Federal Democratic Republic of Ethiopia

Ministry of Agriculture

National Nutrition Sensitive Agriculture

Training Manual for Agricultural Development
Agents

November, 2018

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 Table of Contents
Acronym 7
Preface 8
Definition of key terminologies 9
Chapter 1: Basics of Human Nutrition 10
Introduction 11
1.1 Basic Concepts of Nutrition, Food and Nutrition Security 12
1.2 Food Groups 12
1.3 The six different types of nutrients: 14
1.4 Dietary diversity 15
1.5 Malnutrition and Its Different Forms 16
1.6 Causes of Malnutrition 17
1.7 Effects and Impact of under-nutrition 18
1.8 Status of Under-nutrition in Ethiopia 19
Chapter 2: Agriculture and Nutrition Linkage 21
Introduction 22
2.1 Inter-relationship between Agriculture and Nutrition 22
2.2. Agriculture to Nutrition Impact Pathways 24
2.3 Guiding principles to Nutrition-Sensitive Agriculture (Adapted from FAO) 26
Chapter 3: Crops and Animal Source Foods and Nutrition 30
Introduction 31
3.1 Nutritional value of plant-based foods 31
3.2 Factors affecting bioavailability of nutrients from plant-based foods 33
3.3 Nutritional value of animal source foods 34
Chapter 4: Nutrition Sensitive Intervention 37
Approaches for Improved Nutrition 37
Introduction 38
4.1 Diversified food production and consumption to improve nutrition 39
4.2 Biodiversity for food and nutrition 40
4.3 Bio-fortification for improved nutrition 41
4.4 Good Agricultural practice (GAP) and food safety for nutrition 41
4.5 Food handling practice for improved nutrition 43
4.6 Women empowerment for nutrition 44
4.7 Income generation for improved nutrition 45
4.8 Agricultural market linkages for improved nutrition 45

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 4.9 Nutrition-sensitive social protection 46
4.10 Nutrition education and behavior change communication 46
Chapter 5: Water, Sanitation and Hygiene (WASH) and Nutrition 49
Introduction 50
5.1 The Effect of WASH on Nutrition 51
5.2 Basic WASH Practices that Improve Nutrition 53
5.3 Effect of Small Irrigation Practices on Household Nutrition 55
Chapter 6: Gender and nutrition 57
Introduction 58
6.1 Basic concept of gender 58
6.2 Importance of women’s empowerment to improve family nutrition 59
6.3 The role of women and men in nutrition sensitive agriculture 60
Chapter 7: Agriculture-Nutrition Social Behavior Change 62
Introduction 63
7.1 Social and Behavior Change 63
7.2 Stages of Behavior Change 64
7.3 Barriers to behavior change 65
7.4 Knowledge, Attitude and Practice Gap in behavioral change 66
7.5 Target Groups, Determinants and Activities 66
7.6. Behavior Change principles and approaches 69
7.7 Social Behavioral Change communication 70
Chapter 8. Multi-Sectoral Coordination for Nutrition 75
Introduction 76
8.1. Multi-sectoral Nature of Nutrition 76
8.2. Roles and responsibilities of various sectors in NNP-II 77
8.3. Role of DAs in implementing Multi-Sectoral NSA interventions 79

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 Acronym
AGP Agriculture Growth Program
AMIYCN Adolescent, Maternal, Infant and Young Child Nutrition
BMI Body Mass Index
EDHS Ethiopian Demographic Survey
FAO Agriculture Growth Program
DA Development Agents
FTC Farmer Training Center
GDP Gross Domestic product
GTP Growth and Transformation Plan
HEW Health Extension Worker
HH House Hold
IPC Inter-Personal Communication
IYCF Infant and Young Child Feeding Practices
KAP Knowledge, attitude and practice
MDG Millennium Development Goal
MoA Ministry of Agriculture
NNP National Nutrition Program
NNSAS National Nutrition Sensitive Agriculture Strategy
PSNP Productive safety net program
SBCC Social behavior change communication
SHN School health and nutrition
ATVET Agriculture Technical Vocational Education and Training
UNICEF United Nations Children’s Fund
VIP Ventilated Improved Pit
WASH Water, Sanitation and Hygiene

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 Preface
Agriculture is the major source of food, employment and income for most Ethiopians. Families
living in rural areas derive means of their daily lives from direct involvement in agricultural
activities. Understanding this, the government of Federal Democratic Republic of Ethiopia has
developed a comprehensive Rural Development Policy and Strategy and implemented it through
successive development plans for the past 15 years. Food and nutrition security have always been
a challenge and are among the development targets of the five-year Second Growth and
Transformation Plan, GTP-II. Hence, agricultural development does not only focus on increasing
production but also creating access and means of improving food and nutrition security. The
food that we eat needs to be in adequate quantities, safe and nutritionally diverse. In addition,
there is also the apparent need to improve access to clean and safe water and health services
together with women empowerment interventions.

Agriculture and nutrition are highly interrelated. Agricultural production provides the means to
get food and the essential nutrients that people need. While on the other hand, as agriculture is
highly labor intensive, agriculture requires well-nourished, healthy, and physically fit people. To
improve nutritional outcomes, the agricultural strategy in Ethiopia takes on a nutrition-sensitive
approach. The strategy guides planning and implementation of crop and livestock production,
processing, marketing and consumption in order to address the prevailing malnutrition problem
of the country.

Development agents (DAs) are at the fore front in implementing agricultural programs and
supporting farmers to improve agricultural production and livelihood. Over the past five years,
more than eight nutrition related DA training manuals have been prepared by various projects and
development partners. None of these manuals have been endorsed and are used across the sector
other than project areas due to lack of proper engagement of the MoA. This training reference
manual is developed by MoA in collaboration with development partners. This manual will be
used to train development agents to enable them implement nutrition sensitive agriculture to
contribute for the reduction of under-nutrition in the country by promoting and assisting production
and consumption of diversified foods in rural Ethiopia.

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 Definition of key terminologies
Home garden: Home garden can be described as a mixed cropping system that encompasses
vegetables, fruits, plantation crops, spices, herbs, ornamental and medicinal plants as well as
livestock that can serve as a supplementary source of food and income

Nutrition Sensitive Agriculture (NSA): is an approach that seeks to ensure the production of a
variety of nutritious, affordable, culturally appropriate and safe foods in adequate quantity and
quality to meet the dietary requirements of populations in a sustainable manner.

Food Safety: Assurance that food will not cause harm to the consumer when it is prepared and/or
eaten according to its intended use.

GAP (Good Agricultural Practices): A collection of principles to apply for on-farm production
and post-production processes, resulting in safe and healthy food and non-food agricultural
products, while considering economic, social and environmental sustainability.

Food security is ensured when all people, at all times, have physical and economic access
to safe, sufficient and nutritious food to meet their dietary needs and food preferences for
an active and healthy life.

Nutrition security is when all people at all times consume food of sufficient quantity and
quality in terms of variety, diversity, nutrient content and safety to meet their dietary needs
and food preferences for an active and healthy life, coupled with a sanitary environment,
adequate health and care.

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Chapter 1: Basics of Human Nutrition

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Introduction
Human nutrition describes the processes of obtaining and use of necessary nutrients from foods to
maintain structural and functional integrity of our body. The state of under-nourishment results in
micronutrient and macronutrient deficiencies which affect the health, agricultural productivity,
educational performance and socio-economic development of a country.

Undernutrition is high in Ethiopia and has been affecting the socio-economic development of the
country. The government of Ethiopia identified undernutrition to be among the important action
areas for national development and Ministry of Agriculture has been engaged in implementing
nutrition sensitive interventions to contribute for improving nutrition of the population of the
country.

Understanding the basic concepts of nutrition is important to integrate nutrition into agricultural
programs. Agriculture has huge potential to impact on nutrition and has been the focus of the
government and development partners working in the area. DAs are the frontline actors of the
agriculture sector and this section is designed to give them scientific background on the basic
concepts on nutrition.

Main Objective
At the end of this session, the trainee will be able to apply basic concepts of human nutrition
in achieving nutrition and food security to tackle the problem of malnutrition.

Learning objectives
• Describe basic concepts of human nutrition, food security and nutrition security
• Describe dietary diversity
• Discuss malnutrition and its different forms
• Identify causes of malnutrition
• Discuss the effects and impacts of malnutrition on the community
• Describe the current level of malnutrition nationally

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1.1 Basic Concepts of Nutrition, Food and Nutrition Security
Food is any substance plant or animal based which is consumed to provide nutritional support to
our body. It is usually of plant or animal origin. Meal is a food served and eaten at a time. Nutrition
is the intake of food in relation to the body’s dietary need. Nutrients are components in foods that
an organism uses to survive and grow. There are two types of nutrients: Macronutrients and
micronutrients.

❖ Macronutrients provide the bulk energy an organism's metabolic system needs to

function. It includes carbohydrates, proteins and fats.

❖ Micronutrients are vitamins and minerals found in foods which are required by
our body in small amounts but are vital to development, disease prevention, and
wellbeing.

Nutritional requirements refer to the different nutrients required by the body for energy, growth
and repair, as well as protection from disease. Nutritional requirements differ according to age,
gender, physical activity, height, weight, and health status of the individual.

1.2 Food Groups

1.2.1 The six food groups for children

Foods are combinations of nutrients, and naturally contain a lot of one nutrient and less of other.
Foods are hence grouped according to the nutrient they contain in abundance. After six months of
exclusive breastfeeding, the intake of food from different group including animal-source food for
children is of special importance.

In Ethiopia, it is recommended that children should consume at least 4 of the six food groups every
day. All the six food groups are important and should be eaten to complement each other in
increasing dietary intake and utilization of various nutrients by the body.

Seasonal variation dictates various types of foods to be available at a certain time of the year in
various agro-ecologies. Knowing this helps individual households plan ahead on how to diversify

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their meal, depending on the availability of various food groups in different seasons. Therefore,
DAs are advised to prepare crop calendar for each area and help households plan what crops to
grow and livestock to raise or locally purchase in the different months of the year.

Table 1: The six food groups for Children

Food Groups Examples

1 Staples

2 Pulses and nuts

3 Vegetables

4 Fruits

5 Animal source
Foods

6 Oils and Fats

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1.2.2 The Ten food groups for women
Women need to eat at least five of the ten food groups listed below to have adequate
micronutrient intakes.

Table 2. The ten food groups for women

Food groups

1 Grains, white roots tubers, and plantains 6 Eggs

2 Pulses (beans, peas and lentils) 7 Dark green leafy vegetables

Other vitamin A-rich fruits and

3 Nuts and seeds 8
vegetables

4 Dairy 9 Other vegetables

5 Meat, poultry and fish 10 Other fruits

Source: Food and Nutrition Technical Assistance III Project (FANTA). 2015. Measuring the Quality of Women’s
Diets: Consensus on a Global Indicator for Women’s Dietary Diversity. Washington, DC: FHI 360/FANTA

1.3 The six different types of nutrients:

1. Carbohydrates – are the main source of energy for our body. Cereal, grains, roots and
tubers are the main source of carbohydrates.
2. Proteins - are the building blocks of the body tissue and can also serve as a energy
source. Meat, egg, poultry, milk, fish and legumes are main source of protein.
3. Fats - give the body energy and help the body absorb vitamins. Fats have twice as many
calories as proteins or carbohydrates. Butter, fats, oils, fruits such as avocado, nuts and
soybeans are good source of fat.
4. Vitamins – are essential for normal growth and health. they are required in small
quantities every day. Most vegetables and fruits are good source of vitamins.
5. Minerals – are nutrients such as iron, calcium, iodine, zinc and magnesium that are
important for normal body growth and health. Animal (milk, meat, fish etc) and plant
food sources (vegetables, fruits whole grains etc) provide the important minerals.
6. Water - is needed for our body functions, including to maintain the health and integrity
of every cell in the body.

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1.4 Dietary diversity
Dietary diversity is a measure of the number of individual foods or food groups consumed a day.
Dietary diversification is a common food-based approach used to enhance nutrient intakes of
vulnerable population groups and the total population.

Dietary diversity is considered low when the number of food groups consumed is below four food
groups for children and five food groups for women a
day based on their respective reference values.
Adolescents and adult population groups need to make
their food intake as diverse as possible to meet their
body food and nutrient demand for an active and healthy
life.

Figure 1.1: Diversified diet

Low dietary diversity is a problem in Ethiopia where

diets are frequently based on starchy staples e.g. teff, maize, sorghum, inset, and wheat. The diet
often lacks animal-source foods, fruits and vegetables which are rich in micronutrients.

While staple foods and fats are important sources of energy in the diet, many of the important
vitamins and minerals essential for a healthy diet are found in large quantities in animal source
foods, fruits and vegetables, and legumes. Micronutrient deficiencies are particularly common
among low-income rural households, and areas where diets are predominantly based on staples
diets.

Figure 1.2: Examples of nutrient dense foods

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1.5 Malnutrition and Its Different Forms
Malnutrition includes over-nutrition and under-nutrition.

Under-nutrition is the result of insufficient quantity and

quality of food and frequent episodes of infectious
diseases. Under-nutrition is reflected as being
underweight, being short, being thin or overall poor
nutritional status. A child is defined as undernourished if
it is very thin or much shorter than the average for their
age and sex (see Figure 1.3 and 1.4).
Figure: 1.3: Undernourished baby

Over-nutrition results from excess nutrient in-take

relative to the requirements based on age, gender,
physical activity, height, weight, and health status of the individual. In Ethiopia over-nutrition is
still low, but on the rise in urban populations with increased exposure to energy-dense foods.
Effects of over nutrition include increased lifetime risk of chronic diseases, including
hypertension, diabetes, cardiovascular disease, obesity and various forms of cancer.

The following are the different forms of undernutrition in children

I. Wasting is the result of acute or short-term insufficient food intake often combined
with frequent illness. It results in a child who is very thin (very low weight for its
height and sex).

II. Stunting is an indicative of long-term insufficient energy and micronutrient intake due
to poor diets and non-nutritional causes such as chronic infections. The condition
results in a child who is very short (very short height for its age and sex).

III. Underweight is an indicator assessing adequacy of weight-for-age which could be

wasted or stunted child or both. It refers to a body weight which is low to be healthy.
The causes of which can be both short-term and or long-term.

IV. Poor micronutrient status is when there is a deficiency in vitamins and minerals
because of food which is poor in micronutrients content. Micronutrient deficiencies
can also result from frequent illness (diarrhea, warm infestation etc.)

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 Over nutrition: excess Wasting: too thin for Stunting: too short for Good nutrition status, or
body weight for height and height age may suffer micronutrient
age deficiencies

Figure 1.4: Types of malnutrition

1.6 Causes of Malnutrition

Malnutrition is caused by economic poverty, low dietary diversity, culture, eating habits and the
likes. Poor access to water, sanitation and hygiene practices are also important factor for the
development of malnutrition.

The conceptual framework developed by UNICEF provides a clear framework of the various
factors associated with under-nutrition and it depicts the distinct levels at which these factors act
(Figure 1.2). The causes of under-nutrition are divided into three levels: immediate, underlying
and basic and are explained as follows.

• Immediate causes (individual level): Inadequate food intake and disease are
immediate causes of under-nutrition. These are at the individual level.
• Underlying causes (household and community level): Household food
security, social care for mothers and children, access to WASH & healthy
environment and access to health services are the underlying causes that
contribute to under-nutrition.
• Basic causes (sub-national, national and international level): Political, cultural,
financial and environmental factors also contribute to under-nutrition at the basic
level.

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 Figure 1.2: Conceptual framework for under-nutrition – UNICEF 2013.

1.7 Effects and Impact of under-nutrition

Malnutrition has a multifaceted effect in the society

and affects wellbeing and effectiveness of an
individual from childhood to adult both in the short- as
well as long-term. Figure 1.5: Goiter

The right nutrition during the 1,000-days (270 days of

pregnancy, 180 days of exclusive breast feeding and
550 days) windows has a profound impact on a child’s
ability to grow, learn and thrive and a lasting effect on a
country’s health and prosperity.

Optimum nutrition during this period provides the essential

building blocks for brain development, healthy growth and
a strong immune system.

Figure 1.6: Baby with blind eye due to Vit. A deficiency

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 Short-term effect of undernutrition
➢ Malnutrition significantly increases the risk of mortality in children while under-
nutrition increases the susceptibility to and severity of infections in childhood.

Long-term effect of undernutrition

➢ Malnutrition lead to impaired mental development, ability to learn in childhood
and work productively in adulthood.
➢ Low birth weight may increase the risk of chronic diseases such as diabetes and
cardiovascular diseases during adult hood.
➢ Stunted children have higher risk of becoming shorter adults while a woman’s
being stunted increases risk of having a low birth weight baby.
➢ Stunted children perform less at school and have lower income in adulthood.
➢ Under-nutrition during pregnancy can have a devastating impact on the healthy
growth and development of a child.

➢ Under-nourished babies in the womb have a higher risk of dying and are more
likely to face lifelong cognitive and physical deficits and chronic health
problems during their adulthood.

Therefore, pregnant and lactating women and children under the age of 2 years are the priority groups for
nutrition interventions. Women should be well nourished before, during and after pregnancy. Pregnant
women need one extra meal per day to maintain themselves and the infant in the womb. Similarly,
lactating women need two extra meals per day for their own body recovery, for adequate breast
milk production and proper growth and development of their child as a result.

1.8 Status of Under-nutrition in Ethiopia

Under-nutrition is among the major socio-economic development problems in Ethiopia.
• Only 7% of children aged 6-23 months meet the minimum acceptable diet.
• 38% of children under the age of 5 years are stunted (short for their age);
• 10% are wasted (thin for their height);
• 24% are underweight (thin for their age), and 1% are overweight (heavy for their height).
• 22% of women aged 15-49 are thin (with BMI less than 18.5), and 8% are overweight or obese.

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 Summary
• Ethiopia is a country where malnutrition is widespread and affecting the health and
development of a nation.
• Providing balanced nutrition during the first 1000 days of a child from conception till
the age of two years old is key to ensure optimal health and life of an individual.
• Malnutrition has short and long-term impacts and needs to be addressed with a sense of
urgency.
• Infants, pregnant and lactating women are the most vulnerable group to malnutrition and
priority needs to be given to them.
• Dietary diversification contributes to improve nutritional status of households.
• Healthy diet can be achieved by consuming food from at least four food groups for
children.
• A family should plan what to grow and to buy through the different seasons of the year
based on agro-ecological suitability and conditions allow.

Self-Assessment Questions
Q1. What is the difference between food security and nutrition security?
Q2. Explain how agriculture provides a diverse food for consumption.
Q3. Explain the different forms of malnutrition.
Q4. Discuss the causes of malnutrition.
Q5. Describe the short and long-term effects of malnutrition.

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Chapter 2: Agriculture and Nutrition Linkage

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Introduction
Agriculture is the major source of food and income in Ethiopia. Access to and availability of food
contributes for improved household food security. When agriculture is integrated with appropriate
nutrition interventions approaches, it increased access to adequate, safe and diversified foods and
improves nutrition through consumption of diversified diets.

Agriculture plays the key role for nutrition through different impact pathways. Agriculture and
food security programs should incorporate appropriate nutrition objectives, indicators and
interventions for improved nutritional outcomes. This chapter addresses how agriculture and
impacts on nutrition.

Main Objective
At the end of this chapter, trainees will be able to discuss the linkage between agriculture
and nutrition

Learning objectives
2.1. Discuss the inter-relationship between agriculture and nutrition
2.2 Explain the agriculture-nutrition impact pathways
2.3 Discuss the guiding principles of nutrition sensitive agriculture programing

2.1 Inter-relationship between Agriculture and Nutrition

Agriculture is the main source of food and income in Ethiopia. Smallholder farms are responsible
for about 90 % of the food production in the country. The main role of agriculture in improvement
of nutrition is through improving access to adequate, safe and nutritious foods.

Poor agricultural production can lead to poor harvest and food insecurity. Food insecurity leads to
under-nutrition which negatively affects agricultural productivity, socio-economic development,
educational performance, and community health. Poor nutritional status among farmers can lead
to reduced agricultural productivity, a decline in household income and food insecurity.

Improved nutritional status is an input for increased agricultural productivity. Good nutritional
status is necessary for productive and healthy community.

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Table 2.1. Description of the relationship between agriculture and nutrition.

No Agricultural Interventions Explanation linkages

clarity
1 Adequate and appropriate Adequate and appropriate agricultural technologies and inputs
agricultural (clear
technologies and improve access to nutrient dense nutritious crops and animal source
inputs (crops, animal, foods which can improve nutritional status of HH.
fertilizer, etc…)
2 Improved nutrition sensitive Cropping and farming systems that produce variety of nutritious
agricultural practices foods helps to improve the availability and consumption of
(cropping, animal rearing diversified foods at the household level.
practices, technology, etc…)

3 Nutrition sensitive food value Good agricultural practices result in better production, but only
chain (storage, processing, with improved harvesting, storage, transportation and proper
distribution, marketing, etc…) marketing. Proper processing and storage is necessary to maintain
the nutrient content of the food. The better the food value chain
the better the availability and quality of food.
4 Increased household food Increased production and yield improves household consumption
security and income and income through selling marketable products that helps to
purchase additional nutritious food.

5 Better household income When households have better income, they have the capacity to
improves lives, invests in improve their lives, invest in health care and education for their
health care and education children and other family members.

6 Good access to food For consumption of adequate and diversified foods, there should
(availability, nutrient quality be good access to food (both amount and quality). Better access is
and affordability) determined by good value chain practices.

7 Improved food consumption When households have good access to adequate and diversified
and caring and feeding foods, the consumption of such foods will likely be improved.
practice (diversity, HH food Good agricultural practices that yield good production are also
expenditure, good feeding important for improved consumption.
practices, etc.)
8 Improved nutritional status (of Better consumption and feeding practices will result in improved
farmers, women, children, nutritional status. The investment in health care and education will
etc.) also contribute to improved nutritional status.

9 Productive and healthy The outcome of improved nutritional status is productive and
farmers, women and children healthy farmers. This is an important input for establishing
improved agricultural practices.

10 Nutrition education Good agricultural practices alone may not result in improved
consumption and feeding practices. HH should also have access to
nutrition information that supports positive behavior change.

Source: NNP II, Ethiopia

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In Ethiopia, level of productivity and household food security varies significantly due to diverse
agro-ecology, soil fertility and land holding size differences among farmers. Furthermore, due to
natural and manmade causes, the traditional modes of subsistent production are no longer a
guarantee to ensure food and nutrition security. Rural households in some parts of the country are
under permanent state of food insecurity, suffering from hunger and under-nutrition.

In Ethiopia, there is no difference in prevalence of undernutrition between food secure and insecure
woredas. This clearly proves that increased agricultural production and food security is not by
itself a guarantee for nutrition security. To ensure the contribution of increased production and
food security for nutrition security, agricultural activities should incorporate appropriate nutrition-
sensitive interventions (Refer chapter 4).

Figure 2.1 Conceptual framework of food security and nutritional status at household level

2.2. Agriculture to Nutrition Impact Pathways

Agricultural development through increased access to diversified foods is one of the main
contributing factors for nutrition security. Three main pathways are identified through which
agricultural interventions impact nutritional outcomes and described as follows.

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2.2.1 Agricultural Production for Own Consumption Pathway
This pathway refers to subsistence -oriented food
production for the household’s own consumption.
Plant and animal source foods produced at small
scale levels increases access to household foods
better than commercial farms which in most of the
times sales the products for local and international
markets.
Therefore, development agents should promote, design and implement interventions that increase
food production for own consumptions. Home gardens, poultry production for egg and meat, and
rearing of small ruminants are good examples of these kind of interventions at household levels.

2.2.2 Agricultural Production for Increased Household Income

It refers to agricultural production oriented for sale of
products in markets mainly to earn income for the
household including purchase of nutritious food.
Development agents should identify the food items
(food groups) that are not produced by households in
the community and promote the purchase of these
foods in the markets from the incomes obtained from
sale of the agricultural products. Therefore, agriculture experts and development agents should
maximize the effectiveness of this pathway through nutrition social and behavioral change (SBC)
interventions and strengthening market linkages.

2.2.3 Agriculture Program that Promote Empowerment of Women.

Agriculture interventions that ensure
empowerment of women as agents instrumental
to improvement of household food security and
nutritional outcomes. Women tend to invest in
their children’s nutrition, health and well-being.
The income and resources that women control
yield disproportionately strong effects on health
and nutrition outcomes generally.

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Women who are reached by agricultural and nutrition programs appear to be effective at delivering
improved nutrition outcomes. These characteristic makes women natural priorities for agricultural
programs that aim at improving nutrition. However, these programs must take in to consideration
the women’s time and resource constraints. Development agents should take caution to avoid
programs that can harm women time and resources, and the nutrition of themselves and of their
children.

Figure 2.2: Agriculture to nutrition impact pathways framework, Feed the Future: Linkage
agriculture and nutrition by Herforth and Harris (2014)

2.3 Guiding principles to Nutrition-Sensitive Agriculture (Adapted from FAO)

To ensure the positive impact on nutrition, agriculture and food security strategies and programs
should incorporate clear nutrition objectives, indicators, and targets. The development agents
should apply the below ten main guiding principles that should be considered during design and
implementation of agriculture programs.

2.3.1 Incorporate explicit nutrition objectives and indicators

Agriculture experts and development agents should be keen enough to incorporate appropriate
nutrition objective and indicators during the planning and implementation NSA activities.

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2.3.2 Assess the context at the local level
The local context needs to be assessed to identify potential food resources, type of agro-ecology,
seasonality of production and income, access to productive resources (land, market opportunities
and infrastructure, gender dynamics and roles, opportunities for collaboration with other sectors
and local priorities) for improved nutrition and socio-economic development.

2.3.3 Target the vulnerable and improve equity

The proposed agriculture and food security program should target the most vulnerable segment of
the community, and strive to improve equity through participation, access to resources, and decent
employment. Vulnerable groups may include smallholders, women, youth, elders, the landless,
etc.

2.3.4 Collaborate and coordinate with other sectors

During the design and implementation of the agricultural programs, the agriculture sector should
collaborate with sectors such as health, environment, social protection, labour, water and
sanitation, education, energy, through joint strategies with common goals. This helps the
agriculture sectors and others to address concurrently the multiple underlying causes of
malnutrition.

2.3.5 Maintain or improve the natural resource base

Maintaining the resources bases such as water, soil, climate, biodiversity is critical to the
livelihoods and resilience for sustainable food and nutrition security for all.

2.3.6 Empower women

Empower women working in the agriculture sectors by ensuring access to productive resources,
income opportunities, extension services and information, credit, labor and time-saving
technologies (including energy and water services) and supporting their voice in household and
farming decisions. Equitable opportunities to earn and learn should be compatible with safe
pregnancy and young child feeding.

2.3.7 Facilitate production and consumption of diversified nutrient-dense foods

Agricultural experts should identify and promote production diversification and consumption of
nutrient dense crops and animal source foods. This may include promotion and support of
production of horticultural products, legumes, livestock and fish, underutilized nutrient dense
crops, and bio-fortified crops.

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2.3.8 Improve post-harvest handing and food preservation
Post-harvest handling helps to retain nutritional value, shelf life, and food safety, to reduce
seasonality of food insecurity and post-harvest losses.

2.3.9 Expand markets and market access

This guiding principle refers to expanding markets and ensuring market access for vulnerable
groups, particularly for marketing nutritious foods or products vulnerable groups have a
comparative advantage in producing. This can include innovative promotion (such as marketing
based on nutrient content), value addition, access to price information, and farmer associations.

2.3.10 Incorporate nutrition promotion and education

Agriculture programs should incorporate nutrition promotion and education around nutrient dense
food and sustainable food systems that builds on existing local knowledge, attitudes and practices.
Nutrition knowledge can enhance the nutritional impact of food production and income in rural
households, which is especially important for women and young children, and can increase
demand for nutritious foods among the community members.

Summary
Agriculture that focuses only on increasing production and productivity cannot effectively
contribute for nutrition. It plays a key role in achieving nutrition security. Increased agricultural
production and food security are fundamental components of nutrition security but are not by
themselves guarantee for nutrition security in the community.

The relationship of food and nutrition security and the agriculture-nutrition impact pathways
helps to design and implement effective agriculture interventions that contribute for good
nutrition in the community.

Agriculture program is nutrition sensitive when its programs considered the ten guiding
principles to maximizes the nutritional impact of agriculture to support household access to
adequate and diverse food by targeting nutritionally vulnerable segments of the community.

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Self-Assessment Questions
1. How would you explain the linkage between agriculture and nutrition?
2. What role does agriculture plays for food and nutrition security?
3. What are the pathways through which agriculture affects nutrition outcomes?

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Chapter 3: Crops and Animal Source Foods and Nutrition

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Introduction
Crops are the major staple foods and daily energy sources for majority of Ethiopians. Good mix of
plant-based foods prepared from fruits, vegetables, pulses, cereals, roots, nuts and oil seeds are
important to improve nutrition.

Animals and Animal products make important contribution to human nutrition. Animal source
foods are high in nutritional value. Consumption of animal products thus improves the diets of
families and is effective in addressing under-nutrition.

The Main Objective

At the end of this chapter the trainees will be able to explain nutritional values of different
plant and animal source foods.

Learning objectives
At the end of the chapter the trainees will be able to
• Describe the nutritional value of plant-based foods
• Describe the nutritional value of animal source foods

3.1 Nutritional value of plant-based foods

Plant based foods constitute more than 80 percent of the daily food consumption in Ethiopia. They
are important sources of many nutrients for humans. They contain carbohydrates, proteins, fats,
vitamins, and minerals. For healthy and productive life farmers need to produce different
agricultural products and consume diversified food. The five plant-based food groups are presented
as follows:

31
 I. Staples
In Ethiopia, the most important crop-based foods are
cereals including teff, wheat, maize sorghum, barley
and millet. In some parts of Ethiopia root crops like
potato, enset, taro, cassava, sweet potato, and yam are
the main root crops consumed as staples primarily.
Staple foods are majorly carbohydrate based and are
important source for energy. It usually accounts for
the major portion of daily meal.

II. Legumes and Nuts

Legumes include faba bean, common beans, field pea,
chickpea, lentil, grass pea, ground nuts and the likes.
Legumes are important protein sources and they also
provide energy.

III. Vegetables
Vegetables are low calorie, nutrient dense crops in
nature and provide micronutrients (vitamins and
minerals) and dietary fiber. They include green leaf
and yellow vegetables such as kale, spinach, celery,
cucumber, peppers, broccoli, carrots, cauliflower,
pumpkin, onion, tomatoes, mushroom and others.

IV. Fruits
Fruits are good sources of vitamins, minerals dietary
fibers and provide energy. People who eat fruit
generally have a reduced risk of chronic diseases.
They include bananas, oranges, lemons, pineapple,
papaya, avocado, peach, guava, watermelon, and
many others. Fruits can be obtained from wild source
as well.

32
V. Oils seeds
Oil seeds includes sesame, sunflower, safflower, Niger seed, linseed
and others. They are important source of energy and important fats
for health.

3.2 Factors affecting bioavailability of nutrients from plant-based foods

A. Antinutritional Factors
Anti-nutritional factors are compounds found in food which reduce the absorption and utilization
of nutrients from plants-based foods and some are toxic to our body. The common anti nutritional
factors, their source and method of treatment to reduce or deactivate their effect is indicated below.

Anti-nutritional Common food sources Health effect Treatment to reduce

factors or remove the
antinutrient factors
Goitrogens Cabbage, kale, sweet Causes goiter by limiting Cooking t
potato, spinach, iodine absorption
bamboo shoots etc.
Cyanides Cassava Toxic for the body Soak in water for
30minutes before
cooking
Protease and Legumes, egg whites, Slows starch digestion Cooking
amylase potatoes, cereals
inhibitors
Saponins Soybeans, peas, beans, Toxic to body Soaking prior to
potato yam, oats, etc. cooking
Phytates and whole grains, cereals, Reduces minerals Germination,
Tannins soy, nuts and legumes absorption from dehulling,
consumed foods fermentation

B. Food Processing and Preparation Methods: Heat treatment, germination and malting of
cereal and pulse-based foods improve the nutrient bioavailability of iron and vitamin A from foods
consumed. For instance, nutrients from staple foods become more digestible and bioavailable
when the food is cooked well and consumed while hot. Cooking vegetables for extended time
destroys the vitamin C content of food consumed.

C. Dietary consumption pattern: If antinutrient containing beverages are taken along with the
regular meal, the nutrients in the consumed food may not be available for absorption. For instance,
taking coffee along with breakfast, lunch or dinner meal may hinder absorption of minerals like

33
iron and zinc from the food consumed. In the contrary preparation and consumption of a meal from
different food groups improves nutrient bioavailability. For instance, consuming cereals and pulse-
based foods with vitamin C rich foods improve the bioavailability of iron in plant-based foods.

3.3 Nutritional value of animal source foods

Animal source foods (ASF) provide micronutrients that are difficult to obtain in adequate
quantities from plant source foods alone. Animal source foods are rich sources of nutrients, and
relatively small amounts of these foods added to a plant-based food, can substantially increase
nutrient adequacy. Inclusion of ASF in diets is an important food-based approach for improving
nutritional status of community.

Animal source foods are rich in protein,

energy and excellent source of selected
micronutrients (easily absorbable iron,
zinc, calcium, vitamin A, vitamin B12,
various essential amino-acids, omega-3
fatty acid and iodine). Consumption of
at least one type of animal source food
once a day helps our body to get
essential nutrients. Avoidance of
consumption of these food groups
specially in country like Ethiopia
increases risk of deficiency in essential
proteins, iron zinc, vitamin A, and the

Figure 3.1: Rearing small livestock likes.

3.4 The major type of animal source foods and their nutritional values:
I. Poultry products

Poultry products contributes to improved human nutrition and

food security. It is source of high-quality protein in the form of
eggs and meat. Eggs also contain vitamins A, D, E, K and the B-
complex. Figure 3.2: Poultry product

34
 II. Dairy products

Dairy products are the most nutritious foods. However, the national milk production and the
overall milk consumption in Ethiopia are very low. Per capita consumption of milk in the Ethiopia
is as low as 17 kg per head while the average figure for Africa is 26 kg per head.

Milk contains biologically active compounds, which have

physiological and biochemical functions important for
human nutrition and health. It contains calcium,
magnesium, selenium, riboflavin, vitamin B12 and
pantothenic acid (vitamin B5). Milk consumption is
important for growth and bone strength.

Figure 3.3: Dairy products

III. Meat from livestock

Meat products are good source of protein, iron, zinc, vitamin A and Vitamin B complex. The
inclusion of animal source foods makes it easier to
ensure a good diversified diet for children and
household members. Meat is important source of quality
protein, vitamins and minerals. From vitamins, meat is
rich in B-vitamins including thiamin, riboflavin, niacin,
biotin, vitamins B6 and B12, pantothenic acid and
folacin. Livers is good source of folic acid and Vitamin
A. Meat is also important source of iron copper, zinc and
manganese. Figure3.4: Meat

IV. Fishery
Fishery plays an important role in nutrition security and
food security. Fish is good source of proteins, healthy fats,
omega-3 fatty acids, iodine, vitamin D, and calcium. Fatty
fishes are rich in omega 3 fatty acid and small fishes can
be eaten contributing for good nutrition. Consumption of
fish is important to prevent iodine deficiency and
occurrence of goitre. Figure 3.5 : Fish

35
 Summary

• Staples, vegetable, fruits, Legumes and nuts and oil seeds are the major crop-based
food source.
• Fruits and vegetables are highly nutritious, and their consumption needs to be
increased.
• Animal source food are highly bioavailable and contribute for better nutrition.
• Small amounts of ASF added to plant-based foods substantially increase nutrient density.

Assessment questions:

1. What is the basic difference between animal and plant source protein?

2. Mention at least three crops used for protein source?

36
Chapter 4: Nutrition Sensitive Intervention
Approaches for Improved Nutrition

37
Introduction
Nutrition sensitive agriculture in the food systems requires action to address input quality,
production, productivity, post-harvest handling, processing, marketing and consumption to deliver
safe and nutritious foods all year round. This contributes to improved nutrition outcomes through
diversified, safe and nutrient-rich food production and income generation. It also improves access
to health service, maternal and child care, education, sanitation, labor-saving technologies and
women empowerment activities. This chapter addresses the major nutrition sensitive agriculture
interventions which improve nutritional status of the community.

The Main Objective:

At the end of this chapter the trainees will be able to apply nutrition sensitive intervention
modalities for improved food and nutrition security.

Learning objectives
At the end of the chapter the trainees will be able to
• Identify the diversified food production system and consumption to improve
nutritional status of the community
• Describe the importance of biodiversity for nutrition
• Describe the importance of bio-fortification on the role of improving nutrition
• Describe the importance of food handling, storage and processing to improve
nutrition
• Describe the effect of good agricultural practice and food safety for nutrition
• Describe the importance of value chain for nutrition
• Discuss Women’s empowerment and gender equality for nutrition
• Discus how improved agricultural income improves nutrition
• Describe the role of market linkages for improved dietary diversification
• Describe the role of Nutrition education and behavior change communication
to improve nutrition
•

38
4.1 Diversified food production and consumption to improve nutrition
Diversification of food production improves the availability, affordability, stability and to
consumption of diverse foods and to promote healthy, nutritional and sustainable diets for all. In
areas where commercialization or specialization is recommended, farmers should be advised to
diversify their production system through:
I. Integrated farming systems: is the practice of producing multiple agricultural products
from different farm enterprises that share available resources. The system integrates
different crop production, crop and animal production like agro-silvipastoral systems,
legume-based cropping systems including crop rotation and intercropping. These systems
improve food security, dietary diversity and nutritional security.

Figure 4.1: Integrated farming

II. Home gardening with emphasis on

nutrient-dense varieties of livestock,
vegetables and fruit trees and small-scale
integrated farming systems (e.g. mixed
crop-livestock aquaculture systems) to
improve diet quality and raise levels of
nutrition for producing households.

Figure 4.2: Homestead gardenining

39
 III. Livestock ownership (e.g. cattle, chicken
and other poultry, small ruminants such as
goats and sheep) can contribute to dietary
diversity and nutritional outcomes through
home consumption and income generation,
especially if accompanied with nutrition
education aimed at promoting consumption of
ASFs including for complementary feeding.

Figure 4.3: Rearing Small livestock

IV. Complementary activities such as beekeeping, mushroom and high-value crop farming,
milk production, and maintaining fish ponds may also be included in these strategies to
enhance income and livelihoods.

Figure 4.4: Complementary activities for improved household income

4.2 Biodiversity for food and nutrition

Biodiversity plays key role in ensuring dietary diversity and assuring nutrient adequacy. Globally,
there is a huge loss of biodiversity due to environmental degradation, industrialization and
urbanization. Protecting biodiversity and prioritizing genetic resources to develop new nutrient-
dense, pest-resistant, climate-smart varieties is key to combat malnutrition. Agriculture
development programs need to consider biodiversity protection and utilization for improved food
and nutrition security.

40
4.3 Bio-fortification for improved nutrition
Bio-fortification consists in developing new varieties of staple crops with the explicit intent of
enhancing levels of micronutrients. Bio-fortification is most commonly accomplished using
conventional plant breeding and agronomic bio-fortification (i.e. application of micronutrient-rich
fertilizers via soil or leaves). Various animal source foods such as meat, milk and eggs have been
fortified through fortification of animal feeds.

Fig: Bio fortified Crops

Figure 4.5: Quality protein maize and Orange fleshed sweet potato

Types of Examples of crops fortified with different nutrients

nutrients

Vitamin A Cassava, maize, orange-fleshed sweet potatoes, golden rice

Zinc Rice, wheat, beans, sweet potatoes, maize

Iron Beans, pearl millet, rice, sweet potatoes, cassava, legumes

Protein Maize, sorghum, Cassava

4.4 Good Agricultural practice (GAP) and food safety for nutrition
Good Agricultural Practices (GAP) are practices that address environmental, economic and social
sustainability for on-farm processes and result in safe and quality food and non-food agricultural

41
products. Food safety refers to the assurance that food will not cause harm to the consumer when
it is prepared and/or eaten according to its intended use.
Food safety is defined as a suitable product which when consumed orally either by a human or an
animal does not cause health risk to consumer. There are three potential sources of health risks
caused by food:
I. Chemicals – Improperly stored, handled, or used chemicals can be a source of
contamination. Examples of chemicals used in food production include: fertilizers,
sanitizers, synthetic and non-synthetic pesticides/herbicides/fungicides, equipment
lubricants, cleaning agents, etc.

Exposure to higher levels of aflatoxin which is produced by aspergillus fungus increases risk
for cancer and neural tube defects in children. Aflatoxin can be produced both in preharvest
and post-harvest time. Corn, nuts such as peanuts, oil seeds such as cottonseed, as well as
copra, the dried meat of coconut, are some of the commodities with greater risk of aflatoxin
contamination. Pulses and sorghum have lower risk. Animal feeds, such as hay and straw,
might be contaminated during pre-harvest or drying stages resulting in aflatoxin
contaminated animal products.

II. Physical – Examples include screws, glass, hair, staples, wood, jewelry, insects, etc.

III. Microbial (biological) –Thousands of microbes (organisms too small to see with the naked
eye, e.g., bacteria, viruses, parasite) are naturally present in our everyday environment.
They can be found all around us in the soil, the air, on our skin, in our water, etc. Microbes
that cause illnesses are known as pathogens. Illnesses can range from mild cases of
diarrhea/vomiting to life-threatening cases involving hospitalization and in some cases
death. Examples include viruses, bacteria, parasites, and fungi. Fresh animal-source food,
vegetables and fruits are at highly exposed to food safety hazard. Produce that is not cooked
(raw) is therefore considered to have higher risk for pathogens than those fruits and
vegetables that are cooked. Children, and pregnant are at greater risk to be affected by this
problem

42
Figure 4.6: Four Pillars of good agricultural practices (GAP)

GAP focuses on the best practices to be used for producing agricultural products to ensure the
quality and safety of the final product.

Food quality and safety standards are systematic preventive approaches to food safety that aim to
protect public health and improve accessibility of nutritious and safe foods. Risks related to food
safety and hygiene can be controlled at various points of the supply chain through:
✓ Promote proper application, frequency and amount of agricultural inputs
✓ Promote integrated pest management;

4.5 Food handling practice for improved nutrition

Food handling includes all the steps from farm to plate that harvested plant and animal produces
passes through the supply chain. Food loss can include loss in nutritional value, economic value
and/or food safety. Food loss can take place at primary production level and at post-harvest
(handling and storage), processing, distribution and consumption stages in the agricultural,
livestock, fisheries or forestry food supply chains.

Causes of food loss and waste are context-specific and may relate to gaps in capacity of the food
supply chain actors, inadequate storage facilities and food packaging, lack of access to markets
and consumer behavior.

43
 The following handling practices improve nutritional contribution of different food products:

✓ Crops must be harvested at an appropriate stage of maturity

✓ Good post-harvest handling, supported by appropriate transport and logistical operations,

including efficient, is critical to maintaining the quality of food as it moves from the
producer to the fresh produce market

✓ Promote on techniques to optimize the shelf-life and nutritional quality of foods

processing techniques like soaking, malting, sprouting, and fermentation of grains
and pulses can enhance their vitamin, mineral and protein content and
bioavailability

✓ Promote appropriate cooking techniques (avoid overcooking, over drying, and prolonged
sun exposure to retain nutrient content of the produce)

4.6 Women empowerment for nutrition

Women empowerment are at the nexus of the agriculture, nutrition and health sectors. Research
shows that resources and income that women control have positive impacts on nutrition because
they are more likely to be directed towards food, education, health and care.

Women empowerment for nutrition can be addressed through:

• Ensuring access to productive resources (land, agricultural inputs, extension

services for female headed, trainings…)
• Introduction of time and labor-saving farming technologies
• Male involvement in household care practice
• Women involvement in the house hold budgeting and income

Refer Chapter 6 for detailed information on gender and nutrition.

44
4.7 Income generation for improved nutrition
Regular and decent incomes for consumers is essential to achieve good nutrition. It allows
purchase of healthy foods, access to health care and education services. Increase in household
income does not necessarily relate to improved nutrition. Factors such as information on nutrition,
intra-household income distribution, joint house hold decision making on income, household food
preferences and other determinants affect the contribution of income on nutrition. With increasing
specialization of agriculture and food systems, income becomes more important for diversifying
household diet.

Income generating opportunities:

➢ Value addition practice (fruits, vegetables,
roots, etc. processing)
➢ Caged poultry production
➢ Seed and seedling multiplication
➢ Off farm activities (wage labor, pottery,
petty trade…)
➢ Fattening and dairy farming practice
➢ Horticulture and spices
➢ Bee keeping
➢ Fishery/aquaculture Figure 4.7: Vegetables production for income

4.8 Agricultural market linkages for improved nutrition

Marketing helps to balance food deficits and surpluses across countries, facilitating the availability
of food and contributing to price stability. In the context of urbanization and increased market
reliance, looking at trade through a nutrition lens is becoming important to maximize nutritional
benefits.

Therefore, to promote and sustainably increase availability, and affordability of diversified

nutritious foods for household consumption to improve nutrition, it is important that DAs:
• Facilitate farmers’ access to market information.
• Create market linkages for agricultural products
• Enhance the purchasing power of low-income groups through income generation
• Facilitate access to fresh foods for consumers, safe packaging and transportation of
perishable food items

45
 • Promoting the nutrient dense food in local market

4.9 Nutrition-sensitive social protection

Safety nets and social protection schemes can play an important role in improving nutrition and
addressing the social and economic determinants of malnutrition. The acute and long-term
negative effects of shocks can be reduced if social protection systems already in place can be
expanded and adapted in a timely manner. Every social protection program provide specific entry
points for increasing their impact on nutritional outcomes.

Social protection helps families to access nutritious food, while helping to develop their productive
asset base which is critical for sustaining good nutrition in the long term and facilitating access to
health care and services through:
• Social assistance schemes designed to support the nutrition of vulnerable groups. Food
transfers in kind can be maximized by adding nutrition education component, and by
ensuring high nutritional quality of food baskets. This can include provision of nutrient-
rich foods (e.g. animal-source foods, fruits and vegetables), fortified flours and bio-
fortified staples.
• Social assistance schemes designed to support transfers of productive assets, which can
integrate provision of “nutritionally interesting” assets such as dairy cows, small ruminants,
poultry, fish or nutrient-rich seeds (i.e. fruits and vegetables).
• Promoting local procurement for social assistance programs, such as for school meals or
food distribution, can improve nutrition for both consumers and poor producers.
• Social insurance schemes, including health insurance, targeted weather-based insurance
for crops and livestock, maternity protection and employment insurance also contribute to
protecting basic pro-nutrition assets against shocks and crises.
• Promoting Self-help saving groups

4.10 Nutrition education and behavior change communication

Nutrition education and behavior change communication to community can be delivered using
multiple SBC approaches is more effective than just using one. The more frequently and
consistently individuals practice the desired behaviors, the higher the outcome of behavior change.
Therefore, the more frequently the DAs contact and visit farmers and their families, the more likely

46
they will find instances of behavior change in their locality. To realize the SBC, the following
points should be addressed:
• Conduct appropriate knowledge, attitude and practice gap assessment.
• Conduct selection of relevant target groups, determinants and activities
• Promoting of appropriate SBC interventions to overcome barriers of behavioral change
• Implement relevant and appropriate behavioral change principles and approaches.

Detail information on Nutrition education and behavior change communication is presented on

chapter 7.

Summary
• Nutrition sensitive agriculture intervention approaches need to be implemented
synergistically for improved nutrition outcome and
• Making agriculture and food systems nutrition-sensitive necessitates action to address
input quality, production, post-harvest handling, processing, retailing and consumption, to
deliver safe and nutritious foods all year round to the consumer
• Nutrition-sensitive agriculture and food systems contribute to reduce malnutrition through
production of diverse, safe and nutrient-rich food, application of labor-saving technologies
and income generation.
• Effective market linkage plays important role in sustainably providing nutrient-rich food to the
consumers
• Use of effective preservation, processing and storage techniques contribute to ensure for
improved nutrition.
•

Assessment Questions
1. How does diversified crop production contribute to improved nutrition of the farming
community?
2. What are the possible intervention approaches to diversify crop production?
3. What are the possible consequences of crop specialization on nutrition given the current

47
 cluster-based approach of the agriculture sector?
a. What are the positive consequences?
b. What are the negative consequences?
c. What are the mechanisms to mitigate to the negative consequences of crop
specialization?
4. Discus the effect of pre-post-harvest management techniques on nutrient content of a
food/crop
5. How does management of natural resource contribute for dietary diversification and
improvement of household nutrition?
6. How does market affect dietary diversification and nutrition?

48
Chapter 5: Water, Sanitation and Hygiene (WASH) and
Nutrition

49
Introduction
Water, Sanitation, and Hygiene (WASH) refers to water, sanitation, and hygiene facilities and
services. Improved sanitation facilities are those that ensure hygienic separation of human feces
from human contact. This includes Pit (VIP) latrine, flush/pour flush connected to sewer system,
or septic tanks; Ventilated Improved; pit latrine with slab; and composting toilet. The water
component of WASH refers to household access to safe, pure, and adequate amount of water for
drinking, sanitation, hygiene and small-scale irrigation purposes. The sanitation component refers
to access to facilities and services to keep living environmental clean and safe for optimal health
and nutrition outcome. The hygiene component refers to personal hygienic practice mainly proper
hand washing.

Figure 5.1: Potable water

Rural communities in Ethiopia have poor access to WASH facilities and services. They have also
limited knowledge about personal hygiene and environmental sanitation. Access to safe water,
good sanitary condition, and hygienic practices are essential for safe preparation, handling, and
storage of food, which is important to reduce the risk of food contamination, spoilage, and resulting
in food borne illnesses. This section explains the basic WASH practices important for improved
nutrition.

50
 Main Objective
At the end of this chapter, trainees will be able to discuss WASH practices to improve
nutrition at individual and household level.

Learning objectives
▪ Explain the effect of WASH on Nutrition
▪ Discuss WASH practices that help to improve nutrition
▪ Explain the importance and effect of small irrigation practices on nutrition

5.1 The Effect of WASH on Nutrition

Water, Sanitation, and hygiene (WASH) and nutrition are closely related. Good WASH practices
contribute for good nutrition by reducing contamination and disease burdens at individual,
household, and community level. Lack of access to WASH facilities and services can affect nutritional
status, particularly child nutrition, in many ways. WASH affects nutrition through three direct pathways.
These three pathways are described below.

I. Through Diarrheal Disease: Poor access to WASH facilities and practices leads to increased
onset of diarrhea. Access to
improved WASH facilities
and services could prevent
58% of the total deaths due to
diarrhea in children under
five years of age. Washing
hand with soap alone can
reduce the risk of diarrhea by
up to 40 %.

Figure 5.2: Dearrehoe, open defication

51
 II. Through Intestinal Parasitic Infections:
Soil-transmitted helminths infections are
directly caused by poor hygiene and
environmental sanitary condition. Soil-
transmitted helminths infections can affect
nutritional status by causing loss of appetite,
mal-absorption of nutrients, and increased loss of blood. Figure 5.3: Hook worms

Figure 5.4(Below): Children eating on the floor where animals roam

III. Environmental Enteropathy: Refers
to the condition when an unhygienic
environment affects the normal
function of the gut (food digestion and
absorption). Pathogens that enter
gastro-intestinal tracts can impair
nutritional status even in the absence of
symptoms such as diarrhea. Children
living in poor sanitary conditions are exposed to a high load of pathogens, especially
between six months and two years of age, when they start crawling on the floor and putting
objects into their mouths. Continuous infection with these pathogens causes recurring
inflammation and damage to the gut, leading mal-absorption of nutrients from gut.

Figure 5.3: WASH-Nutrition linkage

52
5.2 Basic WASH Practices that Improve Nutrition
WASH and Nutrition are closely related, mainly through disease transmission pathways. To
improve the nutritional status of the rural community, development agents should promote the key
basic WASH activities listed below, in close collaboration with Health Extension Agents and other
kebele level development workers.

Promote access to safe water source

(piped, treated, controlled
spring/wells,) in the premises of the
household
Promote access to, and use Improved
or Shared sanitation facilities.

Mobilize the community to create an

open defecation free village.
Figure 5.4: Washing hand after using Toilet.
Promote proper hand washing (washing with soap or ash) at all times: before preparing food,
eating or feeding a child, washing babies; milking a cow; and after toilet, cleaning a child’s
waste, adding fertilizers/compost, herbicides, pesticides, farming and spraying equipment.

Promote Safe food handling practices for a safer food

➢ Keep a clean environment for handling food (including hand washing, cleaning food
contact surfaces and utensils, protecting food preparation areas from insects, pests and
other animals)
➢ Keep separately the raw and cooked
foods
➢ Cook food properly (do not
over/under cook food to maintain
nutrients and to keep its safety)
➢ Reheat sufficiently before eating food
which was already cooked to kill
microbes
Figure 5.5: Hand Washing

53
➢ Store food at safe temperature – place unconsumed cooked food in cold place
➢ Use safe water and raw material for food preparation
➢ Milk, fruits and vegetables need to be kept away from direct sunlight

Promote and support key WASH activities related to agricultural production

➢ Water resources need to be kept away free from direct animal contacts.
➢ Avoid rainwater runoff from getting directly to water reservoirs or construct settling pond
to filter off contaminating dirt.
➢ Keep livestock away from the active recharge area for well water that will be used for
household and irrigation.
➢ Keep pesticides and chemicals away during storage, preparation, use or disposal
from the active recharge area for well water and drainage area that will be used for
household or irrigation.
➢ Use filter when possible or settling ponds to improve water quality.
➢ Use potable or filtered water for making up chemical pest management sprays.
➢ Wash harvest and storage equipment with clean water and dry before use
➢ Keep containers off the ground before, during and after harvesting
➢ Remove visible dirt and debris from fruits and vegetables in the field
➢ Limit access of animals, children and other non-workers to the harvest and storage areas
➢ Protect irrigation ponds. To reduce the risk of microbial contamination of irrigation
ponds do not allow livestock access.
➢ Keep harvesting equipment which comes in contact with fruit, clean and in good
condition.
➢ Protect light bulbs and glass on harvesting equipment to avoid contamination of fruit or
fields in case of breakage.

54
5.3 Effect of Small Irrigation Practices on Household Nutrition
Access to water is one of the
key constraints of diversified
foods production in Ethiopia.
Homestead farm production is
limited mainly due to lack of
access to water in rural
communities to practice
homestead gardening.
Development agents should
identify means, promote and
support access to water for
year-round homestead
production. Figure 5.6: Small scale irrigation

Some of the mean to increase access to water for homestead foods production are described
below.

I. Small Scale Irrigation: Water from rivers can be diverted and accessed to households
in both individual and communal water use modalities.

II. Community Ponds: Community pond structures can be constructed to harvest water
during the rainy season and increase access of water in the dry season.

III. Rain water harvest: Rainwater harvested during the rainy season to cultivate fruits and
vegetables in the non-rainy season.

IV. Practicing Re-Use of Waste Water: Water used in the household for different purposes can be
stored, treated and re-used for different purposes such as for home grading.

55
 Summary

Good WASH practices are essential to prevent food borne diseases and improve nutrition. Use of
improved latrines to avoid open defecation prevents human waste from running off from fields and
contaminating water sources. Proper hand washing prevents contamination of foods. Good
sanitation reduces diarrhea and some intestinal parasites/worms that have severe impacts on the
nutritional status and growth of children.

Agriculture is a major user of water and can damage the quality and availability of water when not
properly managed. Keeping water sources clean and safe from practices that have negative impact
need to be known and avoided. On the other hand, proper use of water resources needs to be designed
both for human as well as agricultural purpose. Development agents should clearly understand and
promote the basic WASH practices among the farmer households to improve the health, nutrition,
and wellbeing of the communities.

Self-Assessment Questions
1. What are the pathways that WASH practices will affect nutrition?

2. What are the key WASH practices that help to improve nutrition?

56
Chapter 6: Gender and nutrition

57
Introduction
Gender refers the relationship between women and men. It has been described in the NNP that
gender inequality is the cause and consequence of hunger and malnutrition. Gender inequality is
associated with higher levels of acute and chronic under-nutrition. The nutritional benefits of
increased incomes are determined by who controls the income and how it is distributed within
households. Women typically spend a higher proportion of their income on food and health care
for children than men.

Accordingly, World Bank identified (World Bank 2013) empowerment of women to be among the
best approach to affect nutrition through agriculture. So, women must be at the center of nutrition
related interventions both in the rural and urban settings.

Main objectives
At the end of the section trainees will be able to understand the concept of gender and the
role of women in the family, society and their impact on nutrition outcomes.

Learning objectives
▪ Describe basic concept of gender
▪ Explain the importance of women’s empowerment to improve household nutrition.
▪ Explain the roles of women and men in nutrition sensitive agriculture.

6.1 Basic concept of gender

Gender and sex are not the same. Sex refers to the biological attributes of men and women; these
attributes are universal and cannot be changed. Gender refers to social, behavioral and culturally
specific characteristics defining the behavior of women and men, boys and girls, and the
relationship between them.

Gender roles, status and relations vary from place to place (countries, regions, and villages), groups
(class, ethnicity, religion, etc…), generations and stages of the life cycle of individuals. Gender is,
thus, not about woman or man but about the relationship between them.

Gender equality means when women and men enjoy equal rights, opportunities and entitlements
in civil and political life. It means that women and men, girls and boys benefit equal opportunities,

58
resources, rights and access to goods and services. It also means equal responsibilities in sharing
workloads and energy expended in caring for families and communities. Figure 6.1: Income
generating activities(seedling production).

Promoting gender equality in economic

activities and resource allocation has
significant impact on the implementation of
nutrition programs considering the social,
economic and biological differences between
men and women and addressing barriers to
improved nutrition. Gender roles are the roles both women and men are expected to fulfill in a
society as defined by the virtue of being female or male. Men and women get information about
their role and division of labor from family, schools, media and society at large.

Gender mainstreaming is an approach for achieving gender equality involving and ensuring that
gender perspectives and gender equality are central to policy development, research, advocacy,
dialogue, legislation, resource allocation, planning, implementation and monitoring of programs
and projects.

6.2 Importance of women’s empowerment to improve family nutrition

Women’s access to productive assets such as land, formal
credit, capital, inputs and extension services is
constrained. Their decision-making power on incomes
and household expenditures are limited. They still
contribute significantly to produce the subsistence mixed
agriculture along with their male counterparts and play a
greater role in the management of the household.
Figure 6.2: Model farmer

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 There are key issues regarding gender that need to be considered in agriculture and nutrition
and these are
✓ equal access to land and other resources such as credit and other support services,
✓ the disparity of gender differences in roles be well addressed,
✓ gender and agriculture extension services to be equally provided to both women and
men and
✓ women’s empowerment and equal access to household decision making and ensuring
intra household food distribution

6.3 The role of women and men in nutrition sensitive agriculture

Improving women’s access to agriculture or livelihoods inputs and services has the potential to
reduce under-nutrition in children. One reason is that money controlled by women is more likely
to be spent on household including nutrition and health care for the children and the family.

The time spent on agricultural activities during the different agricultural seasons, may have
variable effects on maternal nutrition status and on the child nutrition. Efforts to boost agricultural
productivity must, therefore, consider the impacts of time use and physical demands–especially of
female’s time spent on agricultural activities. Therefore, it is important that women have access to
infrastructure, time and labor-saving technologies to decrease their workload. Men need to support
women to generate additional income to spend on nutrition or health care, and to help with
childcare practices. Pregnant or lactating women need enough time and physical rest. Women may
be over burdened with triple roles and the
probability that they face time-related
constraints in providing adequate care for
the children and betterment of the
household. Therefore, fathers need to
engage in household activities normally
handled by mothers so that mothers have
enough time to take good care of their
children and themselves. Figure 6.3: Mother caring her child on the field

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DAs are advised to closely work with HEW on maternal and child feeding and caring practices in
the farming community. DAs and HEW need to understand the role of women and men in the
society and help build an understanding to have a positive impact on the welfare of women
themselves, small children, family and the community at large. This entails a well-coordinated and
continuous engagement with the community, elders and religious leaders through sensitization and
realization of the impacts and benefits of balanced gender role.

Summary of the chapter

✓ Gender is the relationship between men and women and the role they play in a society.
✓ Balanced role in economic, agriculture and labor of both men and women play a
positive impact in the wellness of a family.
✓ Nutritional condition of a family can be improved through balancing responsibility and
giving ample time and support to women to take care of themselves and young children
✓ Both DAs and HEW need to identify, plan, implement and monitor interventions in
relation to gender and nutrition in their respective Kebeles

Self-assessment questions
1. Why do you think we need to address gender inequality issues to achieve positive nutrition?
2. What are the roles and responsibilities of DAs to promote gender equality within the context
of nutrition sensitive agriculture?
3. Why are women affected more by nutritional deficiencies in the current context?
4. What needs to be done to address the nutritional challenges of communities in general and that
of women in particular?

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Chapter 7: Agriculture-Nutrition Social Behavior
Change

62
Introduction
Social Behaviour Change Communication (SBCC) has been accepted as a major component of
public health and agriculture programs. It plays a critical role in addressing nutrition-specific and
nutrition-sensitive interventions. SBCC interventions related to agriculture and nutrition aims to
reach families and communities engaged in agriculture activities to improve nutrition practices at
the community and household level.

Main Objective
At the end of this session trainees will be able to apply behavior change approaches and skills
on implementation of nutrition-sensitive agriculture in the community.

Learning objectives

• Explain social and behavior change communication.

• Identify target groups, determinants and activities for SBC
• Explain common barriers of NSA for behavior change
• Explain techniques of adult learning principles

7.1 Social and Behavior Change

Social and Behavior Change (SBC) is the systematic application of interactive, theory based and
research driven communication. The SBC process uses strategies to address change at the
individual, community and the large societal level. In the past, it was believed that providing
pertinent information about agriculture issue to a farmer was considered adequate. For example,
telling a farmer “use beans with high iron and zinc content” may inform the farmer, but it is
difficult to determine whether the farmer acted on the information or not. Although giving
information is still significant, it doesn’t bring about behaviour change. In current days with the
advancement of behavioural sciences, the following points have become clear about behaviour
change. The following sections define behaviour and indicate components related to social and
behaviour change

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 Behaviour: refers to actions or response of an individual or group to the environment, the
actions of another person, or other stimuli. The behaviour should be very specific, measurable
and observable.

Example of behaviour change observed in households:

Before Expected Change:

1. Growing one kind of crops 1. Farmers growing cereal grains intercrop with
2. Chickens were not control in cages legumes.
3. Backyard gardening was not 2. Women who own chickens keep them
dedicated for children food
enclosed in cages always.
diversity
3. Parents (mothers and fathers) with children
4. Bio-fortified crops were not well
practiced under five-year olds plant home vegetable
gardens.
4. Farmers adapted bio-fortified crops (Orange
Flash Sweet Potato, Quality Protein Maize,
Iron Rich Beans, etc.)

Note: A behaviour is often referred to as a “Practice” and when behaviours or practices are
done often they become a habit. Thus, deep-rooted habits whether in agricultural production,
or food consumption determines how crops are produced, harvested, stored, prepared and used
for household consumption.

7.2 Stages of Behavior Change

Behavior change takes place involving series of steps and requires strategic communication to help
people to change or maintain desired behaviors. The BCC process includes identifying,
understanding, and segmenting audiences and providing them with relevant information. The
following pictorial slide highlights the five stages of behavior change.

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Figure7.1: Stages of behavioral change

7.3 Barriers to behavior change

Barriers for behavior change refer to obstacles that people face that prevents them from practicing
a desired behavior. These barriers can be a feeling of personal risk in trying a behavior (i.e fear of
caged poultry farming, fear of bio-fortified crops production), or lack of financial resources to
accomplish an action. These affect the willingness of people to change their behavior. The
following are nutrition sensitive agriculture barriers related for behavior change.
• Lack of clear and consistent information about how to diversify agricultural products for
household consumption.
• Perception gap (preparing a variety of foods daily is expensive and time-consuming)
• Lack of time and labor-saving technologies for the women to care and cook nutritious foods
for children
• Market access to diversified foods (distance and transportation)
• Lack of women decision-making power to influence household nutritious food consumption
(produce, buy etc).
• Poor access to WASH
• Lack of farming activities that provide all nutrient-dense foods for the family year-round

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 • Cultural barriers such as fasting, food taboos, and low priority to children and women family
food share.

7.4 Knowledge, Attitude and Practice Gap in behavioral change

The missing link or the disconnect between what people know, believe and think and what they
practice is widely known as the Knowledge, Attitude and Practice (KAP) gap. The terminologies
below need to be considered in working with individuals or groups through SBC approaches.
• Knowledge: is a familiarity, awareness, or understanding of someone or something, such as
facts, information, descriptions, or skills, which is acquired through experience or education
by perceiving, discovering, or learning.
• Attitude: An attitude can be as a positive or negative evaluation of people, objects, events,
activities, and ideas.
• Practice: a method of learning by doing and repetition to achieve skill

7.5 Target Groups, Determinants and Activities

Development work aimed at improving the lives of people through improved agriculture, nutrition
or other area involves several aspects. The food and nutrition security situations as well as the
needs of people vary influenced by several factors (consummation pattern, socio economic factors,
existing experience, etc.). It is important to know who we are targeting for behaviour change and
why. The following components are to select target groups, determinants and activities are:

• Targets Groups: are groups that refer to the groups of people that we are encouraging to adopt
the behaviour. Priority target groups are found within our target communities (i.e. lactating
and pregnant women and children under 5 years).

• Influencing Groups: is the group that the priority group identifies as having the most influence
regarding the priority group’s adoption of the behaviour. Usually there are one or two
influencing groups. To know who our influencing group are we must conduct quick assessment
on our priority groups such, with religious leaders related to faith based fasting, or other
community leaders.
• Determinants: Determinants represent a person’s livelihood, feelings, beliefs or other
elements with his or her environment that can support him or her from doing behaviour.

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 (e.g. of determinates: lack of access to nutrient dense inputs, lack of materials to build fence
for poultry, lack of eggs to feed children daily). It is important to learn which of these
determinants are the most influential by intervening members of the priority groups.
• Bridges to Activities: are more specific descriptions of what one should do to address the
issue identified by research on determinants. It usually begins with a directional verb (e.g.
Increase access to nutrient dense inputs, decrease post-harvest loss, improve egg feeding to the
children daily) and often proposes to change the perception of the priority group. Note this is
not expressed in percentages.
• Activities: Activities are tasks that program implementers plan, organize or conduct usually
with the priority groups or influencing groups in order to address the bridge to activities.
Activities start with an action verb (e.g: offer a loan to farmer to produce quality and affordable
chicken feed, etc.,)

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 Source: Adapted from Food Security and Nutrition Network Social and Behavior Change Task Force 2013. Designating for Behavior
Change for Agriculture, Natural Resource Management, Health and Nutrition. Washington DC: Technical and Operational
Performance Support (TOPS) Program.
Example showing link between behavior, target groups, determinants and activities: Poultry Management
Behavior Priority Group or Influencing Determinants Bridges to Activities Activities
Groups
Targeted adult men Demo: Adult men and women Negative Consequences: 1. Reduce the perception 1. Create demonstration site at
and women who raise from families who raise chickens. • chickens will stop laying that chickens will stop FTCs
chickens keep them all have children Under 2 yr. or • it will be more effort and laying eggs if they are 2. Communities observe the
enclosed (penned up) a pregnant or lactating woman at more expensive to give penned up. survival of penned chickens
at all times. program start-up. chickens food and water 2. Reduce the perception 3. Provide improved feed, clean
They live in rural villages, Men Positive Consequences: that it takes more water and vaccine.
and women are somewhat • They will not lose effort/expense to care for 4. Train agriculture volunteer
literate; chickens to wild animals penned up chickens. /youth and women groups to
Common Desires: They all want • Less loss due to illness 3. Increase the promote in poultry care (feed,
food security, well-being and • Chickens will not perception that it will be water, vaccine) and construction
education for their children. damage crops and economically beneficial of pens and cages using locally
Current Practices: Chickens gardens to keep chickens penned available materials. Monitor and
wander freely and sleep in trees. • It is easy to vaccinate up. reinforce their ability to transmit
They think chickens will not have them 4. Increase access to skills to others.
enough to eat if they are penned low-cost fencing 5. Provide technical assistance to
• can use manure for
up; they do not know affordable materials and skills for women/youth group to produce
fertilizer
ways to make chicken coops. adapting local materials. and sell quality, affordable
Access:
Stage of Change: awareness chicken feed, and water and feed
• Lack of materials to build
stage. containers made of local or
a fence or cage
recycled materials.
• Cost of chicken feed
Indicator: Indicators:
Percentage of households that raise chickens • Number of successful demonstration sites implemented
and keep them enclosed at all times • Number of families adopting one or more improved poultry care practices
• Number of women/youth group selling chicken feed

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7.6. Behavior Change principles and approaches

Behavior change requires approaches that influence individuals or communities to behave in

ways that will make them productive, safer and healthier. It includes activities that aim to help
people practice behaviors that will positively impact their livelihoods towards economic
wellbeing.

DAs are expected to bring the families /communities to adopt a given practices that can link
nutrition to agriculture. DAs need to build certain skills aimed at bringing behavior change.
This section summarizes SBC principles, approaches, materials and learners’ characteristics to
be considered for effective utilization of SBC principles.

7.6.1 SBC Principles: Social and Behavior Change uses a variety of communication
approaches, including interpersonal communication, community mobilization, mass media and
advocacy. To be effective in bringing behavioral change, the social behavioral change the
following principles need to be considered.

➢ Client-centered: responsive to the challenges farmers/mothers face and what

motivates them
➢ Data-driven: for decisions about priority behaviors and their determinants,
audiences, channels, and placement
➢ Prioritized and sharply focused: on the behaviors with greatest impact on
NSA.
➢ Emotionally appealing to get noticed and motivate change, showing the
behaviors as beneficial, convenient, feasible, and as the “new norms”
➢ Frequently monitored to prompt adjustments

Source: Adapted from the Alive & Thrive

7.6.2 SBC Approaches

This section the different approaches mostly used on Social and Behavior Change. Different
SBC programs and materials can be developed to support the integration of nutrition into
agriculture. The following four SBC program components and which have good results when
used together are presented below.
Interpersonal communication (IPC): is a face to face discussion for example
extension worker with a farmer aimed at deriving behavior change. The process for

69
 developing IPC strategies should be interactive with due consideration of local
situations.

Community mobilization: Community mobilization engages local leaders in

supporting the new agricultural/nutrition practices and the frontline workers’ activities.
Community mobilization can help create new social norms and bring about lasting
behavior change.

Mass media: Mass media for behavior change involves strategic uses of a country’s
available communication channels such as audio or video spots, recorded dramas,
music videos, print advertisements, text messages, and other materials and delivered
through broadcast, out of-home, and digital channels. Mass media is among the
important means to bring about change in social norms.

Advocacy: is the process of influencing higher officials to bring desired change. The
aim is to improve an enabling environment through creating a positive policy and
regularly environment.

Note: Using multiple SBC approaches is more effective than just using one. The more
frequently and consistently individuals practice the desired behaviors, the higher the outcome
of behavior change. Therefore, the more frequently the DAs contact and visit farmers and their
families, the more likely they will find instances of behavior change in their locality.

7.7 Social Behavioral Change communication

Most people are resistant to change and tend to maintain habits formed since childhood. Simply
providing information is ineffective in influencing behaviors. It is important to support DAs
who contact communities for bringing gradual and sustainable change over time. Knowing
your farmer is important when using SBCC tools to change behavior. Identifying what behavior
to change, what kind of actions you want farmers to engage in, the benefits of the proposed
behaviors and which factors influence their behaviors.

7.7.1 The three learning styles

The following three learning styles help the facilitators for his proper
approach and communication with target groups. Many studies show
that the standard leading styles are;

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 1. Visuals: learning by looking the visuals: visuals have a power hock to our emotions
and easily been remembered and is recommended for low literate communities.

2. Auditory: learning by hearing: since our attention span vary

depending on the capacity of the person, learning through hearing
is not that much recommended. It is vividly advised to support
with other styles.

3. Kinesthetic: learning by doing: this is the most preferable way of learning especially
for adults. Since adults have their own
experiences, they like to expand their exposure
and want to test/challenge how new
things/knowledge are practical.

Literatures reveal that in average we retain

• 20% what we have heard (Auditory)
• 40% what we have seen and heard
• More than 80% what we have heard, seen and did (learning by doing)

7.7.2 Suggested Techniques for Participatory Adult Learning

There are different techniques for participatory learning. Selected techniques that are
applicable for promoting NSA through SBC approaches are presented below.

Approach Description and benefit

1. Group discussion This is a good method that can be used to address several issues at one
time by assigning a different topic to each group on specific issues. DAs
can use the FTC or other facilities to transfer agricultural skills to ensure
farmers produce and consume nutrient-dense vegetables, fruits and animal
source foods. These food production trainings can include demonstrations
and hands-on skills on how to raise livestock and poultry, homestead
gardening, and fishing, where appropriate.
During group discussion
✓ Plan on how to use this methodology based on the based-on
leanings from earlier sessions.
✓ Develop clear and focused discussion questions from each group
✓ Let each group clearly understand its assignment
✓ Encourage and motive participants to stay focused
✓ Let representative present and facilitator summarizes.

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 Example: Group Discussion Questions
Group 1: Discus on Why is mixing diverse crops (intercropping) or use of animal source foods important for
nutrition?

Group 2: Identify possible reasons why farmers do not produce diverse crops /livestock’s and suggest
4recommendations to be considered from Regional to kebele level.
Group 3: What is the education situation of young girls and boys in communities, do girls continue their schools
like boys, if not identify the reasons and possible recommendations to promote girl’s education in their communities.
Group 4: Identify practical activities DAs and HEWs can do jointly to transfer NSA skills to ensure
farmers produce and consume nutrient-dense crops and animal source foods.
2. Role plays Role plays are essential to simulate a farming community that participants might
face in their work and to practice how they should handle those situations. It can
be used to develop skills and give feedback on improvement of their skills.
During role plays:
✓ Local scenarios could be used in role plays so that the participants
could act according to the given farming community scenarios.
✓ Provide information on how the farmers are to proceed and what is
expected from each participating farmer during the role play.
✓ The other participants and the facilitator should observe and give
constructive feedback.
✓ Prepare some key points to be discussed after the role play to facilitate
constructive feedback.
3. Inter-Personal IPC is a technique which is conducted face to face with one person for example
Communication with a farmer, mother during home/farm level /FTC visits. When conducting
(IPC) home visits, DAs should give priority and focus on families with young and
small children and women to ensure that parents are feeding their children with
nutrient-dense foods. This will ensure that women have access to the family
income to enable them to purchase additional nutrient-rich foods that the family
may not grow or raise. Balancing gender roles is also important so that both men
and women are responsible for food and nutrition security.
When you use IPC:
✓ Greet, ask, listen agriculture/nutrition related situation of the
family/balancing gender roles, etc
✓ Identify: difficulties identified, priorities determined;
✓ Discuss, recommend, agree on workable actions,
✓ Make appointment stressing suggested options/proposals to
farmer/mother/alternatives.
Note: all counseling materials need to be audience tested and focused on
behavior change

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• Use Negotiation: - is a process during which the person promoting the desired behavior
and the community member discuss the nutrition related issue; and the community member
agrees to try one or more specific behaviors, during an agreed time frame.
• Successful persuasion/negotiation is an important tool in behavior change communication.
DAs can use negotiation to convince farmers and their families to adopt nutrition sensitive
agriculture practices.
• When using negotiation with farmers, DAs must use credible and evidence-based nutrition
sensitive agricultural tools. The negotiation requires careful attention and should focus on
the communities’ needs and demands, and should address the different barriers, so they
can change their attitudes and practice positive behaviors.
• When negotiating individuals, DAs need to encourage farmers and their families to
participate and practice nutrition sensitive agriculture activities, until they feel they have
acquired the desired skills to adopt the behavior.

Summary
• SBC is important to ensure that people adopt a desired behavior on NSA practices.
• For effective SBCC and smooth leaning environment, it is advised to consider the following
common adult learning principles:
• Respect: facilitator actions show respect for the experience and knowledge adult bring
and observed and felt by the learners.
• Immediacy: how soon can the learners use the event in their own setting?
• Relevance: Learners will learn faster and more permanently that is significant to them
and to their present lives.
• Safety: People need feel safe and challenged in smooth way, hold/balance the opposites.
• Engagement: people learn more when they are actively involved; doing what they are
learning.
• Inclusion: With inclusion, a learner is moved to openly collaborate to learning. Without
inclusion, a learning group is fragmented.

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Self-Assessment Questions

1. What are the stages of behavioral change?

2. What are the principles of SBC approaches?

3. Discus the social behavioral learning styles

4. What are the common behavioral change barriers?

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Chapter 8. Multi-Sectoral Coordination for Nutrition

75
Introduction
Coordination is one strategic objective focusing on multi-sectoral coordination and linkages
for nutrition. The purpose is to enhance the nutritional impact at a grass root level by concerted
action of various sectors. Evidence indicates that the factors that hinder progress in improving
nutrition are multi-faceted and multi-sectoral. Therefore, these need to be counteracted by
equally powerful, multi-sectoral, multi-stakeholder forces that combine nutrition-specific,
nutrition-sensitive and environment enabling actions at all levels across sectors in a coordinated
manner.

Objective
The main objective of this chapter is to train DAs on multi-sectoral coordination and
enable them to play roles in coordinating implementation of the NSA strategy at
kebele levels.

Learning objectives
1. Explain the multi-sectoral nature of nutrition
2. Describe the importance of coordination at various administrative levels in
the implementation of the National Nutrition Program (NNP)
3. Mention the roles and responsibilities of various sectors for nutrition in
NNP-II
4. Identify the roles and responsibilities of agriculture and livestock sectors in
implementation of NSA
5. Describe the role of DAs in planning, implementing and evaluating the NSA
interventions in collaboration with HEW and other stakeholders at kebele
level

8.1. Multi-sectoral Nature of Nutrition

Nutrition has a multi-dimension and multi-sectoral nature in terms of both effect and outcome.
The multi-sectoral nature of nutrition requires individual, institutional and system-level
capacities to operationalize effective interventions through collaborative engagement across

76
sectors and stakeholders. Furthermore, effective implementation requires coherence both
vertically (within sectors and stakeholder institutions) and horizontally (across sectors and
stakeholders).

The multi-sectoral signatory actors integrate into the food system for sustainable development
It is important to understand the nutrition sensitive value chain that addresses the conventional
value chain in a nutrition lens from the “demand and supply” sides (nutrient content and
increasing demand for nutrient dense produce) in addition to the “value addition” component
(decrease loss/waste of nutrients and foods) in nutrition-sensitive food system.

Agriculture is nutrition-sensitive when it tackles issues at the root of malnutrition than just food
production (Figure 8.2). Indeed, well-coordinated intra- and inter-sectoral link of NSA
enhances its contribution to improving nutritional status of population. In a nutshell, feed the
soil, and take care of environment to feed plants and animals/people.

Agriculture, Trade & Industry Sectors

Health Sector [Management of Food Materials
[Health (H)E outcome] (ATFi)E]

Education (E): Nutrition Education – Cross Cutting

Figure 8.1 Roles of agriculture, health, industry and education sectors for diversified food
consumption

8.2. Roles and responsibilities of various sectors in NNP-II

The agriculture sector serves as co-chair of the NNP II and primarily takes the lead in the
provision of food for the household and community. The Kebele nutrition technical committee
with technical support of DAs and HEWs plan and execute NSA intervention through
mobilizing the development army. Each of the 12-signatory sector has a role to play in NNP II
and its implementation according to their mandates to ensure good nutrition for the
communities (Table 8.1).

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Table 8.1 The major roles and responsibilities of nutrition signatory sectors
Sectors Major Roles and Responsibilities
Health • Strengthen the community level linkage and capacity of women-based
structures & associations at all levels to promote optimal adolescent, maternal,
infant and young child nutrition (AMIYCN) and caring practices
Agriculture • Increase year-round availability, and access to and consumption of animals
source foods, fruits, vegetables, nutrient-dense cereals and pulses.
• Promote technologies for post-harvest food processing, handling, preservation
and preparation to help ensure that food is both nutritious and diverse.
• Improve nutrition-sensitive agriculture (NSA) knowledge and practice among
farmers.
• Promote production and consumption of bio-fortified crops.
• Promote technologies for post-harvest food processing, handling, preservation
and preparation to help ensure that food is both nutritious and diverse
• Improve nutrition-sensitive livestock and fishery development knowledge and
practice among farmers through behavior change communication.
Industry • Conduct awareness creation events for the private sector on nutrition related
requirements and standards for local manufactured food items.
Trade • Ensure the quality and safety of imported food items as per the national
standard.
• Conduct awareness creation events for the public/consumers on the benefits of
fortified food.
Water, • Increase access to safe and clean water.
Irrigation & • Increase access to small- and large-scale irrigation schemes.
Energy • Increase access to and availability of renewable energy
Youth & • Promote the provision of credits, grants, microfinance services and other
Sport income generating initiatives to support increased access to nutritious foods
among vulnerable groups
Disaster • Strengthen and scale up early warning systems for food and nutrition
risk information from the community level up to the national level.
manageme • Improve knowledge and practice of nutrition- sensitive disaster risk
nt management among farmers, using behavior change communication.
Labor & • Promote the implementation of gender- sensitive social safety net program and
social other social protection instrument in urban settings to protect vulnerable groups
affairs from food insecurity and under nutrition.
Women & • Incorporate a gender analysis as part of the regular nutrition situation analysis,
Children analyzing the needs, priorities and roles of men and women.
• Mainstream gender equality within all nutrition training programs.
• Engage and mobilize women’s groups in nutrition advocacy and skills transfer.
• Promote meaningful male involvement in nutrition interventions.
Education • Promote and scale up school feeding programs.
• Promote school health and nutrition (SHN) interventions through collaboration
with other sectors.
Finance & • Mobilize resources for nutrition and making sure public resources allocated for
economy nutrition are properly utilized.

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8.3. Role of DAs in implementing Multi-Sectoral NSA interventions
The DAs of different disciples jointly have the responsibility to lead the whole agriculture
development activities at kebele level, where they can make a difference in implementation of
the NSA. Based on local potential resources, the DAs plan, implement, monitor and evaluate
the NSA activities in collaboration with farmers, kebele authorities and woreda offices in a
coordinated multi-sectoral manner. This encompasses the need to sensitize farmers and then
mobilize resources based on the nature of development intervention. Some of the nutrition
sensitive agriculture roles and responsibilities of DAs are highlighted below.

1. Nutrition Sensitive interventions

✓ Train and assist adoption of farmers on improved agricultural technologies (crop,
livestock and fishery).
✓ Introducing and demonstrating new technologies for the specific area, including
new/nutrient dense foods for household consumption and market.
✓ Include the NSA in the FTC and on-farm demonstrations of best practices and
proven technologies to farmers.
✓ Facilitate and technically support input supply, production and consumption of
nutrient dense agricultural products at household and community levels.
✓ Support farmers to practice GAP in the use of chemicals, fertilizer, food handling
and the likes to make food produced safe and sustainable.

2. Facilitate the agricultural economic activities

✓ Assess development potentials, diagnose production challenges and plan
interventions in a participatory manner.
✓ Train on expanding the use of homestead garden and small animal rearing to help
diversify household production, consumption and to generate income, with a focus
on women engagement.
✓ Expanding existing infrastructure and helping farmers develop new small-scale
irrigation facilities and effective use of water resource for NSA implementation.
✓ Setting the nutrition demonstrations corners at the FTC where production trials and
nutritious food preparation are carried out.

✓ Create market linkage for nutritious crops and animal source foods to improve
access nutritious foods and also create means of income for producers.

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3. Creating awareness and social mobilization of farmers

✓ Convey nutrition sensitive messages to the farming community using various

extension methods

✓ Creating and further expanding the role of women in use of improved agricultural
technology through focused and demand driven gap filling training.

✓ Train male farmers on gender equality and importance of addressing women’s

empowerment for improved household nutrition.
✓ Conduct food demonstrations and public awareness on diet diversity using various
extension methods.
✓ Conduct development group dialogue on selected nutrition and gender sensitive
agenda that empower women and tackle under-nutrition using the NSA.

✓ Prioritize vulnerable households and women at reproductive age to PSNP, on/off-

farm productive activities.

4. Areas of multisectoral collaboration

✓ Collaborate with stakeholders at kebele level in identifying nutrition problems,
opportunities and share information among the members of kebele nutrition
technical committee.
✓ Addressing NNP and NNSA nutrition priorities by collaborating different nutrition-
sensitive and specific sector.
✓ Monitor the progress on the multisectoral interventions during different seasons of
the year.

✓ Report NSA related practices to respective government structure

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 Summary
✓ There is a need of addressing the multi-sectoral NNP agenda that requires highly
integrated and inter-sectoral interventions through the established coordination
platform, which goes from federal to kebele levels.
✓ The agriculture sector has the prime responsibility of providing diverse and nutritious food
for the family and market.
✓ DAs have the major role of creating awareness, social mobilization, providing
Nutrition Sensitive Training Packages, Facilitate Agricultural economic activities and
collaborating with different sectors to improve production and productivity of
nutritious foods for household consumption.
✓ DAs and other development sectors jointly identifying nutrition problems,
opportunities, planning, execute interventions and share information among the
members of nutrition technical committee at the kebele.

Self-Assessment Questions
1. Discuss the multi-sector nature of nutrition and roles of sector signatories?
2. List out the five strategic objectives of the NNP II?
4. Discuss at least five roles and responsibilities of DAs in implementation of the NSA at
kebele level?
5. Identify the locally specific potentials for implementation of NSA in collaboration with the
HEWs at kebele level?

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