SAFANSI The South Asia Food and Nutrition Security Initiative bringing rural development to bear on human nutrition Intuitively, agricultural and rural development and Rural Development or “INPARD,” and it aimed projects may seem to bear straightforward impacts to introduce and later assess the performance of on human nutrition. Yet nutrition outcomes are activities to promote improved nutrition outcomes not traditionally within the purview of those within the larger rural development Project. who plan and implement rural development programs. For professionals working in this field, While education and awareness activities any improvements in nutrition that emerge as a undertaken by INPARD would duly emphasize result of their activities are likely to be considered consumers participating in the Reawakening naturally-occurring downstream effects of higher Project, substantial efforts would also focus on incomes and more integrated rural economies. development practitioners and local policy makers. However, much of what determines the nutritional These are professionals and public officials working status of a household or community has to do in defined professional disciplines and sectors and with the awareness of nutrition-related issues on separated by a division of labor in which they the part of local people, and their understanding are highly accustomed to communicating freely that the types of foods they consume play an with their peers, using their own vernaculars. Yet important role in their health. For development enabling them to communicate with others who agencies like the World Bank and their partners work outside their field is required because human working at local levels, this raises the question nutrition is an area that all their work affects, and of how to incorporate human development their effective collaboration will be necessary in areas like nutrition and education into more delivering results. conventional economic development-related concerns with agricultural production and rural transport, irrigation, communications, and energy infrastructure. For the South Asia Food and Nutrition Security Initiative (SAFANSI), a logical starting point was to find large-scale rural development programs - large enough to draw comparisons between communities within the project area, as well as with some outside the project area altogether. Differences that emerge between communities in which the project incorporated nutrition and other communities in which it did not, can subsequently be assessed both qualitatively and quantitatively. In Sri Lanka, the Community Livelihoods in Conflict-Affected Areas Project, more often referred to simply as the Reawakening Project, was identified as one such project. The study project undertaken in conjunction with the Reawakening Community healthy cooking session (Photo Credit: Chamil Senevirathne (2015) Project was titled Integrating Nutrition Promotion and Ashan Pathirana (2015), INPARD study team) March 2018 South Asia Region Among consumers on the other hand, improved The training focused in large measure on how outcomes rely on changing the types of food they the work of organization members impacted demand, and in a context of economic growth and nutrition and how collaboration between them urbanization, promoting fruits and vegetables and could take place across sectors. This was followed making people aware of the very real drawbacks of by workshops in which newly assembled multi highly-processed, commercially-advertised foods. sector teams drew up action plans to determine Parents and children warrant particular priority, priorities and carry out interventions within the given that informed consumers affect nutrition communities. across generations. The influence parents and older relatives have on dietary behaviors within Quantitative data collected included household-, the household is not surprising. The significant village-, and school-level information about part that school children play, among other matters like the availability of different foods and things in bringing home the vocabulary needed to how frequently they were consumed. Biometric understand nutrition issues, and lessons learned data measured matters like adult waist size and at demonstration gardens their schools maintain, was complemented by participants’ self-reports was an important finding that INPARD would go of their level of physical activity, consumption of on to report. fruits, vegetables, and proteins, and whether and how often they had been drinking sodas or alcohol The INPARD study was undertaken in November or smoking. 2013 and baseline data collection was completed the following August, after which activities began Qualitative data, often collected through focus with a training program for village-level officers group discussions and informant interviews, such as school principals, midwives, public health captured participants’ knowledge, beliefs, and inspectors, and economic and agricultural agents. attitudes about nutrition-related issues, and was They interacted with community resource persons instrumental in developing an understanding of representing the village development organizations the cultural factors that influenced behaviors. that community members themselves had been organized into. Final assessments were completed Study Areas in October 2016 and the draft report went through several consultations in Sri Lanka and overseas. Study Districts The INPARD Study Areas within the Larger Ampara (RAP Distict) Reawakening Project Moneragala (RAP District) Kurunegala (non-RAP District) The study areas were located in the districts of Ampara and Moneragala, where INPARD would cover households in 112 villages that were participating in the Reawakening Project. A control group of otherwise similar villages that were not participating in the Reawakening Project was also selected for the purpose of eventually comparing with-project and without-project scenarios after INPARD was completed. An additional control group of villages was selected in Kurungela district, far away enough from Project activities to discount any possibility of demonstration effects being gleaned from awareness of Reawakening The process of consultation and participatory Project activities. learning on the part of village-level officers working under the auspices of the various concerned 2 ministries and community members led to the consumption of fruits and vegetables was a serious formulation of a series of interventions which nutritional issue, and the conventional solution of were classified as belonging to one of five areas. promoting home gardening had been rendered Agricultural interventions focused for the most part less feasible by the area’s long dry season. School on household level gardens and how they could children played an important role in disseminating be used to produce highly nutritious foods. They knowledge of technical approaches to managing featured public community events like gardening water scarcity such as water harvesting and competitions, and very importantly included basic wastewater management. instruction on how to produce the compost fertilizers and bio-pesticides necessary for cultivating organic Results foods. Nutrition interventions promoted awareness of issues pertaining to food quality, with particular Changes reported in INPARD villages were focus on infant and early childhood nutrition. These notable at both the village and school levels, featured training on how to prepare highly nutritious and did a good deal to vindicate the value added foods, and on participants’ ability to recognize signs of work purposefully arranged across sectors. of nutrient deficiency when they saw them. Health Among those reflected in village datasets, some interventions were largely parallel to nutrition ones of the most impressive changes were seen among but addressed issues in addition to food quality adults who were newly informed of the benefits of such as hygiene and included sports and exercise improved dietary behaviors. Daily intake of fruits programs. The production and marketing of “health and vegetables increased among both men and foods” paralleled agricultural interventions to some women, and in areas where excessive sodium degree, but placed greater emphasis on food as intake was identified as an issue, salt consumption commodities and the development of new markets declined. The proportion of adults whose body specializing in their sale. Very significantly, these weight was classified as “normal” increased and interventions also went to some lengths in treating those with a healthy waist circumference increased health food production and sales as a source of by more than 7 percent among both men and self-employment. Finally, social development women – important progress in a short period of interventions included sports and social activities time in places where people had previously been for children, youth, and adults, and prevention classified as overweight or obese. of negative behaviors like drinking alcohol and smoking. School data likewise registered some important positive outcomes among schools in project areas. Case studies undertaken in the INPARD The availability of sweets, soft drinks, and fast program foods declined from 35 percent to 25 percent of schools in Reawakening Project schools, while the Yogurt production and marketing in the Kithulkotte proportion of schools in which they were available area of Moneragala district, where limited protein increased from 13.8 to 24.1 percent. Regrettably, intake and low demand for dairy products had fewer than half the schools in both project and been a dietary issue, was identified by numerous control areas had fresh fruit and vegetables stakeholders. available for students, and fewer than a quarter had milk available. At the village level however, Low protein intake was similarly a concern in the protein consumption increased in places where village of Abhayapura in Ampara district, where low protein intake had been identified as an issue. a local variety of fresh water fish known as Rohu was shunned by consumers as undesirable - until The INPARD interventions and analysis of their upon further investigation, stakeholders found results exemplified a strategy developed by the that it is actually considered a delicacy when South Asia Food and Nutrition Security Initiative smoked instead of served fresh. In the village in which a series of four “pillars” support an of Wewinna in Ampara district, low rates of overall objective. 3 Four Pillars of SAFANSI Strategy The case studies were instrumental in demonstrating to service providers how to collaborate across sectors, and its practicality was subsequently re-enforced and institutionalized through monthly divisional meetings to ensure communication and accountability. Innovation Improved Evidence and Enhanced Awareness and Building Systems and Fostering Innovations (the fourth pillar), was fostered at a number of Analysis Commitment Capacity levels, which was important because the practical Knowledge of Increasing Creating the Creating space to lessons derived from new experiences need to be what works and awareness of the institutions and try new solutions why to establish problems and processes that that can work at shared. Encouraging microfinance committees to focus areas for potential solutions will help countries the grassroots and incorporate nutrition-related objectives as criteria programming and among critical better address beyond. policies. audiences within food security they use when considering applications for loans the region. and nutritional and other financial support is a notable example. challenges in a sustainable way. Sharing experiences and best practices at the grassroots level is likewise important, and was facilitated by new channels of communication between counterparts in different areas, for instance school principals and meal providers in neighboring villages. Opening these channels of The first pillar, “improved evidence and analysis,” communication enables local service providers to entails collecting data and using it to quantify how consult one another when planning a new activity the impacts of rural development interventions or facing a challenge which their peers in other change when they expressly incorporate nutrition places may very well already have experience in outcomes as project objectives. This contributes addressing. Of course, they can also refer to the to an empirical base available for future projects growing chronicle of experiences documented in to refer to when their activities involve both health the overall body of knowledge being accumulated and non-health sectors. INPARD also demonstrated by the larger project as its empirical base. what “multi-sector teams” consist of and how they work in identifying nutrition-related problems and More broadly, INPARD established with convincing solutions and in determining priorities. A necessary weight the practicality of work across sectors in part of this interdisciplinary work is developing the pursuit of nutrition-related objectives, and the capacity of local government service providers to value of participatory learning and outcome- work together from within their respective fields, based strategies in achieving these objectives. which was where INPARD activities began (the third pillar). – together with raising awareness among members of the communities being served (the second pillar). Partners SA FANSI Administered by: This results series highlights development results, operational innovations and lessons emerging from the South Asia Food and Nutrition Security Initiative (SAFANSI) of the World Bank South Asia region. Disclaimer: The findings, interpretations, and conclusions expressed herein are those of the author(s) and do not necessarily reflect the views of the Executive Directors of the International Bank for Reconstruction and Development / The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.