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Harmonizing agriculture and health sector actions to improve household nutrition: policy experiences from Afghanistan (2002–2007)

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Abstract

Coordination across sectors to address undernutrition with its varied underlying causes remains a challenge in developing countries. In Afghanistan, harmonization of health and agriculture policies and actions to reduce endemic undernutrition occurred during 2002-2007. This qualitative case study explores the forms of harmonization, enabling features and constraints in the policy process. We interviewed 57 stakeholders (39 central level, 18 provincial) involved in public nutrition or food security issues. Forms of harmonization included written policies, reseach, training and advocacy. Important features of the policy process included: policy entrepreneurs with operational and strategic capacity, consensus-building using a shared causal framework, working groups and strategic alliances. This case presents an interesting alternative to a national nutrition coordinating body, an approach that has met with mixed results, often due to the lack of authority, budget, and operational capacity of such a body to oversee ministries and enforce national nutrition objectives. Mid-level professionals mobilized into task forces achieved much with the support of national and international partners. This study highlights the importance of building capacity for sustaining change through local institutions.

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References

  • Agromet Network. (2006). Seasonal agrometeorological bulletin 2005–2006: Helping agriculture to end hunger. Kabul: Ministry of Agriculture, Irrigation and Livestock.

    Google Scholar 

  • Asian Development Bank. (2003). Rebuilding Afghanistan’s agriculture sector. Manila: Asian Development Bank.

    Google Scholar 

  • Assefa, F., Jabarkhil, M. Z., Salama, P., & Spiegel, P. (2001). Malnutrition and mortality in Kohistan District, Afghanistan, April 2001. Journal of the American Medical Association, 286(21), 2723–2728.

    Article  PubMed  CAS  Google Scholar 

  • Beaudry, M. (1996). Food security and nutrition. Agroalimentaria, 2, 41–46.

    Google Scholar 

  • Beaudry, M., Hamelin, A.-M., & Delisle, H. (2004). Public nutrition: An emerging paradigm. Canadian Journal of Public Health, 95(5), 375–377.

    Google Scholar 

  • Berti, P. R., Krasevec, J., & FitzGerald, S. (2004). A review of the effectiveness of agriculture interventions in improving nutrition outcomes. Public Health Nutrition, 7, 599–609.

    Article  PubMed  Google Scholar 

  • Bryce, J., Coitinho, D., Darnton-Hill, I., Pelletier, D., & Pinstrup-Andersen, P. (2008). Maternal and child undernutrition: Effective action at national level. The Lancet, 371(9611), 510–526.

    Article  Google Scholar 

  • Clark, T. (2002). The policy process: A practical guide for natural resource professionals (Ed.), New Haven: Yale University Press

  • Diouf, J. (2005). Forward: Towards the world food summit and millennium development goal targets. Rome: FAO.

    Google Scholar 

  • Dufour, C., & Borrel, A. (2007). Towards a public nutrition response in Afghanistan: Evolutions in nutritional assessment and response. In A. Pain & J. Sutton (Eds.), Reconstructing agriculture in Afghanistan (pp. 93–118). Warwickshire: Practical Action.

    Google Scholar 

  • Ehrlich, E., Flexner, S. B., Carruth, G., Hawkins, J. M. (1980). Oxford American dictionary (Ed.), New York: Avon

  • FAO. (2007). Supporting household food security, nutrition and livelihoods in Afghanistan GCP/AFG/039/GER: Project findings and recommendations. Kabul: FAO.

    Google Scholar 

  • FAO. (2008). Special program for food security. FAO, http://www.fao.org/spfs/about-spfs/mission-spfs/en/. Accessed 11 August 2008

  • Field, J. O. (1987). Multisectoral nutrition planning: A post-mortem. Food Policy, 12(1), 15–28.

    Article  PubMed  CAS  Google Scholar 

  • Girardet, E., Walter, J., Norchi, C., & Masood, M. (2004). Afghanistan. Crosslines’ essential field guides to humanitarian and conflict zones (2nd ed.). Geneva: Media Action International.

    Google Scholar 

  • Heaver, R. (2002). Improving nutrition: Issues in management and capacity development. Washington: World Bank.

    Google Scholar 

  • Heaver, R. (2005). Strengthening country commitment to human development–lessons from nutrition. Washington: World Bank.

    Book  Google Scholar 

  • Heikins, G. T., Amadi, B. C., Manary, M., Rollins, N., & Tompkins, A. (2008). Nutrition interventions need improved operational capacity. Lancet, 371(9608), 181–182.

    Article  Google Scholar 

  • Hochbaum, G. (1958). Public participation in medical screening programs: A sociopsychological study, PHS Publication No.572. Washington: U.S. Government Printing Office.

    Google Scholar 

  • Islamic Republic of Afghanistan. (2005). Millennium development goals: Islamic republic of Afghanistan country report 2005–vision 2020. Kabul: Islamic Republic of Afghanistan.

    Google Scholar 

  • Jonsson, U. (2010). The rise and fall of paradigms in world food and nutrition policy. (Commentary). World Nutrition 1(3): 128–158

    Google Scholar 

  • Kennedy, E. (1994). Approaches to linking agriculture and nutrition programmes. Health Policy and Planning, 9(3), 294–305.

    Article  Google Scholar 

  • Lautze, S., Stites, E., Nojumi, N., & Najimi, F. (2002). Qaht-e-pool “a cash famine”: Food insecurity in Afghanistan 1999–2002. Medford: Feinstein International Famine Center Tufts University.

    Google Scholar 

  • Leroy, J. L., Habicht, J.-P., Pelto, G. H., & Bertozzi, S. M. (2007). Current priorities in health research funding and lack of impact on number of child deaths per year. American Journal of Public Health, 97(2), 219–223.

    Article  PubMed  Google Scholar 

  • Levin, C. E., Long, J., Simler, K. R., & Johnson-Welch, C. (2003). Cultivating nutrition: A survey of viewpoints of integrating agriculture and nutrition. Washington: IFPRI.

    Google Scholar 

  • Levinson, J. (1995). Multi-sectoral nutrition planning: A synthesis of experience. In P. Pinstrup-Andersen, D. Pelletier, & H. Alderman (Eds.), Child growth and nutrition in developing countries: priorities for action. Ithaca: Cornell University Press.

    Google Scholar 

  • Levinson, J. (2002). Searching for a home: The Institutionalization Issue in International Nutrition. Washington and New York: World Bank-UNICEF Nutrition Assessment Background Paper.

    Google Scholar 

  • Levinson, J. (2003). Institutionalization of nutrition. In S. Gillespie, M. McLachlan, & R. Shrimpton (Eds.), Combating malnutrition: Time to act. Washington: Human Development Network, Health Nutrition and Population Series, World Bank.

    Google Scholar 

  • Levitt, E. J., Pelletier, D. L., & Pell, A. N. (2009). Revisiting the UNICEF malnutrition framework to foster agriculture and health sector collaboration to reduce malnutrition: A comparison of stakeholder priorities for action in Afghanistan. Food Policy, 34, 156–165.

    Article  Google Scholar 

  • London Conference on Afghanistan. (2006). The Afghanistan compact. London: Islamic Republic of Afghanistan.

    Google Scholar 

  • Milio, N. (1990). Nutrition Policy for Food-Rich Countries: A Strategic Analysis. The Johns Hopkins University Press, Baltimore.

  • Ministry of Agriculture Irrigation and Livestock. (2007). Ministry strategy. Kabul: Ministry of Agriculture, Irrigation and Livestock.

    Google Scholar 

  • Ministry of Public Health. (2006). Afghanistan health survey 2006: Estimates of priority health indicators for rural Afghanistan. Kabul: Ministry of Public Health.

    Google Scholar 

  • Ministry of Public Health, & Tufts University. (2003). Public nutrition policy and strategy, 2003–2006. Kabul: Ministry of Public Health, Tufts University.

    Google Scholar 

  • Ministry of Public Health, UNICEF, Centers for Disease Control and Prevention, National Institute for Research of Food and Nutrition-Italy, & Tufts University. (2009). 2004 Afghanistan National Nutrition Survey. Atlanta: Centers for Disease Control and Prevention.

    Google Scholar 

  • Ministry of Rural Rehabilitation and Development. (2007). National risk and vulnerability assessment, edited by Vulnerability Assessment Unit: Ministry of Rural Rehabilitation and Development

  • Mintrom, M. (2000). Policy entrepreneurs and school choice (Ed.), Washington, D.C.: Georgetown University

  • Muhr, T. (2006). Atlas.ti 5.2. Scientific Software Development GmbH, Berlin

  • Pelletier, D., & Ahmed, T. (2008). Mainstreaming nutrition: Overcoming country level challenges in commitment, consensus and capacity for accelerating maternal and child malnutrition reduction. In 35th Session of the Standing Committee on Nutrition (SCN). Hanoi: SCN

  • Pelletier, D., Kraak, V., McCullum, C., Uusitalo, U., & Rich, R. (1999). Community food security: Salience and participation at community level. Agriculture and Human Values, 16, 401–419.

    Article  Google Scholar 

  • Pelletier, D., Menon, P., Ngo, T., Frongillo, E., & Frongillo, D. (2011). The nutrition policy process: The role of strategic capacity in advancing national nutrition agendas. Food and Nutrition Bulletin, 32(2, supplement), S59–S69.

    Google Scholar 

  • Pelletier, D., & The Mainstreaming Nutrition Initiative. (2008). Commitment, consensus and strategic capacity: An evidence-based agenda. SCN News, 36, 38–43.

    Google Scholar 

  • Pinstrup-Andersen, P. (2007). Agricultural research and policy for better health and nutrition in developing countries: A food systems approach. Agricultural Economics, 37(s1), 187–198.

    Article  Google Scholar 

  • Rosenstock, I. (1966). Why people use health services. The Milbank Memorial Fund Quarterly, 44, 94–124.

    Article  PubMed  Google Scholar 

  • Ruel, M. (2001). Can food-based strategies help reduce vitamin A and iron deficiencies?: A review of recent evidence. Washington: International Food Policy Research Institute.

    Google Scholar 

  • Schensul, S. L., Schensul, J. J., LeCompte, M. D. (1999). Ethnographic sampling (Ed.), Essential ethnographic methods. (pp. 231–269). Walnut Creek, CA: Altamira

  • Scrimshaw, N. S. (1995). The new paradigm of public health nutrition. American Journal of Public Health, 85(5), 622–624.

    Article  PubMed  CAS  Google Scholar 

  • Shekar, M. (2008). Delivery sciences in nutrition. Lancet, 371(9626), 1751.

    Article  PubMed  Google Scholar 

  • Trotter, R., & Schensul, J. (1998). Research methods in applied anthropology. In H. R. Bernard (Ed.), Handbook of methods in cultural anthropology. Walnut Creek: Altamira.

    Google Scholar 

  • UNICEF. (1990). Strategy for improved nutrition of children and women in developing countries. New York: UNICEF.

    Google Scholar 

  • World Bank. (1993). World development report 1993: Investing in health. New York: Oxford University Press.

    Google Scholar 

  • World Bank. (2006a). Getting to scale, repositioning nutrition as central to development: A strategy for large-scale action (pp. 95–112). Washington: World Bank.

    Google Scholar 

  • World Bank. (2006b). Repositioning nutrition as central to development: A strategy for large-scale action. Directions in development. Washington: World Bank.

    Google Scholar 

  • World Bank. (2007). From agriculture to nutrition. Washington: The International Bank for reconstruction and Development.

    Google Scholar 

  • World Food Summit. (1996). The Rome declaration on world food security. Population and Development Review, 22(4), 807–809.

    Article  Google Scholar 

  • Young, H., Borrel, A., Holland, D., & Salama, P. (2004). Public nutrition in complex emergencies. Lancet, 364(9448), 1899–1909.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funding for this research was made possible through the generous support of the UK Department for International Development/GRM International Ltd., Food and Agriculture Organization of the United Nations-Afghanistan, the American Institute for Afghan Studies and Cornell University’s College of Agriculture and Life Sciences, Division of Nutritional Sciences, the Mario Einaudi Center for International Studies and the Cornell International Institute for Food, Agriculture and Development. The authors thank the many Afghans and international partners who collaborated to make the data collection possible despite varying security conditions during the research period.

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The authors declare that they have no conflict of interest.

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Correspondence to Emily Jackson Levitt.

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Levitt, E.J., Pelletier, D.L., Dufour, C. et al. Harmonizing agriculture and health sector actions to improve household nutrition: policy experiences from Afghanistan (2002–2007). Food Sec. 3, 363–381 (2011). https://doi.org/10.1007/s12571-011-0135-2

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