Suchergebnisse

This paper estimates country-specific costs and benefits of scaling up key nutrition investments in Nigeria. Building on the methodology established in the global report scaling up nutrition: what will it cost? Authors first estimate the costs and benefits of a nationwide scale up of ten effective nutrition-specific interventions. This will require an annual public investment of $837 million and would yield enormous benefits: over 8.7 million DALYs and 183,000 lives would be saved annually, while more than 3 million cases of stunting among children under five will be averted. As it is unlikely that the Government of Nigeria or its partners will find the $837 million necessary to reach full national coverage, authors also consider five potential scale-up scenarios based on considerations of burden of stunting, potential for impact, resource requirements and capacity for implementation in Nigeria. Using cost-benefit analyses authors propose scale-up scenarios that represent a compromise between the need to move to full coverage and the constraints imposed by limited resources and capacities. This analysis takes an innovative approach to nutrition costing by not only estimating the costs and benefits of nutrition-specific interventions, but also exploring costs for a selected number of nutrition-sensitive interventions implemented outside of the health sector. We identify and cost four candidate nutrition-sensitive interventions with impact potential in Nigeria, including bio-fortification of cassava, aflatoxin control, school-based deworming, and school-based promotion of good hygiene. Overall, these findings point to a candidate list of nutrition-sensitive approaches that represent a cost-effective approach to reducing child malnutrition in Nigeria. Moving forward, these results are intended to help guide decision makers as they plan future efforts to scale-up action against malnutrition in Nigeria and develop nutrition financing plans that bring to bear resources from the health, social protection, education, and agriculture sectors.

The study covered a wide range of topics, making data collection especially challenging. Key informants were sometimes new to their posts and were unable to provide details on specific programs, policies, or coverage rates. Few countries in Latin America and the Caribbean mainstream into their crisis and emergency plans protection of the nutritional status of mothers and children in the first 1,000 days of life. All countries should reinforce the promotion and protection of breastfeeding in emergencies, notably by providing an enabling space for mothers to safely breastfeed their children and by managing the provision of artificial milk formula. It is concerning that during emergencies most countries provide powdered artificial formula instead of ready-to-use artificial milk formula to infants that cannot breastfeed, greatly increasing the risks of illnesses and malnutrition as a result of inappropriate dilution and unsafe water. All countries need to reinforce their monitoring and evaluation systems, including surveillance of food and nutrition insecurity. While most countries have some form of monitoring system, few of those systems are computerized, which impairs timely and informed decision making. Systematic evaluations of emergency and crisis response are seldom performed. A number of countries would benefit from updating their nutrition policy and protocols based on the latest available evidence. Of particular importance are updates to the prevention and treatment of micronutrient deficiencies with micronutrient powders; treatment of acute malnutrition, notably with the use of ready-to-use supplements; and efficient treatment of diarrhea through the use of oral rehydration solution and zinc. Most countries will benefit from adapting the food and water rations given in emergencies to the specific nutritional needs of pregnant and lactating women and children <2 years of age.

This toolkit is the first of its kind to provide information on promoting and protecting the nutritional status of mothers and children in crises and emergencies. Latin America and the Caribbean is one of the most vulnerable regions in the world to major crises and emergencies. This toolkit aims to improve the resilience of the most vulnerable in times of intensified nutritional needs, most notably pregnant and lactating mothers as well as children less than two years of age. Its principal objective is to offer countries, when faced with the transition from stable times into and out of crisis, clear guidance on how to safeguard the nutritional status of mothers and children during times of stability, crisis, and emergency. The principal objective of this toolkit is to offer clear guidance, in a single-source compilation, that will assist countries in safeguarding the nutritional status of mothers and children during times of stability, crisis, and emergency. It aims to inform changes in countries' policies and practices and to guide their attempts to deal with persistently high prevalence rates of malnutrition among their poorest, least educated, and indigenous populations. This toolkit has been crafted so that it can be readily used by non-nutrition specialists.

The nutrition cluster is a very important entity to coordinate actions during emergencies. It is important that the nutrition cluster know in advance which institutions work where and what kind of inputs are pre-positioned. Risk management plans need to be ready at the local level in advance of emergencies. Although emergencies occur every year in Guatemala, the emergency response often fails to incorporate the management of malnutrition among its priority actions. Community programs, like AIN-C (a community- based child care program - atencion integral a la ninez comunitaria), can be an efficient mechanism to protect young children's nutrition and provide an important channel for the government or other assistance agencies to funnel support to communities in need during a period of crisis or emergency. This is because community workers know the families and those who are most vulnerable; they are willing to be called upon to help their community; and they can provide educational support to families to ensure rapid recovery among young children. Community-based growth promotion programs such as AIN-C can be strengthened and scaled up, and they are a good investment, in the aftermath of an emergency or during a time of economic crisis, to swiftly deliver services to affected families. Community agents can carry important information to the community and can distribute food, nutrition and health supplements such as micronutrient powders and oral rehydration salts for young children, as well as hygiene and water purification products. Community kitchens are an efficient approach to reduce hunger among the poor during times of high economic stress. They provide a social safety net and can have a nutrition effect when carefully planned. Community kitchens adjust to the labor market and general economic conditions; hence targeting of the poor and most in need through community kitchens is self-selective. The kitchens can expand and shrink as participants continually assess the trade-off between unpaid work in exchange for free or inexpensive meals and the pursuit of opportunities in the labor market.

Rising demand for agricultural commodities coupled with population growth, climate change, declining soil fertility, environmental degradation and rural poverty in the develop-ing world call for strategies to sustainably intensify agricultural production. Sustainable in-tensification refers to increasing production from the same area of land while reducing its negative environmental consequences. Most of the adverse conditions are particularly preva-lent in Sub-Saharan Africa (SSA), where rates of undernutrition are the highest worldwide, while agricultural productivity is still far below global averages. An important factor in ex-plaining productivity deficits among smallholders in SSA is the slow adoption of new agri-cultural technologies. Recently, governments and international donors especially concentrate on the promotion of 'system technologies', i.e. packages of technologies that should be ap-plied jointly due to synergistic effects. Yet, evidence shows that farmers delay in particular the uptake of system technologies, and tend to scatter practices across plots instead of com-bining them on the same plot. Hence, analyzing how to effectively enhance the adoption of technology packages is crucial, but still understudied. In addition, comprehensive studies on the plot- and household level effects of system technologies that use micro data from farmer surveys are still scarce when it comes to impacts beyond traditional outcomes, such as crop yields and income, but important to understand the consequences of adoption for farmers. This dissertation addresses these gaps by studying the adoption and effects of 'Integrated Soil Fertility Management' (ISFM). ISFM is a system technology comprised of a set of site-specific soil fertility practices which should be applied in combination. Its core is the inte-grated use of organic and inorganic fertilizers with improved seeds. Practices should be adapted to local conditions, accompanied by a general improvement of agronomic tech-niques and, depending on the context, by other technologies such as crop rotation, agroforest-ry or reduced tillage. The general aim of ISFM is an improvement of the soil's fertility by replenishing its nutrient stocks and organic matter level. Enhanced soil fertility is likely to improve food security, incomes, and ultimately, livelihoods of the rural population depend-ing on small-scale agriculture. In addition, healthier and more fertile soils can contribute to restoring and conserving natural resources by providing crucial ecosystem services, such as the storage of soil carbon, erosion control and the prevention of further deforestation. Thus, they can make an important contribution to the sustainable intensification of smallholder agricultural systems. However, ISFM commonly also goes along with increased demand for capital and labor, which often prevents smallholders from adopting it. In addition, ISFM is considered knowledge-intensive, as combining several practices and adapting them to local conditions requires at least a basic understanding of biological processes. Against this background, the dissertation addresses two broad research objectives: Firstly, to assess the role of 'farmer-to-farmer' and non-traditional forms of agricultural extension to enhance knowledge and adoption of ISFM as a pathway to sustainable intensification. And secondly, to assess the productivity and welfare implications of adopting ISFM practices at the plot and household level. The thesis comprises three essays. The first essay concentrates on knowledge and adoption of ISFM as a complex agricultural technology, while the second and third essay analyze the effects of ISFM at the plot, respectively household level. All three essays build on primary data collected among 2,382 farm households in the three Ethi-opian regions Amhara, Oromia and Tigray. The research was carried out in cooperation with the 'Integrated Soil Fertility Management Project' (ISFM+ project) of the German Agency for International Cooperation (GIZ), launched in 2015 in 18 districts in the three highland regions. The first essay focusses on the role of agricultural extension in the dissemination of ISFM. In recent decades, decentralized and participatory extension models have become dominant in SSA. In these 'famer-to-farmer' approaches, only a few 'model farmers' are trained directly by extension agents and should then train other farmers, often organized in groups. From there, information should trickle down to all other households in a community. Yet, evidence suggests that information diffusion is a complex process and does not automatically reach all farmers. On the contrary, knowledge is likely to be transmitted incompletely from model farmers to extension group members and from there to 'ordinary' farmers. This applies in particular to complex system technologies, where farmers have to learn about each individu-al practice as well as the necessity of applying them jointly. In this article, we assess the ef-fects of a farmer-to-farmer extension model and an additional intervention in form of a video on farmers' knowledge and adoption of ISFM. We implemented a cluster randomized con-trolled trial, using 161 microwatersheds (mws) as primary units of randomization. 72 mws received the farmer-to-farmer extension treatment, with model farmers who maintain ISFM demonstration plots and train so-called 'farmer research and extension groups' as core ele-ments. 36 out of these treatment mws received an additional video intervention, explaining the underlying reasons for adopting the ISFM package, and featuring documentaries on suc-cessful ISFM adoption. 89 mws did not receive any intervention and serve as control group. In each of the three groups, 15 households per mws were randomly selected to be included in the sample. Findings show that farmer-to-farmer extension, both alone and in combination with video, increases ISFM adoption, both of its individual components as well as their com-bined adoption on the same plot. Effects are stronger for farmers who are involved in group-based extension activities, but exist to a weaker extent also for farmers in the same commu-nities who are not involved. On average, we find no significant additional effect of the video intervention on adoption. However, the video does show a significant additional effect for farmers in treatment mws who are not members of extension groups, in particular when it comes to the integrated use of the practices on the same plot. Further, while both farmer-to-farmer extension alone and in combination with the video induce gains in ISFM knowledge, effects are significantly stronger for the combined treatment. A causal mediation analysis reveals that increases in knowledge explain part of the treatment effects on adoption. Over-all, these results suggest that farmer-to-farmer extension can effectively foster technology adoption; both among extension group members as well as among non-members residing in the same communities, probably a sign of information spillovers. Yet, for the non-members, providing complementary information via video seems a valuable method to counterbalance incomplete information diffusion and ultimately, foster the adoption of complex system technologies such as ISFM. Essay two analyzes of the effects of different combinations of ISFM practices on land productivity, net crop value, labor demand, labor productivity and financial returns to unpaid labor at the plot level. To date, evidence on the profitability of ISFM in smallholder settings is scarce, in particular when it comes to labor investments. The study differs from previous research by looking into a broader range of outcome indicators, and into the effects of dis-tinct combinations of inorganic fertilizer, organic fertilizer and improved seeds. We employ a multinomial endogenous switching model to account for endogeneity, and data from over 6,000 teff, wheat and maize plots. Results show that both partial and complete ISFM adop-tion lead to significant increases in land productivity and net crop value, in particular when improved seeds are used. On average, the largest effect on land productivity stems from adopting complete ISFM, i.e. improved varieties with inorganic fertilizer and organic ferti-lizer, followed by the combinations containing only one fertilizer type. Analyses for two different agroecological zones suggest that in moister regions, complementing improved varieties with inorganic fertilizer is most important, while in drier regions, enhancing it with organic fertilizer is crucial, most probably due to its water-retaining effect. Regarding net crop value, average effects of combining improved seeds with either one or both fertilizer types are similar, despite the larger effect of the complete package on land productivity; probably due to reduced input costs when only one of the two fertilizer types is used. Further, as expected, ISFM is related to higher labor demand, but also significantly increases labor productivity and financial returns to labor. Hence, despite the additional demand for labor and capital, results suggest that ISFM can be a profitable technology for smallholders, at least when assessed at the plot level. The third essay complements the picture on ISFM effects by analyzing its impacts at the household level. This is important since additional demand for resources associated with a technology (package) may imply a reallocation of labor from one income-generating activity to another, leaving net effects for a household uncertain. Therefore, we study whether adopt-ing ISFM on at least one teff, wheat or maize plot increases income obtained from these crops, as well as total household income and household labor demand, and whether ISFM adoption is related to the probability of pursuing other economic activities. In addition, we assess impacts on food security, measured by self-reported incidences of food deprivation. Further, the essay analyzes effects on children's education as indicator for longer-term wel-fare, assessed by the enrollment rate of children in primary school age, the average number of absent school days and average educational expenditure. On the one hand, additional labor requirements may increase the work burden for children, with possible negative effects for their education. On the other hand, if ISFM is related to income gains, it might also lead to additional investments in education. We apply the inverse probability weighting regression adjustment method to account for selection bias, with propensity score matching as robust-ness check, and account for dissimilar agroecological potential by running disaggregated analyses for moist and dry regions. Results show that ISFM adoption for main cereal crops is related to increased income per capita obtained from these crops in both agroecological zones. Effects sizes of a rather lax definition of ISFM – having used improved seeds in com-bination with at least either organic or inorganic fertilizer – and a stricter definition, which comprises both fertilizer types, are very similar. A reason for that might be the additional costs associated with using two instead of only one fertilizer type; or because the synergistic potential of their joint use does not materialize immediately. Yet, only in the moister re-gions, higher crop income seems to translate into higher household income per capita, while it does not in the dry region. This might be because the share of income from these crops in total household income is not important enough in the latter subsample. Yet, in the dry re-gion, ISFM adoption for main cereals also leads to a lower probability of achieving income from other crops and off-farm activities, probably an effect of resource reallocation (in par-ticular labor). Moreover, we find a food security-enhancing effect of ISFM only for the moister areas, but not for the dry region. In both subsamples, ISFM adoption is related to increased demand for household labor. Yet, despite the higher labor demand, we find no in-dication for increased school absenteeism or even reduced enrollment rates of children, and no effects on educational expenditure. By contrast, ISFM adoption is associated with higher primary school enrollment the moist agroecology. Hence, only for areas where ISFM adop-tion is related to gains in overall household income, we also find positive effects on other welfare indicators, such as food security and education. All in all, these results suggest that broader welfare effects of agricultural innovations have to be evaluated within the complex system of households' income diversification strategies. Overall, this dissertation contributes to the state of research by drawing a more comprehen-sive picture of the effects of ISFM in resource-constrained and diversified smallholder sys-tems, as well as of interventions to foster the adoption of ISFM, or system technologies in general. Firstly, results imply that farmer-to-farmer and other, not traditional forms of agri-cultural extension have the potential to increase knowledge and adoption of complex innova-tions. Yet, extension systems still have to overcome shortcomings and find ways to be more inclusive, probably by means of an effective and creative mix of interventions. And second-ly, findings suggest that ISFM can be a profitable technology for farmers, but also requires more resources. When evaluating broader impacts of its adoption, it is important to account for heterogeneous conditions and contexts.

The study includes: glossary; references; and annexes. A number of countries in the Latin America and Caribbean (LAC) region have been severely hit by food-price crises in 2008 and are still very vulnerable to food-price volatility experienced since late 2010. Humanitarian responses to high food prices, crises, shocks, or emergency situations should help the poor avoid the consequences of the reduced affordability of a basic food basket. This is especially crucial in the first 1,000 days of life (that is, children from pregnancy until they reach 2 years of age and breastfeeding women), since most of the physical and cognitive damages due to improper nutrition in this period are irreversible. The World Bank is leading a regional study on how to improve LAC country responses so as to protect the nutritional status of the poorest and most vulnerable in times of crises and emergencies.

The World Bank and The United Nations Children's Fund (UNICEF) jointly developed this report to calculate the potential human and economic benefits to be gained from increasing nutrition investments in the Kyrgyz Republic. This report provides compelling evidence of the potential to improve health and economic outcomes through scaling up effective nutrition interventions and introducing new proven interventions to reduce the direct causes of under nutrition in order to support the Kyrgyz government's commitment to the well-being and prosperous future of the Kyrgyz people. This situational analysis examines and quantifies the scope of under nutrition in the Kyrgyz Republic by presenting: (1) the epidemiology of under nutrition; (2) an estimate of the health consequences of under nutrition in terms of mortality and disability adjusted life years (DALYs), and the economic losses due to lost workforce and productivity; (3) the health, social protection, and agriculture and food intervention systems relevant to delivering interventions for improving nutrition; (4) the current coverage of nutrition interventions; and (5) the potential economic gains achievable by scaling up effective nutrition interventions. The current context is very favorable for scaling up nutrition interventions in the Kyrgyz Republic. Investing in nutrition has increasingly proven to have excellent development and health returns. The international development community has recognized (1) the need to scale up nutrition interventions; (2) the potential for public-private partnerships; and, (3) a growing consensus around a common framework for action. Reducing under nutrition worldwide is a priority for the World Bank and UNICEF, and also critical to achieving the Millennium Development Goals (MDGs).

Although Sub-Saharan Africa has some of the worst nutrition indicators in the world, nutrition remains a low priority on the policy agendas of many African governments. This despite the fact that proven interventions are known and available and that investment in them is considered a cost-effective strategy for poverty reduction. This case study is one in a series seeking to understand (1) what keeps African governments from committing fully to reducing malnutrition, and (2) what is required for full commitment. It documents how the Ghanaian government has addressed the issue of malnutrition since Independence, examines what political and institutional factors have prevented full commitment, and identifies what conditions have moved the nutrition agenda forward at different points in time. The primary objective of this study as well as the series as a whole is to help African governments, development partners, and nutrition and health practitioners identify, understand and address the political and institutional obstacles preventing sustainable progress in nutrition.