Political and economic dynamics of nutrition and health: B
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Intro animation:

Political and economic dynamics of nutrition and health studies at ANH2020

 

Session recording:

ANH2020: Political and economic dynamics of nutrition and health B

 

Speakers and presentations:

  • Session chair: Alexander Kalimbira, Lilongwe University of Agriculture and Natural Resources (LUANAR)
    @LuanarBunda

  • Jody Harris, Institute of Development Studies and World Vegetable Centre
    @justjody23 @go_vegetables @IDS_UK

    Equity in agriculture-nutrition-health research: A scoping review

    Presentation | Slides

  •  

    Keni Kariuki, SOAS University of London
    @kenikariuki @SOAS

    The political economy of the Kenyan agricultural sector in an era of decentralisation

    Presentation | Slides

  • Limbanazo Matandika, College of Medicine, University of Malawi
    @unimacom

    Operationalizing a real-time research ethics approach: Ethical mindfulness in agriculture-nutrition-health research in Malawi

    Presentation | Slides

  • Scott Drimie, Stellenbosch University
    @scottdrimie @stellenboschuni

    Stories of Challenge: The political economy of nutrition in South Africa and implications for food systems transformation

    Presentation | Slides

Abstracts:

Equity in agriculture-nutrition-health research: A scoping review

Jody Harris1

Winson Tan1

Becky Mitchell1

Dina Zayed1
Institute of Development Studies, UK

Introduction

This scoping review aimed to understand the range of ways that agriculture-nutrition-health (ANH) research addresses equity issues. We defined equity along a continuum, from the aspects of marginalisation that explain unequal outcomes; to the capital and resources that shape people’s life chances; to the political, social and commercial contexts that structure why and how certain groups become marginalised.

Methods

We used the PRISMA guidelines for scoping reviews to structure our study. From an initial list of over 26,000 studies, we reviewed 243 papers which explicitly included an aspect of agriculture, an aspect of health or nutrition, and an aspect of equity in the core analysis of the paper. The number of papers addressing any aspect of equity in ANH research rose steadily over time, from fewer than 10 papers in 2008 to over 40 in 2018.

Findings

Within equity, a majority of papers (n=207) focused on describing how nutrition and health outcomes differ for different groups who may be differentially affected by food system or agricultural activities; very few of these papers (n=2) looked at how these different aspects of marginalisation might interact. A significant number of papers (n=160) went to the next level of understanding inequity, looking at the material circumstances that shape people’s life chances. A smaller number (n=51) looked at the most basic structural determinants of inequity. In summary, most papers looked at what the inequity problem is; fewer looked at how this inequity is shaped; and fewer still looked at why the inequity exists in the first place.

Conclusion

Given the number of studies being undertaken in the ANH research space over the past decade, the total number found to explicitly incorporate any equity considerations within the core analysis is tiny. It is heartening that the number is increasing over time, but same aspects of equity remain the lest studied. Further work can now be done by taking this literature and looking in more depth at particular aspects that interest different research groups, in order that knowledge gaps revealed here might be filled.

References

Arksey, H., & O'Malley, L. (2005). Scoping studies: towards a methodological framework. International journal of social research methodology, 8(1), 19-32.
Marmot, M., Friel, S., Bell, R., Houweling, T. A., Taylor, S., & Health, C. o. S. D. o. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet, 372(9650), 1661-1669.
Nisbett, N., Harris, J., & Baker, P. (2020). Equity, power and global nutrition. In: Global NUtrition Report 2020. Bristol, UK: Development Initiatives.
Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., . . . Weeks, L. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine, 169(7), 467-473.

The political economy of the Kenyan agricultural sector in an era of decentralisation 

Keni Kariuki1

Bhavani Shankar

1SOAS, University of London

Introduction

This paper investigates the effect of decentralisation within the Kenyan agricultural sector and how it altered/if at all, the possibility to positive net benefits to smallholder farmers. The paper primarily explores the formal institutional changes that were brought about by the creation of the Agricultural Food Authority, and the new post-2013 constitutional dispensation. The normative expected outcomes of decentralisation are compared against primary sourced data to highlight that if the distribution of benefits associated with an institution are not acceptable to powerful organisation, the institution is likely to be formally or informally modified to achieve an acceptable distribution of benefits.

Methods

The research methods and case study design primarily sought qualitative output. The primary research methods implemented involved semi-structure interviews and focus groups over 3 phases. This was supplemented by secondary quantitative data based on agricultural public expenditure. Overall, the research covered 5 counties in Kenya adopting a hierarchical approach. Phase 1 was in the capital, Nairobi. 43 semi-structured interviews were conducted with key informants, ministerial staff, AFA staff, other related agricultural public institutions, agricultural NGOs. The purpose was to address the research questions that sought to investigate the effect of decentralisation on the agricultural sector nationally. Phase 2 was based in 4 counties with semi-structured interviews being conducted with political and local administrative agricultural staff which had 38 participants in the counties. This provided details of agricultural experiences at subnational level, while providing an opportunity to snowball for Phase 3, where 22 farmer focus groups with 171 participants in 2 counties were conducted. The focus groups answered structured questions that sought to extrapolate group and overall smallholder farmer experiences pre-and-post decentralisation.

Findings

• Kenya’s decentralisation is thoroughgoing with political, fiscal, and administrative decentralisation occurring. The historical circumstances that led to the 2010 constitution created a unique instrument that incorporated a representative negotiated outcome. • AFA was a result of a decade (2002-2003) of public policy which finally came into fruition close to Kibaki’s departure. AFA was created as a result of a political process that aligned with executive interests and powerful bureaucratic actors that shared Kibaki’s sentiment. • Decentralisation created an unclear division of labour which lead to contestation between national government and counties, which has not been wholly resolved. • The Kenyan agricultural sector was centralised nationally, however AFA fell far short of its potential due to a change in interests upon Kibaki’s departure. • Agricultural budgets and expenditure had increased at across all counties and within the researched counties in the period researched, FY 2013/14 to FY 2016/17. Development expenditure drove the overall increase. Farmers interviewed overwhelmingly claimed that it was the “connected” that were recipients of development programs. • Devolution concentrated power around county and political staff. The top-down nature of resources allocation reoriented resources towards ‘tangible’ agricultural programs, reduced facilitation, and enhanced rent-seeking within counties.

Conclusion

Agricultural autonomy, though not entirely resolved by a formal instrument, had managed to find a political equilibrium where both national and county governments respectively perform their obligations. Kenya’s competitive clientelist political settlement altered the normative expectations relating to the outcomes of decentralisation in the agricultural sector. Regarding development and service delivery, it was found that public goods had not been enhanced despite local government proximity and public participation. The prevalence of patron client relationships arguably influenced emphasis on development expenditure on programs that largely mimicked transfer rents. Overall, smallholder farmers had largely not benefited from decentralisation highlighting collective action problems

References

Acemoglu, D., Robinson, J., 2012. Why Nations Fail: The Origins of Power, Prosperity and Poverty. Crown, New York.
Andae, G., 2019. NCPB boss fired over Mexico maize. Dly. Nation.
Bates, 1989. Beyond the miracle of the market: the political economy of agrarian development in Kenya. Cambridge University Press., Cambridge.
Bates, H.B., 1981. Markets and States in Tropical Africa: The Political Basis of Agricultural Policies. University of Californai Press, Berkeley and Los Angeles, California, Los Angeles.
Gaitho, M., 2017. Blame the government’s incompetence for food crisis. Dly. Nation.
Gideon, K.T., Gachanja, P., Almadi, O., 2013. Effects of Reforms on Productivity of Coffee in Kenya. Int. J. Bus. Soc. Sci. 4.
Government of Kenya, 2009. Kenya: Government subsidizes fertilizer prices to benefit farmers. Relief Web.
Government of Kenya, Ministry of Devolution and Planning, 2013. Vision 2030: Second Medium Term Plan (2013 -2017) - Transforming Kenya: Path to Devolution, Socio-Economic Development, Equity and National Unity.
Government of Kenya, Office of the President, 2010. Agricultural Sector Development Strategy (2010-2020) (ASDS).
Gro-intelligence, 2018. Reading the Leaves of Global Tea Trade. Gro-intelligence, Nairobi, Kenya.
Guguyu, O., 2017. Did State give cartels billions of shillings on silver platter? Standard.
Irungu, G., 2014. Reclusive coffee baron Abraham Mwangi dies aged 68. Bus. Dly.
Kamau, J., 2017. Billionaire millers who shipped maize to Mombasa unmasked. Dly. Nation.
Kamau, J., 2015. Abraham Mwangi, the coffee baron who sowed the seeds of sorrow. Dly. Nation.

Karimi, J., Ochieng, P., 1980. The Kenyatta Succession. Transafrica Book Distributors, Nairobi, Kenya.
Kenya Anti-Corruption Commission, 2010. Review of the Policy, Legal and Regulatory Framework for the Sugar Sub-Sector in Kenya: A Case Study of Governance Controversies Affecting the Sub-Sector. Kenya Anti-Corruption Commission, Nairobi, Kenya.
Kenya Data Portal, 2019. Food Supply - Crops Primary Equivalent [WWW Document]. Knoema. URL http://kenya.opendataforafrica.org//namilvd/food-supply-crops-primary-eq... (accessed 11.11.19).
Kenya National Bureau of Statistics, 2018. Economic Survey 2018. Kenya National Bureau of Statistics (KNBS), Nairobi, Kenya.
Khan, M., 2010. Political Settlements and The Governance of Growth-Enhancing Institutions. Unpublished.
Khan, M., Sundaram, K.J. (Eds.), 2000. Rents, Rent-Seeking and Economic Development. Cambridge University Press, United Kingdom.

Kisero, J., 2015. East Africa’s trade is in the firm chokehold of untouchable barons. Dly. Nation.
Kwamboka, E., 2018. Uhuru takes charge of coffee sector reforms committee. Standard.
Lipton, M., 1977. Why poor people stay poor: A study of urban bias in world development. Temple Smith, London.
Ministry of Agriculture, Livestock, Fisheries & Irrigation, 2019. Agricultural Sector Transformation and Growth Strategy (ASTGS) 2019-2029. Ministry of Agriculture, Livestock, Fisheries & Irrigation, Nairobi, Kenya.
Mitullah, W., Kamau, P., Kivuva, M.J., 2017. Employment Creation In Agriculture and Agroprocessing Sector In Kenya In The Context Of Inclusive Growth: Political Economy and Settlement Analysis. Partnership for African Social and Governance Research (PASGR), Kenya.
Munguti, R., 2018. Kenya: Eastleigh Traders Charged Over Fake Kabras Sugar. AllAfrica.
Namunane, B., 2019. Stingy officers, higher prices abroad caused unga shortage. Dly. Nation.
Nation Team, 2018. Somalia connection in sugar smuggling syndicate revealed. Dly. Nation.
Ochieng, O., 2007. Development through Positive Deviance and its implications for Economic Policy Making and Public Administration in Africa: The Case of Kenyan Agricultural Development, 1930-2005. World Dev. 35, 454–479.
Oruko, I., 2018. Senate wants Henry Rotich, Willy Bett prosecuted over maize scandal. Dly. Nation.
Poulton, C., Kanyinga, K., 2014. The Politics of Revitalising Agriculture in Kenya. Dev. Policy Rev. 32, 151–172.
Raballa, V., 2018. Western Sugarcane Farmers and Miller Call For Revival of KNTC. Dly. Nation.

Republic of Kenya, 2013. The Crops Act, 2013, No.16 of 2013.
The Ethics and Anti-Corruption Commission, 2018. The 3rd Quarterly Report Covering the Period From 1st July, 2018 to 30th September, 2018 (No. EACC/FI/INQ/ELD/25/2018). The Ethics and Anti-Corruption Commission, Nairobi, Kenya.
The Government of the Republic of Kenya, 2010. The Constitution of Kenya.
The Government of the Republic of Kenya, 2001. Sugar Act, No. 10 of 2001.
The National Treasury and Planning, 2018. Comprehensive Public Expenditure Review: From Evidence to Policy. The National Treasury and Planning State Department for Planning Monitoring and Evaluation Department, Nairobi, Kenya.
The Sugar Campaign for Change, 2003. A Summary Of The Recommendations From The Sugar Industry Task Force Appointed By The Minister of Agriculture on 27th March 2003. The Ministry of Agriculture, Kisumu, Kenya.
The World Bank, 2019. World Development Indicators [WWW Document]. Agric. For. Fish. Value Added GDP World Bank Natl. Acc. Data OECD Natl. Acc. Data Files. URL https://data.worldbank.org/indicator/NV.AGR.TOTL.ZS?locations=KE (accessed 5.15.19).
Wanga-Odhiambo, G., 2016. The Political Economy Of Sugar Production In Colonial Kenya. Lexington Books, London.
Wanjala, E., 2018. Newton Terer, chief arrested over Sh6bn NCPB maize scam. The Star.

Operationalizing a real-time research ethics approach: Ethical mindfulness in agriculture-nutrition-health research in Malawi

Limbanazo Matandika1

Joseph Mfutso-Bengo1

Eric Umar1

Alexander A. Kalimbira2

Gabriella Chiutsi-Phiri2

Edward Joy3

Martin R. Broadley4

Kate Millar4

1University of Malawi, College of Medicine
2Lilongwe University of Agriculture and Natural Resources
3London School of Hygiene & Tropical Medicine
4University of Nottingham

Introduction

There has been notable investment in large multi-partner research programmes in the agriculture-nutrition-health (ANH) nexus. These studies often involve human participants and would typically undergo research ethics approval before participant engagement, using existing medical or social science ethics guidelines and procedures. This study extends the notion of ethics in practice1 to explore whether a novel “real-time ethics approach” might be appropriate for ANH research. This involves embedding ethical analysis and decision-making within the implementation of the research, with continuous identification and response to participants’ expectations and concerns. The aim is to improve participant experience while ethically facilitating adherence and retention.

Methods

In this case study, a bioethics team was embedded in a community-based randomized, controlled trial conducted in a rural area of Malawi. The trial, called Addressing Hidden Hunger with Agronomy (AHHA)2, involved distribution of maize flour to study participants, with some receiving flour enriched with selenium and others receiving control flour. The team supported researchers in the identification, analysis and response to ethical issues encountered during implementation. This paper will present some of the findings from the participants’ interviews and how these informed the research process and practice.

Findings

A number of social and ethical concerns were identified. Study related anxieties and rumors that emerged included, (1) blood drawn from participants will be sold, (2) participants who donated blood will die, and (3) men will have fertility issues after eating flour. Further issues relating to social interactions, misconception on community randomization, study design and activities, and return of study results were identified as barriers and facilitators that may affect study participants perspectives and these had implications for researchers’ obligations. To address these concerns, the bioethics team worked with the AHHA implementation team to facilitate community sensitisation meetings during which issues were discussed and addressed with the involvement of local leaders, government extension workers, and the participating communities. Community members suggested tailored information sharing sessions and Community participatory activities that included a community dish sharing get together. Implementation of the real-time research ethics approach provided a responsive and constructive approach to tackling the diverse set of ethical issues encountered during the AHHA trial setup and implementation. The research team was able to respond to a number of ethical issues in accordance with research ethical principles / values and in line with the study ethical approval and the wider societal context.

Conclusion

The real-time research ethics approach showed the value gained from continuous and direct engagement with community participants and researchers on social and ethical issues, which can be used alongside traditional ethical guidance and expert opinions. This work revealed that AHHA trial participants value a deeper engagement with the research community beyond what was required for study recruitment and participation. This deeper engagement appeared to help achieve high recruitment, retention and adherence rates, which was beneficial in terms of AHHA trial research objectives. Further project work is planned to develop embedded real-time research ethics tools for ANH and other research fields.

References

Guillemin, M, and Gillam, L. "Ethics, reflexivity, and "Ethically important moments" in research". Qualitative Inquiry 10, no. 2 (2004). doi: 10.1177/1077800403262360
Joy, E.J.M., Kalimbira, A.A., Gashu, D. et al. Can selenium deficiency in Malawi be alleviated through consumption of agro-biofortified maize flour? Study protocol for a randomised, double-blind, controlled trial. Trials 20, 795 (2019) doi:10.1186/s13063-019-3894-2

Stories of Challenge: the political economy of nutrition in South Africa and implications for food systems transformation 

Laura Casu1

Namukolo Covic2

Scott Drimie3

Mara van den Bold4

1 Institute of Development Studies, United Kingdom
2 International Food Policy Research Institute, Ethiopia
3 Stellenbosch University, South Africa
4 International Food Policy Research Institute, USA

Introduction

South Africa stands out compared to other countries of Sub-Sahara Africa, based on its strong economy and its implementation of policies and interventions, at scale, which aim to address undernutrition and overweight, obesity and non-communicable diseases (NCDs). The country’s nutrition transition, however, has reached a point where obesity prevalence among women has surpassed that of overweight at 41% and 27%, respectively, while under-five stunting is still high (27%), and progress remains uneven across different provinces and population groups. At the same time, South Africa’s food industry has a growing footprint on the continent and potential broader continental impact.

Methods

The Stories of Challenge study in South Africa (2019-2021) seeks to examine how nutrition outcomes in South Africa have changed over times across different locations and population groups, what the drivers are for change (or lack thereof), how the policy environment has responded in terms of translating policies into programs at the provincial level, and what may need to happen for a more holistic address from a food systems perspective. The study, led by the International Food Policy Research Institute (IFPRI) working with partners at the Institute of Development Studies (IDS) and Stellenbosch University, uses a qualitative approach to examine these questions, through a combination of literature and policy reviews, and semi-structured interviews, complemented by a national consultation in March 2020. It aims to situate the findings in the broader analyses of the political economy of nutrition in South Africa, by examining how relations between actors as well as social and economic realities have influenced where and how nutrition progress has occurred and where it has not. In addition to examining these processes at the national level, the study focuses on the Western Cape and North West provinces.

Findings

Preliminary findings from the literature and policy reviews reveals that South Africa has developed and implemented relevant policies to address undernutrition and overweight and obesity and NCDs. These include those on extensive school feeding, food based dietary guidelines, universal staple food fortification, salt legislation to reduce the salt content of processed foods, and more recently a sugar tax. In addition, there has been nutrient profiling of food labels to inform consumer choices. Although such positive policy changes, aiming to address multiple forms of malnutrition and related comorbidities, have been made, the reviews have identified several challenges that hinder policy preparedness and coherence. Interviews across a wide range of stakeholders indicate that challenges hinge on implementation and effective coordination of policies. A key issue is that there are competing priorities beyond nutrition for increasingly scarce fiscal resources that require careful balance. An opportunity lies in recognising the potential for consolidating and reorganising policy to effectively align such that coherence occurs.

Conclusion

Whilst some of the observed challenges are specific to the South African context, others offer important insights on the complexities of food systems more generally, and point at potential entry points of relevance to “double duty” interventions for countries that are similarly experiencing a double burden of malnutrition. The South African experience with regards to tackling undernutrition as well as high prevalence of overweight and obesity is an important story to tell that calls for serious consideration of what a holistic food systems approach should be and how it should be implemented.

References

Boatemaa S, Drimie S and Pereira L., 2018. Addressing food and nutrition security in South Africa: A review of policy responses since 2002. African Journal of Agricultural and Resource Economics (AFJARE), 13(3): 264-279.
Coovadia H, Jewkes R, Barron P, Sanders D and McIntyre D., 2009. The health and health system of South Africa: historical roots of current public health challenges. The Lancet, 374: 817–34. DOI: 10.1016/S0140-6736(09)60951-X
Hendriks SL and Olivier NJJ., 2015. Review of the South African agricultural legislative framework: Food security implications. Development Southern Africa, 32(5): 555-576. DOI: 10.1080/0376835X.2015.1044075.
Igumbor EU, Sanders D, Puoane TR, Tsolekile L, Schwarz C, Purdy C, Swart R, Durão S and Hawkes C., 2012. ‘Big food’, the consumer food environment, health, and the policy response in South Africa. PLoS Medicine, 9(7): e1001253.
Labadarios D, Mchiza ZJR, Steyn NP, Gericke G, Maunder EMW, Davids YD and Parker WA., 2011. Food security in South Africa: a review of national surveys. Bulletin World Health Organization, 89: 891–899. DOI: 10.2471/BLT.11.089243.
Macaulay S, Dunger DB and Norris SA., 2014. Gestational diabetes mellitus in Africa: A systematic review. PLoS ONE, 9(6): e97871. DOI: 10.1371/journal.pone.0097871.
Naudé CE., 2013. “Eat plenty of vegetables and fruit every day”: a food-based dietary guideline for South Africa. South African Journal of Clinical Nutrition, 26(3)(Suppl.): S46-S56.
Said-Mohamed R, Micklesfield LK, Pettifor JM and Norris SA., 2015. Has the prevalence of stunting in South African children changed in 40 years? A systematic review. BMC Public Health, 15: 534. DOI: 10.1186/s12889-015-1844-9.
Temple NJ and Steyn NP., 2011. The cost of a healthy diet: A South African perspective. Nutrition, 27: 505–508. DOI: 10.1016/j.nut.2010.09.005.

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