what is a nutrition-sensitive approach?

20 Pages·2015·0.92 MB·English

Planning a nutrition-sensitive approach
to aquatic agricultural systems research
in Solomon Islands
PLANNING A NUTRITION-SENSITIVE APPROACH TO
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L AQUATIC AGRICULTURAL SYSTEMS RESEARCH IN
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SOLOMON ISLANDS
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IT Joelle Albert and Jessica Bogard
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- Citation
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This publication should be cited as: Albert JA and Bogard J. 2015. Planning a nutrition-sensitive
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IT approach to aquatic agricultural systems research in Solomon Islands. Penang, Malaysia: CGIAR
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V Research Program on Aquatic Agricultural Systems. Program Brief: AAS-2015-15.
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P Acknowledgments
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O The authors wish to thank Enly Saeni, Berris Suruma Olitisa and James Kwaimani Faiau for supporting
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C us in undertaking the field work for this research. We gratefully acknowledge all of our key
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informants in the North Malaita cluster communities (Alea, Suava/Kwai and Fumato’o) and nutrition
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O stakeholders who were interviewed, participated in focus groups, or contributed in any other way

A for spending their valuable time to assist us to carry out the study described in this brief. We would
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U also like to acknowledge the guidance and editing provided by Anne-Maree Schwarz and Andrew
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Thorne-Lyman and the support from the Nutrition Unit of the Ministry of Health and Medical
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IC Services. This brief has been developed with support from the Australian Centre for International

A Agricultural Research (ACIAR)-funded project, Fish in National Development: Contrasting Case
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R Studies in the Indo-Pacific Region FIS/2015/031 and the CGIAR Research Program on Aquatic
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C Agricultural Systems.
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CONTENTS
Introduction 4
Why nutrition research? 5
What is a nutrition-sensitive approach? 6
Best practice principles for nutrition-sensitive approaches 7
Planning a nutrition-sensitive approach 8
Implementing a nutrition-sensitive approach (doing) 16
Supporting principles to enable a nutrition-sensitive approach 17
Conclusion 18
References 19
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INTRODUCTION
Aquatic agricultural systems are places where fishing and farming in freshwater and/or coastal
systems contribute significantly to household nutrition, food security and income (AAS 2012). In
Solomon Islands, where aquatic agricultural systems form the foundation of the rural economy,
80% of the population are rural, subsistence-oriented, smallholder farmers and fishers. Coastal
marine resources provide the primary animal-source foods, while root crops, fruits and vegetables
are produced in household gardens (Andersen et al. 2013).
Communities dependent on these aquatic agricultural systems face major challenges from
rising population and declining quality and availability of marine and land resources. Fish are
increasingly difficult to catch and expensive to purchase as the gap between production of and
demand for coastal marine resources continues to widen (Bell et al. 2009). Garden production has
been negatively affected by the intensification of cropping required to fulfill the needs of a greater
number of inhabitants, which has led to reduced fallow periods, soil degradation, increased pests
and disease, and declining crop yields.
WorldFish, through the CGIAR Research Program on Aquatic Agricultural Systems (AAS) has
engaged in research in development in Solomon Islands to address the challenges faced in
these systems, with the goal of improving the well-being of the people who depend upon them.
Within Solomon Islands, the program has been implemented in two AAS hubs: Malaita hub in
Malaita Province and Western hub in Western Province. Research addresses issues that have been
identified in each of the hubs through joint development of a hub development challenge by local
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N communities, civil society and government agencies, and researchers—the hub stakeholders. The
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In Malaita hub, the development challenge, as defined by stakeholders, is “to improve the lives of
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T people dependent on aquatic agricultural systems through more productive, diversified livelihoods
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that empower communities to be able to adapt to change and make more effective use of their
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resources.” To help achieve the Malaita hub development challenge, research in the farming sector
is focused on improving dietary diversity and income for smallholder farmers through improved
fish and agricultural farming technologies using a nutrition-sensitive approach.
This brief describes the background to, the rationale for and the initial steps towards implementing
a nutrition-sensitive approach to agricultural and fisheries research in development in the Solomon
Islands context.
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WHY NUTRITION RESEARCH?
A recent review of the state of food and officials and nongovernmental organization
nutrition security in Solomon Islands (NGO) representatives in the fisheries and
highlighted that Solomon Islands suffers agricultural sectors in 2014, is the following:
the double burden of malnutrition: the
combination of both stunted children and “Men and women farmers have adopted safer
overweight adults (Andersen et al. 2013). (for the environment and human health) and
National data (collected in 2006–2007) found sustainable farming practices. These practices
that 32.8% of children under 5 years of age will produce a variety of climate-change-
suffer from stunted growth, with higher rates resilient, good-quality, nutritious foods, for
among children under 2 years, particularly both consumption and market. This will result
those in rural areas (Solomon Islands National in families consuming more diverse, nutrient-
Statistics Office et al. 2009). Stunted growth rich local foods that are prepared through
reflects the failure to reach linear growth improved traditional and new efficient ways
potential, in part as a result of long-term of cooking that retain nutritional value.
deficiency of nutrients, energy or both. In Support organizations with activities in the
Solomon Islands, it is suggested that the hub are closely linked and are committed to
prevalence of stunting is attributable to long- sharing knowledge and learning, to be able to
term diets that are inadequate in vitamins and support farmers and transfer and implement W
minerals and/or frequent exposure to infections innovations. As a result, nutrition of men, H
(Andersen et al. 2013). women and children has improved, and farming Y

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systems are more productive, enabling families
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The prevalence of adult overweight and obesity to produce sufficient goods for consumption T
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was also shown to be high, with 44.1% of and increase their income.” I
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women (aged 15–49) overweight or obese; IO
similarly, 30.5% of men (aged 15–49) were N

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overweight or obese (Solomon Islands National
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Statistics Office et al. 2009). Overweight and S
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obesity are associated with higher risk of A
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noncommunicable diseases such as diabetes, C
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cardiovascular diseases, cancers and chronic
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respiratory diseases. In Solomon Islands, rates of
diabetes, along with other noncommunicable
diseases, are among the highest in the world,
with 17% of adults aged 30–70 years diagnosed
with the disease (WHO 2014). Anemia (often
linked to iron deficiency) is also an issue that
affects nearly half of all children under 5 years
of age, as well as 44% of women aged 15–49
years (Solomon Islands National Statistics Office
et al. 2009).
Fisheries and agriculture contribute directly
to the nutrition of Solomon Islanders through
household food consumption, and indirectly
through income generation, livelihoods and
food systems. By working with people reliant
upon aquatic agricultural systems, there is
scope to contribute to improved nutrition. The
vision for aquatic agricultural farming systems
in Malaita hub, as articulated in the theory of
change developed by farmers, government
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WHAT IS A NUTRITION-SENSITIVE APPROACH?
Nutrition is considered both an essential input child immunization). Although nutrition-
to and outcome of sustainable development. specific approaches play an essential role, it
People need good nutrition in order to learn, is now recognized that on their own they are
lead productive lives, and contribute to broader inadequate to achieve the necessary global
social and economic development. At the same reductions in malnutrition (Bhutta et al. 2013).
time, development of institutions, resources Protection of natural resources, equitable
and health services is required to achieve economic growth, women’s empowerment,
population-wide improvements in nutrition. and development of sustainable and resilient
food systems are also essential if improved
A person’s nutritional status is determined by nutrition and health are to be achieved.
a series of immediate, underlying and basic Nutrition-sensitive approaches are those
elements as depicted in the widely cited United that address these basic determinants (the
Nations Children’s Fund (UNICEF) framework enabling environment) of malnutrition, as well
of malnutrition (Figure 1). Nutrition-specific as the underlying determinants, including
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approaches are those that aim to address the food security, social safety nets, gender
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improvements in nutrient intake (e.g. vitamin programs (Figure 1).
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Malnutrition
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Nutrient intake Health status
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Food security Care resources
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and quality and practices
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hygiene

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Institutions
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? Political ideology and framework
Basic determinants
Economic structure
Resources, environment, technology and people
Figure 1. The UNICEF causal framework for nutrition. Source: Herforth and Harris (2014),
originally adapted from UNICEF (1990).
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BEST PRACTICE PRINCIPLES FOR NUTRITION-SENSITIVE APPROACHES
Nutrition-sensitive approaches to agriculture guiding principles (including planning, doing
and rural development have received and supporting principles; see Box 1) from
increasing attention from development relevant institutional documents (FAO 2013).
organizations over the past decade, resulting While it is recognized that not all principles may
in a plethora of guidance documents seeking be achievable within a program, the planning
to enable agriculture and rural development principles outlined by FAO have been used
programs to achieve nutrition impact. Recently, to guide the development of the nutrition-
the Food and Agriculture Organization of the sensitive approach for aquatic agricultural
United Nations (FAO) has synthesized a set of 20 systems research in Solomon Islands.
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Box 1. Guiding principles for maximizing nutrition impact (FAO 2013) R
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Planning principles T
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1. Incorporate explicit nutrition objectives. C
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2. Assess the context to identify nutritional problems and groups most at risk.
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3. Do no harm—avoid unintended negative consequences. R
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4. Measure impact through program monitoring and evaluation. N
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5. Maximize opportunities through multisector coordination. I
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6. Maximize the impact of household income on nutrition. L
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7. Increase equitable access to productive resources through policies and programs. S

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8. Target the most vulnerable groups, including smallholder farmers, women, and O
resource-poor or food-insecure households. R

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Doing principles T
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9. Empower women, the primary caretakers in households. I
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10. Incorporate nutrition education to improve consumption and nutrition effects of I
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interventions. N
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11. Manage natural resources. S
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12. Diversify production and livelihoods. N
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13. Increase production of nutrient-dense foods. I
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14. Reduce postharvest losses and improve processing. I
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15. Increase market access and opportunities to improve smallholder incomes (especially for E

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women) and consumer diets.
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16. Reduce seasonality of food insecurity. P
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Supporting principles
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17. Improve policy coherence. H
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18. Improve good governance for nutrition. S
19. Build capacity in ministries at national, district and local levels, and increase nutrition staff.
20. Communicate and continue to advocate for nutrition.
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PLANNING A NUTRITION-SENSITIVE APPROACH
In this section, we describe the planning From the perspective of Solomon Islands, the
component of the nutrition-sensitive approach main areas of focus for the context assessment
to aquatic agricultural systems research in were (1) understanding who the existing
Malaita, Solomon Islands, in context of the stakeholders active in nutrition were and (2)
guiding principles (FAO 2013). The guiding assessing the root causes of nutrition problems
principles for a nutrition-sensitive approach at the community level.
have some parallels with the AAS research-in-
development approach, described in further In 2015, we undertook a nutrition stakeholder
detail below. In brief, the AAS research in mapping and gap analysis through interviews
development approach promotes six ways with key stakeholders. The purpose of this
of working: (1) focusing on building partner analysis was to identify research, government
capacity; (2) working strategically in effective and nongovernment organizations active in the
partnership to progress development; (3) “nutrition space” in Solomon Islands to which
P conducting research, as much as possible, the program should align.
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according to participatory action research
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N principles; (4) fostering social equity through a Key nutrition stakeholders in Solomon Islands
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gender-transformative approach; (5) investing The Ministry of Health and Medical Services is
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in learning and networking; and (6) engaging the primary actor in the Solomon Islands’ health
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N places, and with particular partners. provider of nearly all services. In recognition
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of the double burden of disease that Solomon
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IO nutrition objectives on nutrition in recent years. Central to nutrition
N activities is the nutrition unit within the Maternal
-S The theory of change for sustainable farming and Child Health Division of the ministry. The
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N in Malaita hub emphasizes that a nutrition- nutrition unit coordinates the development of
S specific objective is a clear requirement in national policies and guidelines for public health
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I order to achieve hub development outcomes. nutrition and is involved in the implementation
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E An overarching nutrition research question of national and provincial-level public health

A is “What constitutes a nutrition-sensitive programs and collection of national data. The
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P approach to integrated farming in the hub nutrition unit has developed and implements a
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O context and how does it influence outcomes nutrition awareness program, mostly working
A from improved farming practices?” through faith-based organizations and focused
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H primarily on urban areas. Notably, two large
Planned nutrition research and interventions national surveys are being conducted in 2015
have been informed by activities undertaken to through the Ministry of Health and Medical
gain a better understanding of nutritional issues Services and the National Statistics Office: a
from a community perspective (see principle follow-up to the World Health Organization
2) and will be conducted in conjunction with (WHO) STEPwise approach to surveillance
research designed to answer a related research of noncommunicable disease risk factors
question: “How can farming practices be from 2006, and an update of the 2006–2007
improved to provide sustainable and equitable Demographic and Health Survey. The results of
increases in system productivity, income and these two surveys, when available, will provide
nutrition for women, men and children?” valuable up-to-date information on the state of
nutrition in Solomon Islands.
Principle 2: Assess the context
World Vision implements a community-level
Context assessments are advocated in order maternal and child health and nutrition program
to build on existing effort, knowledge and in several provinces of Solomon Islands, along
resources and thereby maximize effectiveness with other programs on water, sanitation
of programs and interventions (FAO 2013). and hygiene; disaster risk reduction; gender;
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emergency response; education; and economic Community-level nutrition issues and
development. Within the maternal and child potential solutions
health and nutrition program, baseline surveys, Within the Malaita hub, WorldFish and associated
including assessment of anthropometry, anemia partners work with selected communities
(via collection of blood samples) and certain using participatory research approaches and
dietary practices, have been published for the aim to synthesize scalable lessons. In Malaita
communities in Malaita where World Vision hub, three community clusters in North Malaita
works (Schneider 2012). Other development (Kwai/Suafa, Fumato’o and Alea) have been
organizations, including Save the Children, also identified to be the focus of community-based
focus their education programs on sanitation activities (AAS 2013). The villages within these
and hygiene, an important component of a clusters have varying reliance on the land and
nutrition-sensitive approach. sea—Kwai/Suafa and Fumato’o clusters have
greater reliance on the sea, whereas Alea cluster
A number of agriculture organizations, including encompasses villages with good access to land
the Ministry of Agriculture and Livestock, AVRDC for agriculture as well as nearby artificial islands
– The World Vegetable Center, and Kastom that are heavily reliant on the sea.
Gaden Association, focus on sustainable food
production. Although these organizations do In 2015, qualitative participatory nutrition P
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not implement specific nutrition programs, research was undertaken with two of the three A
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they are involved in research and projects that community clusters in North Malaita (Alea
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promote the production and consumption of and Fumato’o) in order to understand and I
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nutrient-rich crops, also important components document the causes of specific nutrition issues G

of a nutrition-sensitive approach. (and potential solutions) from the community A

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perspective. The third cluster (Kwai/Suafa) was
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The Secretariat for the Pacific Community unable to be included in this analysis due to T
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(SPC) is a regional organization with a strong unforeseen events within the community at the I
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presence in Solomon Islands. SPC has been time of community engagement. A problem I
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active in various nutrition research projects and and solution tree approach was used and N
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has nutrition resources available on its website. involved a series of focus group discussions S
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SPC also manages a youth-at-work program— with male and female fisher-farmers and key N
an internship for unemployed youths—that has informant interviews with community leaders, S
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a plan to undertake nutrition education and clinic nurses and teachers. In total, 10 focus I
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promotion of healthy lifestyles in schools. group discussions were held, involving more E

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than 35 men and 70 women.
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FAO is working on several projects in the Pacific P
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region related to local food production with Problem and solution tree analysis starts with O
an integrated nutrition component. At a policy a problem, represented by the trunk of the A
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level, FAO is working with the Solomon Islands tree. The roots of the tree represent the factors H
government to develop its capacity to improve contributing to or the causes of the problem.
and implement food security, nutrition and The causes are identified by asking, “Why is
sustainable agriculture policies. this the case? What is the cause of this?” This
line of questioning continues until the analysis
Within the nutrition sector, WHO in Solomon reaches a point where no further causes can be
Islands primarily supports the capacity identified. The leaves of the tree represent the
development of the Ministry of Health and impacts or outcomes of the problem. During
Medical Services. For example, WHO is currently this study, the problem was defined by focus
providing technical support to operationalize group participants through the identification of
the fortification of wheat flour (with folic acid, the main foods consumed either too little or too
iron, niacin, riboflavin, thiamine and zinc). The much by adults and children in the communities,
local flour mill, which provides 95% of flour resulting in impacts on people’s health (Figure 3).
consumed in Solomon Islands, is expected to be
producing fortified flour in 2015. Fortified food
can provide a supply of select micronutrients
to entire populations without waiting for long-
term changes in food habits or dietary behavior.
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Once the problem tree was created, participants local stores, and is fast to cook compared
were asked to think about what could be done with local staples such as sweet potato and
(specifically, what the communities themselves yam. Ring cake is a convenient breakfast and
could do) to improve or change the underlying snack option due to availability in the village
causes of the nutrition problem they had and schools (often marketed by women).
identified. This then created the solution tree, Noodles in particular are preferred for “taste”
highlighting potential interventions to address by children and adults alike, particularly as
the root causes of the nutrition problem. the instant noodles include a flavor sachet.
Many people noted that “slippery cabbage is
Nutrition problems only eaten with noodles or tuna these days
In general, excess consumption of imported as there is no good taste without it.” Children
foods such as rice, instant noodles and ring are increasingly eating instant noodles (often
cake (donut) and inadequate consumption of dry) as a snack food, often sourcing their
fruits and vegetables (particularly green leafy own money to purchase noodles through,
vegetables) were identified as the main dietary for example, selling coconuts to local copra
problems having the biggest negative impact (dried coconut meat) producers.
on the health of adults and children.
• A cultural shift. Communities reflected
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L Several common themes as to the causes of that eating rice and noodles is becoming
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N these nutrition issues emerged (summarized as the new norm. There is a general lack of
N a problem tree in Figure 3): interest in local foods, and parents are
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N increasingly being challenged to appease
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• A preference for imported foods. Rice, their children, who are asking for such foods.

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noodles, ring cake and canned tuna have This is coupled with a general trend toward
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U become common staples in households a market-based economy, which creates the
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due to convenience and taste preference. opportunity to access money through the
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IT Rice was said to feed more people and has a sale of local commodities—being then used
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O longer shelf life compared with local foods to buy imported foods, which are perceived
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such as sweet potato, is readily available in to have a higher “wealth status.”
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MALNUTRITION
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OBESITY
E NUTRIENT DEFICIENCIES
A E.G. ANEMIA
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P Shift from
R eating
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C imported
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Preference Cultural shift Lack of knowledge Health concerns Reduced planting of garden foods
taste status lainc klo ocfa iln ftoeordesst peimrcepiovretde da sf o“goodosd ” infants pmeisstuicsied oefs low motivation maloterren aavtaiviela fboleo dsos
convenience perception that less need
increasing access parents pleasing fat = healthy lack of time burden
to money children lean = unhealthy knowledge (esp. women)
foefe pdeso lpotles avianiclarebailsiteyd o f b“enceowm ninogr mth”e (e.gtoi.m nbopeoo idnrtleeexdsp) feponeosrdcivsee ived icnofannctesr ncas nthnaott on cuosrerect incpreeastssingg arden food alvoawila sbeielidty long harvest cycles
imported foods don’t know healthy decreased yield & on some local
faster to cook shift to market alternatives cause skin disease lower quality crops staple crops
imported foods have economy in infants
a longer shelf life management skills poor soil
increased
quality changed rainfallsoil salinity
lack of food safety
knowledge continuous slash and
climate
cropping burn practice
change
increasing
population
Figure 3. Community-derived nutrition problem tree.
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