Most interventions aiming to reduce malnutrition are fragmented and address immediate rather than underlying causes of the problem. Merely enhancing food security is not enough to reduce malnutrition in children. This also requires improving the connection between food security and health care, disease reduction, sanitation enhancement, and health and nutrition education. Local communities experience barriers, such as unstable incomes and working on the fields the entire day – thereby being away from their children, which hinder changes in behaviour. This renders perception and behaviour change less effective on their own. The experienced problems require a variety of interventions to help reduce the barriers to good nutrition. Nutrition-sensitive agriculture provides a new food system approach to address this top concern from a multidisciplinary perspective.
This project aimed to enhance agricultural production to produce nutritious foods for households, improve supply chains in remote communities and change community behaviour towards care of children and pregnant women. In parallel, research was conducted to generate evidence on the effectiveness of and best way to scale-up NSA.
An interdisciplinary approach has been used. Medical Committee Netherlands-Vietnam (MCNV) created a strong connection between partners from central government, provincial and district authorities and experts from national research institutes to support the district partners in planning activities. District partners from agriculture, health, education and women’s union sectors were involved. Households with children under five years old and/or pregnant women participated in planning, contributing to and deciding on the implementation of the intervention model. Agricultural models such as raising chicken for eggs, raising fish and frogs, and planting nutritious vegetables and fruits in home gardens have been implemented. All interventions were implemented throughout the period 2018-2020.
Lessons and outcomes
The study confirms the severity and complexity of food and nutrition insecurity among upland, remote populations in Vietnam and Laos. Together with stakeholders, we have developed context-specific, multi-component and multi-sectoral interventions for both countries. These interventions were implemented and monitored. Household and women groups have been established. In Vietnam, social entrepreneurship initiatives provide nutritious porridge in nursery schools. In Laos, school education programs involving school gardens are implemented.
Findings indicate that NSA is a promising food system innovation, especially for remote subsistence farming communities. Endline studies were delayed due to the COVID-19 pandemic and are currently being analysed. Initial analyses, supplemented with existing qualitative evidence, indicates positive effects on child nutritional status, production and knowledge.
In Vietnam, together with the local government, a legal framework for scaling-up NSA has been developed and modest horizontal scale-up has also been achieved. In Laos, cooperation with other projects directly allowed for horizontal scaling-up and promising collaboration with governments will contribute to vertical scaling-up.