Reducing Malnutrition: A Multisectoral Approach to Addressing Underlying Causes
By: Joni Waldron and Jay Gribble
Malnutrition is a complex problem with negative consequences for millions of mothers and children. In sub-Saharan Africa, approximately 24 percent of pregnant women experience malnutrition, contributing to a range of poor pregnancy outcomes, as shown by one meta-analysis. Globally, 21% of children under the age of 5 experience stunting (low height-for-age) and 7% experience wasting (low weight-for-height). Childhood malnutrition is a leading contributor to childhood illness and death. Beyond its life-threatening impacts, childhood malnutrition also hinders economic growth and perpetuates poverty, as malnourished children experience impaired cognitive development and poorer performance in school, limiting opportunities for higher-paying jobs.
Many programs have attempted to address malnutrition by focusing on immediate causes only. By failing to address underlying causes and seeking multisectoral solutions, those programs risk failure. This blog explores a multisectoral approach to address malnutrition in Malawi. Thinking outside the box about complex issues can result in win-win situations across sectors, while leading to better outcomes for the populations the sectors are working to reach.
Sustainable gains in nutrition require reaching beyond the health sector and investing in approaches that address both immediate and underlying causes of malnutrition.
Programs that address childhood malnutrition often take a siloed approach that focus on immediate causes of malnutrition and address the clinical needs of children and women of reproductive age. Their focus includes proven interventions, such as breastfeeding and supplementation, vitamin A and iron supplements, and deworming. Yet the underlying causes of malnutrition are more complex; household food insecurity, for example, highlights the importance of linking traditional nutrition interventions with complementary interventions in the agricultural and financial sectors to increase access to affordable, nutrient-dense foods. The emerging field of nutrition-sensitive agriculture advocates for this type of multisectoral approach, in which the objectives of agricultural programming include improvements to health and nutrition.
Focusing on household food security provides alternative ways to address malnutrition. The USAID-funded Feed the Future Malawi Ag Diversification Activity (AgDiv), implemented by Palladium, reaches across sectors to achieve nutritional gains and serves as an example of effective multisectoral action. By applying a nutrition lens to agricultural production and economic growth, AgDiv is helping to achieve sustainable improvements in nutritional outcomes. This is being done by improving food security among vulnerable households and increasing access to nutrient-dense foods at the community level, while supporting inclusive economic growth and better access to health services.
Linking agriculture and food security. Improving the productivity of food crops increases the quantity of food available at the household level, while also contributing to increased household incomes, so that households can allocate more income toward the purchase of diverse foods. AgDiv promotes the adoption of low-cost technologies (better seeds, fertilizer, and legume inoculants) that help farmers improve productivity and increase their return on investment for nutritious crops. These crops can be sold for income or eaten at home as nutritious food products. AgDiv has also increased demand for — and access to — hermetic grain storage technologies that reduce post-harvest losses and increase household and national food security.
Linking agriculture and inclusive economic growth. When women are empowered and given equal access to resources — such as seeds, fertilizer, and technology — and control over their incomes, they can improve productivity, household nutrition, and food security. As an income-generating intervention, AgDiv offers enterprising women loans to purchase the SoyaKit, which consists of equipment to process soy into milk and other soy products; the intervention includes training and introduction to a network of “soy entrepreneurs.” A single batch of soy yields 3.5 liters of soymilk, which allows a woman enough to consume at home for increased protein intake and to sell for additional income — increasing protein-rich foods at the community level. Entrepreneurs report making a $20 profit on average each month, which they use for increased food purchases, to help meet basic household needs, and to invest in children’s education.
Linking agriculture and health. AgDiv partnered with the USAID-funded Health Policy Plus project, implemented through a consortium led by Palladium, to train members of youth clubs on grassroots implementation of the Youth-Friendly Health Services (YFHS) Strategy coupled with entrepreneurship. The Mlambe Youth Club in Nankumba began growing maize to support refurbishment of YFHS facilities. Their $1,000 profit was invested in expanding the business to raise goats and improve irrigation efficiency. To enable members to access YFHS health services at the local health center, the club also purchased two bicycles. These links between investments in agriculture and health illustrate how income generated through a commercial endeavor can be used to subsidize a human capital sector, enhancing access to critical health services for young people. It also reinforces that investments and benefits can be take place beyond the household level.
Thinking both inside and outside the box. With additional income from agricultural production and agri-linked businesses, farming households can have greater dietary diversity and can spend more on healthcare. Through a multisectoral approach that links agriculture, increased income, and improved use of health services, programs can work at eroding the underlying causes of malnutrition. And as families have increased agricultural income, they are more likely to use health services so they can better prevent or treat infections that are exacerbated by malnutrition. This virtuous cycle is enhanced through more traditional interventions, such as learning food safety and how to prepare available foods in a nutritious way, helping mothers to learn good care and feeding practices, and optimal food distribution within the household to minimize the risk of malnutrition. An increase in household income doesn’t mean farmers will suddenly be wealthy — but it can lead to the introduction of more diverse and nutritious food sources into the diet.
There is no easy solution to reducing malnutrition. It is a complex problem that is linked to food insecurity, poverty, and cultural and social norms and behaviors. Many traditional programs to address malnutrition focus on vitamins and micronutrients, which are important to childhood growth and development but do not necessarily treat malnutrition as a multisectoral challenge. By taking a step back and considering the links between agriculture, food security, income, and women’s empowerment, projects like AgDiv are addressing these interrelated issues, leading to sustainable solutions and positive impact for rural, agricultural communities around the world. It provides the opportunity to rethink how many development projects are designed and implemented — leading to innovative solutions to complex problems.
Joni Waldron is the strategic communications advisor on USAID’s Feed the Future Malawi Ag Diversification Activity and a member of the economic growth team at Palladium. Jay Gribble is a senior director in Palladium’s health practice leadership team and deputy director for family planning and reproductive health on the USAID-funded Health Policy Plus project.
