Precision geospatial analysis highlights development gaps – now we need precision solutions

Two new studies published in the journal Nature map recent progress made on improving child health and education across Africa at a level of detail that provides a powerful new tool for improving development outcomes in Africa. The studies find that many areas—particularly around major cities—have made tremendous progress in improving both child health and educational outcomes. But the study also highlights stark inequalities across the continent, and the findings show no single country is likely to completely end childhood malnutrition within its borders by the Sustainable Development Goal (SDG) deadline of 2030.

As former UN Secretary General Kofi Annan writes in a Nature commentary piece accompanying the release of these studies: “Such fine-grained insight brings tremendous responsibility to act. It shows governments, international agencies and donors exactly where to direct resources and support.”

Maps from a study in Nature show the prevalence of moderate and severe stunting in Africa in 2010 and 2015 at a granular, 5 x 5 km level. Such mapping capabilities suggest a path to "precision development," the author writes, allowing better targeting of resources to address problems on the local level.

The way the studies drill down to these smaller local levels, deeper than previous efforts, demonstrates how localized problems can persist even within larger areas of progress. Now, we must figure out ways to apply this information to create precise interventions that address these inequalities.

The idea that there can be tremendous spatial variability (as well as variations over time) in development outcomes has been a subject of discussion in the development community for several years now. But almost any level of subnational disaggregation is often deemed too large for precision-focused targeting. Now that the capacity exists to perform the precise level of analysis highlighted in this Nature article, there is a path to begin discussions about what precision public health or precision development might look like.

At the same time, local government boundaries, especially those that signal financial and administrative power, are often well above these smaller geospatial analytic boundaries in many countries. Financial allocations and administrative decisions are made at province or region or district levels in many governments, while these studies map outcomes across the continent in standard 5x5 square kilometer areas. Using this data to consider how to apply it to financing or administrative support decisions is the next task for development practitioners.

As the maps in these studies show, precision public health will be necessary to achieve the global goals to end hunger and poverty by 2030, but the execution of it requires tremendous capability and commitment at local administrative levels.
These studies also show us outcomes, but don’t tell us how the combination of determinants are playing out. We will need more disaggegated data on the coverage of various types of programs, interventions, and services. This would help sharpen both the targeting of actions and the monitoring of changes in coverage and outcomes. Locally-focused diagnostic work is essential in order to accelerate the progress made and reach every last household, mother, and child in ways that reshape the conditions that support better child growth and educational attainment throughout life.

For decades, we have known that investments in nutrition can fuel better educational outcomes later in life, and that the educational attainment of women is crucial not only to their individual health and wellbeing, but also for that of their children and their society. These outcomes are intricately connected, and addressing them together can provide tremendous spillover benefits.

Purnima Menon is a Senior Research Fellow with IFPRI's Poverty, Health and Nutrition Division, based in New Delhi. This blog was originally posted on IFPRI.org.

International Women’s Day: In the fight against malnutrition, empower women’s groups first

As International Women’s Day—with the theme “Rural and Urban Activists Transforming Women’s Lives”—approaches, IFPRI is examining the role of rural women activists in bringing change to nutrition and food systems worldwide. The first of two posts.

The transformative role of women’s groups is drawing rising attention around the world. By organizing, women have been able to achieve change within their communities, households, and themselves—despite obstacles such as restrictive gender norms that limit the scope of their decision-making, legal systems that prohibit them from owning property, and domestic responsibilities that limit their ability to earn income and even to rest and take care of their own health.

Sam Scott/IFPRI
Members of a women's self-help group at a meeting in the Dindori district in Madhya Pradesh, India.

Development organizations are increasingly focusing antipoverty and nutrition initiatives around women’s groups. Will these groups prove to be the secret ingredient to solve the global problems of hunger and malnutrition? Our recent review of the linkages between women’s groups and nutrition outcomes in South Asia sheds light on this important question.

In societies with entrenched gender norms, working through women’s groups helps women build social capital and empower themselves. Organizing in this way helps make women more aware of their rights, builds trust in the group and within the community, provides platforms for collective action, and promotes the active role of women as community leaders. The latter is especially relevant to health and nutrition outcomes, as women often act as the keepers of local norms that guide nutritional behavior—including, but not limited to dietary diversity, infant and young child feeding (IYCF) practices, sanitation and hygiene, and access to and utilization of health services. Real solutions to undernutrition emerge when women are connected and given the chance to lead.

Women’s groups help improve health and nutrition outcomes through one or more of four distinct pathways: Increased savings and greater purchasing power; engagement in agriculture; behavior change communication (BCC) to generate knowledge sharing around health and nutrition; and improved community engagement, resulting in social accountability and community demand for government programs focused on nutrition. Common to all these pathways are three elements: Building social capital, acting collectively, and empowering women themselves.
The strength and connections of women’s groups, which often convene conversations around challenges ranging from health to the workplace, are increasingly recognized as a point of entry for effective development initiatives worldwide. Many development organizations are betting on the power of these groups in getting results. India’s National Rural Livelihoods Mission is delivering anti-poverty programs through women’s self-help group platforms, and the World Health Organization (WHO) has already formally recognized the effectiveness of mobilizing women’s groups in improving newborn health, for example.

However, serious gaps remain in research around how women’s groups impact nutrition and health, and direct links are still coming into focus. Few studies have explicitly targeted the crucial 1000-day window for nutrition impacts on children or focused on other nutritionally-vulnerable age groups, perhaps even fewer are based on more reliable data gleaned from randomized controlled trials, and only one study has provided evidence on the multiple pathways from women’s groups to nutrition.

While it is clear that programs targeting women’s groups have significant potential to address malnutrition, not all groups are structured in the same way, nor do they all achieve success. In our examination of 36 studies, the programs that led to positive changes in behaviors related to nutrition all had an explicit nutrition objective.

To take root and address nutritional challenges, we write, women’s organizations “must effectively enable basic tenets of group-based engagement such as building social capital, promoting women's empowerment, and advocating to community leaders.” Finally, their efforts must be focused on changing behavior around nutrition.

As we continue to learn about the role of women’s groups in addressing malnutrition, one thing is abundantly clear: Women have already proven themselves to be catalysts for community development. Now is the time to support the process that these women, working together to improve their lives, have begun.

Neha Kumar and Agnes Quisumbing are Senior Research Fellows in IFPRI's Poverty, Health, and Nutrition Division. This blog was originally posted on IFPRI.org.

Policy Dialogue- Innovations in Ensuring Remunerative Prices (MSP) to Farmers: Challenges and Strategies & Launch of Global Food Policy Report 2018

Azadpur Mandi-Wholesale Market, New Delhi, India. Source: (Flickr)/ Vaishali Dassani, IFPRI

International Food Policy Research Institute (IFPRI), jointly with the National Academy of Agricultural Sciences (NAAS), and the ICAR- National Institute of Agricultural Economics and Policy Research (ICAR-NIAP), is organizing a Policy Dialogue on Innovations in Ensuring Remunerative Prices (MSP) to Farmers: Challenges and Strategies on Friday, March 23, 2018 at the NASC Complex, Pusa, New Delhi. 

This theme is selected in view of the recent budget speech by the Finance Minister to fix the Minimum Support Prices (MSPs) at 50 percent higher than the production cost, and develop effective mechanisms to ensure remunerative prices to the farmers. Increasing MSP at 50 percent higher than the production cost was long awaited demand by the farmers. The moot issue is how to implement the higher MSP for all the crops. It is in this context, this policy dialogue is planned to develop alternative and feasible options, so that farmers get remunerative prices.

The event will also be marked by the release of the Global Food Policy Report 2018.  The report looks at the impacts on food security and nutrition of greater global integration – including the movement of goods, investment, people, and knowledge – and the threat of current antiglobalization pressures. The report will be launched by Dr Shenggen Fan, Director General IFPRI along with other reputed dignitaries.


More details about the launch event can be found here.

 

Accelerating Progress to Meet 2030 Goals to Improve Child and Maternal Nutrition

 

The recently launched UNICEF-World Health Organization (WHO) 2017 Countdown to 2030 report shows mixed results for childhood health and nutrition. The 81 Countdown countries have made progress, but remain far from universal coverage for most essential interventions for reproductive, maternal, newborn, child health, and nutrition. The report presents detailed country and equity profiles on women’s, children’s and adolescents’ health for countries that together account for 95 percent of maternal deaths and 90 percent of deaths among children under five.

Countdown to 2030 Report/UNICEF

To galvanize attention and mobilize action around priorities in maternal and child nutrition, various global targets have been set, including the United Nations' 2030 Agenda for Sustainable Development and the WHO’s Every Woman Every Child Global Strategy for Women's, Children's and Adolescent's Health (2016–2030). The Countdown to 2030 report systematically tracks progress towards achieving these. IFPRI is a member of the Countdown to 2030 collaboration.

In the accompanying Countdown to 2030 paper published in The Lancet on tracking progress towards universal coverage for reproductive, maternal, newborn, and child health, Countdown collaborators have underscored the need to accelerate the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children under five, to achieve the Sustainable Development Goals by 2030. Such efforts will require a rapid scale-up of effective interventions to all population groups within affected countries, supported by improvements in underlying socioeconomic conditions, including women’s empowerment.

India is one of the priority Countdown countries, and as the findings of this report reflect, is still a long way from achieving universal coverage for most essential interventions in these key health and nutrition areas. The Countdown work has been an inspiration for POSHAN’s research and data visualization work on coverage of interventions across the continuum of care in Indian states. POSHAN’s state-level Policy Notes, based on updated coverage data now available in NFHS-4 (2016), reveal that the coverage of interventions for mothers and children in the first 1,000 days has improved substantially over time, but challenges remain. There are significant state-level variabilities in the coverage for some interventions. Coverage during pregnancy is generally high, up to 75 percent for some interventions, like pregnancy registration. However, coverage of nutrition interventions integrated into pregnancy care is low at less than 33 percent for women who consumed iron and folic acid supplements. During delivery, coverage is high: Nearly 80 percent for interventions pertaining to institutional delivery, skilled birth attendance, and birth registration. However, coverage of interventions for lactating women remains much lower than 50 percent.

An effective way to track a country’s progress towards any global goals is to apply them at the national level. In India, there is much optimism pegged on the recently launched National Nutrition Mission, which aims to reduce stunting, undernutrition, and low birth weight by 2 percent and anemia by 3 percent annually, covering states and districts in a phased manner over three years (2017-20), benefiting more than 100 million people. Meeting these goals will require that India deploy the interventions already in the policy framework at high coverage, reaching across states and districts. Analyzing coverage levels and trends is an important first step in prioritizing interventions where gaps are large and where efforts need to be scrutinized and accelerated.

As 2017 Countdown to 2030 report points out, to address the targets at the global and national levels, it is important to focus on the strengthening of vital statistics, understanding drivers of coverage change, and obtaining better data on early childhood development and adolescent health. In India, the government think tank NITI Aayog now has a Nutrition Dashboard that provides nutrition charts of India's states and districts and examines coverage of some (but not all) critical interventions. POSHAN’s district-level interactive maps and 640 District Nutrition Profiles also provide disaggregated data and detailed in-depth analyses.

In addition to outcomes and coverage, it is also important to focus on the indirect and underlying determinants, like sanitation and hygiene, access to drinking water, women’s literacy, girls’ age at marriage, etc. Countdown’s national profiles and POSHAN’s state and district profiles provide ready reckoners for an assessment of these underlying drivers and help to identify the gaps that need to be closed to accelerate change in health and nutrition outcomes.

Changes in health outcomes will only become a reality with changes in coverage of interventions and in the drivers of these outcomes. Promising beginnings have been made on the nutrition and health landscape and there is much anticipation on the horizon. However, efforts to address coverage and drivers now need to be strategically navigated to catalyse progress towards 2030, both globally and in India.

Purnima Menon and Stuart Gillespie are Senior Research Fellows with IFPRI's Poverty, Health and Nutrition Division and members of the Countdown to 2030 Collaboration: Menon participated in the Coverage Technical Working Group; Gillespie in the overall Technical Review Group. Pratima Mathews is an IFPRI Communications Specialist. This post originally appeared on the POSHAN blog.

Food safety: Challenges in Dairy Industry

Illustration: Ratna Sagar Shrestha/THT

Food safety is, inevitably, a vital component of food security. However, the compliance with food safety measures (FSM) along the value chain remains elusive in most of the developing countries. The emergence of new modern market chains and increasing integration with the global economy has been putting pressure on the governments for better compliance with FSM along the food value chain. In fact, governments in these countries are now seriously looking for ways and means to improve the status of food safety in these countries.

The status of compliance with FSM in South Asia, in general, is not satisfactory and particularly in Nepal it is precarious and even worse. Nepal often has to incur heavy losses when consignments for exports are rejected due to lack of compliance with FSM. It appeared that the efforts taken by the governments in the past have been largely inadequate. The government’s control and command approach to ensure food safety has not worked satisfactorily due to lack of physical, human and institutional capital for monitoring the compliance with FSM across the entire value chain. Globally, the demand-pull systems have worked well in improving the quality and food safety attributes of the product. Nepal too needs a paradigm shift from relying solely on supply-side food safety and develop demand-pull systems for it.

To understand the status of adoption of FSM and its implications, International Food Policy Research Institute (IFPRI), undertook a comprehensive study on compliance with FSM in Nepal’s milk production. We chose milk as it is one of the most important food item — for rich and poor, young (most importantly children) and old. It is also found to be highly sensitive and carries vector of all possible microbes and extraneous particles in it. We focussed our attention at farm level, as better compliance at production level goes a long way to minimise the chances of contamination at successive levels. The issues such as animal welfare, prevalence of drug residues and antibiotics resistance can be effectively addressed at the farm level.

We investigated the status, estimated the cost, identified the drivers and assessed the impact of compliance with FSM in milk production in Nepal. The study was comprehensive and data were collected from geographically and institutionally diverse regions of Nepal. Our results show that the status of farm level compliance is not very encouraging. On an average only 64% of the recommended measures are adopted by the dairy farmers, though the Government of Nepal released the “code of practices for dairy industry” way back in 2002, in which good dairy practices were developed for safety. The intensity of adoption of FSM exhibits significant variations. The dominance of informal channels in Nepal’s milk market further complicates the compliance and consumers, processors and cooperatives often complain about unhygienic milk production at the farm level.

In comparison to the international standards, Nepal’s mean total bacterial count (TBC) was seen to be nine times higher on farm and 104 times higher in plant, directing an urgent need of improving quality of milk production. It seems farmers are not very enthusiastic to fully comply with FSM since it involves incremental costs and the markets in Nepal often do not reward for food safety. On an average, a dairy farmer in Nepal has to incur an additional expenditure of Rs 2 per litre of milk production. The moot question remains to be answered whether the consumers are willing to compensate the producers for enhanced cost of food safety? Several studies elsewhere in the world illustrate that consumers are willing to pay a premium for safer food products.

Several policy actions are recommended based on comprehensive empirical analysis undertaken by IFPRI. Massive awareness needs to be created among the producers especially related to animal health and hygienic maintenance of the surrounding environment. Farmers should especially be sensitized to discard milk from seriously diseased and infected animals, or even from animals receiving medication.

Periodic monitoring and inspection is critical to ensure adherence to “dairy code practices”. The access to information and frequency of inspection for conformity with safety and quality standards are playing critical role in enhancing the compliance with FSM in Nepal. Farms having information about FSM have shown an 11 percent higher adoption. Similarly, the farms which have been inspected for conformity with safety and quality standards have increased their adoption of FSM by 11 percent.

These findings suggest strengthening of extension delivery and monitoring mechanisms in the country. The government should invest adequately to build physical, institutional and human infrastructure on priority in order to build a robust system to ensure compliance with FSM along the food value chain. Further, the integration with formal channels enhances the adoption of FSM by 8 percent. We need to promote and expand the inclusive formal milk markets to ensure better compliance with FSM. Finally, a pricing strategy based on the quality of milk production should be vigorously pursued to incentivise the famers for higher adoption of FSM. Government of Nepal should develop and prioritize short, medium and long-term action plans for improving compliance with food safety measures to access the global markets and reaping the benefits of expanding trade opportunities in agro-products.

Anjani Kumar is research fellow with the International Food Policy Research Institute. This article was originally published in The Himalayan Times

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