Session 6A: Financial incentives and preference analyses for improved nutrition and health
byANH Academy
Academy Week Research Conference
| Agriculture, Economics, Nutrition, Public Health
Date and Time
From: 27 June 2019, 14:10
To: 27 June 2019, 15:30
BST British Summer Time GMT+1:00
Location
Country: India
Open Full Event

 

Five, 10-minute abstract-driven presentations.  

Speakers and Presentations:

 

  • Chair: Sudha Narayanan, Indira Gandhi Institute of Development Research (IGIDR)
  • Ashraful Alam, University of Sydney, Australia
    Lessons learnt from a mixed-methods feasibility assessment of integrating agriculture and nutrition behaviour change intervention with financial incentive to improve maternal and infant nutrition in rural Bangladesh
    Slides/ Recording

  • Samyuktha Kannan, International Food Policy Research Institute (IFPRI)
    Designing nutrition-sensitive crop insurance: A field experiment in India
    Slides/ Recording

  • Shiva Bhandari, University of South Carolina, USA
    An agricultural and finance intervention improved dietary intake and nutritional status of children living in HIV-affected households in western Kenya
    Slides/ Recording

  • Hussaini Yusuf Ibrahim, Federal University Dustin-Ma, Nigeria
    Impact of smallholder farmers’ participation in contract farming on food and nutrition security outcomes in north western Nigeria
    Slides/ Recording

  • Sushil Raj Ghimire, Welthungerhilfe, Nepal
    Improving dietary diversity by exploring retail outlets: A supply-push and demand-pull strategy for sustainable nutrition eco-system
    Slides

  • Q&A 
    Recording

 

Abstracts:

Lessons learnt from a mixed-methods feasibility assessment of integrating agriculture and nutrition behaviour change intervention with financial incentive to improve maternal and infant nutrition in rural Bangladesh

Ashraful Alam, University of Sydney, Australia

Introduction:  Poverty, low incomes, and price hikes restrict poor families in Bangladesh from accessing sufficient and diversified nutritious foods, which leads to their food and nutrition insecurity. To generate positive impacts on nutritional outcomes, agricultural interventions require more focus on nutrition, and need to be linked to nutrition-specific interventions. Improving homestead fruit and vegetable production integrated with enhanced communications about nutrition would lead to improved dietary diversity and nutritional status of children. Such an integrated intervention requires rigorous design and implementation strategy to generate an impact.

Methods:  This study aims to assess the feasibility and acceptability of an intervention package that combines nutrition-specific (nutrition counseling) and nutrition-sensitive (counseling and support for agriculture, and unconditional cash transfers) delivered on a mobile phone platform for improving maternal and child feeding behaviors among low-income families in rural Bangladesh. We conducted a mixed-methods feasibility study. The intervention included counseling on homestead gardening techniques and infant feeding by agriculture and nutrition workers using smartphone apps. Women received weekly individual counseling at home and group counseling fortnightly. Each participating woman received an unconditional monthly incentive of BDT 1200 cash transfer through a mobile banking system called bKash. The intervention took place for six months. We collected data through in-depth interviews and a cross-sectional survey of the participants and their family members.

Findings:  The women were interested in both agriculture and nutrition counseling and understood the messages clearly. They established homestead gardens of seasonal vegetables successfully, including preparing beds, planting seedlings, nurturing the plants, and harvesting. Seasonal rainfall and damage by hens and ducks were major challenges but most of the families were able to find a solution. Most of the women preferred to consume own-produced vegetables and spend the cash provided on purchasing nutritious foods such as fruits, eggs, and milk for their children as advised in the counseling. The project implementation staff and the bKash agent did not report any difficulties in using the mobile banking system for cash transfer.

Conclusions:  Combining nutrition-specific and nutrition-sensitive interventions is a feasible and acceptable approach to the community to improve maternal and infant feeding practices. Using mobile phone technologies can provide additional benefits for the intervention to reach the disadvantage families in rural settings of Bangladesh.

 

Designing nutrition-sensitive crop insurance: A field experiment in India

Samyuktha Kannan, International Food Policy Research Institute (IFPRI)

Introduction:  Smallholder farmers suffer increasingly from weather extremes. Climate change leads to income losses, reduced investments in nutrition and health, as well as increased conflict over resources not only in the short term, by causing crop damage, but also in the longer term, by discouraging risk-averse farmers from investing in profitable yet high-risk cash crops, including horticultural activities. Although many low-income countries are exploring subsidized crop insurance as a solution to mitigate impacts of climate change on nutrition, health, and gender outcomes, very few pay attention to designing these schemes in a nutrition-, health- and gender-sensitive way.

Methods:  We therefore analyze the potential for crop insurance to be designed in a nutrition-sensitive way, focusing on a pilot implementation of picture-based insurance with approximately 600 farmers in Haryana State, India. First, to assess the potential impact of crop insurance for different types of crops on nutrition and health outcomes, we analyze the extent to which weather shocks and damage to different types of crops affect nutrition and health, using survey recall data and focus group discussions. Our hypothesis is that shocks to high-value vegetable crops will have larger impacts than shocks to lower-value grains. Second, we assess to what extent farmers value insurance for these two types of crops differently, hypothesizing that farmers will express a greater willingness to pay for vegetable crop insurance. To that end, we elicit willingness-to-pay for both types of insurance products using the Becker-DeGroot-Marschak method. Third, utilizing the same experimental method, we elicit farmers’ valuation of receiving personalized advisory services from the insurance provider. Using these data, we study the question of whether farmers are willing to pay more for risk management recommendations around vegetable production versus recommendations on how to manage production risk in the cultivation of grains.

Findings:  We find that there is strong potential for crop insurance to improve nutrition and health outcomes. First, weather shocks causing damage to high-value vegetable crops have strong negative impacts on women’s nutrition, healthseeking behavior, and mental health. Impacts are weaker in the case of weather shocks causing damage to grains. Second, we find that farmers are willing to pay on average 5% of the coverage amount for vegetable crop insurance, which is significantly higher than the average 1.5% of the coverage amount that farmers are willing to pay for insurance that covers their wheat. This gap is explained only partially by farmers expecting their vegetables to be damaged with a higher probability, suggesting higher aversion towards vegetable production risk than towards production risk in wheat. Along the same lines, farmers attach greater value to personalized advisory services when messages focus on vegetable crops than when focusing on wheat. Combined, these findings indicate that focusing on vegetable production can increase the demand for financial and information services to manage production risk.

Conclusions:  Existing programs to help smallholder farmers manage production risk primarily focus on staples such as wheat and rice. Potential impacts of these schemes on nutrition and health outcomes can be strengthened by expanding coverage to include horticultural cash crops. These crops are more often affected by weather shocks, damage to these crops has stronger adverse effects on women’s nutrition and health outcomes, and farmers reveal a greater demand for agricultural risk management services when these services focus on vegetables. Thus, it is important to improve smallholder farmers’ access to climate information services and affordable high-quality crop insurance targeting vegetable crops.

 

An agricultural and finance intervention improved dietary intake and nutritional status of children living in HIV-affected households in western Kenya

Shiva Bhandari, University of South Carolina, USA

Introduction:  Children under five years of age living in households affected by HIV and AIDS are at high risk for food insecurity and its subsequent negative impacts on nutrition and somatic growth. This study tested whether an intervention that was shown previously to have improved food security, dietary intake of adults, and HIV health outcomes also improved dietary intake and nutritional status of children living in HIV-affected households.

Methods:  The study was conducted in Nyanza Region, Kenya, where two health facilities were randomly assigned as intervention or control arms. The intervention included a human-powered water pump, a microfinance loan to purchase farm commodities, and training in sustainable farming practices and financial management. One hundred children (6 to 60 months of age) from households with HIV-infected adults 18 to 49 years’ old on antiretroviral therapy and with access to surface water and land were enrolled in each arm. Children were assessed beginning in April 2012 and every three months for one year. Data were collected on dietary intake, height, weight, and mid-upper arm circumference. The difference in differences from the first visit and in linear trends over visits were tested using fixed-effects regression models.

Findings:  Compared to the control arm, the intervention arm had a larger increase in weight at the 12-month visit (β: 0.42, 95% CI: 0.08, 0.76) and increase in MUAC at the 6-month visit (β: 0.28, 95% CI: 0.08, 0.49), with no difference in changes in height over time. Compared to the control arm, the intervention arm had a larger increasing trend over time in intake of staples (β: 0.22, 95% CI: 0.02, 0.44), fruits and vegetables (β: 0.42, 95% CI: 0.10, 0.75), and meat (β: 0.07, 95% CI: 0.03, 0.12), and a larger decreasing trend in intake of condiments (β: -0.16, 95% CI: -0.23, -0.09) and tea (β: -0.12, 95% CI: -0.19, -0.05), with no differences in intake of eggs, dairy, and fat over time.

Conclusions:  This intervention that improved food security, dietary intake of adults, and HIV health outcomes in HIV-affected households also improved dietary intake and nutritional status of children living in those households.

 

Impact of smallholder farmers’ participation in contract farming on food and nutrition security outcomes in north western Nigeria

Hussaini Yusuf Ibrahim, Federal University Dustin-Ma, Nigeria

Introduction:  The participation of smallholder farmers in contract farming is a potential pathway for improving their welfare in developing countries. However, little is understood or known about the impact of smallholder farmers’ participation in contract farming arrangements on household food security and nutrition in Nigeria. Previous studies in Nigeria on the impact of contract farming have not focused on food and nutrition security outcomes. We analyze impacts of smallholder farmers’ participation in contract farming arrangements on household income from maize, food security and nutrition with cross-sectional data from Nigeria.

Methods:  Cross-sectional data from five rural communities in northwestern Nigeria were used for the study. The data was collected using semi-structured interviews with 250 randomly selected farm households. T-Test analyses were performed to assess the differences in the impact indicators between the households participating in contract farming arrangements and those not participating. The gross margin analysis was used to measure Income from maize production, while household food security and nutrition status were measured using the Household Food Insecurity Assessment Scale (HFIAS) and the Household Dietary Diversity Score, respectively. The propensity score matching technique was used to analyze impact pathways. Two matching algorithms, the nearest neighbor and the caliper or radius matching, were used in the study.

Findings:  The likelihood of participation in a contract farming scheme increases with an increase in commercialization index, ownership of transport assets, experience in maize farming, other occupations, and acquisition of farm land, while total labor and distance to market reduces the probability of participating in contract farming. The ATE, ATT and ATU for the respondents were ₦37170.8/ha,₦50234.8/ha and ₦28809.8 respectively. This implies that participation in contract farming will lead to an increase in maize income. However, the increase was not significant at (P=0.10) for all categories of respondents. For Household Dietary Diversity, the ATE, ATT and ATU were -3.09, -3.1136 and -3.1277 respectively. The results show that participation in contract farming will adversely affect farming households’ nutrition. Furthermore, the ATE, ATT and ATU for the Household Food Insecurity Assessment Scale were 3.69, 4.23, and 4.58 respectively, implying that participation in contract farming may lead to a precarious food security situation among smallholder maize farmers.

Conclusions:  The study reconfirms the potential role of contract farming in enhancing the income of smallholder farmers. However, if food security and nutrition concerns are not factored into contract farming agreements, it may trigger precarious household food security and nutrition outcomes among smallholder farmers.

 

Improving dietary diversity by exploring retail outlets: A supply-push and demand-pull strategy for sustainable nutrition eco-system

Sushil Raj Ghimire, Welthungerhilfe, Nepal

Introduction:  Welthungerhilfe (WHH) has been working in Nepal for over 35 years and is currently implementing a nutrition project at Salyan district – a remote mountain district with a very high malnutrition rate. The project aims to improve the nutrition status of the households and the major focus to achieve this is by creating, strengthening, and mobilizing the market actors in the area through improved demand creation, established supply system, effective behavior change communication (BCC), and efficient governance.

Methods:  Dietary diversity (DD) is perhaps the best proxy indicator to measure the food security status – individual and household – and in general higher the DD score, the greater the nutritional status. Among others, as part of supply-push strategy, the project is explicitly working with retail outlets in the district to ensure the availability of diverse food items locally, which indeed is synergized through other complementary interventions such as improved demand due to increase income and BCC. It is interesting to highlight that almost all nutrition stakeholders in the country are directly working with community people through subsidized intervention and/ or demand creation; and this is the first time WHH as an agency is trying to tackle the malnutrition issue through market economy. The retailers were supported with a one-time revolving fund to buy and sell more nutritional food items and were also oriented to deliver the nutritional messages. The intervention is ongoing, and a sample of 5 retail outlets was interviewed as part of mid-term impact monitoring.

Findings:  The following average results were drawn while comparing the baseline data: i) The DD score has been increased from 3 to 4.5; ii) There was no effect on price of the goods; iii) More fruit and vegetable types are offered to sell and 25% more customers are coming to buy; iv) The total amount of fruits and vegetable sold has also increased by 30%; v) Sales of eggs and meat (chicken included) has doubled; and vi) With increased food groups available, more females member of the households visit the shops.

Conclusions:  In a context like rural Nepalese hilly areas, supply-push and demand-pull strategies with appropriate mobilization of market actors can be an effective, sustainable, and scalable approach while the objective is reducing malnutrition.

Speakers:
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