vulnerability Assessment Committee

NASFAM National Smallholder Farmers’ Association of Malawi

NAP National Agriculture Programme

NCD Non Communicable Disease

NECS Nutrition Education and Communication Strategy

NEPAD New Partnership for Africa’s Development

NESP National Education Sector Programme

NGO Non-Government Organization

NNPSP National Nutrition Policy and Strategic Plan

NSO National Statistical Office

NRT Nutrition Resource Tracking

NRU Nutrition Rehabilitation Units

OPC Office of the President’s Cabinet

PHI Presidents Hunger Initiative

PLHIV People Living with HIV

Acronym Abbreviations

PMTCT Prevention of Mother-to-child Transmission

REACH Renewed Action for Ending Child Hunger

RoM Republic of Malawi

RUTF Ready to Use Therapeutic Food

SC Save the Children

SNIC Support for Nutrition Improvement Component

SO Strategic Objective

SUN Scaling Up Nutrition

SWAp Sector Wide Approach

TA Traditional Authority

TIP Trials of Improved Practices

TB Tuberculosis Bacillus

ToR Terms of Reference

TWG Technical Working Group

U5MR Under-five Mortality Rate

UN United Nations

UNDP United Nations Development Programme

UNICEF United Nations Children Fund

UNSCN United Nations System Standing Committee on Nutrition

US United States of America

USAID United States Agency for International Development

VAD Vitamin A Deficiency

WALA Wellness and Agriculture for Livelihood Advancement (Title II)

WASH Water and Sanitation Hygiene

WFP World Food Programme

WHO World Health Organization

WVI World Vision International

16 | P a g e

Purpose of Study and Research

The agriculture and food systems are best placed to influence food production and the

consumption patterns of nutritious foods necessary for a healthy and active life. Some of the

present agricultural and food systems have evolved to become more complex and global with

longer supply chains from farm to fork, while for a large proportion of the world’s population self

reliance and local food systems still provide for household food security.

Nutrition-centred agriculture aims to maximize the impact of the food and agricultural sector on

nutrition outcomes while minimizing any unintended negative nutritional consequences of

agricultural policies and interventions on the consumer. It is placing a nutrition lens on the food

and agricultural sector, without detracting from the sector’s other goals which include production,

productivity and income.

‘Nutrition Sensitive’ interventions were defined as “interventions or programmes the address the

underlying determinants of foetal and child nutrition development – food security; adequate care

giving resources at the maternal, household and community levels; and access to health

services and a safe and hygienic environment – and incorporates specific nutrition goals and

actions” (Ruel and Alderman 2013)

There is increasing attention to addressing the multiple forms of malnutrition (underweight,

stunting, micronutrient deficiencies, overweight, the double burden of malnutrition and obesity)

through agriculture and the food system. Important initiatives include the Scaling Up Nutrition

(SUN) Movement, with attention to multi-sectoral development action, the Zero Hunger

Challenge launched by the UN Secretary General to end hunger and malnutrition within our

lifetimes, the development of country CAADP plans (Comprehensive African Agriculture

Development Programme) that include nutrition in Pillar 3 (Food Supply and Hunger), the

CGIAR research program (CRP-4) on Agriculture for Improved Nutrition and Health (A4NH),

and the mainstreaming of nutrition as corporate priority for FAO WFP, UNICEF, and the UN

Network in general. In addition, several development partners are developing agriculture-

nutrition guidance and tools.

Applying a nutrition lens to agriculture and food systems should include a consistent focus on

nutritional outcomes and indicators within national food and agricultural policies and

programmes, and the broader macroeconomic policies and development strategies. The aim

should be to improve food and nutrition security and combat the multiple burden of malnutrition

through food and agriculture, and other relevant sectors. Although there is wide agreement on

the great potential for agriculture and the food system to improve nutrition, at present there are

limited experiences with this approach at scale and insufficient existence of rigorously supported

evidence-based technical recommendations to inform policy makers.

Therefore, there is a need to better understand how agricultural and food systems impact

nutrition outcomes. There is need to identify whether and how these systems can be modified to

better meet nutrition goals in a sustainable way and reduce the risk of the multiple burden of

17 | P a g e

malnutrition, including diet-related non communicable diseases (NCDs). There is an urgent

need to provide practical answers and guidance for countries on the “what to do?” and “how to

do it?” and “how to measure it” questions. There is also a need to understand how sectors can

work together to achieve agreed goals, objectives and funded plans.

A number of countries have started to link their national agriculture or food and nutrition security

policies to nutrition related outcomes and the multiple burden of malnutrition. These countries

refer to the multiple underlying causes of malnutrition in broad areas such as agriculture, food

security, food supply as well as various stages along the value chain. Some country strategies

take account of the multi-sectoral nature of nutrition.

Eight countries2 have been selected for in-depth review of specific ways in which food and

agricultural policies are having or are intended to have an impact on nutrition in that country.

These eight countries reflect different stages of the nutrition transition, – i.e. a position where

both undernutrition and obesity co-exist. In view of the multiple burden of malnutrition - hunger

and undernutrition are common, especially among children, while the incidence of overweight,

obesity and nutrition-related NCDs are increasingly occurring among adults- the case studies

are looking at both sides of the malnutrition problem.

Objectives of the Malawi Case study

• To review how food and agricultural policies are having or are intended to have an

impact on nutrition through food systems in Malawi

• To contribute to the advancement of the discussion on ‘nutrition –sensitive’ agriculture.

• Prepare for the ICN2 International Conference on Nutrition in 2014

Specific Objectives

• To review the current food and nutrition situation in Malawi

• To review key policies

• identify potential points of impact on the food and nutrition system

• To describe policy processes how they support the Nutrition-Agriculture links

• To review implementation of key policies

• To review impact or potential impact of policies / strategies/ actions on nutrition

The example of agricultural diversification and dietary diversification will be used to illustrate the

links between agriculture and nutrition for this case study.

The work will concentrate on undernutrition rather than obesity and overweight as Malawi is in a

very early stage in the ‘Nutrition Transition’.

2 Brazil, Malawi, Mozambique, Nepal, South Africa, Sierra Leone Senegal and Thailand,.

18 | P a g e

1. Introduction

1.1 Background

In 2008 the Lancet published a series of papers on Nutrition and identified actions that had

sufficient evidence to show positive impact on the prevention or treatment of malnutrition and

referred to them as ‘nutrition specific interventions’, which were largely interventions from the

health sector. Other nutrition interventions where evidence of impact was less clear were

referred to as ‘nutrition sensitive interventions’, which were basically nutrition interventions from

outside the health sector. Evidence of every aspect of nutrition needs to be better measured,

documented and shared, not just one aspect. Agriculture is one of the sectors that needs more

nutrition evidence.

In practice, there are multiple nutrition interventions that are needed to address all levels of the

Nutrition framework. Some interventions are for preventing nutrition disorders in order to

address root causes of the issues and to eliminate problems. Other interventions are

treatments, or preventative treatments, that address the immediate symptoms of the problem. A

combination and balance of both prevention and treatment interventions are required to address

current issues.

Guiding Principles for improving Nutrition through Agriculture are under development and are

detailed in Box 1. (FAO 2013). These principles were discussed at ‘the Meeting of Minds’ in

Geneva and under frequent revision. However they are straightforward and a useful ‘aide

memoire’ for assessing the Nutrition interventions in Agriculture policies.

Box 1: Guiding Principles for Improving Nutrition through Agriculture (FAO 2013)

Food systems provide for all people’s nutritional needs, while at the same time contributing to

economic growth and healthy environments. The food and agriculture sector has the primary

role in feeding people well by increasing availability, accessibility, and consumption of

diverse, safe, nutritious foods and diets on a daily basis, aligned with dietary

recommendations and environmental sustainability. Applying these principles helps strengthen

resilience and contributes to sustainable development.

Agricultural programmes and investments can strengthen impact on nutrition if they:

1. Incorporate explicit nutrition objectives and indicators into their design, track and

mitigate potential harms, while seeking synergies with economic, social and environmental

objectives.

2. Assess the context3 at the local level, to design appropriate activities to address the types

and causes of malnutrition4.

3 Context assessment can include potential food resources, agro-ecology, seasonality of production and

income, access to productive resources such as land, market opportunities and infrastructure, gender dynamics and roles, opportunities for collaboration with other sectors or programmes, and local priorities.

19 | P a g e

3. Target the vulnerable5 and improve equity through participation, access to resources,

and decent employment.

4. Collaborate and coordinate with other sectors (health, environment, social protection,

labour, water and sanitation, education, energy) and programmes, through joint strategies

with common goals, to address concurrently the multiple underlying causes of malnutrition.

5. Maintain or improve the natural resource base (water, soil, air, climate, biodiversity),

critical to the livelihoods and resilience of vulnerable farmers and to sustainable food and

nutrition security for all. Manage water resources in particular to reduce vector-borne illness

and to ensure sustainable, safe household water sources.

6. Empower women by ensuring access to productive resources, income opportunities,

extension services and information, credit, labour and time-saving technologies (including

energy and water services), and supporting their voice in household and farming decisions.

Equitable opportunities to earn and learn should be compatible with safe pregnancy and

young child feeding.

7. Facilitate production diversification, and increase production of nutrient-dense crops

and small-scale livestock (for example, horticultural products, legumes, livestock and fish

at a small scale, underutilized crops, and biofortified crops). Diversified production systems

are important to vulnerable producers to enable resilience to climate and price shocks, more

diverse food consumption, reduction of seasonal food and income fluctuations, and greater

and more gender-equitable income generation.

8. Improve processing, storage and preservation to retain nutritional value, shelf-life, and

food safety, to reduce seasonality of food insecurity and post-harvest losses, and to make

healthy foods convenient to prepare.

9. Expand markets and market access for vulnerable groups, particularly for marketing

nutritious foods or products vulnerable groups have a comparative advantage in

producing. This can include innovative promotion (such as marketing based on nutrient

content), value addition, access to price information, and farmer associations.

10. Incorporate nutrition promotion and education around food and sustainable food

systems that builds on existing local knowledge, attitudes and practices. Nutrition

knowledge can enhance the impact of production and income in rural households, especially

important for women and young children, and can increase demand for nutritious foods in

the general population.

Food and Agriculture Policies can support food security and nutrition if they:

11. Increase incentives (and decrease disincentives) for availability, access, and

consumption of diverse, nutritious and safe foods through environmentally

sustainable production, trade, and distribution. Focus on horticulture, legumes, and

small-scale livestock and fish – foods which are relatively unavailable and expensive, but

nutrient-rich – and vastly underutilized as sources of both food and income. All people

should be able to access diets recommended by dietary guidelines.

4 Malnutrition includes chronic or acute undernutrition, vitamin and mineral deficiencies, and obesity and

chronic disease. 5 Vulnerable groups include smallholders, women, youth, the landless, urban dwellers, the unemployed.

20 | P a g e

12. Monitor dietary consumption and access to safe, diverse, and nutritious foods. The

data could include food prices of diverse foods, and dietary consumption indicators for

vulnerable groups.

13. Include measures that protect and empower the poor and women: Safety nets that

allow people to access nutritious food during shocks or seasonal times when income is low;

land tenure rights; equitable access to productive resources; market access for vulnerable

producers (including information and infrastructure). Recognizing that a majority of the most

vulnerable are women, ensure equitable access to all of the above for women.

14. Build capacity in human resources and institutions to improve nutrition through the food

and agriculture sector, supported with adequate financing.

15. Support multi-sectoral strategies to improve nutrition within national, regional, and local

government structures.

Food value chain

The food value chain includes all the components of a food system from production to

consumption back to production again (recycling nutrients to close the loop) and the actors

involved with each step. Values chains for nutrition focus on the ‘value for nutrition’ that is added

or lost at each stage. One part of this is the nutritional quality of food as it passes through the

chain where nutrients can be retained, lost or added. These stages are affected by a wider

range of processes and inputs such as human resources, natural resources, government, policy,

technology, innovation, capital and consumer demand (Figure 1). Throughout the different

stages along the food value chain (light blue boxes), varying underlying values may emerge

(purple boxes) presenting the diverse main actors (dark blue boxes) involved in the particular

food value chain stage (Hawkes and Ruel 2012).

Nutrition gap

The nutrition gap is the difference between current food intake patterns and intake patterns that

have optimal nutrient content compared recommended intakes. We need to narrow the “nutrition

gap” in order to improve the food and agriculture-based aspects of nutrition security (Traoré,

Thompson et al. 2012). In addition, (Haddad 2013) emphasizes agriculture and food production

should be driven by nutrition and not seeing improvements in nutrition as ‘optional extras for

agriculture’. At each step in the food value chain there are opportunities for guarding the

nutrition quality of our foods.

21 | P a g e

Figure 1: Food value chain (Garrett 2013), Adapted in pink/purple boxes.

1 | P a g e

1.2 Situation analysis

1.2.1 Malawi Country context

Malawi is a landlocked country in the south-

eastern part of Africa and shares borders with

Mozambique, Tanzania and Zambia. It covers an

area of 118,484 square kilometres, of which 20.4%

of the land is water. The important water body in

the country is Lake Malawi, which is on the eastern

side of the country, stretching from north to south

covering more than 30,000 km square kilometres.

The country is divided into the Northern, Central

and Southern administrative regions. Malawi has

28 districts: six in the Northern, nine in the Central

and 13 in the Southern Region. With a population

of over 15 million people, Malawi is one of the

most densely populated countries in the Southern

African Region (UNICEF 2013).

Malawi scores 170 out of 186 in the United Nations

Development Programme (UNDP) Human

Development Index (UNDP 2013), putting Malawi

in the ‘low human development’ category.

Poverty in Malawi has declined from 65% in 2004 to 39% in 2010 (SUN 2011). Malawi ranked 2

(out of 45) in the Hunger and Nutrition Commitment Index (HANCI) (IDS 2013). This index ranks

governments on their political commitment in order to provide greater transparency and public

accountability by measuring what governments achieve, and where they fail, in addressing

hunger and undernutrition. This shows that although Malawi is low on the Human Development

Index, commitment to Nutrition is strong. See section 3.2 for more details of historical events in

Malawi.

Governance

Malawi’s current multiparty system began in 1993. Malawi is due to hold elections in 2014 and

the planning to organize tripartite elections and organize voting for the presidential,

parliamentary as well as local government.

Malawi established the Department of Nutrition, HIV and AIDS (DNHA) in 2004 to fight

malnutrition and HIV and AIDS (GoM 2009).

Figure 2. Malawi and its flag (WorldBank 2011)

2 | P a g e

1.2.2 National Nutrition Situation

Chronic malnutrition is a major contributor to Malawi’s ill-health outcomes and is an underlying

cause of high infant and child morbidity and mortality rates. Slight progress has been seen in

stunting rates in children under five in the past 20 years: 55.8% in 1992 compared to 47.8% in

2010. See figure 3. (DHS 1992-2010, MICS 2006)

49 47

24

13.8 16 18 22

5.4 4.1 5.5 5.2 3.3

53 53

Figure 3: Nutrition status of Malawi children under five, 1992–2010. Blue=stunting; Green=underweight;

Orange=wasted. Source: Global WHO Database on Child Growth and Malnutrition, Jan 2012.

Dietary Transition The nutrition transition, a position where both undernutrition and obesity co-exist is starting in

Malawi. Overweight in children <5 years was 8.3% and overweight in women 17.1% (NSO

National Statistical Office 2011). Prevalence of overweight in adult women (BMI >25 kg/m2) is

twice as prevalent as underweight (BMI <18.5) (Table 1) Overweight women tend to be from

urban and wealthier groups with 25% or more of this population affected.

Infant and young child feeding There have been significant improvements in exclusive breastfeeding practices. The MDHS

from 2004 and 2010 showed mothers exclusively breastfed their children for the first 6 months

from 53% to 71%, respectively.

Dietary diversity is far short of recommendations for 6-23 months children (Table 1). Dietary

adequacy is only reached for 20% of breastfed children and most those who are not breastfed

during this age range do not meet IYCF guidelines.

3 | P a g e

Anaemia, linked to iron nutritional status Anaemia is very highly prevalent in Malawi, and is an indicator that the micronutrient, iron is

poorly available from diets. According to the Micronutrient survey (GoM 2009) the highest

prevalence of anaemia was found in under five children, (54.8% haemoglobin (Hb)<11.0 g/dL)-

followed by non-pregnant women (32.0% Hb<12.0 g/dL), school-aged children (25.4% Hb<11.5

g/dL), pregnant women (13.0% Hb<11.0 g/dL) and men (12.2% Hb<13.0 g/dL). These

prevalences accord broadly with the DHS data (Table 1).

Table 1: Nutritional status and selected health indicators from Demographic and Health Survey

2010 (NSO National Statistical Office 2011)

GROUP DHS 2010 PERCENTAGE

(WHO growth standards 20006)

Infants/ Children

Underweight of children < 5 yr 12.8

Stunting of children < 5yr 47.1

Wasting of children < 5yr 4.0

Infants being exclusively breastfed (0–5 months) 71.4

Overweight of children < 5yr 8.3

Dietary diversity 4+ food groups (6-23 months) (breastfed) 27.9 / (non-breastfed) 45.4

Minimum meal frequency (6-23 months) (breastfed) 55.9 / (non-breastfed) 33.5

Dietary adequacy (4+ food groups and minimum frequency) (breastfed) 19.9

Infants born with low birth weight 12.3

Prevalence anaemia (6-59 months) 62.5

Infant Mortality 66 /1,000

Under-5 Mortality 112/1,000

Female/Maternal nutrition

Prevalence anaemia (<12g/dl) non-pregnant woman 28.0

(<11g/dl) pregnant 37.5

Woman with low BMI (<18.5kg/m2) 8.8

Woman with high BMI (>25kg/m2) 17.1

Stunting prevalence 43.3

Underweight prevalence 11.7

Wasting prevalence 3.8

Male nutrition

Stunting prevalence 51.1

Underweight prevalence 14.0

Wasting prevalence 4.2

6 The nutritional status indicators are expressed as standard deviation units from the median of the WHO child growth

standards 2006

4 | P a g e

1.2.3 Agriculture situation of the country

Agriculture Malawi’s economy is predominantly dominated by the agrarian sector (Chirwa, Kydd et al. 2006).

Agriculture is practiced by the vast majority of the households (ASWAp 2011). Moreover, 85%

of the households depend on agriculture as their major source of income (Chinsinga 2012).

Farmers’ own production plays a dominant role concerning the food consumed, especially for

maize and vegetables (90% and 81% respectively). According to WFP’s Rural Malawi

Comprehensive Food Security and Vulnerability Analysis (2010), approximately 40% of

households had either no land or less than 1 acre to cultivate compared to the national average

of 1.2 ha for smallholder farmers (ASWAp 2011). Malawi’s Current Total Factor Productivity

(TFP), the ratio of an index of agricultural output to an index of agricultural inputs, declined

substantially and is now catching up with the level in 1961 (Benin, Nin Pratt et al. 2011). This

implies that agriculture is moving further from a sustainable model, possibly due to the FISP

(Farm Input Subsidy Programme) that encourages use of farm inputs.

Main agricultural products

The main staple crop in Malawi is maize, grown on 85% of the total cropped land (ASWAp

2011). For many Malawians ‘maize is life’ (Smale 1995). Maize accounts for 60% of Malawians

total calorie consumption (Denning, Kabambe et al. 2009) and a meal in Malawi is considered

incomplete without inclusion of ‘nsima’ which is usually made of refined maize flour. Maize was

cultivated by 97 % of the households, followed by groundnuts (39 %), beans (23 %), tobacco

(21 %), potatoes (21 %) and cassava (17 %). Crop diversity varies across the country. The

poorest was in Phirilongwe Hills where almost half households cultivated just one crop (maize).

The majority (84%) of households used no irrigation. For maize, 80% of vulnerable households

had access to subsidized fertilizers; subsidies were more moderate for beans (22%) and very

rare for the other crops. Chemical fertilizers were more common (75%) than natural products.

Subsidized planting materials were accessed by 51% of farmers for maize but were virtually

non-existent for other crops (WFP 2010).

There have been steady increases in requirements for diverse foods as population has grown,

however there could be over-estimation in the maize requirements because maize is assumed

to be the only source of dietary energy in estimations. There is an upward trend for mziae

production, albeit with massive annual fluctuations (figure 4). With respect to livestock, the study

found that 67% of households own at least one farm animal (NSO National Statistical Office

2011). Agricultural production in Malawi faces many challenges related to climate change and

overdependence on rain fed agriculture, environmental degradation (water, soil, air, plants,

trees, animals, insects and microbes), financial and economic constraints, poor health and

nutrition of the farming population, gender- related constraints due to poor support for women

farmers amongst others.

Diversification is further constrained by the focus on maize in both policies and the food culture

in Malawi.

5 | P a g e

Figure 4: National Maize Production and Calorie Requirements over 25 Years. From (Denning,

Kabambe et al. 2009), as cited by (FAO 2008). N.B. This figure demonstrates the over-emphasis on maize

to fulfil calories in Malawi. A green line was imposed on the graph to show approximately how many calories

are recommended according to Malawi’s six food group model from just grains (meaning all grains, not just

maize, and not including other staples, such as starchy tubers and fruits). In Denning and Kabambe’s review

of the 25 years they concluded that if maize production did not reach or exceed the populations estimated

calorie needs that a ‘deficit’ resulted. This is an inaccurate assumption as in all but 3 years maize production

alone fulfils more than the recommended grain calories.

1.2.4 Food Security and Consumption

Food Security has been equated with ‘maize security’ in Malawi and typically measurements of

dietary diversity is a gap. According to the National Agriculture Policy (GoM MoAFS 2011):

‘While the country has attained food security, there are still pockets of households that face

chronic food insecurity. These include resource poor female, child and elderly headed of

households and those with chronic illnesses. This is due to a number of factors such as

1. Inadequate access to farm technologies

2. Pre and post harvest crop losses

3. Drudgery and limited labor

4. Extreme weather events (dry spells, floods)

5. Depressed land sizes due to increase in population

6. Low soil fertility due to land degradation

7. Limited credit facilities to enable farmers obtain modern inputs’

Approximate recommendation for Consumption of GRAINS: e.g. rice, millet, sorghum, maize, tef, oats, etc.

6 | P a g e

This rather optimistic statement on Food Security, implying that food insecurity is limited to

some ‘pockets’ does not accord to the Malawi Food Security Vulnerability Assessment; 11% of

the surveyed households had poor food consumption; 37% of households had borderline food

consumption; and 52% of households had acceptable food consumption7 (WFP 2010). The food

consumption scores (FCS) reflect the diversity and frequency (number of days per week) of the

food items consumed by households (Ruel 2003). The households with better consumption

profiles had higher dietary diversity, with pulses, then animal products and oil, being

incorporated into diets as consumption improved. Those with poorer consumption cultivated

less diverse crops (WFP 2010).

- “Food consumption was negatively affected by: (i) presence of a woman head of household;

(ii) illiteracy of the head of household; (iii) high frequency of coping mechanisms (CSI); (iv)

absence of an irrigation system; and (v) limited crop diversification.

- Food consumption was positively influenced by: (i) migration of the head of household; (ii)

large household size with high proportion of working members; (iii) high production of maize;

and (iv) large area of land cultivated.” (WFP 2010)

IFPRI present an analysis

that takes dietary diversity

into consideration. Table 2

shows a target food

consumption compared to

data from the Integrated

Household Survey and the

Malawi Vulnerability

Assessment. Consumption in

Malawi is dominated by

staples – mostly maize- with

poor dietary diversity. Fruit,

vegetables, beans, nuts,

animal foods and fat are all

lower than the target.

Despite all the challenges faced by Malawi to reach food security, the Global Hunger Index

shows improvements in Malawi: ‘From 1990 to 2012, the greatest improvements in absolute

scores took place in Angola, Bangladesh, Ethiopia, Malawi, Nicaragua, Niger, and Vietnam’. In

Malawi the index reduced from 30 (extremely alarming) in 1990 to 13 (serious) in 2012 (IFPRI

2012). The Global Hunger Index does not take diversity into consideration in its calculation that

is based on 3 dimensions: Underweight, ‘Undernourishment’ a calorie based indicator) and

Child Mortality.

7 Two thresholds (21 and 35) are used to distinguish consumption level. The thresholds define three groups: poor consumption

(≤ 21); borderline consumption (>21 and ≤ 35); and acceptable consumption (> 35) based on the method developed by Ruel (2003).

Table 2: Share of Different Food Groups in Total Calorie Intake (%)

Table from (IFPRI 2012) referring to (Nordin 2005; Ecker and Qaim

2011; Malawi Vulnerability Assessment Committee 2011)

7 | P a g e

Malawi uses 6 food groups in its policies and promotional materials. There are

recommendations throughout agriculture and nutrition policies for consumption of at least one

food from each group per day. The groups are fruits, vegetables, legumes & nuts, animal foods,

fats and starchy staples. This is a straightforward and practical system for promotion of dietary

diversity. However as Table 2 demonstrates, Malawian diets do not meet this recommendation

and are heavily reliant on starchy stables.

1.2.5 The Millennium Development goals

With all the challenges, Malawi is nevertheless on track to achieving several of the MDGs.

Progress has been made in reduction of underweight from 28% to 12.8% from 1990 to 2011.

This goal has therefore already been achieved according to report (GoM 2011). The proportion

of people living below dietary energy requirement is also well on track to achievement (23.6% to

15% reduction). There have been impressive improvements in health in Malawi over recent

years. Malawi’s life expectancy was 40 years in 2000 and has improved to 52.2 years in 2009

(WorldBank 2011). The life expectancy at birth in 2012 was 54.8 (UNDP 2013). The under-five

mortality rate is 83 per 1000 live births, from 227 in 1990 (UNICEF 2013). According to

UNICEF’s statistics, it is very likely Malawi will reach its Millennium Development Goal 4 (MDG),

target of 76 per 1000 live births in 2015. Maternal mortality rate is 460 deaths per 100 000 live

births. HIV adult prevalence is 10.9%, coming down from 14% in 2000 (WorldBank 2011).

Environment and Sanitation issues are also improving and MDGs are likely to be met. The

Millennium Development Goals do not give a direct indication of improvements in agriculture for

nutrition.

Table 3: Selection of Millennium Development Goals (adapted from GoM 2011)8

MDG Indicator Basline Current Status

2015 Target

To be met?

1. Eradicate extreme poverty and hunger

Prevalence of Underweight Children (%) 28 12.8 14 met

Proportion of population below minimum level of dietary energy consumption (%)

23.6 15 11.8 likely

4. Reduce child mortality Under-five mortality rate (per 1,000) 234 112 78 likely

5. Improve maternal health

Maternal mortality ration (per 1,000) 1120 675 155 unlikely

6. Combat HIV, malaria and other diseases

HIV prevalence among 15-24 year old pregnant women (%)

17.4 12 0 Likely

7. Ensure environmental sustainability

Proportion of population with access to improved sanitation

72.3 93 86.2 Likely

8 Visit http://www.un.org/millenniumgoals/ for complete description of MDGs and status of each.

8 | P a g e

1.2.6 Causes of Undernutrition in Malawi

Figure 5 shows the immediate, underlying and basic causes from a Malawi specific analysis.

What is clear from this diagram is that multi-sectoral action is necessary to address nutrition in

Malawi. No one approach, in one sector is likely to have impact if other causes still remain

unaddressed. This is the challenge of prevention of chronic malnutrition and why in every

context it is necessary to start with this type of mapping exercise.

The causes presented in this figure were the topic of discussion with nutritionists.

Figure 5: Main Causes of Undernutrition in Malawi. Adapted from National Nutrition Policy and

Strategic Plan (NNPSP) (Republic of Malawi DNHA 2007)

9 | P a g e

1.2.7 Critical Issues to Explore:

Comparing agriculture, food security, nutrition and hunger reports some questions emerge:

What has contributed to the improvements in nutrition and health shown by MDGs and DHS

reports?

There is an assumption that increasing maize production, promoted by the FISP will improve

food security. But what is the relationship between increased maize production and nutrition

security?

What is the relationship between maize production and agricultural diversification?

What is the relationship between agricultural diversification and diet quality?

These questions were explored throughout the case study.

2. Methods

The timeline for the assignment was from the end of March 2013 when all the consultants for

the 8 country studies met in Geneva for the ‘Meeting of the Minds’ to August 2013. The ‘Meeting

of Minds’ provided an opportunity to discuss ‘Nutrition Sensitive’ development with a group of

international experts and to think through the policy analysis process. ToRs, Guidance and

outlines for the assignment however were made later as the case studies started.

The Terms of Reference for the assignment are in Annex 4.3. This was a generic ToR for all

consultants working in 8 Countries9 that was then adapted to the Malawi context. Discussions

were carried out between the UNSCN, the Government of Malawi, Office of the President and

Cabinet, key UN staff in Malawi and the consultant to ensure that the assignment would be

useful for the country. From these discussions, it was agreed that whilst it was necessary to

carry out a broad analysis of policy for nutrition centred agriculture the interviews and field trips

would concentrate on examining the topic of Agriculture and Dietary Diversification and to

concentrate on potential nutrition impacts on children under 5. This is one of the 10 Guiding

Principles that have been developed to assess the ‘nutrition sensitivity’ of agriculture actions.

2.1 Literature sources

The Government of Malawi provided policy and strategy documents. Documents were obtained

from key informants and through contacts. The review of literature was not systematic given the

time limitations and the breadth of the topics. Literature search was therefore carried out on

particular topics, for example for Malawi and ‘Agriculture Sector Wide Approach’ and on Dietary

Diversity and Agriculture Diversity in Malawi. The main statistical data bases from FAO, WHO,

UNICEF, WFP were searched for reports.

9 The countries were: Brazil, Malawi, Mozambique, Nepal, Senegal, Sierra Leone, South Africa, Thailand

10 | P a g e

2.2 Policy Analysis

The following policies, frameworks and strategies were reviewed for ‘nutrition sensitivity’:

1. Malawi Growth and Development Strategy II 2011-2016

2. Economic Recovery Plan

3. National Agricultural Policy

4. Malawi Agriculture Sector Wide Approach

5. Food Security Policy

6. Presidential Initiative on Legumes

7. Presidential initiative on small stock production

8. National Nutrition Policy Strategic Plan NNPSP

9. National SUN Nutrition Education and Communication Strategy

The policies were analysed

By reference to the ‘Guiding Principles’ that are listed in box 1. Each policy was reviewed for

its potential contribution to each dimension of these guiding principles. This analysis takes

no consideration of whether the policies are being implemented, or have been funded. The

analysis is based on what is written in the policy documents.

The agriculture policy results frameworks were reviewed for ‘nutrition sensitivity’ i.e. are

nutrition indicators, included in the M & E plans.

With particular reference to Agriculture and Dietary Diversity:

What was the framing of the problems associated with agriculture and dietary diversity

What data were presented to support the rationale

What % of budgets were assigned to agriculture and dietary diversity?

What data are available on implementation of the policies

What data are available on impact of the policies on nutrition?

2.3 Country visit to Malawi

The schedule for the Lilongwe meetings and trips to the Regions was planned ahead of the

consultant’s visit by the Office of the President and Cabinet, Department of Nutrition, HIV and

AIDS (DNHA) in consultation with WHO and FAO representatives in Malawi. Meetings were

held in Lilongwe followed by trips to Zomba, Mangochi and Kasungu. The final schedule and list

of people met is in Annex 4.1.

2.4 Interviews and group discussion

Group discussions and key informant interviews were carried out. The aim of these discussions

were two-fold: to understand the particular area of work of the respondent and to ask some

more general questions about diet and agricultural diversity. The questions were open-ended

with most of the discussion related to the area of work carried out by the respondents. Some

particular questions were posed as appropriate to the discussion.

11 | P a g e

People met were from the Malawi Government at National and District level in the ministries of

Health, Agriculture and Education and their partners in UN agencies, donors, NGOs and the

Private sector. Details are in Annex 4.1. Group discussions were organized with:

DNHA & Sector

Nutritionists:

Policy frameworks, coordination, responsibilities for nutrition, causes of

malnutrition in Malawi

DoNutS

(Donor Nutrition): Discussion on ideas for improving agriculture and dietary diversity

Ministry of Agriculture

& Food Security:

SCN assignment and rationale, policies in Malawi, discussion on key points

for improving nutrition through agriculture

Mangochi district:

Cross sectoral discussion on Agriculture Extension systems, School Health

and Nutrition projects and Home Grown School Meals project pilots in the

district with Agri-business, Agriculture Development, District Medical

Officer, Education officer, Food and Nutrition officer, and Nutrition

coordinator

Kasungu district:

Discussion on crop and diet diversification with particular reference to

legumes with Irrigation officer, Crop production officer, Horticulture officer,

Crop protection officer

2.5 Project visits:

Project visits to 3 regions enabled the consultant to view at first hand implementation of programmes and visit district level government staff for discussions about policy strategies and plans, opportunities and challenges: • Millennium Villages project in Zomba district

• School Health and Nutrition, Monkey Bay, Mangochi district (WFP)

• Improved Food Security and Nutrition, Kasungu (FAO/FICA)

• Never-ending-food Permaculture project, Lilongwe

Stakeholder questions, examples:

1. What are important causes of malnutrition according to your experience?

2. Which are the most promising food-based strategies to improve nutrition (particularly for the

child <5 years)?

3. What is/ are the strongest strategies for improving agricultural and dietary diversity?

4. What facilitates effective implementation of these policies / strategies or actions?

5. What makes implementation difficult

6. Where do you think action should be taken to improve agricultural and dietary diversity

7. What capacity is there for improving agricultural and dietary diversity?

8. Are there any incentives for sustainable diversified food production? If so, what?

9. How is impact of policies on nutrition assessed (are results frameworks in place and data

being collected)?

10. Are there any results showing nutritional impact?

11. Where do you find the strongest links between agriculture and nutrition in Malawi’s policies?

12. How can sectors work together to improve nutritional impact of agricultural policies?

Further to policy analysis and country visit a list of case studies were drawn together to illustrate

implementation of the policies around the topics of agricultural and dietary diversity. For each

programme, project or action, the following questions were posed:

12 | P a g e

What is the theoretical link to nutrition improvement & relevant policy

What problem is it addressing theoretically

Where does it link with the Food & Nutrition System in Malawi

What is the action to improve agriculture/ dietary diversity

What is the capacity in Malawi to implement this action

What are the advantages/ opportunities presented by the case

What are the challenges/ suggestions to overcome the challenges

What are the nutrition results reported

2.6 Q-Sort method for assessing opinions

This part of the assessment was carried out by Nynke Kampstra as part of her MSc thesis. Details are available in Appendix z. The full thesis as part of the MSc Public Health and Society, Wageningen University, will be available in November 2013. This will combine the results from in-depth interviews linked with intersectoral action frameworks and will identify where perceptions match/mismatch on improving nutrition among the various Malawian ministries and district workers having a mandate on nutrition consulted during the field visits (n=18).

2.6.1 Introduction on Q methodology

The Q methodology has been applied for very diverse topics in a wide range of disciplines such

as in political science, psychology, health science, communication, education, the human and

behavioural sciences and in the field of policy (Stephenson 1935; Donner 2001; Brown 2008).

Moreover, it shines light on a person’s opinion, belief, attitude, and the personal viewpoint

(Brown 1993). As stated by Hoppe and Reinelt (2009 p.9) the Q methodology is a useful

method concerning organizations, groups as well as communities to help uncover the “collective

story”. As cited by Brown (1993), the method maps ‘the flow of communicability surrounding any

topic’ in ‘the ordinary conversation, commentary, and discourse of everyday life’. Individual

perspectives are being analyzed and can be used with a small sample set of participants and is

not aiming to generalize the results to a larger population (Steelman and Maguire, 1999).

2.6.2 Objective

For the Malawi Case Study, this exercise will identify how agricultural, food and nutrition actions

are ranked through pointing out important focus areas for engagement in advancing nutrition by

the various ministries consulted. This in order to conduct a ministerial stakeholder assessment

of nutrition-sensitive agriculture in Malawi through determining alignment and/or gaps among

stakeholders’ expectations, sectoral priorities, decisions and actions.

2.6.3 Methods

In total, 12 participants completed the Q-Sort exercise and the participants provided additional

comments on their reasoning to interpret the variety or shared viewpoints on the topic. For more

methodological background information and an overview of the included statements, see Annex

2. The participants are working in the MoAFS (n=7), the MoH (n=1), the MoGCCD (n=1), the

MoE (n=1), MoEACC (n=1) and the OPC DNHA (n=1). All the interviewees were consulted

individually.

13 | P a g e

3. Findings

3.1 Stakeholder perception of the causes of undernutrition

A group discussion with Nutritionists from the different sectors on the causes of undernutrition in

Malawi was centred on the analysis presented in the National Nutrition Policy and Strategic Plan

(NNPSP) (figure 5). The causes of undernutrition cited by this group were broadly in alignment

with those cited by the NNPSP but the group emphasised some underlying and basic causes

related to agriculture – these are listed in box 2.

Box 2: Causes of undernutrition highlighted by lead nutritionists from different sectors. Additional causes highlighted Underlying Causes

Health and Caring practices:

Emphasis on knowledge misses the barriers and facilitating factors for key behaviours. The

limitation for behaviours is not necessarily knowledge but a whole range of constraints faced

by households

Lack of access to health services. Outreach is not widespread

Food security causes

Availability of open pollinated seeds; hybrid seeds cannot be saved by farmers and breed

true in the following season. This can be true for both maize and other species.

Poor soil fertility

Lack of crop diversity for harvests through the year from all food groups, too much emphasis

on a few staples and more recently, a few legumes.

Agricultural diversity does not necessarily result in improved dietary diversity. When farmers

are poor they cannot afford to give high value crops to their children, they need to sell them

for income or grow maize for their own security before diversifying into other crops.

Basic causes

Low purchasing power, poor incomes

Poor regulatory frameworks for policies

Lack of capacity for implementation of nutrition programmes

Communication is poor across sectors although the structures for coordination are available.

Food and nutrition security information systems – particularly inadequate for food nutrients

Grain silos for national storage of maize. Large loss to spoilage; needs research, lacks

diversity and mostly focuses on maize storage

Physical access to markets is a constraint for farmers (i.e. physical access that is not strong in

policies)

Trade important for fortified foods

Nutrition Education needs to be combined with Agricultural diversity

14 | P a g e

3.2 Agriculture history & policies

Table 4 provides an overview of important agriculture and policy events in Malawi.

Table 4: Overview of significant agriculture and nutrition events in Malawi (Chirwa, Kydd et al.

2006; Chinsinga 2012; IFPRI 2012) with additions from authors

YEAR ACTION

1948 Malawi signed on to the Universal Declaration of Human Rights which is inclusive of food &

nutrition

1980 Malawi hosted 1 million refugees from Mozambique. Pressure on Malawi’s food supply

1981 Structural adjustment programmes (SAPs), specific reform packages

1990 Sharp devaluation of local currency, made inputs unaffordable

1991/2004 Substantial increase in price maize

1993/94 Malawi regained multi-party democracy

1994 The National Smallholder Farmers’ Association of Malawi (NASFAM) is founded, the largest

independent, smallholder-owned membership organization in Malawi with 108.000 members

in 2012 (IFPRI 2012)

1995 - Malawi constitution

1998/1999

Growing season Starter Pack (SP) free inputs for 2.86 million households, worth 0.1ha

fertilizer and legume seed. Funded by UK Department for International Development (DFID)

1999/2000 Growing season Starter Pack (SP) repeated, (linked to electioneering)

2000/2001 SP scaled down to Target Input Programme (TIP) half of the rural families benefiting

2001/2002 Hunger crisis. Food shortages due to severe drought combined with mis-management of the

previous years’ food excesses, over sold to other countries leaving the grain silos nearly

empty (affected 3.2 million people)

2003 Comprehensive African Agriculture Development Programme. (CAADP 2010) African

governments agreed to allocate at least 10% of their resources to agriculture (Maputo

Declaration) with the goal to achieve and sustain growth of 6% in order to achieve

agriculture led socio-economic growth (Andersson 2011)

2004/05

Withdrawal of DFID (sole donor to TIP programme), return Extended Targeted Input

Programme (ETIP), severe droughts

Hunger crisis. Food shortages due to severe drought, environmental degradation and lack of

agricultural diversity (affected 4 million people)

Maize season (planted October–December 2004 and harvested April–June 2005) was the

worst in a decade

2004 OPC DNHA Established

2005 Agriculture Sector Wide approach, harmonized agriculture investment plan. In addition,

the government launched the Farm Input Subsidy Programme

2006

Malawi growth and development strategy (MDGS). Policy directions of reducing poverty

on a sustainable basis. Prepared second MDGS for the period 2012-2016

15 | P a g e

YEAR ACTION

Government developed Agriculture Sector Wide Approach (ASWAp) for period 2008-

2012, A results oriented framework for implementing the agriculture components of the

MDGS

2007 Nutrition Policy & Strategic Plan (2007-2012)

2008 Ministry of Agriculture and food security reintroduced price band

2010

Launch of Nutrition Policy & Strategic Plan (2007-2012)

Launch of the SUN-1000 Days Movement in Malawi;

2011 Malawi becomes a SUN ‘Early Riser’ Country

2012

Government decided to devalue value the national currency based on reality, Consumer

purchasing power declined

Famine Early Warning Systems Network state number of Malawians in need of humanitarian

help has jumped from 1.63 to 1.76 million (October 2012-March 2013)

The death in office of President Ngwazi Professor Bingu wa Mutharika and appointment of

Mrs Joyce Banda as President of the Republic of Malawi

Introduction of the Economic Recovery Plan by President Joyce Banda

2013 Launch of the Presidential Initiatives for Legumes and small livestock

In 2012 there were significant macroeconomic policy developments in Malawi with implications

for smallholder farmers. Agriculture has been prioritized in policies. Malawi has adopted the

Maputo Declaration which calls on Governments to allocate at least 10% of their resources

towards agriculture to realize 6 percent annual growth in agriculture. In Malawi the Agriculture

Sector Wide Approach was adopted (Republic of Malawi MoAFS 2011) as part of the CAADP

compact

Table 5 Overview of the Malawi policies (Chirwa, Kydd et al. 2006) updated to 2013. Those

with bold text were reviewed for the case study

YEAR ACTION

1995 - Framework for Poverty Alleviation Programme

1998 - The Malawi Vision 2020

2000 Gender Policy

2002 – 2005 The Malawi Poverty Reduction Strategy (MPRS)

2004 - The Malawi Economic Growth Strategy (MEGS)

2004 - 2010 Ministry of Health Programme of Work, Essential health package

2005 Water Policy

2006 - 15 The Malawi Growth and Development Strategy (MGDS)

Farm Input Subsidy Programme (FISP)

2006 Food Security Policy

2007 – 2012 National Nutrition Policy and Strategic Plan (NNPSP)

2008 Sanitation Policy

16 | P a g e

YEAR ACTION

2008 – 2017 National Education Sector Plan (NESP)

2009 Infant and Young Child Nutrition Policy (IYCN)

2009 - 2013 Education Sector Implementation Plan

2009 - 2018 National School Health and Nutrition Strategic Plan (NSHNSP) &

Guidelines (separate document)

2011-2015 Agriculture Sector Wide Approach ASWAp

Agriculture Sector Gender, HIV and AIDS Strategy

2011 National Agricultural Policy (not ratified)

2011 - 2016 National Nutrition Education and Communication Strategy (NECS)

2011 - 2016 Malawi Growth and Development Strategy II (MGDS II)

National budget

Economic recovery plan

Model Village Concept for Total Transformation

2013 President’s Hunger Initiatives

Promotion of legumes production and marketing project

Initiative on Small Stock Production

3.3 Main objectives of the policies

Since 1994, Malawi has developed policy documents addressing agricultural development and

emphasizing poverty reduction and food insecurity. Agriculture and Nutrition policies developed

together from 2004 then split to develop separately in 2006 and 2007, although the topic of

diversification of both agriculture and diet has drawn together initiatives from both sectors and

there is a joint monitoring system.

Table 6. The overall aim of the key policies reviewed

Policy Aim

1. Malawi Growth and

Development Strategy II

2011-2016

Wealth creation and reduction of poverty through sustainable

economic growth and infrastructure development.

2. Economic Recovery Plan Implied: reducing poverty through economic growth and

infrastructure development.

3. Presidential Initiative on

Legumes

to promote production, processing, storage, utilization and

marketing of legumes in Malawi

4. Presidential initiative on

small stock production

The overall goal of the programme is to improve livelihoods of

vulnerable groups (particularly women) through sustainable

small stock production and marketing.

5. National Agricultural To promote agricultural productivity and sustainable

17 | P a g e

Policy Aim

Policy management of land resources to achieve national food

security, increased incomes and ensure sustainable socio-

economic growth and development.

6. Malawi Agriculture Sector

Wide Approach

reducing poverty through sustainable economic growth and

infrastructure development

7. Food Security Policy To guarantee that all men, women, boys and girls, especially

under-fives in Malawi have, at all times, physical and economic

access to sufficient nutritious food required to lead a healthy

and active life.

8. National Nutrition Policy

Strategic Plan NNPSP

To lay a solid foundation for human capital development and

economic growth and prosperity in Malawi through a better

nourished population

9. National SUN Nutrition

Education and

Communication Strategy

To effectively support a national effort to reduce the prevalence

of stunting among the children less than two years of age to

less than 20% over a five year period 2011-2016

The overarching policy in Malawi is the Malawi Growth and Development Strategy (GOM

MGDS II 2011) and incorporates other policy initiatives, with the exception of those that were

introduced after the formulation of the policy.

The Malawian National Agriculture Policy has not been ratified at the time of writing (GoM

MAFS 2011), but is now essentially superseded by the Agriculture Sector Wide Approach

(ASWAp) (Republic of Malawi MoAFS 2011) which also includes elements of the (now out-

dated) National Nutrition Policy and Strategic Plan (Republic of Malawi DNHA 2007). The

NNPSP later led to more detailed nutrition policies and strategies that elaborate particular areas,

such as the National School Health and Nutrition Strategic Plan (GoM MEST 2009), the

IYCN Policy (GoM OPC undated) and the National SUN Nutrition Education and

Communication Strategy (NECS) (GoM DNHA 2011).

The Agriculture Sector Wide Approach (ASWAp) was supported by the CAADP compact.

(CAADP 2010). The CAADP compact was signed by relevant Malawian Ministries (Agriculture &

Food Security, Local Government and Rural Development, Finance, Development Planning and

Cooperation, Irrigation and Water Development, Industry & Trade as well as NEPAD, COMESA,

DCAFS, the Malawi Chamber of Commerce and Industry, Civil Society representative,

CISANET, and the Farmers Union of Malawi. The ASWAp priority areas correspond to CAADP

pillars 1-4; of particular relevance to this case study is Pillar 3 (Increasing food supply and

reducing hunger) which relates to the first ASWAp focus area (Food Security and Risk

Management) which includes i) Maize self sufficiency ii) diversification of food production for

improved nutrition with focus on crops, livestock and fisheries and iii) risk management for food

stability at National level. Hence high level support and agreement was reached to prioritise

agricultural diversity for nutrition objectives.

18 | P a g e

The other key initiative around this time was the Scaling Up Nutrition (SUN) initiative which

Malawi has joined as an ‘Early Riser’. The SUN movement has enabled Malawi to move more

into nutrition prevention activities and brought extra funding to Malawi for Nutrition. This has

resulted in support for the National SUN Nutrition Education and Communication Strategy

(NECS) which is now geared towards prevention of chronic undernutrition during the first 1000

days ‘Window of Opportunity’ to prevent stunting. (GoM DNHA 2011). The NECS covers a

detailed strategy for advocacy and Behaviour Communication through a cascading capacity

building mechanism to reach communities with BCC activities. Included in the NECS is

Information Education Communication (IEC) materials on diet diversification and use of local

foods to meet dietary needs, particularly for Pregnant and Lactating Women and children in the

first 2 years. The NECS is being initially rolled out in 5 districts in Malawi.

The Economic Recovery Plan was introduced after Dr. Joyce Banda took over the Presidency

in 2012. The Economic Recovery Plan is focused on economic goals. The first year includes a

social support package aimed to mitigate any negative socio-economic impacts of the other

initiatives in the plan. Scaling up the Farm Input Subsidy Programme (FISP) is also included

in other agriculture policies. There is also a scaling up of the Labour Intensive Public Works

Programme (LIPW). Of particular relevance to the case study is the scaling up of legume seed

multiplication, agro forestry and soil conservation, multiplication of cassava cuttings and sweet

potato vines and extending village savings club; Scaling up school meals programme and

vitamin A supplementation; and continuing the Social Cash Transfer Programme.

The Presidential initiatives on hunger were also introduced under the new President in 2012 and

include The Presidential Initiative on Legumes (GOM MAFS 2012) and the Presidential

Initiative on Small Stock Production (GOM MAFS 2012). These initiatives focus on

production for sale and economic growth. They are both deliberately targeted to small farmers

and the livestock initiative has a clear consumption objective – to improve meat consumption.

The legume initiative does not include a consumption objective, but the focus is on legumes for

sale to improve economic growth. Agricultural diversification is the aim of both these initiatives.

The Food Security Policy of 2006 is divided into actions to improve availability, access and

stability in food supply. (Republic of Malawi MoAFS 2006) Institutional arrangements and

monitoring and information systems are described. As far as diversification and ensuring

nutrient quality of food consumption, the policy includes provision of storage at the community

and national level for all 6 food groups. For availability the following strategies are promoted:

Irrigation, fertiliser supply, improved varieties and establishment of seed banks, integrated pest

management, access to credit for women, land tenure security, sustainable practices, adoption

of appropriate technologies, integration of livestock in smallholder farming systems, integrate

fish farming into irrigation development, sustainable harvesting of natural food resources and

promotion of indigenous foods. Also, coordination of food aid is covered.

For food access, strategies include sustainable access to adequate nutritious food at household

and national level by promoting traditional and cultural practices that improve food security for

women, men girls and boys. Increasing purchasing power, supporting subsistence farmers to

19 | P a g e

commercial markets, social protection through safety nets. Access to markets for transparency

and fairness also included.

For stability in food the strategy is to improve management of disasters.

The 2006 Food Security Policy gives no details of implementation modalities, but these have

been elaborated and updated in the ASWAp (Republic of Malawi MoAFS 2011). The previous

‘Food and Nutrition Security Policy’ produced just one year before also contained a chapter on

‘Utilisation’ which covered areas of the policy, such as promotion of healthy diets, nutrition

treatments and food safety. These areas were transferred to the NNPSP in 2006.

Conclusions:

Most of the policies reviewed had an overarching aim to improve economic performance and

reduce poverty in Malawi (Table 6). The NNPSP aims to ‘achieve human capital development

and economic growth and prosperity through a better nourished population’. Therefore nutrition

is seen as a means to improve economic development. For the majority of the policies nutrition

is not specifically mentioned as a high level priority and therefore, although nutrition is included

it is not afforded high priority. In an environment of enormous constraints on funding, nutrition

actions can easily be sidelined or even dropped altogether. Food security is a high level aim for

the National Agricultural Policy and the Food Security Policy only. The NECS is focused

particularly on prevention of stunting and is aligned to a national campaign ‘1000 special Days’

with outreach to many different sectors of the population emphasizing the ways in which they

can contribute to prevention of stunting, for example farmers, religious groups, the media, civil

society, traditional leaders and political leaders, .

3.4 Agriculture and Dietary Diversification in policies and strategies

The National Nutrition Policy and Strategic Plan NNPSP expands on the topic of dietary

diversification (published in 2007):

Efforts at the programme level

‘Promotion of the production and consumption of high nutritive value foods in agriculture has

been on-going in the past (including the broadening of the scope of the Government agricultural

input subsidy to target leguminous crops). The emphasis, however, has been on farm income

diversification and enhancement as opposed to nutrition. The nutrition gap has been addressed,

partially by integrating nutrition into the Agricultural Development Programme (ADP). The ADP

is results based and has a major focus on selected high nutritive value food crops and animal

production according to the country’s agro-ecological zones to enhance household food

availability and diversity. The ADP awaits government approval and resource allocation. The

other gaps are the low extension worker to farmer ratio, shortage of legume seed on the

domestic market, and the energy shortage which affects the high nutritive value diets

preparation such as those including beans among others.’

20 | P a g e

Immediate causes of undernutrition

‘Sub-optimal infant and young child feeding practices and limited dietary diversity in Malawi are

widespread problems and mainly caused by a combination of inadequate knowledge, food

taboos, and low availability and access to nutritious foods in terms of quantity, diversity and

quality as a result of inadequate resources for production of a variety of nutritious foods.

Inadequate knowledge of appropriate food choices and combinations from the Malawi Six Food

Groups and sub-optimal childcare and feeding practices are some of the major contributors to

poor infant and child feeding in Malawi.’ ‘Low food diversity also arises from limited agricultural

diversification. Poor agricultural diversification is mainly caused by inadequate access to farm

inputs, for example, access to legume seed. In spite of recent efforts directed at diversifying

agricultural production so as to produce high nutritive value foods (such as pulses, small

livestock, dairy and aquaculture), the quality of diets of the majority of the population remains

poor. Insufficient knowledge on diets prevents households from maximizing the nutritional

benefits of available foods and other resources. Presently, on average, energy foods (cereals,

roots and tubers) contribute about 86% to the total calorie intake of the national population;

legumes supply 11%, while the contribution of oils, animal foods, fruits and vegetables remains

a paltry 3%. This is against the recommended ratio of at least 35% for legumes or at least 35%

for oils, animal foods, fruits and vegetables together.’

The Agriculture Sector Wide Approach (ASWAp) presents the following insights on

agricultural diversification:

Food Security

In addition to maize self-sufficiency, diversification of smallholder farming systems can increase

food availability, through creating economically attractive production options for drought-

resistant crops such as cassava, sorghum and millet. As importantly, the evidence is clear that,

once farmers reliably achieve food security, they rapidly explore other, potentially more

profitable, livelihood options (both on- and off-farm). This further diversification helps reduce the

vulnerability of households to unexpected shocks. There are, however, challenges to this

strategy as shown by published Malawi experimentation. conventional rotation and intercrop

systems often produced moderately reduced quantities of grain compared to monoculture maize,

which could be unacceptable to risk-adverse farmers on small land holdings (even though

legume grain has enriched value compared to maize grain). The notable exceptions are the

long-lived legumes for which reliable on farm Malawi data show can produce the same quantity

of grain as monoculture maize, and which increase the fertiliser use efficiency from 17kgs of

grain from 1 kg of nitrogen to 30 kgs of grain. This indicates that shrubby legumes could

transform the economic viability of fertilizer subsidy policies.

Nutrition Security:

The long term goal of government is to significantly reduce the degree and severity of

malnutrition in all its forms in the country i.e. chronic and acute malnutrition and micronutrient

deficiency disorders among the men, women, boys, girls, under-five children, expectant and

breast feeding mothers, and people living with HIV and affected by AIDS. The ASWAp

programmes will therefore ensure that Malawians have both physical and economic access to

adequate nutritious food for an active healthy life. The ASWAp will therefore address most of

21 | P a g e

the critical factors which create a food and nutrition insecure situation in Malawi mainly; chronic

poverty; low agricultural productivity; low food intake due to lack of economic opportunities

either to produce adequate nutritious food or to exchange labour for income to purchase

nutritious food; poor food utilization due to inadequate knowledge and skills about food values;

food choices, dietary diversification and child feeding practices; poor nutrition education which is

currently targeting women and not reaching men as decision makers at household level;

inadequate knowledge, skills and technologies for food preparation, processing and

preservation; inadequate capacity of institutions to implement nutrition programs at national,

district and community levels.

Sustainable Agriculture land and water management

The critical natural resource inputs into the production of food and commercial crops are land

and water. However, these resources are not sustainably managed resulting in land degradation,

soil erosion, deforestation, diminishing water resources and declining biodiversity. Sustainable

land and water management is key to sustained agricultural production.

These paragraphs lay out many of the issues in Malawi and why diet diversification is difficult to

achieve. These can be broadly summarised as:

Chronic poverty of the population; lack of economic opportunities

Policies focused on economic benefits of farm diversification rather than nutrition

focused benefits

Inadequate capacity of institutions to implement nutrition programmes at national, district

and community levels

Insufficient Extension workers in all sectors related to nutrition: Agriculture, Health,

Teachers, Community Development, Social Welfare, Water, Forestry, Energy. The

retrenchment of home economic focused staff in 1998 from Agriculture Farm Home

Assistants and Gender’s Home Craft Workers. Extension workers are not working

across sectors.

Shortage of inputs that are diversified and sustainable for all food groups: staples that

aren’t maize, legumes & nuts, animals, fruits, vegetables and fats.

Inadequate knowledge for producing of variety of foods

Poor management of natural resources with widespread degradation of soil, water,

plants and animals.

Farmers’ perceptions of limited total yield of rotation or intercrop systems (single crop

yield can decrease but total yield should be improved)

Insufficient energy & nutrients in the diets

Inadequate knowledge skills & technology for food preparation and preservation using

Malawian foods and food taboos

Inadequate knowledge and skills on child feeding practices

Nutrition education is not reaching men who are the decision makers

Current constraints and opportunities to diversify agriculture and diets were further explored

through key informant interviews and FGDs.

22 | P a g e

3.5 Priorities in the current national nutrition policy and action plans.

The NNPSP Objectives are listed in Box 3. The NNPSP is now out of date, and ran from 2007

to 2012. Its successor is still not finalized.

Strategic Objective 1 was identified following publication of the ‘Lancet Series’ on

undernutrition in 2008 (Black, Victora et al. 2008) and includes the Essential Nutrition

Actions which focuses on health sector interventions along with interventions from other

sectors such as: promoting access to diverse foods, nutritious meals for school children,

food safety and quality and nutrition-related non-communicable diseases, recognizing that

these have become a small but nevertheless growing public health problem.

Strategic Objective 2 focuses on the treatment of nutrition and links to ‘nutrition from

agriculture’ are not as strong. However the production of therapeutic products using

Malawi’s agricultural produce is an example.

Strategic objective 3 brings together the coordination, advocacy and capacity for

strengthening an enabling environment for nutrition mainstreaming with a central

coordinating body within the DNHA.

Box 3: NNPSP

The NNPSP overall objective is to: lay a solid foundation for human capital development and

economic growth and prosperity in Malawi through a better nourished population.

Three strategic objectives:

Objective 1: To prevent and control the most common nutrition disorders among women, men, boys,

girls in Malawi by 2011 with emphasis on vulnerable groups.

Objective 2: To increase access to timely and effective management of the most common nutrition

disorders among women, men, boys, girls in Malawi by 2011 with emphasis on vulnerable groups.

Objective 3: To create an enabling environment for the effective implementation of nutrition services

and programmes between 2007 and 2011.

Strategic Objective 1 Priorities:

1. Promotion of optimal breastfeeding practices for children 0-6 months in the context of HIV and AIDS

at facility, community and household level.

2. Promotion of optimal feeding practices for children 6-24 months or beyond to sustain breast feeding

while giving appropriate complementary feeds with emphasis on feeding frequency, amount, energy

and nutrient density and diversity based on the six food groups.

3. Strengthening of optimal feeding of a sick child during and after illness.

4. Promotion of women’s nutritional status among the general public.

5. Prevention and control of micronutrient deficiency disorders with emphasis on Vitamin A deficiency,

anaemia and iodine deficiency disorders.

6. Promotion of practices that promote health life styles, food availability, diversity, access, proper

storage, preparation, utilisation, the consumption of a variety of foods from the six food groups every

day, safety and quality in the general population.

7. Promotion of access to at least one nutritious meal and related health and nutrition services for the

school-going children through the school feeding and the school health and nutrition programmes.

23 | P a g e

8. Strengthening capacities for households and communities to attain adequate nutrition for their

families with emphasis on socio-economically deprived persons.

9. Promotion of food safety and quality.

10. Controlling of nutrition related non-communicable and other diseases.

Strategic Objective 2 Priorities

1. Scaling up of Community Therapeutic care (CTC), Therapeutic and Supplementary feeding services

to whole district in all the 28 districts.

2. Scaling up of the provision of Nutrition Treatment, Care and support to People Living with HIV

(PLHIV), TB and other chronically ill patients in all the ART sites in all the Districts and through the

Home-based care, orphan care and work place programmes.

3. Strengthening of logistics, linkages and referral in the continuum of care of children, adolescents and

adults with malnutrition up to the community level.

4. Strengthening of service delivery for early detection and management of Nutrition-related Non-

communicable diseases such as diabetes, obesity, hyper tension, gout and many others at the

community to the district and Central and hospitals.

Strategic Objective 3 Priorities

1. Establishment of a well defined coordination mechanism for nutrition services, programmes and

projects at national, district and community levels.

2. Advocacy to reposition nutrition at the top of the national development agenda.

3. Development of legal and other operational instruments to guide the implementation of nutrition

programmes and services.

4. Increased budgetary allocation of resources by government and development partners for the

implementation of the NNPSP.

5. Building of institutional and human capacities for the effective delivery of nutrition services and

design, development and implementation of relevant nutrition programmes, projects and interventions

in the public sector.

6. Promoting evidence-based programming of nutrition programmes, projects, activities, interventions

and services through the generation and dissemination of nutrition research information and findings

and appropriate documentation and dissemination of best practices.

7. Promotion of a national nutrition response

8. Development and operationalization of results-oriented monitoring and evaluation.

Table 7 shows the main direct actions for diet and agricultural diversification of four policies from

lists of outcomes, objectives or priority areas from the Appendices of the respective policies

(NNPSP: National Nutrition Policy and Strategic Plan, SUN NECS: SUN Nutrition Education and

Communication Strategy, ASWAp: Agriculture Sector Wide Approach, MGDS: Malawi Growth

and Development Strategy II) . The policies cover diversification from production to consumption

with little cross-over between the policies. The ASWAp includes some consumption, and BCC

components. The area of storage, processing and preservation, i.e. the post harvest activities

are not strongly represented in policies for diverse crops (i.e. crops other than maize). This area

appears to fall between the Agriculture and Nutrition sectors. Processing for maintenance of

nutritional value is not emphasised in the policies. This could be an important area for

micronutrient malnutrition as key nutrients tend to be lost during agro-processing staple foods.

24 | P a g e

Table 7: Policy actions to improve dietary and agricultural diversity in 4 key policies

Agriculture nutrition outcomes /objectives /priorities: NNPSP NECS ASWAp MGDS

Utilization (all are nutrition-related: food, water, health)

Increase number of women eating a variety of foods y

Promote availability accessibility and consumption of a variety of foods from the six food groups by women and general public

y

Promote consumption of micronutrient rich and fortified foods among all Malawians

y

Develop and disseminate recipes and guidelines based on various food combinations for family meals

y

Develop and disseminate guidelines on food utilisation, processing post harvest management, storage preparation based on typical available foods

y

Promote consumption of adequate food in both quality and quantity to meet nutritional needs of rural and urban households

y

Increase knowledge among consumers on food safely and quality y

Reduced prevalence of stunting <2 year old y

Understanding of 1000 days messages y

Adoption of appropriate 'SUN' behaviours y

Intensify nutrition education y

Promote dietary adequacy y

Improved dietary practice of PLHIV OVC and affected individuals and households

Y

Production Availability

Increase production of pulses y

Increase production of horticulture crops y

Increase production of cassava, sweet potato, Irish potato y

Increase production of eggs and poultry y

Increase agricultural diversification Y

Increased production of high value agricultural commodities for export

Y

Increased livestock and fish production y Y

Enhanced agricultural risk management Y

Accessibility

Improved agricultural market systems Y

Improved agricultural market systems Y

Utilization: Processing

Diversified agro-processed products Y

Diversified agro-processed products Y

NNPSP: National Nutrition Policy and Strategic Plan

NECS: Nutrition Education and Communication Strategy

ASWAp: Agriculture Sector Wide Approach

MGDS: Malawi Growth and Development Strategy II

25 | P a g e

3.6 Review of terminology and concepts used in Malawi related to food and

nutrition security

3.6.1 ‘Nutrition Sensitive Agriculture’

The concept of ‘Nutrition-sensitive Agriculture’ has not been introduced into the language of the

policies in Malawi. From the interviews: ‘Not a ‘workable’ definition, policymakers need to use a

different word. Something that really shows the connection’. In the opinion of the author and

other stakeholders, therefore, it is not a useful term because it tends to belittle the major role for

agriculture in prevention of undernutrition. Alternatives could be ‘nutrition driven’, ‘nutrition

focused’, ‘nutrition centred’.

3.6.2 ‘Food Security, Nutrition Security, Food & Nutrition Security, or Food Security &

Nutrition Security

The Malawi Growth and Development Strategy II refers mostly to ‘Food Security’ where Food

Security is described in strategies for ‘Agriculture and Food Security’. The term ‘Food and

Nutrition Security’ is used infrequently and mostly in the HIV and AIDS strategy, which is

probably a more recent addition to the strategy.

The National Agriculture Policy uses the term ‘Food Security’ more frequently than ‘Food and

Nutrition Security’ and again, it is not clear whether a difference in meaning is actually implied,

or whether the use of terms merely reflects later additions to the policy, particularly the HIV and

AIDS strategy (GoM MAFS 2011).

The Agriculture Sector Wide Approach uses both ‘Food Security’ and ‘Food and Nutrition

Security’. Also the term ‘Food Security and Nutrition’ is used.

‘The MGDS sees food security as a prerequisite for sustainable economic growth and states

that food should be available in sufficient quantities, either through domestic production or

through imports, so that Malawians have access to sufficient nutritious food to lead a healthy

and productive life. It is the intention of the government to move away from the experience of

severe food shortages that characterised the final decade of the last millennium and the first five

years of the current one to a situation of sustainable food and nutrition security.’

Extract from ASWAp section 2.3.1 (Republic of Malawi MoAFS 2011)

The National Nutrition Policy Strategic Plan (NNPSP) refers to a Food and Nutrition Security

Framework. This was developed previously under the ‘Food and Nutrition Security Policy. The

term ‘Food and Nutrition Security’ is not used other than to refer to this. ‘Food security’ is

generally mentioned with Agriculture. By the time of this policy in 2006 the Ministry of

Agriculture had incorporated Food Security (Republic of Malawi DNHA 2007). The Nutrition

component of the Food Security policy was transferred to the NNPSP.

The Food Security Policy refers to both ‘Food Security’ and ‘Food and Nutrition Security’. The

previous policy was entitled ‘Food and Nutrition Security Policy’ but a decision was made to

26 | P a g e

split the food and nutrition components of the policy The Nutrition components were transferred

to the NNPSP and the policy became the ‘Food Security Policy’. (Republic of Malawi 2005;

Republic of Malawi MoAFS 2006). The Food Security Policy of 2006 no longer has a section of

‘Utilisation’ which was transferred to NNPSP. This reduces the potential impact of the Food

Security Policy on Nutrition.

The Presidential Initiatives (on legumes and livestock) use the term ‘Food Security’ without

mention of Nutrition Security. The Economic Recovery Plan does not include discussion of food

or nutrition security.

3.7 Analysis of the nutrition-sensitivity of the specified food and agriculture

policies and frameworks: Policy mapping for 10 dimensions of nutrition

sensitivity

Table 8 shows the Malawian policies assessed according to the ‘Guiding Principles for

Improving Nutrition through Agriculture’. Taken as a whole the policies match up to most of the

dimensions. Malawi has worked on gender mainstreaming and cross sectoral working so these

features appear in most policies. ‘Targeting the vulnerable’ is also widely reflected in the

policies. Increasing food production and diversified food production is featured widely in all but

the Economic Recovery Plan. Nutrition objectives and indicators are built into the ASWAp but

not the Food Security Policy (as described above). The Economic Recovery Plan has no

nutrition objectives.

Post harvest issues – storage, processing and marketing of nutrient-rich foods is an area that is

not widely covered in policies. In Malawi the number one priority is maize and this takes

precedence over other crops in post harvest policies. The policies that do mention processing,

either of maize or other crops, do not mention processing for nutrient retention. This is a large

potential area to improve nutrient content of foods and is so far an under-emphasised area for

policy. In a study in Bangladesh the most important way to improve nutrient content of rice was

through manageable adjustment to the amount of rice lost on milling (Mayer 2011).

Environmental sustainability, natural resource management is included in most policies, apart

from the Economic Recovery Plan and Presidential Initiative on Legumes. In Malawi economic

recovery is seen as something apart from building nutrition and natural resources.

27 | P a g e

Table 8: Policy Mapping for 10 dimensions of Improving Nutrition through Agriculture

Policies and Programmes Improving Nutrition through agriculture

1 2 3 4 5 6 7 8 9

MGDS II

NAP draft

ASWAp NNPSP SUN-NECS

FSP ERP PHI:

Legumes PHI:

Livestock

1 Have explicit nutrition objectives yes yes yes yes yes partial no no partial

2 Have explicit nutrition indicators / link with nutrition M&E system

yes partial partial yes yes yes no no no

3 Have goals/activities based in the local nutrition context

yes yes no yes yes partial no partial no

4 Target the most vulnerable yes yes yes yes partial yes partial yes yes

5 Empower women yes yes yes yes no yes no partial yes

6 Increase food production yes yes yes yes partial yes yes yes yes

6.1 of nutrient-rich foods yes yes yes yes partial no no yes yes

7 Reduce post-harvest losses yes yes yes yes partial yes no yes no

8 Promote diversification of agricultural products yes yes yes yes partial yes partial yes no

9 Presence of nutrition promotion / education components

yes yes yes yes yes no no no no

10 Improve processing of foods yes yes yes yes partial no no yes no

10.1 to retain nutritional value no no no no no no no no no

11 Improve storage yes yes yes yes no yes no yes no

11.1 storage of nutrient-rich foods yes

12 Expand markets and market access of the most vulnerable

yes yes no no no yes yes yes yes

12.1 of nutrient-rich foods no no no no no no no yes yes

13 Collaborate with other sectors yes yes yes yes yes yes yes no no

14 Maintain / improve the natural resource base (sustainability approach)

yes yes yes partial no yes no no partial

28

3.8 Impact pathways key impacts and where the policies fit into the IFPRI

pathways model and the UNICEF causes of Child Undernutrition model

The polices were mapped onto the IFPRI developed conceptual model for linking agriculture to

nutrition. The main action of the policies is marked on the framework to show the main points

along the causal pathway from agriculture to nutrition where impact is likely to occur.

The policies reviewed work on different possible pathways to improve nutrition through

improved income pathway or direct consumption pathway. The pathway that starts with female

employment and resources was not recognized as a nutrition-related pathway in the policies,

nor is impact being measured. The Nutrition policies and strategies (NNPSP and SUN NECS)

operate closer to the nutrition outcomes at food consumption, health care and caring practices

level; the ‘underlying causes’. Similarly, at the programme level the focus is on different paths

on a causal pathway. This may be driven by a theoretical understanding guided by evidence, or

a belief system about what is needed to improve nutrition driven by sectoral or personal beliefs.

This is explored further in the Q-Sort results presented in Table and Box 7.

It would make sense if the polices measured impact at these points if possible. Where indicators

are listed, these broadly do follow these pathways (see table 8).

Adapted by J. Harris and A. Herforth from: Stuart Gillespie, Jody Harris, and Suneetha Kadiyala, 2012 The Agriculture-Nutrition Disconnect in India, What Do We Know? IFPRI Discussion Paper 01187

Food prices

Food consumption

Food expenditure

Non-food expenditure

Nutrient intake Child nutrition outcome

s Health status

Mother’s nutrition outcomes

Health care expenditure

Female employment /

resources

National nutrition outcome

s

Income (agricultural and non-agricultural)

Caring capacity & practices

Female energy

expenditure

Food production

Nutrition knowledge

National economic growth

Figure 6: Pathways from agriculture to nutrition: Main objectives of Malawi’s policies:

Numbered policies are from Table 6

1,2,3,4,6,8,

1,2,3,6,7,8,9

1,2,3,6, 8

1,3,4,5

1,3,4,5,6

1,4

1,4,5

1,4,7

29

3.9 How the stated policies impact nutrition outcomes (directly and/or indirectly)

(undernutrition, micronutrient deficiencies, and dietary diversity) of different

population groups

3.9.1 Is there any evidence of impact of policies on nutrition – particularly agriculture

and dietary diversity improvements

It is difficult to attribute the clear improvements in nutrition experienced in Malawi over the past

decade (described in section 3) to nutrition or agriculture policies. This would require

systematic, detailed and regular impact studies. These were not readily available for the

purpose of the case study. This is a gap; if data were collected it might be possible to show how

improvements came about and hence a case could be made for following particular policies and

strategies. As things stand it is difficult to determine what has contributed to improvements in

nutrition and how and where successes occurred.

Nutrition policies are focused on the main nutrition problems outlined in section 2 – i.e. chronic

and acute malnutrition. Micronutrient deficiencies tend to be approached through nutrient

supplementation.

The agriculture policies do not address specific nutrition problems through a food-based

approach. Micronutrient malnutrition is implied by the focus on agricultural diversification, for

example in the priority areas of the ASWAp: The justification for focusing on nutrition security is:

‘The long term goal of government is to significantly reduce the degree and severity of

malnutrition in all its forms in the country i.e. chronic and acute malnutrition and micronutrient

deficiency disorders among the men, women, boys, girls, under-five children, expectant and

breast feeding mothers, and people living with HIV and affected by AIDS.’

‘Malnutrition will be reduced by agricultural diversification that includes legumes, vegetables,

fruits, small stock (Goat meat and milk), pigs, rabbits, chicken and guinea fowl meat and eggs,

and fish.’ ( ASWAp)

Dietary diversification is therefore proposed as a means to tackle micronutrient malnutrition, but

there is no focus on food-based approaches for particular deficiencies (e.g. meat for Fe

deficiency). These details would be more likely to appear in strategy documents and guidelines.

The Agriculture Community Nutrition manual and the Nutrition Guidelines contain food based

guidelines. There is need for an Agriculture Nutrition strategy. It is unclear how much the

Agriculture Community Nutrition manual has been used in practice. Gender also had a specific

nutrition manual with the details of the dietary diversification but again, it is not clear how useful

it was in practice. The national guide for non-communicable diseases is one of the policy

accompanying documents that is specific on the foods that should be promoted for consumption

to tackle particular nutrition problems.

30

3.10 National data trends on Agriculture and Dietary Diversification

Trends are available for agricultural production but not consistently for consumption. (Ministry of

Agriculture Irrigation and Water Development 2010 2011). Some NGOs collect data that could

be useful for evaluation purposes, but it is not systematic nor national level. It would be useful to

have national data on consumption patterns to determine how well diversification strategies are

working. Also, consumption studies are needed to quantify dietary practices – to assess

consumption against nutrition goals for all nutrients. This could be achieved through following

sentinel sites regularly or carrying out nationally representative surveys regularly. Some of these

data are collected by the MVAC but this is specific to vulnerable groups and hence not

representative of all groups.

3.10.1 How are nutrition-centred agriculture and food policies being funded and

implemented

The NNPSP is now out of date, and ran to 2011 so latest budgets are not available. However,

there is much donor interest in Nutrition in Malawi, and a dedicated task force (the DONUTS)

who work to coordinate nutrition allocations. The largest donors to ‘Nutrition’ in the past year

are CIDA, World Bank and the EU. Nutrition Resource Tracking Tool (NRT) shows that as much

as 98% of the Nutrition funding is provided by donors and only 2% from Malawi’s own resources

(2010-2012) The NRT does not include Agriculture, Education and Gender budgets for Nutrition

however and it also under-estimates the contribution of salaries, utilities infrastructure and

consumables from Malawi resources. The figure of 98% is therefore probably an overestimation.

A challenge for Malawi is that CIDA’s contribution is due to phase out in 2014 leaving a large

funding gap.

A SUN Costing analysis shows that of the USD 436.5 million devoted to nutrition (2011-16) 39%

is focused on nutrition activities in the health sector, 47% on nutrition from other sectors and

14% on governance. Of the 47% spent on non-health sector interventions, most (98%) is for

food security and 2% is for other health interventions, water and sanitation activities. This

analysis does not correspond directly to the NRT which did not include budgets on agriculture or

education. The SUN costing exercise is also limited because projected budgets beyond 2011

are not available for nutrition specific activities. Overall the analysis estimates that an average of

USD 62.3 million per annum is targeted to Nutrition (Boyce and Dolan 2013). Further work on

mapping the funding and Nutrition allocations is planned (DNHA 2012).

3.10.2 The proportion of budgets allocated to non-health sector nutrition actions and to

agricultural/ dietary diversity in particular

The National Nutrition Policy and Strategic Plan (NNPSP), now out of date, allocated 51% of

the total budget to School Nutrition, 23% for optimal breastfeeding, feeding of the child 6-24

months and feeding of sick child. Prevention in general is allocated 79% of the budget. M and E

system is 17% leaving approximately 4% for management of malnutrition. The budget

commitments are not described in the NNPSP (Republic of Malawi DNHA 2007).

31

The National Education and Communication Strategy (NECS) has attracted much interest

and its focus on BCC roll out at the community level is important for agricultural diversification to

have an impact on diets and nutrition. It is not straightforward to determine all the funds

attached to the NECS because most donor money passes straight to NGOs without passing

through government financial systems and donors are responsible for different geographical

areas of the country where different NGOs operate.

The Agriculture Sector Wide Approach (ASWAp) budget for 2013-2014, requires resources

of USD 422 million. The largest proportion (39%) is for maize self sufficiency – largely for the

Farm Input Subsidy Programme. Diversification and nutrition are allocated 10% of the budget

and sustainable water management 23%. Other allocations are less than 10% (Table 9). For

maize self sufficiency 78% of the budget is available from local resources with donors pledging

an extra 11% leaving a funding gap of 11%. For diversification and nutrition, however only 5% is

allocated from local resources and donors pledging 49% thus leaving a funding gap of 46%.

Maize self sufficiency is clearly a priority compared to diversification and nutrition. (Republic of

Malawi MoAFS 2011). Agricultural diversification is therefore written into agricultural policies

but the funding commitment is not strong from Malawi’s own resources. The Economic and

Food Security (in terms of ‘Maize Security’) programmes take priority.

Table 9 Resource analysis for the Agriculture Sector Wide Approach 2013/4 (Republic of

Malawi MoAFS 2011) Analysis carried out by author, using data in the ASWAp appendices

Agriculture Sector Wide Approach Focus area/ Component Resources

Required 2013-4 %

Food Security and risk management

• Maize self sufficiency 163 127 750 39%

• Diversification and nutrition 41 361 570 10%

• Risk Management for Sustainable food availability 3 171 250 1%

Commercial agriculture and market development

• Agriculture export for improved balance of trade and income 11 170 000 3%

• Commercial production for import substitution and domestic market development 28 089 250 7%

• Input and output market development through Private Public Partnership 480 000 0%

Sustainable land and water management

• Sustainable agricultural land management 14 545 400 3%

• Sustainable agricultural water management 98 400 000 23%

Technology generation and dissemination

• Results and market oriented research and provision of technical and regulatory services 2 972 075 1%

• Efficient farmer-led extension and training services 25 884 000 6%

Institutional strengthening and capacity building

• Strengthening public management systems 15 956 840 4%

• Capacity building of the public and private sector 9 411 510 2%

• Cross cutting issues

• Mainstreaming of gender and HIV AIDS 7 658 590 2%

Grand total 422 228 235 100%

32

3.11 Summary points on financing

At this time it is not possible to be clear about budgets allocated to nutrition centred

agriculture because there is a lack of coordination between ministries, donors and NGOs on

financing, as far as was able to be determined for this case study. There is also the

challenge that a follow up policy and strategy to the NNPSP is not available.

With these caveats, it is nevertheless clear that many donors are interested in funding

Nutrition. So far the obvious channel for this has been the NECS, but for nutrition centred

agriculture, funding through a Sector Wide Approach would be helpful. The present ASWAp

includes diversification of agriculture and diets but this is not prioritised in comparison to

production of maize. The relationship between the dietary diversification mentioned in the

ASWAp and the dietary diversification in the NECS and who funds what is unclear.

3.12 Commitments to Nutrition Centred Agriculture in Malawi

3.12.1 Scaling Up Nutrition Movement (SUN)

During the past years, Malawi has demonstrated a high level of political commitment to the

Scaling Up Nutrition Movement as well as the 1,000 Days Movement (SUN 2011). Malawi has

actively engaged in the SUN movement, being one of the first five ‘Early Riser’ SUN countries.

Moreover, the country has developed a National Nutrition Education and Communication

Strategy (NECS) as an advocacy and implementation tool.

3.12.2 Presidential Commitment

Nutrition was included as a priority at Presidential level. The following nutrition linkages were

created at governmental level (SUN 2011):

Malawi Growth and Development Strategy I (MGDS) is stating nutrition is on the

development agenda addressing the underlying cause of malnutrition;

MGDS II, followed up on the commitment and is operationalized by the National Nutrition

Policy and Strategic Plan (NNPSP). One of the major objectives is to reduce stunting

among children <2 years by less than 20% 2011 – 2016;

Integration of nutrition in Sector Wide Approaches (SWAps) of various Ministries being

present in the following departments: Agriculture, Gender and Youth, Health, Education,

Information, Water and Irrigation, Natural Resources and Local Government. Hence,

nutrition is gradually getting integrated in key sectoral policies (IDS 2013)

Creating multi-stakeholder platforms and SUN taskforce committees have been

established coordinating planning and implementation of the SUN-1000 Days launch

and follow up the activities. According to (SUN 2011), the public sector in strongly

involved. Members of the multi-stakeholder platforms are people working in the

government and its various ministries, UN agencies, development partners, academia

and civil society.

3.12.3 The Hunger and Nutrition Commitment Index (HANCI)

33

The HANCI report concludes the GoM takes a multi-sectoral approach to nutrition (IDS 2013)

and scores second on commitment to nutrition.

‘Within sub-Saharan Africa, there are some success stories to be told. Some of the smaller

economic powers (Malawi, Madagascar, The Gambia) are now leading the charge against

hunger and undernutrition; (IDS 2013) p10) .

The report emphasises the Government, leading from the SUN movement, has undertaken a

wide range of interventions aiming to improve hunger and undernutrition which is addressed in

the various policies. Nevertheless, the report stresses:

‘Nutrition policy preferences are deemed to be much less well represented in budgets than

hunger policy preferences (IDS 2013) p73)’. ‘While hunger policies are seen to be implemented

fairly well, for nutrition this is only mediocre. Particularly for nutrition therefore, capitalising on

commitment may require supporting the effective functioning of policy and programme delivery

mechanisms (IDS 2013) p74)’.

3.12.4 ‘Nutrition for Growth’ conference in June 2013, London

Malawi agreed to commit to Nutrition actions, see box 4. For nutrition-centred agriculture, there

are some important commitments, including the commitment to nutrition strategies with

agriculture, increased financing and extra support at District and Community levels for nutrition.

There was a commitment by the GoM to increase the nutrition budget from 1-2% to 3.3%

3.12.5 Support for Nutrition Improvement Component (SNIC) (DNHA 2012)

The objective of the project is to increase access to and utilization of selected services known to

contribute to the reduction of child stunting, maternal and child anaemia. There are two

subcomponents:

1. Enhancing and scaling up maternal and child nutrition service delivery at community level

- This sub-component will contribute towards a strengthened nutrition service delivery

platform at community level through provision of a “minimum package” of nutrition

interventions offered in targeted communities in fifteen (15) districts.

2. Strengthening Sectoral Policy and Program Development Management and Coordination

for DNHA, line ministries, as well as the district-based capacity for nutrition program

planning, management, monitoring and coordination of NGOs and District Councils. In

addition, this project will strengthen the governance and oversight of nutrition policies and

programs through the creation of a nutrition sector oversight structure which will

complement the technical and operational coordination structures already in place.

Specifically the project will support:

Development and review of policies and other strategic documents;

Joint planning, review, monitoring and evaluation nutrition-relevant; activities at central

and district levels;

Nutrition education and communication;

Coordination of nutrition function at central and district level;

Institutional capacity of the DNHA.

34

Box 4: Malawi commitments for the London Summit on Nutrition (OPC DNHA 2013)

Goal: “Unite to end stunting” To reduce prevalence of stunting among children less than 5 years of age from 47.1

10% to less than 20%

11 by 2020

Political or policy commitments Finance commitments Delivery or programming

commitments

Review the National Nutrition Policy and strategic plan (2007 - 2012 by 31

st

December 2013.

Develop sectoral specific strategies for Nutrition for ministries of Agriculture and local government with emphasis on Stunting by 2014

Establish Cabinet committee on Nutrition, HIV and AIDS to strengthen political oversight on Nutrition

12

Develop Nutrition Act by 31st December 2016 to raise the status of nutrition as a national priority

Increase maternity leave from 2 months in private sector and 3 months in public sector to 4 months by 31st December 2016

Strengthen the institutional arrangements to deliver effective policy leadership and implementation of nutrition services and programmes. This is through placing of district nutrition officers in the local councils and line ministries and elevation of nutrition units in Ministries of Local government, Health, Education and Agriculture to full directorates by 2015.

Increase budgetary allocation for nutrition by 50% in ministries of Agriculture, Education Health, and local government by 2020.

Develop and operationalise financial resource tracking tool for accountability in the utilisation of nutrition resources by 2014.

Scale Up Nutrition Education and Communication to promote behaviour change through different channels by 2016 for improving maternal and Child Nutrition in all districts.

13

Increase coverage of community based nutrition services in all districts at Traditional Authority level and Village level through care group model or Community Leaders Actions in Nutrition (CLANS) by 2016.

Scale Up coverage of Community based Management of Acute Malnutrition in all districts from 50% to 80%.

Strengthen community structures for effective delivery of community-based nutrition interventions through placement of frontline community workers in all districts by 2020

14

Roll out/strengthen National Nutrition Monitoring and Evaluation framework in all the districts by 2014.

Strengthen Public Private Partnerships through quarterly National Fortification Alliance meetings with industries by December 2014.

10

Malawi DHS 2010 11

Targets set in the National Nutrition education and Communication Strategy 2011-2016 12

Advocate for establishment of Cabinet Committee on Nutrition, HIV and AIDS to fast truck cabinet approvals on policies and legislations on Nutrition and lobby for increased budgetary allocation for nutrition. 13

Focus is to build capacity of national media houses including television, community radios, develop IEC materials aimed at reducing stunting and other forms of malnutrition. 14

Focus should be placed at building capacity of village development committees and Arial development committee to conduct community mobilisation and monitor implementation at group village level

35

3.13 Policy Implementation

The agriculture and nutrition policies provide a supportive environment for agricultural and

dietary diversification, but the question is whether implementation is possible? Policy

implementation could be assessed by review of programme and project reports, monitoring and

evaluation reports, budget allocations, human resource deployment and impact studies. These

sources of information are not so far available for the case study. To assess implementation,

therefore programmes and projects were reviewed that illustrate implementation of the policies

by fields visits and interview with stakeholders.

Projects and programmes and indigenous systems that emphasise agricultural and dietary

diversity are used as examples of nutrition-centred agriculture. The examples that follow are

illustrative rather than systematic due to time constraints of the consultancy. The choice of

examples has been informed by discussion with key informants in Malawi.

The key informants described government and non-government programmes, actions and other

activities that are being implemented to improve dietary diversity and sustainable agriculture.

Also some practices – neither supported by government nor NGOS, illustrate the inherent

strength of some traditional systems to support diversification. The private sector is also a key

player in this arena and their influence on agricultural practices is important. The challenges

faced by these projects also sheds light on some of the opportunities and problems for

implementation of policies. This list is illustrative rather than comprehensive. Box 5 describes

Agro-ecological approaches to improving nutrition. These describe indigenous and innovative

approaches to sustainable agriculture that will, if implemented contribute to lasting

improvements in the environment, nutrition and small holder viability.

Box 5: Agro-ecological approaches in Malawi

Malawi has traditional agricultural practices and a range of agro-ecological approaches that

promote diversification. These are supported by the ASWAp that also emphasises sustainable

agricultural practices and diversification. WFP has produced a manual designed for field

workers in Nutrition, Agriculture and allied fields as a practical guide to application of

sustainable methods for promoting agricultural and dietary diversification and nutrition. (Nordin

2013). Most of the policies in Malawi promote some form of agriculture sustainability, and this is

also one of the guiding principles for nutrition centred agriculture.

Promotion of production of indigenous crops , cooking and preparation: Malawi has a rich

source of information on indigenous foods, agricultural practices and cooking and publications

describing these, such as ‘Malawi’s Traditional and Modern Cooking’ by Chitukoko Cha Amayi

m’Malawi (Development of women in Malawi). For plants ‘Useful plants of Malawi’ by Jessie

Williamson listing edible indigenous species to Malawi. ‘Landcare Practices in Malawi’ describes

agri practices suitable to the Malawi context (Nordin 2013). The nutrient content including

bioactive phytochemical content of indigenous fruits and vegetables compares favourably with

the nutrient content of ‘exotic’ species. Seed supply, however is one of the challenges to

diversifying agriculture raised by key informants.

36

Conservation agriculture: Conservation Agriculture is gaining momentum in Malawi. It is

known as a way to introduce zero-tillage systems where soil disturbance is kept to a minimum to

maintain soil structure and fertility and for adaptation and mitigation against climate change.

There are also gains to be made on yields. Inter-cropping or rotations with legumes to maintain

soil nitrogen. The National Conservation Agriculture Taskforce formed in 2007 meets quarterly

with a mandate to promote uptake of conservation agriculture as one of the strategies for

sustainable production to mitigate negative impacts of land degradation and climate change.

Conservation Agriculture is a broad term that can also include use of herbicides, so not all the

CA in Malawi would be classified as an ‘Agro-ecological’ approach.

Agroforestry: The World Agroforestry Centre (ICRAF) with funding from Irish Aid Malawi, has

been implementing the Agroforestry Food Security Programme (AFSP) in 11 districts. Partners

included government departments, research institutions, Universities and national farmers. The

agroforestry technologies being promoted include fertilizer trees, fruit trees, fodder and fuel-

wood options. The adoption of these technologies is expected to raise the productivity of land

and labour, overall production of food, improved nutrition and income generation from he

processing and marketing of tree products. The programme targets 200,000 farmers over a

four-year implementation timeframe; which is expected to have a positive impact on up to 1.3

million people in terms of food security.

Permaculture ‘(Permanent Agriculture)’ is ‘the conscious design and maintenance of

agriculturally productive ecosystems which have the diversity, stability and resilience of natural

ecosystems system that use both indigenous knowledge and modern technology to design

sustainable productive systems. It is the harmonious integration of landscape and people

providing their food, energy and other material and non material needs in a sustainable way.’

(Mollison 1988). One of the design principles is the introduction of diversity into agriculture

systems; this includes a range of crops and livestock that provide food in the 6 food groups

identified as essential in Malawi. At least 1000 practitioners have been trained . Permaculture

has been used in the design of school landscapes with examples in at least 10 Districts of

Malawi. ’Seeding Schools’ is scaling up support to many new districts.. There has only been

one study recently on the impact of Permaculture on Food Security & Dietary diversity, nutrition

impact indicators were not included. Additional studies are planned (S. Nordin, personal

communication).

3.14 Example 1 Agriculture and Health extension systems for implementation of

the ASWAp and NNPSP at District and Community Levels

3.14.1 Policy links:

ASWAp, the and NNPSP also the District Agriculture Extension Services System Policy.

Extension services are described in both agriculture and nutrition policies and are implemented

by local government structures. New opportunities for rolling out BCC activities are offered by

the SUN NECS.

37

Extension services are a clear necessity for the implementation of most nutrition activities and

depend on sufficient resources available that reach the communities.

Agriculture: At the community level Nutrition Groups (mostly farmers) are supported by the

Food and Nutrition Officers who work under DAES. Their focus is on teaching groups how to

plan, budget, grow and/or purchase, and prepare nutritious foods using the 6 food group

model. The Food and Nutrition officer trains Agriculture staff on nutrition.

Health: This is complemented by nutrition training on ENA that is provided by Nutritionists

under the MoH to HSAs

Roll out of Care Group Model through NECS: Use of Care group model was pioneered by

NGOs in Malawi and elsewhere and offer opportunities for HSA and Agriculture extension &

other service providers to reach the population, particularly vulnerable groups with IYCF

messages, introduction of recipes for diet diversity. Special recipes have been developed.

Complimentary feeding guidance and materials are available. Care groups trained in

different topics according to NGO support. Agriculture extension also works with Care

groups; hence there is an opportunity to link Ag and Diet diversity at the Care group level.

Different donors and NGOs support different districts.

3.14.2 NGO/Donor involvement:

Numerous local and international NGOs are supporting Agriculture and Health Extension

services at the District and Community level by providing technical and logistic support to

Community Frontline Workers. For example (not a comprehensive list) :

WALA (Wellness and Agriculture for Life Enhancement) includes a wide range of NGOS

(CRS, Emmanuel International, ACDI/ VOCA, World Vision, Save the Children, DSI, Total Land

Care, Africare). WALA supports Community groups in Maternal and Child Health and Nutrition;

Food Security including grains and legume production; Village Savings and Loans and

marketing – ‘Farming as a Business’ model; Building capacity of vulnerable groups to withstand

shocks, climate change adaptation.

‘Improving Food Security and Nutrition Policies and Program Outreach’ supports

communities to improve food security to enhance family livelihoods and promote good nutrition.

MICAH (Micronutrients and Health) programme implemented by World Vision aims to reduce

stunting and anaemia using an integrated approach through agriculture improvement for year-

round Food Security, pass-on scheme for goats, promotion of indigenous vegetables and fruits

as well as health components to prevent common ailments. They work with Health and

Agriculture Extension workers at Community level using existing structures using PD Hearth

Approach to address micronutrient problems using Food Based Approach with local available

foods. Supplements are also promoted.

Farm Income Diversification Programme (FIDP). The objective is to support diversification

from maize to other crops and introduce menus for improving nutrition with local foods amongst

many possible projects. Communities have the choice about what projects to pursue and NGOs

38

support the AEDO or other Extension staff to facilitate the process at the village/community

level.

3.14.3 Impact on Nutrition:

An impact assessment of the MICAH programme 15 showed large reduction in stunting in

children <5) from baseline 60.2% in 1996 to 43.0 and 45.1% in MICAH and comparison areas

respectively by 2004. It is interesting to note that there was also a large reduction in the

comparison area, raising a question about what had contributed to the reduction? There was

also reduction in anaemia prevalence in both intervention and control areas for children and in

the intervention areas a higher reduction of anaemia in women. It is not clear whether the

supplements or the Food-based Approach contributed to these improvements. (Kalimbira 2011).

No other published information was obtained for this review on the actual implementation of

extension services and how effective they are at improving agriculture and nutrition.

3.14.4 Challenges:

Those interviewed at National and District level described some of the challenges they face to

implement and these are listed below.

Coordination depends on individual ways of working rather than strong district structures.

Coordination between Agriculture and Health extension workers and local government

officers therefore depends on leadership and motivation of individuals as well as the

resources available

Capacity is limited by the recruitment and retention of nutritionists at the district level and

their training needs. When district nutritionists from the MoH leave for study they are

temporarily replaced by Environmental Health staff who are not qualified to the same level

in nutrition. Reports vary on the % of posts filled at the District level, from 15 to 25%

Nutrition is not a high priority for many agriculture extension who deal with numerous topics

and have to prioritise the support they offer. Nutrition is one amongst many technical areas

of support (see table 10)

Resources are a challenge, With high fuel costs and shortage of vehicles it is difficult to

reach communities

Sustainability of NGO presence. Government relies on them, but they can leave at any

time. However, working with NGOS is good because they help implement; ‘without NGOs

the work would not be possible’ also ‘NGO staff are well motivated and have the necessary

resources to carry out their work’

NGOs do not have their own Extension Officers, but rely on the Government Extension

Officers, this creates a ‘top heavy’ structure whereby the Extension staff have to deal with a

lot of technical and logistical demands.

Mapping of activities and support at each District presents a challenge for National

coordination, although decentralisation also has benefits of reasonable local autonomy.

15

http://www.wvnutrition.net/home/tagSummary/MICAH.html

39

Table 10: Areas of focus for Agriculture Extension: From the District Agriculture Extension

Service System Implementation Guide (MAFS GOM 2006)

3.15 Example 2: Legume production and utilisation in Kasungu District

3.15.1 Policy links:

Legume production by small farmers is supported by the ASWAp and the Presidential Initiative

on Legumes as well as the Food Security Policy. Consumption is covered by the NNPSP under

dietary diversification strategies. The Presidential Initiative promotes availability of seeds

(ground nut, soy pigeon peas and beans) to poorer farmers. Respondents estimate that 50% of

farmers take up the seeds. Several NGOs, and other organisations are supporting legume

production in Kasungu District:

ICRISAT (International Crop Research Institute for the Semi-Arid Tropics) is present in

Chitedze Agricultural Research Station and develops locally adapted legumes for Malawi.

The Farm Input Subsidy Programme (FISP) provides seed and fertiliser inputs to the

farmers

Maziko project (meaning ‘foundation’) is working in the area implemented by Care Malawi

also provide legume seeds and irrigation . The organisation also works with mothers on

nutrition.

The Clinton Foundation also provide soy seeds in the area

‘Total Land Care’ supports farmers with legume seeds and maize

IRLADP (Irrigation Rural Livelihood Agriculture Development Project) provides irrigation

NASFAM (National Smallholder Farmers Association of Malawi) is active supporting small

farmers with seed production in the area

Improving Food Security and Nutrition, Policies and Program Outreach Project (IFSNP) supported by FAO & FICA supports farmers with legume seeds of their choice along with

some training in improved production, storage and utilization

40

Within the District Government Office most Officers play a role in production, post harvest or

consumption of legumes:

The Crops Officer for Legumes provides technical growing support for Agriculture

Development Extension Officers (AEDOs)

The AEDOs provide technical support to Lead Farmers

The Community Lead Farmers provide training and support on legume production to

many more farmers in their community.

The Food and Nutrition Officer trains AEDOs on food preparation and cooking methods

for the legumes

The Horticulture Officer provides technical support for growing of green beans and other

horticultural crops

The Irrigation Officer works with communities to build irrigation systems

The Land Resources Officer provides technical support about land suitability for legume

production

Fisheries Officer and Livestock Officer support use of legume products for production of

fish and livestock respectively. Livestock manure is used to fertilise legume production,

so livestock and legumes are part of a joint system

The Agribusiness Officer supports farmers with business advice on selling and

marketing

Crop Protection Officer to offer advice on safe processing and storage of crops

3.15.2 Impact on Nutrition:

No data are available on the impact on nutrition of polices that aim to improve legume

production. Data on legume production are available from the MA&FS on an annual basis.

3.15.3 Challenges faced:

Transport problems to reach the communities; lack of fuel and vehicles

Staffing problems (65/105 Extension Plan Areas have AEDOs (62%) the other 40 lack

an AEDO to carry out extension services)

Lack of essential equipment, for example protective clothing for hazardous agricultural

chemicals

Allowances paid by NGOs are unregulated and can cause motivation problems for

activities that are not compensated.

Seed procurement problems for horticultural crops and fruit with high nutritional values

Climate change effects the types of crops that can be grown

Environmental degradation (soil clearing and/or burning, mono-cropping, tree cutting)

Training on utilisation of crops, processing and storage is identified as a gap.

There is a lack of watershed management that would enable better irrigation

opportunities

41

3.16 Example 3: School Health and Nutrition Strategy

3.16.1 Policy Links:

Under the Ministry of Education and linked to the NNPSP, Decentralisation policy, food

security policy, agriculture extension policy. At National, Division, District, Zonal and Community level there are communication and responsibility structures involving Ministries of Education, Agriculture and Food Security, Irrigation and Water Management, Natural Resources, Local and Regional Government and the Office of the President and Cabinet. This gives the opportunity for all these ministries to work together under the ‘School Health and Nutrition Working Group’.

The School Health Nutrition Strategic Plan 2009-2018 (GoM MEST 2009)

Goal: By 2018 Malawi will have healthy school-aged children who can fulfil their optimum

learning potential.

Objectives:

1. Improve the health and lifestyles of school-aged children

2. Improve the nutrition of school aged children

3. Improve the management and coordination of SHN at all levels

4. Establish an effective capacity building framework

5. Increase public awareness knowledge and competitiveness of SHN at all levels

Covered by this strategy are School nutrition interventions (School meals, micronutrient

supplementation, productive school environment), water sanitation and hygiene interventions,

Information Education and Communication,

The Productive School Environment is moving forward in various ways including ‘Teaching and

Learning Using Locally Available Resources (TALULAR) and Permaculture. Also the Junior

Farmer Field Schools.

This strategy is a good example of linking nutrition to agriculture. It is addressing the clear

problems of poor nutrition in school-aged children that were identified by surveys carried out

prior to the initiative. These were: iodine deficiency, anaemia, high stunting prevalence, with

high morbidity with common illnesses – intestinal worms, malaria, bilharzias. The approach

tackles poor nutrition using multi-sectoral integrated approaches using health, education,

gender, and agriculture strategies.

The component on productive school landscapes has been developed to specifically focus on

production for school consumption, teaching, controlling the microclimate of schools, water and

sanitation provision, and forming partnerships with the community. Capacity building is a high

priority with, for example, Permaculture intensive training for teachers and agriculture extension

staff to be trained in sustainable systems design (see box 5 on Agro-ecological methods).For

example, during a visit to Mangochi we had the opportunity to discuss the local SHN

programme with Agri-business, Agriculture Development, District Medical Officer, Education

officer, Food and Nutrition Officer, and Nutrition Coordinator before visiting a School project.

42

Food production in schools is being promoted under the School Health and Nutrition Strategy

and also the Home Grown School Meals in Malawi which is being supported by WFP as part

of a wider international ‘Home Grown School Feeding’ initiative. In Malawi it is rolled out in 2

districts and is linked to the School Meals Strategy The objective is to provide school children

with one meal using the 6 food groups; (not necessarily each group each day). Schools are

given recipe books to guide choice of foods and meals. Links are made with local farmers to

supply foods as much as possible. In Mangochi district, for example, 5 out of 254 schools in the

district are piloting Home-grown School Meals; another 64 receive Corn Soya Blend (CSB) as

supplementary food from WFP. The CSB is supplied either locally or through food aid.

Opportunities and Challenges: In Mangochi, the school visited reported improved enrolment and

punctuality and reduced dropouts. Children had more energy for school work and made good

progress academically. Fresh foods were being provided for children from school gardens with

dry foods supplied by local farmers. Children were enthusiastic about the project and local

farmers appreciative of the associated income.

3.17 Example 4 Model Village Approach Concept (GOM DAES 2000)

Agriculture and dietary diversification is built into the concept of the ‘model village’. One

example in Malawi that illustrates the approach is the Millennium Villages Project.

Objective of Model villages: ‘to transform rural villages by empowering them to respond to

their needs by maximizing their ability and assets to improve their livelihoods. These needs

relate to food and nutrition, health, social and physical infrastructure, access and control of

resources and benefits by the various gender categories.’

What is a model village? A village with improved livelihoods of people through integrated

interventions. One feature is ‘Human Resource and Development’ and includes ‘Healthy and

well nourished people’ who practice dietary diversification, micronutrient intake is ensured.

‘Community Based Social Structures and Organizations’ should have, amongst other things

‘Crop Diversification and intensification’ including support for a wide range of production

including orchards, backyard gardens, crop seed pass-on schemes, labour and time saving

technologies and integrated pest management. ‘Livestock diversification and intensification’ and

‘Diversified processing and utilization of foods’.

Millennium Villages is supported by the Model Village approach

Core partners are Colombia University Earth Institute and Millennium Promise.

The project is located in 7 villages in Mwandama, Zomba district. It is in a highly food insecure

region of Malawi where there are recurrent famines. It is intensively cultivated both by

smallholders growing maize, pigeon peas, cassava and groundnuts, and by the commercial

estate owners growing tobacco and maize. The project includes

Income generating programmes including Irrigation clubs are supported to grow high

value foods for sale as a source of income. Reforestation including planting of

mango trees for processing and sale. Livestock pass-on schemes

43

Community Grain banks operated by communities with a system to provide inputs

that are paid back after the harvest. The grain bank idea helps farmers with

investment for maize production and also supplies surplus to vulnerable people who

have been identified by the grain bank committee.

Legume seeds are supplied as part of the Presidential Hunger Initiative (GOM MAFS

2012). There are no plans for a community grain bank for legumes to date.

Nutrition groups and health clinics are supported by project with cooking

demonstrations and nutrition education

Health components include: Growth Monitoring and Promotion, Vitamin A

supplementation and de-worming.

Impact on Nutrition:

Chronic malnutrition (stunting) among children under two was reduced by approximately one-

third .The stunting reduction cannot be independently verified, nor is the timeframe for this

reduction known.

3.18 Conclusions from the examples:

The examples of projects and programmes given illustrate the ways in which government and

NGOs are working together with Civil Society and the private sector to improve agriculture and

dietary diversity. The policies and strategies provide a framework for programme

implementation and to support farmers. The examples show what is possible, rather than

attempt to cover comprehensively all the wide range of activities happening in Malawi. Also it is

worth noting, again that indigenous knowledge, skills and practices provide the basis for

agriculture and nutrition at community level. Documentation of coverage and impact of these

programmes would be useful to add to the body of evidence of nutrition centred agriculture.

3.19 Stakeholders’ views on implementation of nutrition centred agriculture

What facilitates effective implementation of these policies / strategies or actions?

Commitment by stakeholders to nutrition goals; the advocacy on nutrition has worked to

raise the profile of nutrition.

Several donors are now supporting Agriculture/ Nutrition links following the SUN strategy

and advocacy. This enables fuller implementation of the policies

SUN movement is facilitating work at Community level through the NECS. The roll out

has started. With the Care group model it is possible to reach a much greater proportion

of the population with trainings than where Extension workers interact directly with the

population

Since the inception of the DNHA under the OPC, Nutritionists are appointed across

many sectors at National level. This allows for a nutrition voice to be heard in each

sector.

Use of barrier analysis, positive deviance approach for BCC. This helps to fine tune

messages based on people’s real constraints. This could be extended for Agriculture to

understand constraints to adoption of diverse agriculture practices

44

The Care group model also works with lead farmers, committed members who are trained, so basically these farmers are trained in agriculture, in different areas such as health and disaster risk management, so that when the project faces out, these people will be ´resourced persons´.

3.19.1 What are the important barriers to implementation of policies to improve

agricultural and dietary diversity?

Capacity and support for field operations

There is lack of clarity on responsibilities for actions. Implementation needs to be

followed up and enforced. Clear duty holders for activities need to be established. This is

particularly problematic for multi-sector topics, such as improving diet diversification

through agricultural diversification.

Information flow from National to District level is a challenge; District level staff are not

aware of the latest developments nor do they know how to use of BCC materials and

guidelines. They need more support for implementation.

Support is needed for districts to help prioritise use of materials on different topics for

dissemination through extension services and the health system for example

Also, different agencies work independently. This is tiresome for the community.

Everybody will be looking at a specific area where somebody has their specialization

and then go to the districts. Programmes which have an outreach should not come from

each ministry separately, but should come in a package at the community level.

Capacity for implementation at district level – Nutritionist posts are not filled; EHO are

stepping in to role of nutritionist.

For Principal Officers working at the district level, it would be valuable for the day-to-day

work to receive feedback on the workplans as well as information from other districts in

the ADD to learn from other experiences.

Within the district the Nutritionists tend to focus on clinical nutrition rather than

preventative actions such as health education. This is due to lack of human and other

resources. In a limited resource setting it is always going to be necessary to treat first

and prevent later.

Markets are weak which is a disincentive to production

Nutrition is included in the ASWAp but not mainstreamed enough.

3.19.2 Policy processes and alignments

Cross sectoral coordination: stakeholder participation, stakeholder coordination

mechanisms and model for collaboration between Ministries and across sectors for

nutrition centred agriculture.

National Level

45

The formation of the DNHA within the OPC has enabled Nutrition actions to be coordinated

through one office that reports straight to the President. This both illustrates the high priority

now afforded to Nutrition and provides a means to achieve impact.

The DNHA Nutrition team are technically divided into ‘Nutrition Management’ group and a

‘Community Nutrition’ group. At the time of writing, the HIV and AIDS high level posts within the

DNHA have been vacant.. Nutritionists have been appointed to Ministries of Agriculture, Health,

Education, Information, Defence, Home Affairs, Works, Gender, Local Government,

Environmental Affairs, Energy and mining. All positions also cover HIV and AIDS. With the

‘Sector Wide Approaches’ Nutrition has been mainstreamed into all these sectors.

Box x details the working groups at National level.

Figure 6 describes the coordination processes for the ASWAp and refers to technical working

groups but there is no mention of the DNHA or MoH nutrition structures in this framework nor

the Food and Nutrition Officers that come under the MoAFS. Figure 7 shows the structures for

the NECS that is being rolled out at national district and community levels (GoM DNHA 2011).

Both structures are dependent on the DEC (the District Executive Committee) and the good

functioning of structures at the District level.

Box 6: Nutrition and Agriculture technical working groups at National level

The Joint Task Force on Food and Nutrition Security, ran for about 8-10 years coordinating

TWGs, until the early 2000s. There are several coordinating structures in place:

OPC DNHA

o Parliamentary Committee on Nutrition and HIV AIDS

o National Nutrition Committee with 6 Technical Working Groups for Nutritionists in the

different sectors coordinated by DNHA. Includes development partners, Academia and

Sector ministries. The TWGs cover Micronutrients, Food Fortification, IYCFN, CMAM,

Targeted Nutrition Programmes and Research.

o Nutrition Education and Communication Technical Working Group (NECTWG) for

NECS is The SUN donors rotate the chairing on an annual basis. Irish Aid and UNICEF

are the current co-chairs.

o SUN Task Force Core Technical working group including Agriculture, Health,

Education, Development Partners, Academia

o SUN NGO network: Coordination of CBOs

ASWAp

o Agriculture: 6 or so Technical Working Groups: including Food Security and

Sustainable Natural Resource Management Technical Working Groups for ASWAp

Donors

o The UN agencies and Donor group also have technical Nutrition positions and are

formed into a group known as the DONUTS (Donors in Nutrition) who meet regularly.

46

Challenges for Coordination at the National level

Coordination was cited as a challenge by most stakeholders interviewed: There are several working groups that overlap and it is difficult for technical staff to keep abreast of activities and attend all necessary meetings. Coordination of activities across sectors is not happening well, despite the many technical meetings

NGO activities are not well coordinated and follow particular interest areas dictated by donor or NGO interest. They are ‘top heavy’ i.e. support technically but all activities have to pass through Frontline Workers.

Clear budget lines for Nutrition within Ministries are lacking; Nutrition must compete with other interests. The budget and responsibilities for capacity building are not clear.

Nutrition is understood differently by different people – for some it is about treatment, for others it is about prevention and there are different understandings of causes of nutrition problems. e.g. where some see the FISP resulting positively in multi-life effects and making the country food secure, others see this as a political game and a programme which cannot be sustained by farmers

The NECS concentrates on the Health and Behaviour change constraints to nutrition, but is lacking a clear link to Agriculture.

There has been much staff turnaround since the change in President in 2012 which means some continuity is lost.

The TWGs of the National Nutrition Committee do not included a committee on nutrition centred agriculture. This would provide an opportunity to link Nutrition and Agriculture.

With more emphasis on nutrition from various sectors there is need for mapping of activities by different organisations in all nutrition interventions.

The opinions of respondents were fully explored in the Q-Sort exercise described in Table 11 and Box 7

Figure 6: Coordination Mechanism for the ASWAp

47

Figure 7. SUN Implementation Framework; Coordination and Dissemination structures

District coordination mechanisms.

For Nutrition and Agriculture, the relevant committees at the District level and reporting to the

District Executive Committee (DEC) are

District Agriculture Coordinating sub-committee for ASWAp

- District Agriculture Extension Coordinating Committee

District Nutrition Coordinating Committee (DNCC)

- District School Health and Nutrition subcommittee

- SUN task force

DHMT for Health

NASFAM district groups

Coordination at the District level

The lead Nutritionist is responsible for coordination of District Nutrition Committee therefore

when the post is not filled the committee becomes ineffective. Capacity is also limited in

management of inter-sector coordination at DEC in districts. There is high turnover and

handover is not adequate to maintain consistency after people leave. The NECS supported

by SUN is recommending District SUN task force linking to the DEC. Whether this is a

duplication or works with the DNCC will depend on local arrangements.

48

Coordination of multiple NGO priorities for implementation at the District & Community level

is a challenge. It is difficult to maintain a portfolio of work when there are different priorities

and resources of the donors and NGOs

Agriculture Education and Health catchment areas are different – i.e. Health districts,

Agriculture Zones do not overlap well. This makes it difficult to have cross sector technical /

implementation coordination.

There is decentralization at extension worker level, they are supported along sector lines. At

the district level coordination across sectors does not work well and is ad-hoc. Work at the

district level is decentralised and depends on the priorities of the District hierarchy who may

or may not place Nutrition as a high priority

Area level coordinating mechanisms are also present (not included here)

Community Coordination Mechanisms

At Community level the Health Surveillance Assistants (HSAs) and Agriculture Extension

Development Officers (AEDOs) are frontline workers responsible for working with the

community. Various community structures exist, or are proposed. The Village Development

Committee is a traditional structure. The AEDOs with support from the MoAFS have been

working with ‘Nutrition groups’ who have been formed for nutrition training specifically on

agriculture and food-related nutrition topics.

The CLAN (Community Leaders for Action on Nutrition) is a new structure to cascade

information, and advice to the CARE group. Malawi has adopted the Care group model from the

positive experience of NGOs working in the area. The advantage of the Care group model is

that it introduces an extra layer for cascading training. Without this layer it is very difficult for

frontline workers to directly interact with the whole community that is targeted for interventions.

Primary school Teachers also have a role from 6-18 years

Community Development work with CBCCs but the number of extension workers are the fewest

of all extension.

Challenges for community level coordination reported by stakeholders:

Agriculture extension workers out-number Food and Nutrition Officers, who have to both

interact with Agriculture Extension Development Officers and ‘compete’ for their topic to

be prioritised at community level.

The focus of the AEDOs and HSAs depends on support from NGOs who have particular

agendas and can provide incentives for these frontline workers that will incentivize

particular activities. AEDO are ‘torn apart’ by conflicting interests.

Transport is costly and budget for fuel and vehicles insufficient to reach communities

frequently. Without NGO support it is difficult for District staff to support Frontline staff.

49

3.20 M & E systems (as described in key policies & strategies)

The following data are being collected in Malawi (listed in the Food Security Policy):

Agricultural statistics (crop production estimates, gender based, livestock census,

agriculture census input/output market prices, coping mechanisms);

Health and nutrition information (nutrition indicators, health statistics);

Population statistics;

Demographic and Health statistics;

Macro-economic information (national accounts, trade statistics, exchange rates,

inflation)

Natural resources information (land, water, meteorology, environmental factors)

Market information systems;

Other institutional arrangements for specific collection, analysis and dissemination of

food and nutrition information such as the Malawi Vulnerability Assessment Committee

(MVAC), Health Information System (HIS), Integrated Household Survey (IHS) and the

Malawi Socio-Economic Database (MASEDA) need to be recognized and enhanced to

support this integrated monitoring system

As described in the Food Security Policy, these data are collected by different sectoral

ministries and are managed separately. The NNPSP describes a detailed M & E system, but it

is not clear where the results have been published or if they have been published. The ASWAp

also lists many indicators of Agricultural production, and nutrition and process indicators that are

published in quarterly reports. For this case study it has not been possible to access data from

M & E systems in Malawi, so it is not possible to comment on the quality. The data are not

readily accessible for review.

Table 8 shows the main actions for 4 policies that have associated indicators in the plans of the

policies. The other policies reviewed did not have detailed monitoring plans nor has monitoring

data been made available for review.

Challenges to Assessing impact of actions

The M and E system needs strengthening. There is a lack of clarity on who is

responsible for data collection, analysis and dissemination

Obtaining impact data is a major challenge. The NGOs have data but it is not national

coverage nor consistent with indicators or methods.

There is no ‘real’ data on what the population eats, systematic food consumption

surveys are not carried out. This could be a task led by the DNHA in collaboration with

the Statistics Office.

These tools need to move towards harmonization so that each and everyone, including government, the donors and other governmental organizations, have a harmonized package for monitoring and evaluation.

50

3.21 Q-Sort Results

Results and Opportunities

After analyzing the Q-Sort results with the statistical programme PQMethod, four different

groups can be identified on their shared viewpoint or attitude in the way they ranked the

included statements on level of importance (Annex 2). These four groups form similarities in the

way they prioritized and thus ranked the 21 statements. Table 11 presents the most

important/strongly agreeing and least important/strongly disagreeing statements ranked by the

members of the particular group.

Resulting from the Q-Sort, besides the different attitudes, it is showcasing consensus items,

including the statements ranked roughly the same level of importance (either high, low, or

neutral) by most participants (see Table 2 in Annex 2 for the full overview). Furthermore, below

in Box 7 the main contention items are identified combined with participants’ reasoning, these

are statements showing split decision, indicating the item is very important to some and less

important to others participants.

51

Table 11. Summary of the viewpoints or attitudes among the participants.

Most important Least important Focus areas to improve nutrition

Nutrition enthusiasts (n=5) Start with nutritional needs of

the population and then work

back to agriculture.

Food accessibility; nutritious

food has to become more

accessible to everyone.

Move away from policy of

government to policy of the

state.

Focus on cash crops including

tobacco in order to improve

nutrition in Malawi.

Nutrition is an optional extra for

agricultural growth.

Fertilizer subsidies to

guaranteed household food

security.

Focus on sectoral growth will

inevitably lead to improving

nutrition outcomes.

Recognizing the private sector

as the agent for growth.

Food access, nutritional needs first and overall policy of the state.

Multi-sectoral and fertilizer enthusiasts (n=2) Multi-sectoral collaboration

with the different ministries in

order to improve nutrition.

Farm Input Subsidies

subsidies to guaranteed

household food security.

Focus on cash crops including

tobacco in order to improve

nutrition in Malawi.

Move away from policy of

government to policy of the

state.

It is important to change the

feeding practices & behaviours

of Malawians.

Multi-sectoral collaboration and fertilizer subsidies.

M&E enthusiasts (n=2) Include nutrition indicators and

evaluate on nutrition status

results.

Start with nutritional needs of

the population and then work

back to agriculture.

Fertilizer subsidies to

guaranteed household food

security.

Move away from policy of

government to policy of the

state.

Focus on cash crops including

tobacco in order to improve

nutrition in Malawi.

Start with nutritional needs and nutrition indicators (M&E).

Multi-sectoral and nutrient accessibility enthusiast (n=1) Food accessibility; nutritious

food has to become more

accessible to everyone.

Multi-sectoral collaboration

with the different ministries in

order to improve nutrition.

Nutrition is an optional extra

for agricultural growth.

Move away from policy of

government to policy of the

state.

Fertilizer subsidies to

guaranteed household food

security.

Focus on cash crops including

tobacco in order to improve

nutrition in Malawi.

Food accessibility, multi-sectoral collaboration and nutrition can be a optional extra for agriculture.

Note: the items in italic are distinguishing statements. These are statements that particular subgroup have ranked

significantly differently from other subgroups (higher or lower than overall average).

52

Box 7. The following statements are shown to be agreeable/ important to some and disagreeable/less important focus areas to others (contention items) in order to include long term goals and measuring effects on nutrition outcomes.

i. ‘Nutrition is an optional extra for agricultural growth; food production is not driven by

nutrition.’ Nutrition is not prioritized enough in the ASWAp, some participants state nutrition is not mainstreamed, like gender or agribusiness approaches and strategies in the ASWAp. One of the participants’ reasoning on this: ‘ Why should nutrition be an option? It has to be at the centre, it has to be the most important thing, is should not be optional, it has to be a goal, it should be put as a goal for agricultural growth. It is very important, if we don’t put this as a goal, then we will fail the whole issue of nutrition’.

ii. ‘Malawi should move from policy of government to policy of the state.’ Referring to for example the effectiveness of ad hoc interventions, such as the Presidential Initiatives and the long term nutrition policy and strategy, including National Nutrition policy and the ASWAp in order to include long term goals and measuring effects on nutrition outcomes. One of the participants‘ reasoning on this: ‘It is not about the form of the government, to me I think it is a question of being able to do what we have planned. After all, the first one is political will to support agriculture, to support nutrition through evidence from the budget allocations.’

iii. ‘Fertilizer subsidies will contribute to guaranteed household food security’, referring to the Farm Input Subsidy Programme (FISP) targeting the poor households. Where some

see this programme as a guarantee to make the country food secure and providing economy wide impacts, others see difficulties in sustaining it in the long run. One of the participants‘ reasoning on this: ‘To me I see at this as a political game sometimes. Because, even the people who are benefiting from this, it might not even be 20% of the population. So if you want to sustain something, you have to look at something which people can do and continuously do it on their own.’

iv. ‘Intervention strategies should start with nutritional needs of the population and then work back to agriculture’. This refers to the lack of being able to bridge the diversity reflected in the food system aiming to diversify the Malawian diets. Moreover, how the Six Food Groups in Malawi are being reflected in people’s diets through focusing on dietary diversification as stated in the National Nutrition Policy. There is need to have a policy direction in linking diversification of the production system to the actual diets. One of the participants‘ reasoning on this: ‘Our policies are pointing at trying to commercialize agriculture, forgetting the actual beneficiary should be the individual, so if we are going to have a rare condition of to look at how best we can assist the people themselves, so instead of working there going down, let’s start with the people themselves, look at what is more nutritious. Because if people are getting nutritious food, they will be able to even work extra hard and be more in the field.’

53

3.22 Final appraisal of nutritional value of analysed action

Lessons learned on ‘what to do’ and ‘how to do’ nutrition and agriculture for the country, which

includes technical considerations as well as issues relating to institutional capacity, policy

processes and alignment, and stakeholder participation.

3.23 Achievements

Nutrition and Health indicators reveal improvements in the nutrition condition of children in

Malawi over the period of the MDGs from 1995.

The HANCI index, SUN movement, Presidential initiatives, CAADP compact and other

numerous recent nutrition initiatives reveal a high level of commitment to Nutrition in Malawi,

- the second highest ranking out of 45 countries assessed by HANCI.

The ASWAp and NECS policies are well supported by recent high level interest in Nutrition

and funding is starting to reach Malawi for this through SUN and CAADP initiatives amongst

others.

The policies in Malawi are, taken as a whole, promising for Nutrition in Agriculture. Most of

the areas in the 10 dimensions laid out in the ‘Guiding Principles for Improving Nutrition

through Agriculture’ are covered.

Agricultural diversification is well covered in policies. The budget allocated for this in the

ASWAp is small compared to the budget for maize production and little is committed from

Malawi’s own resources. External donors, however are committed to this through the

pledges they have already made.

Sustainable agriculture / Agro-ecological approaches have gained momentum through

Permaculture training and introduction of Permaculture principles in School Nutrition and

Health.

The School Health and Nutrition strategies have gained funding and momentum and there

are promising models for using these initiatives to promote nutrition, health and

environmental sustainability.

Strategies to identify and address barriers to behaviour change have been piloted and are

being introduced through the Care-group model that is being rolled out using the SUN –

NECS.

3.24 Opportunities

Documentation and learning

The policies have sophisticated and well planned systems of monitoring, but reports from

these data appear sparse. There is an apparent lack of documentation of implementation of

54

policies, resulting in a lack of understanding of ‘what is happening on the ground’. More

readily available reports on implementation would help the documentation process.

Impact data for nutrition is a key priority. Dietary data to show impact of agricultural

interventions and nutritional status for integrated programmes that include BCC

components, for example. Analysis of the relationship between agricultural production and

consumption would be a step towards understanding how well agricultural diversification

practices do or do not lead to improved diets either at the household or national level.

With greater attention to good impact evaluations, it would be possible to show how well

policies, programmes and actions are working in Malawi. Strong evidence would serve to

provide evidence for donors, but perhaps more importantly show what strategies are

working and where improvement is needed to achieve impact. For nutrition-centred

agriculture this is particularly important because the evidence internationally is sparse so it is

also not possible to draw on international evidence to support policies and programmes.

This means locally produced evidence is all the more valuable – both nationally and

internationally.

Dietary diversification through BCC activities is being rolled out through the NECS and

existing Agriculture Extension systems, but the extent to which communities have been

reached by these programmes is unknown at this time. It would be useful to have regular

reports available on Coverage of programmes. This would be helpful for planners, donors,

NGOs as well as CBOs for advocacy purposes.

Sustainable approaches to agriculture and food security

Food security is commonly interpreted as ‘maize security’; there is an opportunity to re-orient

food security to include diverse food production and to meet all nutritional needs.

There is a strong belief that economic development and food security are to be met by

increased production of staple crops or production and sale of high value crops. There is

also an opportunity to promote high value crops to satisfy nutrition requirements.

Agro-ecological agriculture offer promising decentralised sustainable and empowering

approaches to diversified food and nutrition security. These approaches would gradually

reduce the need to subsidise agricultural inputs when soil fertility and local sources of fertility

are established. Farming systems that are sustainable can be powerful tools for dealing with

modern problems of, for example climate change

Indigenous knowledge, crops, cooking methods and systems of organisation in communities

offer good opportunities to improve nutrition. As recommended in the IAADSTD report,

indigenous knowledge is key to improvements in Food Security and is key to success of

agriculture (IAASTD 2008). The WFP publication on sustainable nutrition describes

sustainable food and nutrition security practices using a combination of indigenous and up-

to-date innovations. ‘(Nordin 2013)

There is little mention of ways to ensure nutritional quality of foods other than through

enrichment, fortification, biofortification using plant breeding. There is considerable

opportunity to improve nutrient content of foods through agronomic approaches and through

55

reduction in losses on processing and through diversification to naturally high nutrient

content foods. Research and development of this area would provide sustainable ways to

improve dietary micronutrient intake.

Climate change behaviours are often synonymous with what is needed for improved

nutrition: biodiversity, healthy soil, water management, etc. Nutrition can capitalize on this

with those working in climate change.

Value Chains approach

The ‘Value Chains for Nutrition’ approach to nutritious crops in Malawi would help to support

each stage from ‘farm to fork’. Examples are available in Malawi, such as the ‘Land-o-lakes’

approach to milk production (not described in this report).

Post-harvest processing, storage and safety of foods other than maize is not strong in the

policies and appears to have fallen between the cracks of the sectors to some extent. With

the high proportion of food lost to spoilage and waste, this topic would merit receiving

attention alongside strategies to improve agricultural production. The case study has not,

however explored this topic in depth to determine the extent to which actions in this area are

happening.

- Storage and processing of diverse crops should be emphasized – millet sorghum,

bambara nuts, cow peas, oilseeds, etc.

- Indigenous knowledge on production and utilization should be strengthened and shared.

- Contamination with mycotoxins, such as Aflatoxin is rarely mentioned in the polices nor

research agendas, apart from in the context of export regulations. ASWAp does have a

component on Post harvest handling and management that talks about Aflatoxin

management. This is an important food security issue for Malawians that may need to

come out stronger in multi-sectoral documents. Without control of Aflatoxins for domestic

consumption the danger is that Malawians will consume contaminated maize and ground

nuts for example. Greater focus on Aflatoxin control for home consumption would be an

opportunity to improve food safety in Malawi.

One important obstacle to production of diverse foods is lack of seed availability. The

Presidential initiative and other actions are working to address this for a few legumes and

selected animals. A stronger focus on promotion of local, indigenous fruit and vegetables

would help support their production

Poverty reduction

In Malawi an effective way to address nutrition is always going to be targeting small and

marginal farmers for support. What is clear is that small farmers will be the route to

agriculture and poverty reduction. When small farmers are more secure in the knowledge

that staple foods are sufficient, diversification will be more acceptable. Therefore MPRS and

other strategies are going to be key to nutrition. This is already a goal of policies, as

described in the policy analysis above.

A range of options for interventions should be discussed and match with beneficiaries to

assure a good match (e.g. higher capital needed for cement storage, cows, etc.).

56

Coordination and alignment of policies and actions

The District local government offices offer a good opportunity for coordination of work in

Nutrition; one caveat is that duplication needs to be avoided to ensure that precious meeting

time is well spent and confused agendas avoided. The same caveat goes for National

coordination where time can be lost in almost parallel discussions in different meetings. The

reliance on District Nutritionists to convene District Nutrition Coordination might mean that a

different cadre could take this forward in the absence of the Nutrition role. Coordination of

the meetings could be carried out or supported by an administrative role.

The NGOs are working in most parts of the country in a variety of ways and carrying out

very important implementation, documentation and advocacy work. The coordination

appears to be a challenge, and even causing confusion and competition (as are the small

islands that donor support provides for short periods of time). There is a question over how

even or consistent is the spread of their interventions nationally. Coordination and mapping

of NGO activities could help address this issue. Coordination of allowances would also

address the oft mentioned competition for local workers. Lessons-learnt and impact of

programmes need to be documented, published and disseminated to enable real learning to

result from the experiences of implementation.

There appear to be parallel systems for the UN/ Donors/ Government/ NGOs in terms of

policy development, strategic planning, financing, coordination, human resourcing, training

and programme implementation. All have structures in place for these areas and without

coordination confusion can result at all levels. Sector wide approaches are necessary and

need to be carried through from policy to strategy to action.

The mapping and coordination exercise of the ‘Support for Nutrition Improvement in Malawi’

project will help with coordination and implementation of nutrition actions.

In the same way as Malawi has an ‘Agriculture Sector Wide Approach’ a ‘Nutrition Sector

Wide Approach’ would be able to draw together policies and strategies guidelines and

budgets for Nutrition. A Nutrition and Agriculture strategy might be appropriate to address

the difficult task of coordinating these sectors.

Funding and Capacity for implementation

From stakeholder reports, nutrition capacity is inadequate at the district and community

levels. With the clear interest in nutrition at this time, this could be an area for NGOs to

concentrate their efforts, bearing in mind, some of the criticisms that their input is ‘top

heavy’.

There is an opportunity to increase funding for Nutrition in Malawi; this will be facilitated by

drawing up clear plans for nutrition centred agriculture with support from SUN.

57

3.25 Conclusions

Malawi has prioritised nutrition in its policies.

The dimensions of nutrition-centred agriculture laid out in current guidelines have been largely

adhered to in policies. Post-harvest issues for nutrition are the exception and do not appear

strongly in policies for nutrition impact. Both agriculture and dietary diversification however are

often included. It is less clear what is actually happening at the community level and how well

implementation is working.

Coordination between sectors and between government, NGOs, the private sector and

communities is often cited by stakeholders as limiting implementation; as is capacity for

implementation.

The case study has taken a set of examples to show that certainly good programmes are being

implemented, although to what extent is not known. Examples of indigenous practices and new

innovations in agro-ecological agriculture exist in Malawi alongside subsidised input mono-crop

farming. It is important to gather evidence soon to understand what models offer the best

impacts for food and nutrition security, so that Malawi can invest in cost effective programmes to

improve nutrition.

It is also important, at this stage for Malawi to avoid falling into the ‘double burden of

malnutrition’ where overweight and chronic disease coexist with under-nutrition experienced by

so many countries and introduce clear strategies to prevent this.

58

4. Annexes

4.1 Schedule and people met

Nutrition Agriculture DIVERSIFYING AGRICULTURE & DIETS

Programme for Consultants Anne-Marie Mayer & Nynke Kampstra

May 22 – June 5, 2013

Wednesday 22nd

May Met

09.10 Arrival Anne-Marie Mayer, at

Kamuzu International Airport

(to Pacific Hotel)

WHO

12.20 Arrival Nynke Kampstra, at

Kamuzu International Airport

(to Pacific Hotel)

WHO

15.00 Courtesy call at Principal

Secretary (PS) Nutrition,

HIV and AIDS Office

DNHA Edith Mkawa

15.30 Office of the President and

Cabinet (OPC), Ministry of

Agriculture (MoA), World

Health Organisation (WHO),

Food and Agricultural

Organisation (FAO) Planning

meeting

DNHA Edith Mkawa (DNHA), Jean Chilemba,

(DNHA)

Blessings Muwalo,(DNHA)

Mzondwase Agnes Mgomezulu (DAES)

Dr. Susan Kambale (WHO)

Stacia Nordin (FAO)

Thursday 23rd

May

09.00-

11.00

Forum with Government

Nutrition staff from

Department of Nutrition,

HIV and AIDS (DNHA) and

Sectors

­ Agriculture Department of

Agriculture Extension

Services (DAES) and

Agriculture Ministry

Headquarters (HQ),

Education, Health, Gender

DNHA Margaret Lwanda (DAES), Agnes Msondwase

(DAES), Martha Mwale (ADD) Jean

Chelemba (DNHA) Blessings (DNHA)

Maureen Maguzadembo (DNHA) Fred

Simwaka (gender) Nynke

13.00-

13.45

Meeting with Deputy

Director for Nutrition in

Ministry of Education,

Science and Technology

(MoEST)

­ C. Mazinga

MoEST Not happened

14.00- Meeting with Chief Nutrition MoH Daliso Kang’ombe, Tapiwa Ngulube (MoH)

59

14.45 Officer in Ministry of Health

­ D. Kang’ombe

15.00-

16.30

Meeting with Director of

Agriculture Extension,

Deputy Director for

Nutrition, HIV and AIDS,

Deputy Director for Nutrition

& staff

­ M. Lwanda, M.

Mgomezulu

DAES WG Lipita (Controller) Alex Namaona (Dir of

Planning) Evance Kazzmbe (DAES), Martha

Mwale (Prin Food and Nut officer); Margaret

Lwanda (Dep Dir Nutrition HIVAIDS),

Mzondwase Agnes (DAES) Pearson Jase Soko

(Agribusiness officer) Tumbikani Munthali

(HR mgt) C Chenga Soko (Prin Nutrition HIV

AIDS officer) Doshanie Kadokera (Economist)

Hastings Nsoma (Risk disaster Expert) Nynke

Blessings

Friday 24th

May – Anne Marie with DPs, Nynke with Government

Anne-Marie with Development Partners (DP) – guidance to be sent

09.00 –

12.00

Meeting with Donor

Nutrition Support (DoNuts)

­ Build on UN REACH

mission to focus on

Agriculture Nutrition

­ Each Development

Partners (DP) to prepare 5-

10 minutes on Nutrition

and Agriculture (Nut-Ag),

consultants will send

guidance

DNHA Jecinter Oketch (UNICEF) Stewart Gee

(CWW) Susan Kambale (WHO) Jean

Chelemba (DNHA) Maureen Maguza-Ntemo

(DNHA) Stacia Nordin (FAO)

Mpumulo.Jawati (Irish Aid)

13.00-

13.45

Meeting with USAID

(Wellness and Agriculture for

Life Advancement (WALA),

Save the Children (SC),

Improved Nutrition in Value

Chains (INVC)

­ V. Orchardson

USAID Violet Orchardson (USAID)

14.00-

14.45

Meeting with World Food

Programme (Home Grown

School Meals (HGSM)

Programme)

­ L. Gonani

WFP Mtinta Hambayi, Osborne Sibande (prevention

of stunting)

Chalizamudzi Matola, Martin Mphangwe

(School meals)

15.00-

15.45

Meeting with European

Union (EU) Commission

Food Security and Nutrition

(Farm Income

Diversification Project

(FIDP))

­ T. Msiska

EU Colin Scott, FIDP team leader

16.00-

16.45

Meeting with FAO & WHO

technical board of directors

TBD Stacia Nordin (FAO)

60

(TBD)

­ S. Nordin & S. Kambale

Saturday 25th

Sunday 26th

May - travel to Zomba District

Monday 27th

May - Zomba District field visits

08.00 Meet with Government staff

(District Commissioner

(DC), District Agriculture

Development Officer

(DADO), District Health

Officer (DHO), District

Education Manager (DEM))

Rhoxinah Malamba acting Nutrition officer

Zomba district (usual post is Agriculture

Gender HIV/AIDS officer)

Anne-Marie - visit Nutrition Agriculture Programmes

10.00-

12.00

Millennium Villages Millennium

villages

S. Mhango/F. Mbvundula

14.00-

16.00

WALA Programme WALA Paul and Helen Jones and team

16.00-

18.00

Travel to Mangochi

Tuesday 28th

May – Mangochi District field visits

08.00 Meet with Government staff

(District Commissioner

(DC), District Agriculture

Development Officer

(DADO), District Health

Officer (DHO), District

Education Manager (DEM))

Wedison Kamwendo (Agribusiness Officer),

Mary Mbobo (Food and Nutrition Officer),

James Chickoya (Assistant District Agriculture

Development Officer) William Beno (District

Medical Officer) Sam Kalanda (Education

Officer)

Anne-Marie - visit Nutrition Agriculture Programmes

10.00-

14.00

Visit to School Health and

Nutrition (SHN) school &

school doing home grown

school meals school.

Kankhande School, Monkey

Bay

MoEST Redson Meya (Headmaster), Norman

Nsolomba (Deputy Headteacher)

15.00-

17.30

Travel to Lilongwe

Wednesday 29th

May – Kasungu District field visits

08.00 Meet with Government staff

(DC, DADO, DHO, DEM)

Abil Mahowe (Irrigation Officer) Cloudi

Mng’Amba (Crop Production Officer,

legumes), Maria Kang’ombe (Horticulture

Officer), Jane Kokota (Crop Protection)

Anne-Marie - visit Nutrition Agriculture Programmes

61

10.00-

15.30

Field visit Kasungu District

(Improved Food Security and

Nutrition (IFSN), FAO/

FICA

Community Management of

Acute Malnutrition

(CMAM), Presidential

Initiative on Hunger)

District

(not seen)

Soka Chitaya (District Manager for Kasungu

IFSN)

Wells F Kumwenda (Project Mgr IFSN)

16.00-

17.30

Travel to Lilongwe

Thursday, 30th

May – Lilongwe private sector meetings

Meeting with Seed Trade

Association of Malawi

STAM Supply Chisi

Meeting with Deputy

Director of AGRESS

DAES Frieda L. Kayuni

Meeting with Irish Aid IA Mpumulo Jawati, Blessings Botha

Meeting with International

Food Policy Research

IFPRI Karl Pauw (Research Fellow), John Mazunda

(policy analyst)

Friday, 31st May – Lilongwe NGO meetings

08.00-

12.00

Field visit to World Vision

International (WVI) sites

within Lilongwe (any

MICAH sites?)

­ E. Kapyepye/R. Mandere

WVI We cancelled

13.00-

14.00

Meeting with Save the

Children (SC) & Improved

Nutrition in Value Chains (

INVC)

­ J. George

SC Not available

14.30-

15.30

Meeting with National

Association for Smallholder

Farmers in Malawi

(NASFAM)

Nasfam Not available

16.30-

17.30

Meeting with Valid Nutrition

­ T. Banda/B. Shaba

Valid We cancelled

Additional Meeting with Dept Agriculture

Research Services

Dr M. H Phillimon Banda

ARS Dr M. H Phillimon Banda

Meeting with ASWAp M and E

specialist

MoAFS Phiko Kavinya (Principle Economist for

Monitoring and Evaluation)

Meeting on the Presidential

Initiative

Presidential

Initiative

Mrs Kaluwile

62

Meeting on Community

Nutrition

DNHA Maureen Maguza-Ntemo (Chief Nutrition

Programme Officer)

Meeting on Nutrition in

ASWAp

Korea

Garden

Lodge

Mzondwase Agnes Mgomezulu

Saturday 1st June

Meeting with Concern

Worldwide

Mairead Petersen

Sunday 2nd

June

Monday 3rd

June – Lilongwe, University meeting

Meeting with Lilongwe

University of Agriculture and

Natural Resources

DNHA Dr. A. Kalimbira

Dr D Mkwambisi

Meeting with School Health

and Nutrition

MoEST Virginia Kachigunda (Nutritionist)

Chikonki Chiumbuzo (OVC HIV& AIDS &

Gender) Maxwell Dzikanyanga (M & E

Coordinator)

Meeting with FAO, Stacia

Nordin & tour of Never-

ending-Food project

Home Stacia Nordin (FAO)

Tuesday 4th

June

Meeting with UNICEF UNICEF Piyali Mustaphi

Meeting with FICA FICA Nikolas Bosschler

Debriefing meeting with

stakeholders

DNHA Nynke Kampstra, Jean Chilemba (DNHA),

Gideon Mphunda (DNHA), Stacia Nordin

(FAO), Jecinter Akinyi Oketch (UNICEF),

Piyali Mustaphi (UNICEF), Peter Nkhoma

(DAES)

Meetings with MoAFS MoAFS Daisi Kachingwe (Chief Economist for Food

Security)

Hastings Ngoma

Meeting with World Vision

International

Pacific

Hotel

Regina Mandere (Nutritionist)

Meeting with DNHA DNHA Jean Chilemba (Director of Nutrition) and

Janet Guta (Deputy Director of Nutrition

Management). Blessings Muwalo (Chief

Cliinical Nutrition Officer)

Wednesday 5th

June

Departure to London DNHA

63

4.2 Timeline of the consultancy

Revised from ToR

Participate in meeting to develop approach and methods: 25-28 March 2013

Carry out country study: 21 May to June 5 2013 First draft of report: 06 July 2013 Comments received: 22 July 2013 Final draft of report: August 2013 33 working days within the period from 3 April until August 2013 (Note, actual working days was much longer)

64

4.3 Terms of Reference

COUNTRY POLICY ANALYSIS NUTRITION IMPACT OF FOOD SYSTEMS

VERSION 21 MARCH 2013, REVISED Background The agriculture and food systems are best placed to influence food production and the consumption patterns of nutritious foods necessary for a healthy and active live. The present agricultural and food systems have evolved to become more complex and global with longer supply chains from farm to fork. Nutrition-sensitive agriculture aims to maximize the impact of the food and agricultural sector on nutrition outcomes while minimizing any unintended negative nutritional consequences of agricultural policies and interventions on the consumer. It is placing a nutrition lens on the food and agricultural sector, without detracting from the sector’s own goals which include production, productivity and income. There is increasing attention to addressing the multiple forms of malnutrition (undernutrition, micronutrient deficiencies, and overweight and obesity) through agriculture and the food system. Important initiatives include the Scaling Up Nutrition (SUN) Movement, with attention to multi-sectoral development action, the Zero Hunger Challenge launched by the UN Secretary General to end hunger and malnutrition within our lifetimes, the development of country CAADP plans (Comprehensive African Agriculture Development Programme) that include nutrition in Pillar 3 (Food Supply and Hunger), the CGIAR research program (CRP-4) on Agriculture for Improved Nutrition and Health (A4NH), and the mainstreaming of nutrition as an FAO corporate priority. In addition, several development partners are developing agriculture-nutrition guidance and tools.

Applying a nutrition lens to agriculture and food systems should include a consistent focus on nutritional outcomes and indicators within national food and agricultural policies and programmes, and the broader macroeconomic policies and development strategies. The aim should be to improve food and nutrition security and combat the multiple burden of malnutrition through food and agriculture, and other relevant sectors. Although there is wide agreement on the great potential for agriculture and the food system to improve nutrition, at present there are limited experiences with this approach at scale and insufficient existence of rigorously supported evidence-based technical recommendations to inform policy makers. Therefore, there is a need to better understand how agricultural and food systems impact nutrition outcomes. There is need to identify whether and how these systems can be modified to better meet nutrition goals in a sustainable way and reduce the risk of the multiple burden of malnutrition, including diet-related non communicable diseases (NCDs). There is an urgent need to provide practical answers and guidance for countries on the “what to do?” and “how to do it?” questions. A number of countries have started to link their national agriculture or food and nutrition security policies to nutrition related outcomes and the multiple burden of malnutrition. These countries refer to the multiple underlying causes of malnutrition in broad areas such as

65

agriculture, food security, food supply as well as varies stages along the value chain. Some country strategies take account of the multi-sectoral nature of nutrition. Eight countries16 have been selected for in-depth review of specific ways how food and agricultural policies are having or are intended to have an impact on nutrition in that country. These eight countries reflect different stages of the nutrition transition. In view of the multiple burden of malnutrition - hunger and undernutrition are common, especially among children, while the incidence of overweight, obesity and nutrition-related NCDs are increasingly occurring among adults- the case studies are looking at both sides of the malnutrition problem. Specific thematic areas will be assigned to each of the country´s study, such as related to the food supply chain as well as to food and agricultural and trade policies, and their potential link to nutrition and health outcomes in the country. For these the more detailed specifications and analysis frameworks will be elaborated with a group of experts during the Meeting of the Minds in Geneva, 25-28 March 2013. These TORs refer to the country case study in Malawi

Objective The descriptive review of food and agricultural policies in Malawi will contribute to advance the discussion on nutrition-sensitive agriculture. The study will provide answers to some of the emerging questions on:

the specific nature and range of policies and other actions to improve nutrition through food and agriculture (for various populations and geographies), including the characteristics of the system, at what point these policies and other actions engage with the food and agricultural system, and how; through what actors and institutions; and with what known or potential effects;

the potential process and impact indicators related to actions that enhance the impact of food and agriculture on nutrition and methods of measuring both;

key knowledge gaps in the relationship between the shape and operation of food and agricultural system and nutrition.

Description of the assignment i) The consultant will participate in the preparatory Meeting of the Minds that will take place in Geneva between 25 and 28 March 2013. ii) The consultant is responsible for conducting an in-depth review of specific aspects of the agriculture and food system and its potential impact on nutrition in the assigned country/countries. iii) The consultant will document all relevant information and analysis in a country report according to the provided template. One country report per assigned country will be delivered. iv) The consultant will contribute to the synthesis report.

16

Brazil, Thailand, Nepal, Mozambique, South Africa, Malawi, Sierra Leone and Senegal.

66

For activities and timeline see below. The in-depth review of specific aspects of the agriculture and food system and its potential impact on nutrition includes the following study components:

Identify and describe actions (strategies, policies, programmes and investments) in agriculture and the food system that may have an impact on diet and nutrition.

Describe the envisaged impact pathways for these actions and explain how they may affect nutrition (undernutrition, micronutrient deficiencies, obesity and overweight) in particular population groups.

Document (identify, collect and describe) the available information and evidence to substantiate the impact of such actions on diet/nutrition outcome variables or on logically related intermediate variables.

Describe policy processes and alignment, including alignment around common results frameworks and stakeholder participation.

Identify factors contributing or impeding collaboration between relevant ministries. Identify applied language and terminology with regard to food and nutrition security and

describe whether and how this reflects / or not reflects attention paid to nutrition when designing, planning and monitoring food security policies and programmes.

Highlight good practices and lessons learned from the implemented actions, including considerations on the design of the actions as well as issues relating to institutional capacity, policy processes and alignment, and stakeholder participation.

Identify information and knowledge needs and gaps that should be addressed through further study and suggest potential processes for monitoring and evaluation.

Method The country analysis includes a secondary data analysis, a literature review, snowballing interview approach, and a country visit to the assigned country/countries. The consultant will review the information from relevant country policy and programme documents to seek out relevant information on strategies, policies and investments in food and agriculture, their impact pathways on various nutritional outcome, direct and indirect ones, institutional capacities, stakeholder participation, alignment, cross-sectoral collaboration processes, and others. The literature review will provide further insights and background information. The consultant will refer to and build on country papers developed in preparation for the International Conference on Nutrition (ICN2) as well as use data in existing databases or country profiles (e.g. the NLIS (WHO) or FAO country profiles, World Bank, UNDP). The consultant will consult with national government focal points and experts in the specific sector areas using a predefined and country adapted policy checklist and interview guide. These and the common methodological approach for the country study will have been elaborated and agreed upon during the preparatory Meeting of the Minds in Geneva 25-28

67

March 2013. This meeting will provide the detailed template for the studies, including a framework of analysis, list of research questions to be answered, and the agreed common methodological approach. Country visit: The country visit will give opportunity for more in-depth interviews with national partners and experts. Potential partners to interview include: The government focal point, representatives from the Ministry of Planning, Ministry of Agriculture, Ministry of Health, national level SUN movement stakeholders, REACH facilitators and UN country teams (if applicable), international and local NGOs and CSOs, and donors in country including the donor convener (if applicable). According to the context this list is not exclusive. The information and its analysis will be included in a final country report. For this report the agreed template will be used. The report will include the description of the methodology, of the relevant policy areas, an analysis of their sensitivity to nutrition, lessons learned and good practices, and recommendations for ‘how to do nutrition-sensitive agriculture’ and potentially ‘how not to do it’. It will also include the timetable of the consultancy, the country visit and a list of people that were contacted and/or interviewed, a list of references and relevant policy documents. Content of the final country report (a report template will be provided in annex 1)

Description of the stage of dietary transition.

Description of relevant actions (strategies, policies, programmes and investments) in agriculture and the food system that may have an impact on diet and nutrition.

Analysis how they may affect nutrition (undernutrition, micronutrient deficiencies, obesity and overweight) and / or health (infections, other communicable diseases, non-communicable diseases) of different population groups.

Documentation of the impact of such actions on diet/nutrition outcome variables or on logically related intermediate variables.

Description of policy processes, stakeholder participation, stakeholder coordination mechanisms and model for collaboration between Ministries, like Ministry of Agriculture and Ministry of Health etc.

Final appraisal of nutritional value of analyzed action. Lessons learned on ‘what to do’ and ‘how to do’ nutrition-sensitive agriculture, including technical considerations as well as issues relating to institutional capacity, policy processes and alignment, and stakeholder participation.

Description of the identified need for more information and knowledge gaps that should be addressed through further study.

Executive summary.

Conclusions and recommendations.

Annexes (will be specified, including:) o List of persons met and interviewed o List of references o Timeline of the consultancy

68

Activities and Timeline The consultant’s tasks include: Participate in meeting to develop approach and methods: 25-28 March 2013

33 working days within the period from 3 April until 12 June 2013 Carry out country study: 3 April – 28 May 2013 First draft of report: 29 May 2013 Comments received: 06 June 2013 Final draft of report: 12 June 2013 Qualifications Great value is placed on the technical qualification and independence of the expert. Candidates should have the following basic and essential qualifications: • Advanced University degree and relevant experience in nutrition; food security and

agricultural sciences; food policy; or related fields • Scientific publications in peer reviewed journals or relevant publications within the last ten

years • At least five years of country level experience (including in Africa) in linking nutrition to

food and agriculture at policy, strategy, programme level • Participation in national or international scientific bodies, committees, and other expert

advisory bodies pertinent to the scope of this study is an asset • Applicants must have excellent working knowledge of English; additionally knowledge of

French or Portuguese is an asset. Working language The working language for this assignment is English. Starting period and duration The study is to start at the beginning of April 2013 and will take about 6-8 weeks, during which one country visit for further in-depth analysis of up to 2-3 weeks will be conducted. Planning The consultant will participate in the preparatory planning meeting from 25-28 March 2013 in Geneva Location of assignment The place of the assignment is the residence country of the consultant. In addition a country visit will be conducted, if the assigned country is different from the country of residence. The following number of country-visit days are foreseen for this particular country:

69

Up to 25 days Reporting All documents will be written in English and references well documented. The final report will be delivered in English, and compiled following the agreed template. Obligations: To participate in the preparatory meeting in March 2013 in WHO Geneva Give updates on the progress of work to the UNSCN Secretariat focal point: planning stage, mid-term update, end-term update. In country: give feedback (also for verification) to relevant stakeholders that were contacted and were involved in the information collection process. Outline of the Country Study Report Will be elaborated in details during the meeting 25-28 March 2013 Meeting of the Minds, 25-28 March 2013 This meeting is by invitation only and you have been identified as an important stakeholder in the nutrition - agriculture – food security nexus arena. The UNSCN Secretariat, in close collaboration with WHO and FAO, therefore invites you to attend the Meeting of the Minds on Nutrition impact of agricultural policies taking place in the WHO Headquarters in Geneva from 25-28 March 2013. PART I: 25-26 March: participants will discuss the nutritional impact of policies shaping the food systems of countries at different stages of the nutrition transition; PART II: 27-28 March: participants will advise on the development of frameworks that can be used to describe and analyse national policies in the area of agriculture, trade and related sectors using a value chain approach in selected countries at different stages of the nutrition transition.

70

4.4 Q Methodology Exercise

4.4.1 METHODOLOGY OBJECTIVE: EXAMINING MINISTERIAL STAKEHOLDERS’

EXPECTATIONS ON IMPROVING NUTRTITION

Governmental changes in Malawi have resulted in a focus to reduce the underlying causes of

malnutrition with particular importance in investment in nutrition through agriculture. As stated at

the Nutrition for Growth Summit the 8th of June 2013 by Joyce Banda, the president of Malawi,

nutrition is embedded in the national budget and that Malawi would increase its spending on

nutrition from 1-2% to 3.3% by 2020. Stunting of children <5 years rates showed to slightly

decrease and demonstrated a decrease in prevalence of stunting, coming from 56% in 1992 to

53% in 2004 and 47% in 2012, respectively (UNICEF 2013). Malawi has identified a national

target to improve nutrition outcomes by reducing stunting prevalence to <20% in children <2

years by 2016.

Objective

This stakeholder expectation exercise will be a analysis aiming to map how nutrition-sensitive

agriculture strategies are addressed in six different ministerial offices, having a mandate on

nutrition in Malawi. More specifically, the aim is to identify where there is consensus, contention

and map distinct groups how to improve nutrition outcomes among the interviewees. This will

identify how food and agricultural actions are ranked through mapping important focus areas for

engagement in advancing nutrition by the various ministries consulted. It will review how food

and agricultural policies are having/are intended to have an impact on nutrition in the country

and is prioritized in Malawi identifying its engagement for advancing nutrition at ministerial level.

The major objective is to identify how and where perceptions match/mismatch on improving

nutrition in the various Malawian ministries and district workers having a mandate on nutrition

through determining alignment and/or gaps among these stakeholders’:

expectations;

sectoral priorities;

decisions; and

actions.

Moreover, this exercise will consult various people with different ministries working both in the

field of agriculture, health and nutrition as well as people working at district level. Therefore,

various ministries having a mandate on nutrition are covered as well as staff working in the field

of policy, programme development, programme implementation and the district officers working

with the frontline workers and extension workers and find out:

Research focus

Determine alignment of food system stakeholders’ expectations, priorities, decisions and actions to improve nutrition outcomes through agriculture/food systems in Malawi.

71

Sub-research areas

1) Determination and gap analysis of stakeholders’ priorities to improve nutrition through

agriculture in the food policies/frameworks/programmes;

2) Identification of high-impact changes of food system policies/frameworks/programmes

leading to improved nutrition outcomes that can be realized by identifying focus areas

and entry point aiming to improve nutrition.

Why, now?

It has been widely acknowledged that integration of nutrition principles in agriculture practices is

needed (IFPRI 2011; Chung 2012). Traditionally, agriculture development has focused on

improving agriculture outputs through increasing crop yields and raising productivity. The links

between nutrition and health outcomes and agriculture are complex and are firmly embedded in

a country’s food system. This is not a one arrow relationship, as cited by (IFPRI 2011) “anything

that affects agriculture has the potential to affect health and nutrition, and anything that affects

health and nutrition has the potential to affect agriculture—for good or ill.” In order to improve

nutrition, there is no ‘one size fits all’ approach, but multidisciplinary actions are needed in order

to improve nutrition outcomes including agriculture and rural development, social protection and

safety nets, water supply and sanitation, education, gender and community-driven development

(WorldBank 2006).

What for?

In order to improve nutrition through agriculture, it is important to have an understanding of the

various ministries involved and exploring the expectations from each other regarding their

mandate on nutrition, working in collaboration with the agriculture sector. It is crucial to analyze

and map the underlying thoughts from the diverse ministerial stakeholders as well as nutrition

and health workers working on more district level in order to make effective progress in shaping

policy and ensuring sustainable improvements are made. In addition, to create a benchmark to

monitor and evaluate successfully aiming to realize improvements in nutrition outcomes.

Outcome

This stakeholders’ discourse analysis will provide insights to the understanding of agriculture

and nutrition linkages, and how improving nutrition is envisaged and thus what is prioritized

among the Malawian actors working in the various ministries. This analysis will provide insights

for enhancing agriculture development and map the views on the role of the agriculture sector

and its linkages to Malawi’s nutrition profile and how this is addressed in the current policies,

programmes and interventions (situation/explanation of the situation/formulation of both actions

and non-actions). This will provide an understanding what the various ministries see as an entry

point in order to improve nutrition. In addition to this, where they see similarities and differences

in their viewpoints contributing to and translating nutrition into their policies and actions.

72

4.4.2 METHODS

Study Design: Q-Sort Methodology

The Q methodology was introduced by William Stephenson (1935). This methodology is

described as a systematic study of subjectivity allowing the participants to sort a set of items

individually (Brown 1980). This method has been applied for very diverse topics in a wide range

of disciplines such as in political science, psychology, health science, communication, education,

the human and behavioral sciences and in the field of policy (Brown 2008). Moreover, it shines

light on a person’s opinion, belief, attitude, and the personal viewpoint (Brown 1993). As stated

by Hoppe and Reinelt (2009 p9) the Q methodology is a useful method concerning

organizations, groups as well as communities to help uncover the “collective story” for the

purpose of the study. As cited by Brown (1993), the method maps ‘the flow of communicability

surrounding any topic’ in ‘the ordinary conversation, commentary, and discourse of everyday

life’. Individual perspectives are being analyzed, Q methodology can be used with a small

sample set of participants and is not aiming to generalize the results to a larger population

(Steelman and Maguire, 1999).

The participants included were presented with a sample of statements regarding topic of the

study, called the (the Q set). The participants (the P set) were asked to individually rank the

included statements based on the own opinion and viewpoint. Thomas and Watson (2002)

emphasize the following stages, especially the first two, being crucial for the quality of the

results:

1) The Q-study must be properly designed;

2) The Q-Sort must be properly administered;

3) Analyzing the results from the Q-Sort.

The 12 participants were presented with a sample set of 21 statements, the Q-set. As cited by

van Exel and de Graaf (2005), by ranking the Q-Sort statements, the participants give their

subjective viewpoint and thus it gives an indication of the personal profile. The participants were

consulted in face-to-face sessions in order to avoid bias due to social desirability. The

participants were asked to sort the statements on level of importance from their individual point

of view, answering the question (see Sub-Annex 3.2 for the Instruction Sheet):

According to you, what should the Malawian government focus on in order to improve nutrition

outcomes in the coming years? Sort the statements listed on the chips from least important to

most important priority.

Including Statements

The statements were collected by selecting form the literature, policy documents and quotes

from interviews regarding issues that are relevant in this nutrition scenario study. As stated by

Donner (from Krueger et al., 2001 p33) “the best thing to keep in mind is that while no list of

statements is perfect, no list has to be. Since what is really of interest are the tacit, underlying

criteria and perceptions people use to consider an issue, the elements themselves are of

secondary importance.”

73

The statements were included based on criteria retrieved

from 1) nutrition-sensitive interventions 2) nutrition-

specific interventions 3) issues of accessibility,

affordability and availability specified for the Malawian

situation. The statements were linked to trade, private

sector, multi-sectoral collaboration, behavioural aspects,

gender and subsidy programmes. In order to improve

the understandability of the included statements, they

were kept close to the original wording. The different statements were discussed in order to test

the completeness. Finally, the 21 most relevant statements were included in the Q set (more

background information will be included in the thesis, see Box 1).

Q-Sorting Session

The 21 statements (Table 3) have been collected from questionnaires, interviews as well as

drawing quotations from the literature and policy documents. The items were printed and

laminated on 7-5 cm chips, numbered randomly. The sheet to sort the statements on was

printed and laminated on a 42-30 cm piece of paper. An appropriate environment was created,

most often in the participant’s office, in order to create a one-on-one setting. This in order to

make sure the participant can compare the statement and arrive at a comparative judgment

based on his/her personal opinion without being influenced by others.

Figure 1. Guide to sort the statements.

Before starting the exercise, the participants received an information sheet (Sub-Annex 3.2)

which was reviewed together with the person as well before reading through the statements. In

order to sort the statements, there was a fixed scale from -3 ‘least important/strongly disagree’

to +3 ‘most important/strongly agree’ (Figure 1) allowing the participant to sort one statement in

every empty box. As written in the instruction sheet, the participant was asked to first divide the

printed statements into three piles: ‘least important’, ‘neutral’ and ‘most important’. Next, the

participant was asked to sort the statements from each pile starting with either the ‘most

important’ or ‘least important’ pile and first selecting the two statements of which they think

should be located in either the -3 or +3 columns. They were forced to assign a the 21

The full MSc thesis as part of Public Health and Society, Wageningen University, will be available in November 2013. This will combine the results from in-depth interviews linked with intersectoral action frameworks and will identify where key changing agents match and mismatch in bridging agriculture and nutrition.

Box 1. Thesis Note

74

statements to each of the scoring categories, ranging in level of importance. Moreover, the

participant was informed there is no difference in the columns themselves but there is only a

difference in level of importance comparing the 7 different columns. Eventually, each sort had to

be filled with one statement and the participant was being told (s)he could ask questions

anytime during the exercise. After completing the exercise, the participant was asked why they

sorted the statements the way they did in the column -3 and +3 (4 statements in total). The

researcher was psychically present throughout the full exercise.

After completing the exercise, the participant was asked to review the Q-sample on the sheet in

order to arrive at a their comparative judgment on where to place each statement based on their

personal viewpoint. The participant could only use the included statements and thus was forced

to make a decision to place and sort them.

After sorting all the statements, a follow-up interview was carried out in order to elaborate more

on the subjects’ reasoning. Moreover, the participant was asked why (s)he sorted the

statements in the both extreme ends of the continuum on the sheet (-3 and 3). This was taped

using a voice recorder in order to interpret factors and thus for further analytic purposes.

The completed Q-Sort and the participants’ additional comments provide the data to interpret

the variety or shared viewpoints on the topic.

Subjects and Sampling

The interviewees are selected based on their mandates on nutrition working in the different

ministries in the Malawian government. In collaboration with staff from the Office of President

and Cabinet (OPC), it was decided who to consult. Besides, on day one after arrival in Malawi,

Lilongwe, the stakeholders meeting gave input to ask for suggestions who to select for the

purpose of the study. Hence, purposive sampling as well as snowball sampling was the strategy

employed for the aim of this study.

The major constituency represented for the purpose of this study is government. Staff working

at various ministries in the Malawian government, having their mandate on nutrition were

included. 12 staff members working at ministry level were selected in collaboration with the

assigned moderator from the OPC. Due to confidentially reasons, participants’ position within

the ministry is not incorporated in the results. Table 1 presents the participants information and

when they were consulted. The 12 participants work in diverse fields within the following

ministries.

(1) the Ministry of Agriculture, and Food Security (MoAFS) (n=7);

(2) the Ministry of Health (MoH)(n=1);

(3) the Ministry of Gender, Child Development and Community Development (MoGCCD) (n=1);

(4) the Ministry of Education (MoE) (n=1);

(5) Ministry of Environment Affairs & Climate Change (MoEACC) (n=1);

(6) Office of President and Cabinet (OPC), Department of Nutrition, HIV and AIDS (DNHA)

(n=1).

75

Table 1. Participants overview.

ID NR

Q-Sort Exercise Constituency Date

interview

I-1 Ministry of Agriculture and Food Security (MoAFS) 24-05-2013

I-2 Ministry of Agriculture and Food Security (MoAFS) 24-05-2013

I-3 Ministry of Health (MoH) 24-05-2013

I-4 Ministry of Gender, Children & Social Welfare (MoGCSW) 27-05-2013

I-5 Ministry of Agriculture and Food Security (MoAFS) 27-05-2013

I-6 Ministry of Agriculture and Food Security (MoAFS) 30-05-2013

I-7 Office of President and Cabinet (OPC), Department of Nutrition, HIV and AIDS

30-05-2013

I-8 Ministry of Agriculture and Food Security (MoAFS) 31-05-2013

I-9 Ministry of Education (MoE) 03-06-2013

I-10 Ministry of Environment Affairs & Climate Change (MoEACC) 04-06-2013

I-11 Ministry of Agriculture and Food Security (MoAFS) 04-06-2013

I-12 Ministry of Agriculture and Food Security (MoAFS) 05-06-2013

4.4.3 Data Collection

Data is selected through one data wave and each participant is consulted once for the Q

methodology exercise. Before starting the interview, the participants had to read the participant

information sheet, informing them about the purpose of the study, how the information will be

used, information about confidentiality and further practical information (Sub-Annex 3.3). After

completing this, the participant had to sign the informed consent form agreeing they understood

the participant information sheet and thus accept taking part in the study (Annex III).

The participants in the study were consulted face-to-face. The Q-Sport session took

approximately 40 minutes. One researcher, Nynke Kampstra, carried out the interviews. A

specified time was set together with the participant in order to undertake the face-to-face

interview in Malawi (Lilongwe, Zomba district and Mangochi district) in a one-on-one session. In

allowance with the participant, the interview was voice recorded using a voice recorder to

enable the researcher to review the data in greater detail.

Analysis and Interpretation The analysis was carried out with the PQMethod software for Windows (December 2012,

release 2.33). After entering all the 12 participants Q-Sort data, a pattern analysis is conducted

in order to analyze the outcomes. This maps the statements explaining the variety of the Q-set.

A correlation matrix of all the included Q-Sort will show the level of (dis)agreement between the

individual items. In addition to this, the factor analysis will show the number of factors or in other

words, the shared viewpoints or attitudes. The number of factors extracted are having

Eigenvalues >1.00, which indicate the sum of squared factor loading for each factor (Brown,

1980 p 40). This will therefore result in scoring patterns which are called factors. Thus, a factor

in the Q methodology is a more technical term for the resulting shared perspectives and

viewpoint among the participants.

76

4.4.4 RESULTS

The dataset showed four factors or distinct shared perspectives/viewpoint/attitudes based on

the results from the Q-Sort. The factors were determined based on the Eigenvalues >1.00. The

four factors described 72% of the variance including the 12 Q-Sort participants. 10 participants

had a significant loading and 2 participants did not have a clear loading to on any of the four

factors (Table 2). Participant number P3 and P7 individuals’ viewpoint did not have something in

common with the four factors and thus, their shared viewpoint.

Table 2. Assigned participants to factors: “flagging” assignments to subgroups marked with *

Automatic (manual adjustment was not needed due to the absence of negative loads)

Participant Viewpoint1

(n=5)

Viewpoint 2

(n=2)

Viewpoint 3

(n=2)

Viewpoint 4

(n=1)

P 1 0.62941* 0.12245 0.31806 -0.34012

P 2 0.73373* 0.27736 -0.12412 -0.07291

P 3 0.54571 0.22360 0.25516 0.45243

P 4 -0.09217 -0.01044 0.84702* 0.22866

P5 0.05445 0.64111* 0.30715 0.50815

P6 0.31626 0.07692 0.77855* -0.20421

P7 0.49236 -0.08686 0.53551 0.53272

P8 0.74776* -0.18947 -0.13597 0.17974

P9 0.04761 0.04006 -0.02806 0.81828*

P10 0.74300* -0.15845 0.24333 0.18099

P 11 -0.00555 0.92419* -0.07519 -0.03653

P12 0.85125* 0.04432 0.25760 0.10264

Results: 5 participants in group 1, 2 in group 2, 3 in group 3, and 1 in group 4. Two participants (P3 & P7) are unassigned.

Based on the patterns, the summary in Table 2 presents the shared viewpoints among the

participants and their most important focus areas and least important focus areas in order to

improve nutrition. Table 3 gives an overview of the consensus items, these are statements

ranked at a similar same level of importance by the participants. The table ends with the

contention items. These are statements with the highest level of variance across the factor

scores, indicating they were highly agreeable to some participants and disagreeable to others.

77

Table 2: Summary of the viewpoints or attitudes among the participants.

Group Most important Least important Focus areas to

improve nutrition

1) Nutrition enthusiasts (n=5)

Start with nutritional

needs of the

population and then

work back to

agriculture.

Food accessibility;

nutritious food has to

become more

accessible to

everyone.

Move away from policy

of government to

policy of the state.

Focus on cash crops

including tobacco in order to

improve nutrition in Malawi.

Nutrition is an optional extra

for agricultural growth.

Fertilizer subsidies to

guaranteed household food

security.

Focus on sectoral growth will

inevitably lead to improving

nutrition outcomes.

Recognizing the private

sector as the agent for

growth.

Food access,

nutritional needs first

and overall policy of

the state.

2) Multisectoral and fertilizer enthusiasts (n=2)

Multisectoral

collaboration with the

different ministries in

order to improve

nutrition.

Fertilizer subsidies to

guaranteed household

food security.

Focus on cash crops

including tobacco in order to

improve nutrition in Malawi.

Move away from policy of

government to policy of the

state.

It is important to change the

feeding practices & behaviors

of Malawians.

Multisectoral

collaboration and

fertilizer subsidies.

3) M&E enthusiasts (n=2)

Include nutrition

indicators and

evaluate on nutrition

status results.

Start with nutritional

needs of the

population and then

work back to

agriculture.

Fertilizer subsidies to

guaranteed household food

security.

Move away from policy of

government to policy of the

state.

Focus on cash crops

including tobacco in order to

improve nutrition in Malawi.

Start with nutritional

needs and nutrition

indicators (M&E).

4) Multisectoral and nutrient accessibility enthusiast (n=1)

Food accessibility;

nutritious food has to

become more

accessible to

everyone.

Multisectoral

collaboration with the

different ministries in

order to improve

nutrition.

Nutrition is an optional

extra for agricultural

growth.

Move away from policy of

government to policy of the

state.

Fertilizer subsidies to

guaranteed household food

security.

Focus on cash crops

including tobacco in order to

improve nutrition in Malawi.

Food accessibility,

multisectoral

collaboration and

nutriton can be a

optional extra for

agriculture.

Note: the items in italic are distinguishing statements. These are statements that particular subgroup have ranked significantly differently from other subgroups (higher or lower than overall average).

78

Table 3. Summary of Contention and Consensus Statements. # Statement Fac1 Fac2 Fac3 Fac4 Note

17 Farmers’ income should be enhanced through increasing market

sales. 0 1 -1 0

Consensus Item

10

What is grown should be more matched to what is eaten; the

infrastructure from production to consumption should undergo

changes.

0 1 0 -1 Consensus item

18 We need to find ways to move from aid to trade. 0 0 2 1 Consensus item

9 Focus on sectoral growth will inevitably lead to improving

nutrition outcomes. -2 0 1 0

2 It is important to focus on cash crops including tobacco in order

to improve nutrition in Malawi. -3 -3 -1 -3

20 We need to find a way of recognizing the private sector as the

agent for growth. -2 0 -1 0

12 It is important to change the feeding practices & behaviors of

Malawians. 1 -1 1 1

13 In order to increase smallholders’ productivity, interventions

should target different categories of smallholders. -1 -2 -1 1

5

Biofortification is one example of how to potentially increase the

supply of key micronutrients without compromising (and even

possibly increasing) the supply of macronutrients.

1 0 -2 -1

7 Greater control by women at all stages in the agriculture–

nutrition chain is needed. 0 -1 0 2

11 Malawi should find alternatives to reduce the reliance on maize. 0 -1 2 0

16 Multisectoral collaboration with the different ministries is needed

in order to improve nutrition. 1 3

1

3

1 Greater farm productivity leads to greater farm income, which

can generate economy-wide income growth. -1 2 0 1

3 On-farm income generation should focus on high nutrition-value

crops. -1 1 1 -2

8 Malawian policies are adequate but should focus on

implementing the existing policies. 2 2 -2 0

14 Nutritious food has to become more accessible to everyone. 3 -1 0 3

4 The agriculture-nutrition community needs to include nutrition

indicators and evaluate on nutrition status results. 1 1 -3 -2

15 Nutrition is an optional extra for agricultural growth; food

production is not driven by nutrition. -3 0 -2 2

Contention item

21 Malawi should move from policy of government to policy of the

state. 2 -3 -3 -1

Contention item

6 Fertilizer subsidies will contribute to guaranteed household food

security. -1 3 -3 -3

Contention item

19 Intervention strategies should start with nutritional needs of the

population and then work back to agriculture. 3 -2 3 -1

Contention item

Consensus items are statements which rated more or less at the same level of important (either high, low, or neutral) by most of the participants. Contention items are split decision statements, indicating they were highly agreeable to some participants and disagreeable to others.

79

4.4.5 Summary of Factors

The key output from Q methodology analysis are the results from each different subgroup and

their shared profiles regarding their perspectives. Sub-Annex 3.4 presents the results from the

subgroups and how they on average ranked the 21 statements (Table 4-7). Next, the results

from the Q-Sort and the participants’ reasoning, why (s)he sorted the statements in the both

extreme ends of the continuum on the sheet (-3 and 3), will be presented.

Viewpoint 1: the Nutrition Enthusiasts (n=5) This perspective is determined by participants working with the Ministry of Agriculture and Food

Security (MoAFS, n=4) and the Ministry of Environment Affairs & Climate Change (MoEACC,

n=1). Moreover, the participants have their background in the following areas: nutrition,

agriculture, public health and economics. Concluding from Table 4 (Appendix III), this

perspective states the Malawian government should focus on making sure intervention

strategies start with nutritional needs of the population and then work back to agriculture.

Participant 10 explaining the importance of statement 19 (Intervention strategies should start

with nutritional needs of the population and then work back to agriculture): “We should look at

the situation, what is the problem in Malawi in terms of malnutrition, ok, and what are the

nutritional needs. We already have a problem there. How do we tackle the problem if you don’t

know the problem? We have to target the nutritional needs of the population”.

Furthermore, they share their viewpoint that nutritious food has to become more accessible to

everyone in order to improve nutrition outcomes. Finally, the members particularly state Malawi

should move from policy of government to policy of the state to envisage nutrition improvements.

Participant 10 explaining the importance of statement 21 (Malawi should move from policy of

government to policy of the state): “We have a lot of policies, we have a lot of strategy papers,

we have a lot of plans and paper. But I think these policies are well linked, but we still have

problems with in implementation because I think we are still implementing these policies as

individuals and we are not coordinating enough with implementation”.

Participant 12 explaining the importance of statement 8 (Malawian policies are adequate but

should focus on implementing the existing policies): “Yes, for instance the policy here, our

present national nutrition policy and strategy. It is well documented, it is a good document and I

has plans in terms of strategy. But the implementation is what is an issue. Even now, our

national policy on nutrition, if you look at it now, even though it is the draft version. It is well

written. It has nutrition, but is has not been translated into action and resources. It think we can

improve on that, on the implementation side.”

The participants state it is less important to focus on cash crops, including tobacco, in order to

improve nutrition in Malawi and do not see nutrition is an optional extra for agricultural growth. In

addition to this, they disagree with and/or find it less important to recognizing the private sector

as the agent for growth.

80

Viewpoint 2: Multisectoral and Fertilizer Enthusiasts (n=2) The reasoning in this shared viewpoint is determined by participants working with the Ministry of

Agriculture and Food Security (MoAFS, n=2). Moreover, the participants have their background

in the following areas: economics and agribusiness. Concluding from Table 5 (Appendix III), the

members from subgroup share their viewpoint on the statement that the Malawian government

should focus on multisectoral collaboration with the different ministries and that the fertilizer

subsidies (such as the Farm Input Subsidy Programme) will contribute to guarantee household

food security and improve nutrition outcomes.

Participant 5 explaining the importance of statement 16 (Multisectoral collaboration with the

different ministries is needed in order to improve nutrition): “Multisectoral collaboration is

needed in the different ministries in order to improve nutrition. Definitely nutrition is not just

agriculture. It is more than just agriculture. Nutrition starts at the grass roots in the village, where

you have the community”. Participant 11 explains: “Multisectoral collaboration is as we say, it is

not a one-man show, it has to take care of collaboration, the others that are doing the same”.

Participant 11 explaining the importance of statement 6 (Fertilizer subsidies will contribute to

guaranteed household food security): “Fertilizer subsidies targets the poorest of the poor. So,

as I said, malnutrition is cause by poverty, so by giving the subsidies it means the farmer can

produce. They produce maize, they can sell bags of it, they will be able to eat. They have some

extra income that provides nutrition. That’s that. It has allot of multi-life effects, economy wide

impacts, school, health, equipment”.

The participants sharing their viewpoint state it is less important to focus on cash crops

including tobacco in order to improve nutrition and nutrition outcomes in Malawi. In addition, the

participants disagree/find it less important that Malawi needs to move from policy of government

to policy of the state.

Viewpoint 3: M&E Enthusiasts (n=2) Factor 3 is determined by participants working with the Ministry of Gender, Children & Social

Welfare (MoGCSW n=1) and the Ministry of Agriculture and Food Security (MoAFS, n=1).

Moreover, the participants have their background in the following areas: social sciences and

agriculture. Concluding from Table 6, the members from subgroup 3 share their attitude in

focusing on including nutrition indicators and evaluate on nutrition status results as well as the

importance that intervention strategies should start with nutritional needs of the population and

then work back to agriculture in order to improve nutrition.

Participant 6, explaining the importance of statement 19 (Intervention strategies should start

with nutritional needs of the population and then work back to agriculture): “Intervention

strategies should start with nutritional. Why this is so important and I strongly agree is that we

have formulated policies on the assumption that this is what the population needs, or these are

the nutritional needs of the population without maybe adequate concentration on what is it that

they need. So interventions should start with nutritional needs, assessing the nutrition needs

and then we can work back and say, for example if we are having certain deficiencies, in terms

81

of agriculture, what foods do we need to produce, so that we address those nutrition

deficiencies”.

Participant 4 explaining the importance of statement 4 (The agriculture-nutrition community

needs to include nutrition indicators and evaluate on nutrition status results): “As I said, these

two sectors, they work in isolation. So if agriculture could also put in the factor of nutrition and if

they see that one of the outputs is nutrition, maybe and probably their strategies will be maybe

very much stimulated to see nutrition as one of their outcomes. So, by doing so, they will be part

of the team, the leading team, to come up with the result of nutrition. They should be able to

work towards growing crops good, in the end giving out the results leading to nutrition”.

The participants sharing their viewpoint disagree/ find it less important to focus on fertilizer

subsidies and hence don’t see this as a solution to guaranteed household food security. Also,

the participants find it less important that Malawi needs to move from policy of government to

policy of the state. They distinguish themselves from the other viewpoints and find it less

important to focus on cash crops including tobacco in order to improve nutrition in Malawi.

Viewpoint 4: Multisectoral and Nutrient Accessibility Enthusiast (n=1) Although one subject was assigned to this viewpoint, it is important to highlight the substantive

importance the viewpoint, despite this is a small size or even one participant (Brown, 1980 p.

42). This participant is working with the Ministry of Education (MoE, n=1). The participants’

background is in the field of nutrition. Concluding from Table 7, the member of this viewpoint

puts a high level of importance on making nutritious food more accessible to everyone and that

multisectoral collaboration is needed with the different ministries in order to improve nutrition.

Participant 9 explaining the importance of statement 16 (Multisectoral collaboration with the

different ministries is needed in order to improve nutrition): “Things don’t get to the grass root.

So, that need for collaborations, people work together including the NGO’s and the donors, to

take the issues down, down, down to the grass roots. This is where we have the problems,

otherwise we can just be between policy formulation and the central level and producing books,

heap and heaps of books according the policies, but they are useless if they are not being put

into use, so we need to work together to put the policies into actions.”

Participant 9 explaining the importance of statement 14 (Nutritious food has to become more

accessible to everyone): “This is very very true, because it is not just eating Nsheema, but what

we need is nutritious food. That is what is the most important area. So even if, in whatever

situation, what we need is nutritious food. Not just food. Right from production , the processes,

and as it goes down transportation form where to food is being transported to the market and

form the market going to the household level. […] They are being taken from different areas

going distances to different areas, and then when it will get there where their nutritive value is

denatured. So, what is important is that nutritious food has to become accessible. Be eaten at

the production level”.

82

The participant from this viewpoint disagrees/ find it less important to focus on fertilizer

subsidies and does not see this as something which is necessarily guaranteeing household food

security and improve nutrition outcomes through this. The subject distinguishes from other

viewpoints with the item and find it less important that Malawi has to move from policy of

government to policy of the state.

4.4.6 CONCLUSIONS: CONSENSUS AND CONTENTION ITEMS

There seems to be consensus on the following three items, although ranked quite low on level

of importance (ranked in between -1 to 1): (1) statement 17: farmers’ income should be

enhanced through increasing market sales; (2) statement 10: what is grown should be more

matched to what is eaten, the infrastructure from production to consumption should undergo

changes and (3) statement 18: we need to find ways to move from aid to trade.

Areas of conflict show there is allot of variation of level of importance in order to improve

nutrition (ranked in between -2 to 3 or 2 to -3). As presented in Box 1, four statements showed

to be very important focus areas to some and least important to others, the contention items

(Table 3). The following four statements were ranked different on level of importance by the 12

participants: (1) statement 15. nutrition is an optional extra for agricultural growth; food

production is not driven by nutrition; (2) statement 21. Malawi should move from policy of

government to policy of the state (3) statement 6. fertilizer subsidies will contribute to

guaranteed household food security and (4) statement 19. intervention strategies should start

with nutritional needs of the population and then work back to agriculture.

4.4.7 Key Findings and Participants Reasoning

Four different factors could be identified, which can also be described as shared viewpoints,

perspectives or attitudes. In Table 4 is shown that the viewpoints distinct from each other. This

indicates the four factors or shared viewpoints ranked the statement different from each other

and thus the four shared perspective do not show similarities in the way the participants ranked

the statements (all <0.7, rule of thumb in factor correlation matrix). The highest correlation is

found between factor 1 and 3, since both shared their viewpoint by ranked high on stating

‘Intervention strategies should start with nutritional needs of the population and then work back

to agriculture’. In addition to this, they both scored low on ‘Nutrition is an optional extra for

agricultural growth; food production is not driven by nutrition’ as well as the statement ‘Fertilizer

subsidies will contribute to guaranteed household food security’.

Table 4. Correlation between factor scores

Factor 1 2 3 4

1 1.0 0.02 0.25 0.09

2 0.02 1.0 0.03 0.009

3 0.25 0.03 1.0 0.09

4 0.09 0.09 0.09 1.0

Knowing the areas of conflict/contention (Box 1) and consensus, this can identifying where the

different staff workers experience their worries and where they see areas of activities that may

83

lead to improve nutrition. It showed issues that should be discussed and may be sensitive when

discussing. Finally, the input from the shared perspectives concerning improving nutrition can

be used as input for policy and making decisions in determining the entry point in order to

improve nutrition in Malawi. The various perspectives presented were related to their knowledge

and experience and support a feeling of ownership in the discussion around Malawi’s aim to

improving nutrition. In the MSc thesis, available in November 2013, the groups will be compared

with the results from the in-depth interviews. This will present more on the perceptions from the

members of the groups and their viewpoint/attitude in order to identify where they match or

mismatch in advancing nutrition linked to the Healthy Alliances (HALL) framework (Koelen et al.,

2013) as well as the Health in All Policies (HIAP) framework (Ståhl et al., 2006).

4.4.8 REFERENCES

Brown, S. R. (1980). Political subjectivity: Applications of Q methodology in political science.

New Haven, CT: Yale University Press. Brown, SR. (2008). Q Methodology in Assessment and Research. Summer Intersession (May

19-23, 2008,) Workshop notes. Accessed 18 June 2013 from: http://schmolck.userweb.mwn.de/qmethod/syllabus08.pdf.

Chung, K. (2012). An Introduction to Nutrition-Agriculture Linkages: Michigan State University, Department of Agricultural, Food, and Resource Economics.

Exel van, J., & de Graaf, G. (2005). Q methodology: A sneak preview. Accessed 18 June 2013 from: http://www. qmethodology. net/PDF/Q-methodology.

Herforth, A. 2013. Synthesis of guiding principles on agriculture programming for nutrition. Rome, FAO.

Hoppe, B., & Reinelt, C. (2010). Social network analysis and the evaluation of leadership networks. The Leadership Quarterly, 21(4), 600-619.

IFPRI. (2011). Leveraging Agriculture for Improving Nutrition and Health: Highlights from an International Conference. Washington, DC.

Koelen, M. A., Vaandrager, L., & Wagemakers, A. (2012). The healthy alliances (HALL) framework: prerequisites for success. Family practice,29(suppl 1), i132-i138.

Krueger, R.A., Casey, M.A., Donner, J., Kirsch, S., Maack, J.N. (2001) Social analysis: selected tools and techniques World Bank report no 36. Washington, DC: The World Bank.

Ståhl, T., Wismar, M., Ollila, E., Lahtinen, E., & Leppo, K. (2006). Health in all policies. Prospects and potentials. Helsinki: Finnish Ministry of Social Affairs and Health.

Steelman, T. A. and Maguire, L. A. (2009) Understanding participant perspectives: Q- methodology in national forest management, J. Policy Anal. Manag., 18, 361–388.

Stephenson, W. (1935). Technique of factor analysis. Nature, 136, 297. Thomas, D. M., & Watson, R. T. (2002). Q-sorting and MIS research: A primer. Communications

of the Association for Information Systems, 8(1), 141-156. UNICEF. (2013). Improving child nutrition. The achievable imperative for global progress.

Accessed 17 April 2013 from www.unicef.org/publications/index.html. World Bank. (2006). Repositioning Nutrition as Central to Development. A Strategy for Large-

Scale Action. Washington DC.

4.4.9 Answer sheet and instruction sheet

Answer Sheet for the Q-Sort: participatory processes questionnaire*

According to you, what should the Malawian government focus on in order to improve nutrition outcomes in the coming years? Sort the statements listed on the chips from least important (-3) to most important (3):

Researcher: Nynke Kampstra Participant ID:

Guide to sorting statements

Least important -3

Strongly disagree

-2

Disagree

-1

Somewhat disagree

0 Neutral

Neither agree or disagree

1

Somewhat agree

2

Agree

Most important 3

Strongly agree

2 statements 2 statements 4 statements 5 statements 4 statements 2 statements 2 statements

Once you have completed the Q-sort, please double-check that there is one number in each cell and no duplicates. *The statements have been numbered randomly

85

4.4.10 Instruction sheet for the Q-Sort

Detailed Instructions (will review this with you in person as well)

1. Count the chips. You should have 21 statements and one board including numbers ranging from -3 to 3. Please check if all chips are available.

2. Each chip contains one statement and concerns one possible element of a vision for improving nutrition in Malawi.

According to you, what should the Malawian government focus on in order to improve nutrition outcomes in the coming years? Sort the statements listed on the chips from least important to most important priority.

3. Look for a minute at the diagram on the next page and at the “header.” To complete the exercise, you are asked to organize the chips in the shape according to the diagram: 2 statements go under the column marked “-3: least important”, 2 statements under “-2”, 4 under “-1”, 5 under “0: neutral”, and so on. There is no difference among the importance of items as long as they are placed in the same column.

4. Most people find it difficult to do this prioritization in one step. Instead, it is easier to start by separating the statements into three piles: not important (or disagree), neutral, and important.

5. Once you have three general piles, focus first on the “important” pile. Leave the others aside and simply try to organize the chips you considered important into the appropriate number of slots for “1”, “2” and “3: most important.” 6. Now turn to the general pile you called “not important” and perform the same sort.

7. Next sort out any statements you left in the “neutral” pile in the beginning.

8. You should now have a complete sort that matches the number of statements listed on the header. Feel free to look at the whole picture and make any changes you want. 9. When you are comfortable with the sort, write the NUMBER of each statement in the corresponding slot on the answer sheet.

10. If you have any questions, please ask the researcher for help.

86

4.4.11 Participant information sheet

PARTICIPANT INFORMATION SHEET

1) Title of Study A stakeholder discourse analysis on agriculture & nutrition linkages in Malawi. Examining stakeholders’ expectations on nutrition-sensitive agriculture.

2) Invitation Paragraph You are invited to participate in this study. Before you decide to participate, it is important for you to understand the background and aims of the study and what it will involve. Please take time to read the following information carefully and feel free to ask any questions to the researcher, Nynke Kampstra (MSc Public Health and Society student, Wageningen University, the Netherlands). Please also feel free to discuss with other colleagues or with the UNSCN Secretariat. We would like to stress that you do not have to accept this invitation and should only agree to take part if you want to.

3) Purpose of this research It has been widely acknowledged that integration of nutrition principles in agriculture practices is needed (IFPRI 2011; Chung 2012). Traditionally, agriculture development has focused on improving agriculture outputs through increasing crop yields and raising productivity. The links between nutrition and health outcomes and agriculture are complex and are firmly embedded in a country’s food system. This is not a one arrow relationship, as cited by (IFPRI 2011) “anything that affects agriculture has the potential to affect health and nutrition, and anything that affects health and nutrition has the potential to affect agriculture—for good or ill.” In order to improve nutrition, there is no ‘one size fits all’ approach, but multidisciplinary actions are needed in order to improve nutrition outcomes including agriculture and rural development, social protection and safety nets, water supply and sanitation, education, gender and community-driven development (WorldBank 2006).

4) What for? In order to improve nutrition through agriculture, it is important to have an understanding of the disciplines involved and exploring the expectations from the sector itself and considering the expectations from other disciplines and sectors working in collaboration with the agriculture sector. It is crucial to analyze and map the underlying thoughts from agriculture stakeholders as well as nutrition and health workers in order to make effective progress in shaping policy and ensure sustainable improvements, in addition to creating a benchmark to monitor and evaluate success realizing nutrition improvements.

5) Why have I been chosen to take part?

You have been identified as a key-decision maker having a mandate, directly or indirectly, impacting nutrition policies in Malawi. We value your opinion on nutrition issues related to: the policy environment, the implementation of activities and whether the activities lead to the envisaged nutrition outcomes.

87

6) What will I be asked to do in this research? Participation is voluntary and all participants are free to withdraw from the study throughout the stages during the research without any further implications or consequences. As a participant in the study, you will be interviewed face-to-face and this will take approximately 60-90 minutes. One researcher, Nynke Kampstra, will carry out the interview. As a participant you will be responsible for agreeing on a specified suitable time for the interview, planned in collaboration with the researcher for undertaking the face-to-face interview in Malawi in a one-on-one session. The interview will be audio taped to enable the researcher to review the data in greater detail and analyzing the results. The voice recordings will be deleted once the research has been finalized.

7) How will my information be used The information you provide will be analyzed and used to generate conclusions on the subject

area for Nynke Kampstra’s Master Thesis, MSc student Public Health & Society at the

Wageningen University, the Netherlands. This stakeholders’ discourse analysis will provide

insights to the understanding of agriculture and nutrition linkages, and how nutrition-sensitive

agriculture is perceived among the Malawian actors of different sectors. This analysis will

provide insights for enhancing agriculture development and map the views on the role of the

agriculture sector and its linkages to Malawi’s nutrition profile and how this is addressed in the

current policies, programmes and interventions. This will provide an understanding how

nutrition-sensitive agriculture is addressed by the various stakeholders in Malawi.

In addition, this study feeds into the UNSCN country case study conducted in Malawi by Dr.

Anne-Marie Mayer. For a brief overview of this project and how it is complementary to the Dr.

Anne-Marie Mayer’s case study, see Figure 1. The following overall objectives have been

formulated:

I. To review how food and agricultural policies are having or are intended to have an

impact on nutrition in the country;

II. To contribute to the advancement of the discussion on nutrition-sensitive agriculture.

8) Will my information be kept confidential?

All the information and opinions you provide will be kept highly confidential and secure from others. When analyzing the results and writing the report, no names will be included. The information, opinions and views will be kept anonymously. During the interview, there will be a voice recorder documenting the conversation in order to transcribe the interview and allow the research to analyze the results more in detail. Once the research is completed, the voice recording will be deleted.

9) Expenses and / or payments There are no reimbursements available for participants of this study and it is envisaged no expenses will be made by the participants.

10) Are there any risks in taking part? There are no risks for participants taking part in this study.

11) Are there any benefits in taking part?

88

There is no immediate benefit for participants. The information which will be generated and

analyzed as part of the study will however benefit Malawi as it will identify opportunities and

challenges to enhance nutrition impact of the agricultural sector. Moreover, it will examine

where there is consensus, split decision and/or possibly map distinct groups among the

interviewees. It will review how food and agricultural policies are having/are intended to have an

impact on nutrition in the country and thus what is prioritized in Malawi’s nutrition-sensitive

development by the various actors.

12) What will happen if I want to stop taking part?

At any stage during the interview, you can withdraw from the study without explanation. Participants may request that their results are destroyed and no further use is made of them.

13) Who can I contact if I have further questions?

If you have question, unclarities, feel unsatisfied or experienced any problems, please contact Nynke Kampstra’s (nynke.kampstra@wur.nl) or her master thesis supervisor from the Wageningen University, the Netherlands: Dr. Laura Bouwman (laura.bouwman@wur.nl). Assistant Professor Wageningen UR, Chairgroup Health & Society (HSO), Department of Social Sciences. Telephone: +31 0317 486150.

Figure 1. Malawi case study overview.

89

4.4.12 Q Sort REFERENCES

Chung, K. (2012). An Introduction to Nutrition-Agriculture Linkages: Michigan State University, Department of Agricultural, Food, and Resource Economics.

IFPRI. (2011). Leveraging Agriculture for Improving Nutrition and Health: Highlights from an International Conference. Washington, DC.

World Bank. (2006). Repositioning Nutrition as Central to Development. A Strategy for Large-Scale Action. Washington DC.

90

4.4.13 Informed consent form

INFORMED CONSENT FORM

Research project: A stakeholder discourse analysis on agriculture & nutrition linkages in Malawi. Examining stakeholders’ expectations on nutrition-sensitive agriculture. Researcher(s): Nynke Kampstra

1. I confirm that I have read and have understood the Participants Information Sheet for the above study. I have had the opportunity to read through the information, ask questions and have had these answered.

2. I understand that my participation is voluntary and that I am free to withdraw at any stage without giving any reason, without my rights being affected.

3. I understand that I will not be identified or identifiable in any report produced by the researcher.

4. I accept that taking part this study is voluntary and confirm that any risks associated with this have been explained to me.

5. I agree to take part in the above study.

Participant Name Date Signature

Researcher Date Signature Contact details of master thesis supervisor from the Wageningen University, the Netherlands: Dr. Laura Bouwman (laura.bouwman@wur.nl). Assistant Professor Wageningen UR, Chairgroup Health & Society (HSO), Department of Social Sciences. Telephone: +31 0317 486150.

91

4.4.14 Summary of the factors (1-4)

Table 4. Summary of Factor 1 (n=5)

Number Statement Score Note

19 Intervention strategies should start with nutritional needs of the population and

then work back to agriculture.

3

14 Nutritious food has to become more accessible to everyone. 3

8 Malawian policies are adequate but should focus on implementing the existing

policies.

2

21 Malawi should move from policy of government to policy of the state. 2 High

4 The agriculture-nutrition community needs to include nutrition indicators and

evaluate on nutrition status results.

1

5 Biofortification is one example of how to potentially increase the supply of key

micronutrients without compromising (and even possibly increasing) the supply of

macronutrients.

1

12 It is important to change the feeding practices & behaviors of Malawians. 1

16 Multisectoral collaboration with the different ministries is needed in order to

improve nutrition.

1

7 Greater control by women at all stages in the agriculture–nutrition chain is needed. 0

17 Farmers’ income should be enhanced through increasing market sales. 0

18 We need to find ways to move from aid to trade. 0

10 What is grown should be more matched to what is eaten; the infrastructure from

production to consumption should undergo changes.

0

11 Malawi should find alternatives to reduce the reliance on maize. 0

6 Fertilizer subsidies will contribute to guaranteed household food security. -1 Low

13 In order to increase smallholders’ productivity, interventions should target different

categories of smallholders.

-1

3 On-farm income generation should focus on high nutrition-value crops. -1

1 Greater farm productivity leads to greater farm income, which can generate

economy-wide income growth.

-1

9 Focus on sectoral growth will inevitably lead to improving nutrition outcomes. -2 Low

20 We need to find a way of recognizing the private sector as the agent for growth. -2 Low

2 It is important to focus on cash crops including tobacco in order to improve

nutrition in Malawi.

-3

15 Nutrition is an optional extra for agricultural growth; food production is not driven

by nutrition.

-3 Low

The statements at the top of the table are ranked as more important by the group. Items at the bottom of the page are ranked as less important. ‘High’ and ‘low’ highlight the contention statements. These statement have been ranked significantly different from the other subgroups (higher or lower compared to the overall average).

92

Table 5. Summary Factor 2 (n=2)

Number Statement Score Note

16 Multisectoral collaboration with the different ministries is needed in order to

improve nutrition.

3

6 Fertilizer subsidies will contribute to guaranteed household food security. 3 High

8 Malawian policies are adequate but should focus on implementing the existing

policies.

2

1 Greater farm productivity leads to greater farm income, which can generate

economy-wide income growth.

2

4 The agriculture-nutrition community needs to include nutrition indicators and

evaluate on nutrition status results.

1

3 On-farm income generation should focus on high nutrition-value crops. 1

17 Farmers’ income should be enhanced through increasing market sales. 1

10 What is grown should be more matched to what is eaten; the infrastructure from

production to consumption should undergo changes.

1

20 We need to find a way of recognizing the private sector as the agent for growth. 0

15 Nutrition is an optional extra for agricultural growth; food production is not driven

by nutrition.

0

5 Biofortification is one example of how to potentially increase the supply of key

micronutrients without compromising (and even possibly increasing) the supply of

macronutrients.

0

9 Focus on sectoral growth will inevitably lead to improving nutrition outcomes. 0

18 We need to find ways to move from aid to trade. 0

14 Nutritious food has to become more accessible to everyone. -1

7 Greater control by women at all stages in the agriculture–nutrition chain is needed. -1

11 Malawi should find alternatives to reduce the reliance on maize. -1

12 It is important to change the feeding practices & behaviors of Malawians.

-1 Low

13 In order to increase smallholders’ productivity, interventions should target different

categories of smallholders.

-2

19 Intervention strategies should start with nutritional needs of the population and

then work back to agriculture.

-2

2 It is important to focus on cash crops including tobacco in order to improve

nutrition in Malawi.

-3

21 Malawi should move from policy of government to policy of the state. -3

The statements at the top of the table are ranked as more important by the group. Items at the bottom of the page are ranked as less important. ‘High’ and ‘low’ highlight the contention statements. These statement have been ranked significantly different from the other subgroups (higher or lower compared to the overall average).

93

Table 14. Summary of Factor 3 (n=2)

Number Statement Score Note

4 The agriculture-nutrition community needs to include nutrition indicators and

evaluate on nutrition status results.

3 High

19 Intervention strategies should start with nutritional needs of the population and

then work back to agriculture.

3

11 Malawi should find alternatives to reduce the reliance on maize. 2

18 We need to find ways to move from aid to trade. 2

12 It is important to change the feeding practices & behaviors of Malawians. 1

16 Multisectoral collaboration with the different ministries is needed in order to

improve nutrition.

1

3 On-farm income generation should focus on high nutrition-value crops. 1

9 Focus on sectoral growth will inevitably lead to improving nutrition outcomes. 1

7 Greater control by women at all stages in the agriculture–nutrition chain is needed. 0

14 Nutritious food has to become more accessible to everyone. 0

1 Greater farm productivity leads to greater farm income, which can generate

economy-wide income growth.

0

10 What is grown should be more matched to what is eaten; the infrastructure from

production to consumption should undergo changes.

0

17 Farmers’ income should be enhanced through increasing market sales. 0

20 We need to find a way of recognizing the private sector as the agent for growth. -1

2 It is important to focus on cash crops including tobacco in order to improve

nutrition in Malawi.

-1 Low

13 In order to increase smallholders’ productivity, interventions should target different

categories of smallholders.

-1

8 Malawian policies are adequate but should focus on implementing the existing

policies.

-1

15 Nutrition is an optional extra for agricultural growth; food production is not driven

by nutrition.

-2

5 Biofortification is one example of how to potentially increase the supply of key

micronutrients without compromising (and even possibly increasing) the supply of

macronutrients.

-2

6 Fertilizer subsidies will contribute to guaranteed household food security. -3

21 Malawi should move from policy of government to policy of the state. -3

The statements at the top of the table are ranked as more important by the group. Items at the bottom of the page are ranked as less important. ‘High’ and ‘low’ highlight the contention statements. These statement have been ranked significantly different from the other subgroups (higher or lower compared to the overall average).

94

Table 7. Summary of Factor 4 (n=1)

Number Statement Score Note

14 Nutritious food has to become more accessible to everyone. 3

16 Multisectoral collaboration with the different ministries is needed in order to

improve nutrition.

3

7 Greater control by women at all stages in the agriculture–nutrition chain is

needed.

2

15 Nutrition is an optional extra for agricultural growth; food production is not driven

by nutrition.

2 High

12 It is important to change the feeding practices & behaviors of Malawians. 1

13 In order to increase smallholders’ productivity, interventions should target

different categories of smallholders.

1

1 Greater farm productivity leads to greater farm income, which can generate

economy-wide income growth.

1

18 We need to find ways to move from aid to trade. 1

9 Focus on sectoral growth will inevitably lead to improving nutrition outcomes. 0

11 Malawi should find alternatives to reduce the reliance on maize. 0

17 Farmers’ income should be enhanced through increasing market sales. 0

8 Malawian policies are adequate but should focus on implementing the existing

policies.

0

20 We need to find a way of recognizing the private sector as the agent for growth. 0

10 What is grown should be more matched to what is eaten; the infrastructure from

production to consumption should undergo changes.

-1

5 Biofortification is one example of how to potentially increase the supply of key

micronutrients without compromising (and even possibly increasing) the supply of

macronutrients.

-1

19 Intervention strategies should start with nutritional needs of the population and

then work back to agriculture.

-1

21 Malawi should move from policy of government to policy of the state. -1 Low

4 The agriculture-nutrition community needs to include nutrition indicators and

evaluate on nutrition status results.

-2

3 On-farm income generation should focus on high nutrition-value crops. -2

6 Fertilizer subsidies will contribute to guaranteed household food security. -3

2 It is important to focus on cash crops including tobacco in order to improve

nutrition in Malawi.

-3 Low

The statements at the top of the table are ranked as more important by the group. Items at the bottom of the page are ranked as less important. ‘High’ and ‘low’ highlight the contention statements. These statement have been ranked significantly different from the other subgroups (higher or lower compared to the overall average).

95

4.5 References

Andersson, A. (2011). "Maize remittances, smallholder livelihoods and maize consumption in Malawi." Journal of Modern African Studies 49(1): 1-25.

Benin, S., A. Nin Pratt, et al. (2011). "Trends and Spatial Patterns in Agricultural Productivity in Africa, 1961–2010. ReSAKSS Annual Trends and Outlook Report 2011. International Food Policy Research Institute (IFPRI).".

Black, R. E., C. G. Victora, et al. (2008). "Maternal and child undernutrition and overweight in low-income and middle-income countries." The Lancet 382(9890): 427-451.

Boyce, S. and C. Dolan (2013). "MQSUN SUN Costing-Phase II (extension) Malawi Country visit report ".

Butao, R. (2012). "Joint coutry assessment of Nutrition in Malawi (draft June) ".

CAADP (2010). "CAADP in practice. Highlighting the successes. Accessed 15 April 2013 from: http://www.caadp.net/pdf/Highlighting%20the%20successes%20280611%20v3%200%20web.pdf."

CAADP (2010). "The Malawi CAADP (the Comprehensive Africa Agriculture Development Programme) compact to support the successful implementation of the Agriculture Sector Wide Approach."

Chinsinga, B. (2012). "The Political Economy of Agricultural Policy Processes in Malawi. Future Agricultures, Working Paper 039.".

Chirwa, E., J. Kydd, et al. (2006). "Future scenarios for agriculture in Malawi: challenges and dilemmas."

Chung, K. (2012). An Introduction to Nutrition-Agriculture Linkages, Michigan State University, Department of Agricultural, Food, and Resource Economics.

Denning, G., P. Kabambe, et al. (2009). "Input subsidies to improve smallholder maize productivity in Malawi: Toward an African Green Revolution." PLoS biology 7(1): e1000023.

DNHA, O. (2012). "Support for Nutrition Improvement in Malawi."

Ecker, O. and M. Qaim (2011). "Analysing nutritional impacts of policies: an empirical study for Malawi." World Development 39(3): 412-428.

FAO (2008). "FAOSTAT database. Production: Crops. Accessed 15 April 2013 from http://faostat.fao.org/site/567/default.aspx.".

FAO. (2013). "Key Recommendations for Improving Nutrition through Agriculture."

Garrett, J. (2013). Principles for Multisectoral Approaches for Improving Nutrition. UNSCN Meeting of the Minds on Nutrition Impact of Food Systems. Accessed 24 April 2013 from:

96

http://www.unscn.org/files/Annual_Sessions/UNSCN_Meetings_2013/Garrett_MoM_Working_Multisectorally.pdf

GoM (2009). "(Government of Malawi). A report for the national micronutrient survey. p 1-275.".

GoM (2009). "(Government of Malawi). Produced by the Department of Nutrition, HIV and AIDS. Malawi nutrition bulletin. Accessed 17 April from http://www.reachpartnership.org/c/document_library/get_file?uuid=02e4781c-2a69-44b6-a142-ea509add71c3&groupId=94591."

GoM (2011) "Malawi's progress towards achieving the Millennium Development Goals . http://www.malawi.gov.mw/Publications/MDGs2011.pdf."

GOM DAES (2000). "Model Village Approach Concept."

GoM DNHA (2011). National Nutrition Education and Communication Strategy.

GoM MAFS (2011). "Ministry of Agriculture and Food Security: The National Agricultural Policy."

GOM MAFS (2012). "Presidential Initiative on Small Stock Production Programme."

GOM MAFS (2012). "Presidential Initiative Promotion of legumes production and marketing project."

GoM MEST (2009). "Ministry of Education Science and Technology: National School Health and Nutrition Strategic Plan."

GOM MGDS II (2011). "(Government of Malawi) Malawi Growth and Development Strategy II."

GoM OPC (undated). "Office of the President and Cabinet: Infant and Young Child Nutrition Policy."

Haddad, L. (2013). "From Nutrition Plus to Nutrition Driven: How to realize the elusive potential of agriculture for nutrition?" Food & Nutrition Bulletin 34(1): 39-44.

Hawkes, C. and M. T. Ruel (2012). "Value chains for nutrition." Edited by Shenggen Fan and Rajul Pandya-Lorch: 73.

IAASTD (2008). "International Assessment of Agricultural Knowledge, Science and Technology for Development (IAASTD) Executive

Summary of the Synthesis Report. (online) Kundzewicz ZW, Mata LJ, Arnell N, Doll P, Kabat P, Jimenez."

IDS (2013). The Hunger And Nutrition Commitment Index (HANCI 2012). Measuring the Political Commitment to Reduce Hunger and Undernutrition in Developing Countries. Brighton.

IFPRI (2011). "Leveraging Agriculture for Improving Nutrition and Health: Highlights from an International Conference. Washington, DC.".

IFPRI (2012). "Global food policy report. International Food Policy Research Institute. Washington, DC ".

97

IFPRI (2012). Maize Consumption Estimation and Dietary Diversity Assessment Methods in Malawi Malawi Strategy Support Program.

Kalimbira, A. (2011). Learning from National and local perspectives: the MICAH project. Unleashing agriculture's potential for improved nutrition and health in Malawi. Conference Report.

MAFS GOM (2006). "District Agriculture Extension Services System: Implementation Guide."

Malawi Vulnerability Assessment Committee (2011). Food Security Monitoring Report. Lilongwe Malawi,.

Mayer, A. B. (2011). A food systems approach to increase dietary zinc intake in Bangladesh based on an analysis of diet, rice production and processing. Combating Micronutrient Deficiency : Food-based approaches. B. Thompson. Rome, FAO: 256.

Ministry of Agriculture Irrigation and Water Development (2010 2011). Annual Agricultural Statistics Bulletin.

Mollison, B. (1988). Permaculture a designers manual. Tyalgum Australia, Tagari.

Nordin, S. (2005). Low input food and nutrition security: growing and eating more using less. World Food Program.

Nordin, S. (2013). Sustainable Nutrition: Growing and eating best using less. World Food Program. Lilongwe.

NSO National Statistical Office (2011). "Malawi Demographic and Health Survey 2010. Zomba, Malawi, and Calverton, Maryland, USA: NSO and ICF Macro."

OPC DNHA (2013). Malawi Committments on Nutrition. Presented at the ‘Nutrition for Growth: beating hunger through Business and Science’ Event

Republic of Malawi (2005). "Ministry of Agriculture: Food and Nutrition Security Policy."

Republic of Malawi DNHA (2007). "Department of Nutrition HIV and AIDS: National Nutrition Policy and Strategic Plan."

Republic of Malawi MoAFS (2006). "Ministry of Agriculture and Food Security: Food Security Policy."

Republic of Malawi MoAFS (2011). "Ministry of Agriculture and Food Security: Malawi Agricultural Sector Wide Approach."

Ruel, M. T. (2003). "Operationalizing dietary diversity: a review of measurement issues and research priorities." The Journal of nutrition 133(11): 3911S-3926S.

Ruel, M. T. and H. Alderman (2013). "Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?" The Lancet.

Smale, M. (1995). "“Maize is life”: Malawi's delayed Green Revolution." World Development 23(5): 819-831.

98

SUN, S. U. N. (2011). "Compendium of Country Fiches, Rome."

Traoré, M., B. Thompson, et al. (2012). "Sustainable nutrition security Restoring the bridge between agriculture and health. FAO, Rome, Italy."

UNDP (2013). "Human Development Report 2013. The rise of the South: Human Progress in a Diverse World. Acessed 15 April 2013 from http://hdr.undp.org/en/media/HDR2013_EN_Summary.pdf."

UNICEF (2013). "Improving child nutrition. The achievable imperative for global progress. Accessed 17 April 2013 from www.unicef.org/publications/index.html."

WFP (2010). "Rural Malawi Comprehensive Food Security and Vulnerability Analysis. World Food Programme, OMXF Food Security Analysis Service. P 1-188.".

WorldBank (2006). Repositioning Nutrition as Central to Development. A Strategy for Large-Scale Action. Washington DC.

WorldBank (2011). Malawi: country brief. Accessed 15 April 2013 from http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/MALAWIEXTN/0,,menuPK:355882~pagePK:141132~piPK:141107~theSitePK:355870,00.html.

99

UNITED NATIONS SYSTEM

STANDING COMMITTEE

ON NUTRITION

The United Nations System Standing Committee on Nutrition (UNSCN) is the food and nutrition policy harmonization forum of the United Nations. Its vision is a world free from hunger and malnutrition, where there are no longer impediments to human development.

UNSCN

Chair: Ramiro Lopes da Silva

c/o World Health Organization

20 Avenue Appia, CH 1211 Geneva 27

Switzerland

Telephone: +41-22 791 04 56

scn@who.int

www.unscn.org