Evidence‐based evolution of an integrated nutrition‐focused agriculture approach to address the underlying determinants of stunting

Abstract

Despite progress in reducing hunger and malnutrition since the 1990s, many still suffer from undernutrition and food insecurity, particularly women and young children, resulting in preterm birth, low birthweight and stunting, among other conditions. Helen Keller International (HKI) has addressed malnutrition and household food insecurity through implementation of an Enhanced Homestead Food Production (EHFP) programme that increases year‐round availability and intake of diverse micronutrient‐rich foods and promotes optimal nutrition and hygiene practices among poor households. This paper reviews the evolution and impact of HKI's EHFP programme and identifies core components of the model that address the underlying determinants of stunting. To date, evaluations of EHFP have shown impact on food production, consumption by women and children and household food security. Sale of surplus produce has increased household income, and the use of a transformative gender approach has empowered women. EHFP has also realized nutrition improvements in many project sites. Results from a randomized control trial (RCT) in Baitadi district, Nepal showed a significant improvement in a range of practices known to impact child growth, although no impact on stunting. Additional non‐RCT evaluations in Kailali district of Nepal, demonstrated a 10.5% reduction in stunting and in the Chittagong Hill Tracts in Bangladesh, revealed an 18% decrease in stunting. Based on evidence, the EHFP has evolved into an integrated package that includes agriculture, nutrition, water/hygiene/sanitation, linkages to health care, women's empowerment, income generation and advocacy. Closing the stunting gap requires long‐term exposure to targeted multi‐sectoral solutions and rigorous evaluation to optimize impact.

Effect of enhanced homestead food production and aquaculture on dietary intakes of women and children in rural Cambodia: A cluster randomized controlled trial

“…The aquaculture intervention was designed to increase the production of three types of small fish (typically consumed whole): Amblypharyngodon chulabhornae , Esomus species, and Trichopsis vittata ; and three types of large fish (typically sold for additional income or fillets consumed): Cirrhinus mrigala , Labeo rohita , and Barbonymus gonionotus . More information on the EHFP model utilized by the FoF intervention can be found in the paper by Haselow, Stormer, and Pries ().…”

Process evaluation improves delivery of a nutrition‐sensitive agriculture programme in Burkina Faso

“…To address these challenges, HKI adapted its well‐known EHFP model from the Asian context, where it was developed and has been shown to improve multiple nutrition indicators (Haselow, Stormer, & Pries, ), to the semi‐arid context of the African Sahel. In Burkina Faso, the model used community gardens as platform to train and empower women producers, including volunteer village farm leaders (VFL) and the women's group members they mentor, to increase the diversity and volume of nutrient‐dense foods produced and consumed by households.…”

“…Here, we report on some of the key findings from the PE conducted 1 year after programme implementation began (Olney, Behrman, Iruhiriye, van den Bold, & Pedehombga, 2013), how the findings were used to refine programme implementation and rectify weaknesses in real time through a series of consultations. Another study from this programme examined the challenges of integrating interventions across multiple sectors and outlined lessons learned (Harris & Buchsbaum, 2014 To address these challenges, HKI adapted its well-known EHFP model from the Asian context, where it was developed and has been shown to improve multiple nutrition indicators (Haselow, Stormer, & Pries, 2016), to the semi-arid context of the African Sahel. In Burkina Faso, the model used community gardens as platform to train and…”

Nutrition‐sensitive agricultural interventions and gender dynamics: A qualitative study in Nepal

“…Helen Keller International's (HKI) Enhanced Homestead Food Production (EHFP) programmes aim to improve nutritional well‐being for women and their children (Meinzen‐Dick, Behrman, Menon, & Quisumbing, ) and generally include three components: (a) physical inputs for homestead gardening and small livestock rearing, (b) behaviour change communication to promote awareness of essential nutrition actions and essential hygiene actions, and (c) strengthening of multi‐sectoral governance (Haselow, Stormer, & Pries, ). Evidence from HKI's EHFP programmes in Nepal, Bangladesh, and Cambodia has illustrated how these kinds of programmes can benefit dietary quality, food security, nutritional outcomes, and women's status, decision‐making, and income levels (Bushamuka et al, ; HKI, ; Talukder, Huq, Pee, Darnton‐Hill, & Bloem, 2000).…”