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Hunger, health and society
Introducing nutritional considerations into agricultural and rural development
International Food Policy Research Institute, Washington, D.C., USA
There is little doubt that calorie-protein deficiencies are widespread in many developing countries, even though current estimates of the magnitude of malnutrition vary widely and are subject to considerable uncertainty. Absolute poverty, high food prices, poor health and sanitary conditions, limited knowledge of nutritional matters among certain households, and fluctuations in incomes, food availability, and food prices are some of the principal reasons for the prevalence of malnutrition.
A variety of programmes, projects, and policies have been implemented for the explicit purpose of alleviating malnutrition. Nutrition education programmes, direct feeding programmes for preschool children and pregnant women, integrated health and nutrition programmes, food stamp programmes, and certain types of food price subsidies and public food distribution schemes exemplify such efforts.
But in addition to the impact such programmes have on human nutrition, it is also influenced by a large number of projects and policies that are not explicitly aimed at the achievement of nutritional goals. Many projects and policies within agricultural and rural development fall into this category. In some cases the nutritional impact of agricultural and rural development projects and policies is assumed; in others it is unexpected and unintended. In very few cases are the potential nutrition effects explicitly considered in the design of agricultural and rural development projects and policies; in even fewer instances do estimates of the potential nutrition effects play a significant role in such design.
Direct nutrition intervention programmes may be effective in reducing nutritional deficiencies. However, to be effective they are usually very costly. Furthermore, because they do not become self-sustaining over time, their effectiveness depends on a continued outlay of funds. Thus, while such programmes may provide the best solution to a large part of the nutritional problem in the short-run, a long-term, self-sustaining solution must be sought through broader development efforts that will eventually reduce and even eliminate the need for direct nutrition intervention programmes. Agricultural and rural development projects and policies offer great opportunities for such long-term nutritional improvements.
To realize these opportunities fully, nutritional issues must be considered in project and policy design, and due consideration must be given to the potential nutrition effects of alternative projects and project modifications. If this is not done, potential positive nutrition effects may not be taken advantage of and potential negative effects may be overlooked or ignored. This does not suggest that nutritional goals should take priority over all other goals of agricultural and rural development, but that they should be explicitly considered along with other goals. (As argued by Swaminathan, "We now need a symphony approach to rural development where employment, income generation, education and nutrition all become catalysts of each other." See paper cited in the Appendix below, p. 41.) If the nutritional effects of alternative projects or project designs are estimated, it is possible that positive effects may be enhanced and negative ones reduced without unacceptable losses in the achievement of other goals.
Positive effects of modifications in agricultural and rural development projects and policies may exceed the benefits of direct intervention programmes, while negative effects may cancel them. Thus, ignoring the potential and real nutrition impact of modifying agricultural and rural development projects and policies while promoting direct nutrition intervention programmes makes little sense even in the short-run.
There are four principal reasons why the impact on human nutrition is not explicitly considered in most agricultural and rural development projects and policies. First, improved nutrition is assumed to be linked directly to expanded food production: the more food produced, the greater the nutritional improvement. Thus, the argument goes, if the impact on food production is considered, nutritional impacts need not be. Second, it is believed that increases in incomes are a good proxy for improved nutrition. Third, the estimation of the nutritional effects is perceived to be too difficult, too expensive, and/or too time-consuming, or the estimates that could be made are too unreliable to be useful for project or policy design. Finally, the impact of agricultural and rural development on human nutrition may not be considered because there is no real interest in the relevant government agencies for doing so.
Contrary to the assumptions mentioned above, the amount and kinds of food made available by a project need not result in corresponding changes in the degree of malnutrition. As shown elsewhere, the amount of nutrients made available by a given project or policy is a poor indicator of nutritional effects, and choice among alternative projects on the basis of relative contributions to the quantity of available nutrients is not likely to be effective from a nutritional point of view (1). The nutrition effect of changes in food supply depends on the distribution of the supply change between malnourished and well-nourished groups and among groups with different degrees of malnutrition. Such distribution will depend on how the supply change comes about, e.g., which commodities are affected, how food prices are affected, and whether there are simultaneous changes in incomes of malnourished or well-nourished groups.
Similarly, expected increases in overall incomes are a poor proxy for expected nutritional improvements. Only the proportion of the income change that affects households with malnourished members is likely to have a positive nutritional effect. But income increases among the wellnoutrished part of the population may result in upward pressures on food prices and associated negative effects on food intakes among households with malnourished members. Furthermore, only parts of the income increase obtained by households with malnourished members will be allocated to improving nutrition. In certain cases the nutritional impact of increased incomes may be negligible, while it may be very significant in others. Parts of the additional incomes may be spent on food for wellnouritshed members of the household, or it may be spent on non-food items. Furthermore, increasing household incomes may result in commodity substitution towards more expensive nutrients. Thus, merely looking at the amount of income generated by a project indicates little about the nutritional effect. It may be argued, of course, that increasing real income is what counts irrespective of whether the increase is spent on improving nutrition. This argument, and how it relates to household preferences, is further discussed below.
The perceived difficulties of estimating the effects within reasonable cost and time frame, the third reason for not considering nutritional effects mentioned above, is a very important consideration for the project planner. Many new demands have been placed on project planners during the past 10 to 15 years. Depending on the institution within which they work, project planners may be requested to estimate not only the economic and financial rates of return, but also the impact on specific population groups, for example, women, and on the environment and possibly other areas of particular interest to the institutions or individuals involved. But project planners frequently do not possess the necessary analytical tools and may not have the required time and resources to do useful analyses of such impacts. Therefore, the matter becomes one of meeting requirements with some sort of impact statement that, rightly or wrongly, may be perceived by the project paner to be of little or no utility for project choice and design. 11 project planners view efforts to incorporate nutritional considerations into project preparation in the same light, they will obviously oppose them. Rather than trying to convince project planners to undertake a useless exercise, the challenge is one of developing methods for incorporating nutritional considerations into project preparation and design that will provide useful guidelines without being excessively costly and time-consuming. As further discussed in a subsequent section of this paper, such efforts are currently being undertaken in a number of institutions.
But if neither the additional quantities of food produced nor the overall incomes generated provide acceptable indicators of nutritional effects, what indicators should we look for? A brief overview of the factors influencing the nutritional status of an individual may assist in providing the answer. Such an overview is presented in the next section.
Agricultural development and human nutrition: the linkages
Factors Influencing Food Consumption and Nutrition
The factors influencing food consumption and nutrition are depicted in figure 1. Although the relative importance of each of these factors may vary among countries and population groups, low household incomes, insufficient food availability, and high food prices are likely to be primary causes of calorie-protein deficiencies. Changes in any of these three factors are likely to influence food consumption. From a nutritional point of view, only changes in food consumption by households within which some or all members are currently malnourished, or where the risk of introducing such malnutrition is significant, are of interest. Thus, changes in food supplies affect the nutritional status of individuals only to the extent that the food consumption of malnourished or at-risk individuals is affected. Estimates of total per capita food availability for a given country or region are of little or no use as indicator of the magnitude of calorie-protein deficiencies. Deficiencies frequently exist alongside a more or less plentiful food supply. Whether a plentiful food supply exists is irrelevant to households that do not have access to adequate food. Therefore, the effect of agricultural and rural development on food consumption of households with malnourished or close-to-malnourished members must be at the core of any attempts to estimate the nutritional effects of such project and policies. Estimating the effects on overall incomes and food availability is merely a first step.
Food consumption by the poor - particularly the urban poor is very sensitive to changes in food prices. Thus, agricultural and rural development projects and policies that affect food prices and their fluctuation over time are of particular interest from a nutritional point of view. High price levels and severe price fluctuations are much more harmful to the poor than to the better-off urban consumers. The rural poor, on the other hand, who depend on food production for their incomes either directly as producers or indirectly as farm labourers, are likely to benefit from higher food prices. Of course, the level of food prices also influences future food production and thus future food availability.
Fig 1 Agricultural and Rural Development and other factors influencing food consumption and nutrition.
The Case of the Semi-subsistence Farm Family
A considerable proportion of existing malnutrition is found among households that produce most or all of the food they consume - the semi-subsistence farm households. For these households, changes in cropping systems that influence the amounts and kinds of food produced and fluctuations in food availability during the year will be much more important than changes in food prices. Agricultural and rural development projects and policies may change the crop mix and the cropping patterns to meet better the nutritional requirements of the semi-subsistence farm family. They may also result in a worsening of the nutritional situation for these families. In fact, certain projects may create a nutritional problem where there was none before.
Traditional systems have been developed, modified, and adapted over a long period of time to meet farmers' goals, including nutritional goals, best within existing ecological conditions and other constraints external to the farm. If some of these constraints are removed, changes in the system may be advantageous to the farmer. However, projects and policies aimed at changing traditional farming systems must be preceded by efforts to understand fully why farmers use existing systems, and what the repercussions will be if the systems are changed. (See paper by Okigbo, listed in the Appendix, for a fuller discussion of farming systems.)
Projects and policies promoting a shift from mixed cropping systems to mono-cropping should be carefully watched for possible negative nutritional effects. This is particularly important for projects that promote substitution of a non-food cash crop for a mixture of food crops traditionally produced for home consumption. This is not to argue that the nutritional effects of such projects are usually or always negative. The additional income generated within the farm household and the associated expansion of purchased food may fully compensate for the loss in the consumption of self-produced food and provide for additional real income that may be used for nutritional improvements or other desired welfare gains. But it cannot be assumed that this will always be the outcome.
The issue is not whether the project will contribute to increased farm incomes, because if it does not, farmers are unlikely to participate. Rather, the issues are: (a) how the farm family will adjust its consumption patterns as a result of shifting from semi-subsistence to a market economy, and lb) what can be done to facilitate an adjustment that is nutritionally advantageous. These questions are part of a much larger issue of how to facilitate rural transformation for the benefit of the poor, an issue that is beyond the scope of this paper. However, from a nutritional point of view, some of the questions that should be asked when designing projects of the type discussed here include: whether the farm family that shifts from food production for own consumption to cash crop production would have access to the required food at the local level; whether and by how much local food prices and price fluctuations would be affected by the project (due to reduced supply, expanded demand, and possibly a very inelastic local food supply); to what extent the farm family is capable of money management, with primary emphasis on the question of cash flow and seasonal fluctuations in food consumption; and whether the family possesses the necessary knowledge about nutrition. Answers to these and related questions may then be used to guide activities that would enhance positive nutritional effects, or at the very least prevent adverse effects from occurring.
Such activities might include improving food marketing and expanding food imports to ensure an increasing and stable flow of food into the area to meet changing food supply and demand at the local level without large food price increases, providing nutrition education, promoting home gardens, and introducing various other policies and institutional changes to facilitate an effective local food market and influence household spending patterns. It is important that the specific needs for such activities be identified during the project design phase and introduced simultaneously with the project. Failure to do so is the principal reason why in the past some cash crop projects have had negative nutritional effects.
A considerable proportion of existing calorie-protein deficiencies among semi-subsistence farm families appears to be caused by seasonal fluctuations in food production. In large parts of the humid tropics, traditional semi subsistence farming systems include a number of food crops that are harvested at different times throughout the year. Replacement of such systems with a single crop harvested once or twice a year may greatly increase the risk of seasonal malnutrition unless appropriate steps are taken to avoid it.
Household Preferences and Related Factors
Household incomes, food prices, and food availability determine the extent to which nutritional requirements could be met by the individual household. Whether, in fact, the possibilities will be fully utilized for meeting nutritional requirements depends on a number of factors, as illustrated in figure 1. Some of these factors, such as the availability and prices of other goods, the intra-household distributional process, and certain health considerations, may be influenced by agricultural and rural development projects and policies. Consideration of the influence of rural development projects on intra-household budget control, the time allocation of women, and the resulting nutritional impact through changes in spending patterns, breastfeeding, child care, food preparation, and eating habits in general may help to improve project design.
Although food consumption patterns may be influenced by agricultural and rural projects and policies, the final decisions regarding actual food consumption are made by the individual household or household member. Thus, to predict the impact of a given project on food consumption by the malnourished, attention must be focused on household behaviour, which in turn is influenced by social, cultural, and other factors. How the project affects incomes of households with malnourished members, their access to food, and the prices they have to pay must be estimated, as well as how they will adjust their food consumption in reaction to such changes in income, food availability, and food prices.
The consumption preferences of households with malnourished members need not reflect the wishes of wellmeaning governments and foreign aid agencies. Attempts by agents external to the household to change the consumption and spending patterns of individual households may fail because the households make a series of opposing adjustments according to their preferences. Efforts such as direct feeding programmes, aimed at expanding food consumption, may be much less effective than originally expected because the households reduce the consumption of purchased food. Part of the purchasing power or real income embodied in the feeding programme is freed for the purchase of other goods that the household prefers (2). Although malnutrition exists in the household, there are other desires that may take priority over its elimination. Lack of understanding of nutritional needs, promotion of junk foods, high-cost foods, and non-food commodities, and many other outside influences may play an important role in this respect. Recent evidence from India shows that income improvements among households with malnourished members may result in considerable substitution of higher-for lower-cost calories (3).
Household consumption and spending patterns may depend on how the control over household incomes is divided among family members (4). Closely related to this is the role of women in food production and marketing and the labour allocation within the household. Thus, the nutritional effects of rural development projects that generate additional incomes for the poor may be a function of how the project affects the participation of women in food production and marketing and household decision making. (The role of women is further discussed by Savanè - see Appendix.)
The fact that ultimate consumption decisions are made at the household level on the basis of individual preferences should not lead to the conclusion that household food consumption cannot be influenced from outside the household. Rather, the points to be made are: (a) Household consumption and spending patterns are constantly being influenced from the outside; transformation of traditional subsistence or semi-subsistence rural communities toward market economies, increasing availability and promotion of various food and non-food commodities, migration to urban areas, and many related changes are all exercising such influence. (b) Households cannot be expected to behave as we think they "ought to," e.g., place first priority on fulfilling nutritional needs of all household members irrespective of other needs and desires. (c) Household behaviour must be understood so that it can be predicted in order to incorporate nutritional considerations into
agricultural and rural development effectively. And (d) the well-being of individuals depends on the degree to which they are able to fulfill a number of needs, among which nutrition is only one, although a very important one. As one participant at the SCN symposium put it: "We must not lose on poverty while winning on nutrition."
The factors influencing food consumption and nutrition are interrelated. Changes in one of these factors may be ineffective unless others are changed simultaneously. For example, efforts to expand food availability will not result in improved nutrition if the ability of households with malnourished members to obtain more food is not improved. Similarly, efforts to improve the household purchasing power may be of little use if food availability is strictly limited, if poor health or sanitary conditions deter effective absorption and utilization of additional food intakes, or if households with malnourished members do not take advantage of such improved purchasing power for nutritional improvement, but instead translate additional real income into the purchase of non-food commodities.
Many efforts to improve human nutrition focus on one of these factors but ignore the above interactions. Agricultural projects and policies aimed at the promotion of food production often overlook the possibility that the additional food may be inaccessible to malnourished people. Direct nutrition intervention schemes such as direct feeding or other food transfer programmes frequently ignore the fact that household may not desire net additions to food consumption of the magnitude provided by the programme, and thus make opposing adjustments in intra-household food distribution or in food purchases. Efforts to introduce nutritional considerations into agricultural and rural development must deal with these interactions.
Incorporating nutritional considerations into agricultural and rural development: the approach
If nutritional considerations are to be explicitly incorporated into agricultural and rural development, this must be done in such a way that they can influence the direction of future development in a positive manner. For this purpose, knowledge of how past development efforts affected human nutrition is important and may be essential for predicting the effects of future efforts. But unless it is used to guide future activities, the knowledge will have no nutritional impact. Thus, on the basis of knowledge of the performance of past projects and available data, or data that can be obtained at a reasonable cost and within a practical time frame, an effective approach must be capable of either identifying the most appropriate projects and policies from a nutrition point of view, or of estimating the nutritional effects of alternative project and policy design and modifications.
Because agricultural and rural development usually is aimed at the achievement of a number of goals, an effective approach should take into account how changes in project design for the purpose of improving nutritional impact would affect the expected achievement of other goals. The degree to which projects and policies should be designed or modified to meet nutritional goals must be determined on the basis of the associated costs in terms of not achieving other goals, and the cost of achieving nutritional goals by some alternative means. In some cases it is possible that project designs may be altered to meet nutritional goals better without reducing the extent to which other goals are achieved.
Although a certain change in project design may enhance nutritional effects, the negative impact on the achievement of other goals may be so large that the nutritional improvement is better reached through some other means. In other cases, the project design may be changed to improve the impact on nutrition without adverse or unacceptable effects on the achievement of other goals. It is clear, however, that if the nutritional effects of alternative project designs are not considered, it will be impossible to know which of the two situations prevailed before changes were made.
Nutritional considerations may be incorporated at the sector level or at the project/policy level, Ideally, they should be incorporated at both. At the sector level, nutritional considerations are needed to provide guidelines for development plans and strategies, whereas at the project and policy levels they are needed to assist in the design and modification of individual projects and policies.
Food sector strategy reviews, as originally proposed by the World Food Council and currently undertaken in a number of countries, provide an example of the introduction of nutritional considerations at the sector level. Attempts are made to identify nutritional problems and to delineate development strategies and sets of projects and policies for the food and agricultural sectors that would effectively alleviate these problems (see World Food Council paper listed in the Appendix for additional details on this approach). The Mexican food system (Sam) is another very innovative and significant effort aimed at the same goal.
At the project and policy levels a number of approaches are currently being considered and tested. The FAO has developed a set of guidelines that are currently being tested in case studies of agricultural and rural development projects in six countries. According to the FAO, "The experiences gained through the case studies have clearly
demonstrated that there is generally considerable scope for improving the nutritional impact of agricultural projects, and that the general direction of the strategy seems to be correct" (see Lunven and Sabry, p. 32 - listed in Appendix). On this basis, the FAO is developing a more detailed manual of procedures (5).
USAID is currently undertaking a series of studies on the nutritional effects of selected agricultural policies in various countries, and the International Food Policy Research Institute (lFPRI) has recently initiated research on the impact of technological change in agriculture on food consumption and nutrition. Furthermore, the World Bank, IFAD, and other international institutions have given considerable attention to the issue. However, none of these institutions has incorporated nutritional considerations into project identification and design on a routine basis.
Other approaches for incorporating nutritional considerations into the design of agricultural projects and policies include the establishment of nutrition monitoring units in a number of countries.
Although some of the above efforts look promising, more field testing is needed to select an approach that is effective yet workable within the resources and time constraints normally found in project preparation. (A survey of past and ongoing activities in this general area is presented in the paper by Pinstrup-Andersen listed in the Appendix and in reference 6.) Until such an approach is available and adequately tested, it will be difficult to incorporate nutritional considerations into the design of agricultural and rural development projects on a routine basis.
Characteristics of an Effective Approach
Efforts to develop and field-test an effective approach should have high priority. (See papers by Lunven and Sabry and by Pinstrup-Andersen cited in the Appendix for suggestions in this regard.) The following discussion suggests a few of the desirable characteristics of such an approach.
Ideally, an effective approach would estimate with considerable certainty how different projects and policies or different project and policy designs and modifications would affect nutritional status, as measured by selected nutrition indicators such as mortality and morbidity of specific population groups, work capacity, or anthropometric measures. However, cost and time considerations mentioned above suggest that such an "ideal" approach may be neither feasible nor desirable from a practical point of view. The challenge is to strike the right balance between practicality and cost on the one hand, and on the other the degree to which the results are useful for project choice and design, and the associated potential nutritional gains. In the words of one symposium participant, the approach must be "cost-effective and low-cost."
Fig 2 Simplified illustration of Two Approaches to project evaluation.
Cost and time considerations are heavily influenced by data requirements. It is important to avoid an approach that requires large data collection efforts to provide useful results. Data collection should be selective. Comprehensive data collection efforts may not be necessary to obtain a workable knowledge of the nutritional situation in a given region. Local community knowledge should be utilized to the fullest extent possible. Similarly, it is important that the analytical procedures be relatively simple. On the other hand, the utility of the results depends on identifying the most important relationships and estimating the most important parameters that determine the nutritional impact of the projects and policies of interest. The mechanism by which nutritional status is influenced must be understood. The key elements in a project or policy that influence the nutritional status of individuals or groups of individuals must be identified and the corresponding parameters estimated. Although a more comprehensive approach would be desirable, initial efforts may aim at the development of a relatively simple "first approximation" or "short list" for incorporation into project identification and preparation.
If the sole purpose of a given study is to evaluate the impact of a specific project or policy on the nutritional status of a particular group of people, it may not be necessary to identify the key elements and analyse the mechanisms by which such an impact is transmitted. A simplified illustration of such a study is given in part A of figure 2. The "black box" signifies the mechanism, linkages, and key elements. No attempt is made to analyse what is happening in the black box. The study merely compares a situation where the project or policy is present to a situation where it is absent, either over time for the same population group or at a given point in time across population groups. A number of past evaluations of individual nutrition programmes have been of this type. But if the analyses of past and current projects and policies are to be truly useful for choice and design of new ones and modifications in current ones, the linkages such as those illustrated in part B of figure 2 cannot be ignored. The intermediate steps and how they are influenced by a particular project or policy must be understood.
The key elements in most or all of the agricultural and rural development projects and policies are relatively few, and many of them are common to different kinds of policies and projects. But there is an almost unlimited number of possible project and policy combinations that may be designed. If we understand how a given project affects the key elements and, in turn, how these key elements affect nutritional status, we can design effective projects by selecting and combining the elements that are most appropriate for the particular set of circumstances.
Furthermore, the impact of factors other than those directly influenced by a given project must be understood and quantified. In particular, knowledge about health and sanitary conditions and how they affect nutrition is important to determine the nutritional effects of additional food intake. If sanitary conditions are the nutritional bottleneck, agricultural and rural development projects that result in additional food intake among the malnourished may have little or no nutritional effect.
Where do we go from here?
If nutritional considerations are to be effectively incorporated into agricultural and rural development, ongoing efforts to develop and field-test appropriate analytical approaches must be strengthened. In particular, additional work is urgently needed to understand fully what takes place within the black box illustrated in figure 2, including identification of the key factors that link agricultural and rural development projects and policies to the nutritional status of individuals. Improved understanding of the behaviour of poor rural households and how they adjust their consumption patterns in reaction to agricultural and rural development projects and policies is of particular importance in this regard.
Simultaneously with the development of more appropriate analytical approaches, efforts should be made to draw the attention of agricultural sector analysts and planners, project designers, and others influencing the direction of agricultural and rural development and the design of individual projects and policies to existing nutritional problems and the opportunities for influencing these problems through agricultural and rural development.
Even in the absence of a more formal analytical approach, the mere fact that explicit attention is being paid to the potential nutritional effects may result in projects and policies with a more positive or a less negative nutritional impact than would otherwise be the case. Emphasis should be placed on identifying projects and project designs likely to have severe negative effects and seeking ways to avoid them. The most appropriate way of increasing the awareness of potential nutritional effects and opportunities for influencing them may differ among institutions. In some cases seminars, brief training courses, and/or the development of short lists of the most important nutritionrelated issues or questions for incorporation into project preparation manuals may be useful approaches.
Also, it would be appropriate to include issues related to the integration of agriculture, food, and human nutrition into formal training of agriculturalists and agricultural economists. Similarly, agricultural students should have sufficient exposure to existing nutrition, health, and agricultural problems at the village level to grasp fully the presence of the most important interactions, and to relate these problems to the course work in which they are invoIved.
Participation of the affected population in project preparation and design is another way to improve project contribution to welfare, including nutritional improvements. Although this is frequently discussed, it is not often practiced. The issue extends far beyond nutritional concerns to the decisive question of how to make rural development projects more relevant for the people they are supposed to serve.
Institutional changes are needed in many countries to facilitate a closer interaction between agriculture and nutrition. A number of countries have recently established nutrition monitoring units, food policy units, and similar agencies focusing on various aspects of this interaction. Such efforts must be strengthened. In many countries, institutional rigidities and vested interests deter an effective integration of nutrition and agriculture. It is difficult to believe that countries that maintain such adverse institutional structures are seriously interested in solving their nutritional problems in a self-sustaining manner.
Incorporating nutritional concerns into agricultural and rural development will not immediately eliminate the need for direct nutrition intervention programmes. In most countries with significant degrees of malnutrition, some kinds of nutrition programmes, such as direct feeding schemes, integrated health and nutrition programmes, and targetted food subsidies, will be needed for a long time to come. Incorporating nutritional concerns into agricultural and rural development will reduce such needs particularly, but not exclusively, in rural areas. Together with a general orientation of economic development strategy towards the eradication of extreme poverty, a nutrition focus of agricultural and rural development may eventually eliminate the need for direct nutrition intervention programmes.
As mentioned above, the cost of improving nutrition through changes in agricultural and rural development projects and policies relative to the costs of relying on the best alternative should be used as a guide to determine how far nutritional considerations should dictate the choice and design of these projects and policies. But if such cost comparisons are to be realistic, the best alternatives must be identified and their costs and benefits estimated. Available information on the cost and benefit of the various types of nutrition programmes has been obtained mostly through ad hoc programme evaluation. Such information does not provide effective guidelines for policy makers on questions such as those discussed above. Therefore, there is an urgent need for a co-ordinated research and evaluation effort to improve our knowledge on how well the various types of nutrition programmes perform under different conditions and at what costs. An effort such as the one currently proposed by the SCN is needed, not only to facilitate the above cost comparisons, but also to choose among types of nutrition programmes.
The role of the international assistance community
The international assistance community may assist in a number of ways. First, aid agencies that support agricultural and rural development activities may incorporate nutritional considerations into their own activities to the extent justified by available analytical methods. Many external aid agencies are not currently equipped to do so because agriculture and nutrition are not integrated within the aid agency, either institutionally or philosophically. Thus, external aid agencies that advocate the incorporation of nutritional considerations into agricultural and rural development in developing countries might begin by reorganizing their own institutional structure, if needed.
Second, external assistance is needed to strengthen institutional and professional capabilities in a number of developing countries. The exact nature of such assistance varies according to the needs and weaknesses of each country and institution. Current efforts in a number of countries to develop institutions and/or assemble small multidisciplinary groups of professionals for the purpose of analysing and monitoring development strategies, projects, and policies in the areas of agriculture, food, and nutrition in an integrated fashion suffer from lack of financial as well as professional resources. Foreign financial and technical assistance for such efforts should be given high priority. It is important that the assistance - including that provided through the World Food Council, supporting food sector strategy reviews - be focused on the development and strengthening of institutional and professional capabilities that will assure a continued and self-sustaining effort. Formulation and assessment of agricultural, food, and nutrition policies and development strategies are activities that must continue over time. Foreign assistance based on the perception that the "correct" policies, strategies, and investment requirements can be identified once and for all may do considerable harm and should be avoided.
Third, the international assistance community may wish to undertake and/or support additional research and testing related to the various issues discussed in this paper. In addition to the question of how best to incorporate nutritional considerations into agricultural and rural development, such support might focus on improving current knowledge of the best way to reduce malnutrition under different conditions through the use of whatever means are available to governments and private voluntary organizations. Research and assessment undertaken by international institutions should include comparative analyses and other activities such as monitoring, collection, and exchange of results from country-specific studies that may be useful across countries. Foreign aid agencies may encourage the undertaking of nutrition impact analyses, data collection, development and testing of methodology, and training in individual countries through financial and technical assistance. Finally, foreign aid agencies may wish to co-ordinate their efforts among themselves through periodic meetings, such as the annual meetings of the ACC Sub-committee on Nutrition.
APPENDIX: Papers Presented at the ACC/SCN Symposium on Introducing Nutritional Considerations into Agricultural and Rural Development (Rome, 2 March 1981)
K Chutikul, "Implications for Faculties of Agriculture in Introducing Nutrition into Their Teaching and Research," SCN 81 /5a.
P. Lunven and Z.l. Sabry, "Nutrition in Agriculture, Introducing Nutrition into Agricultural and Rural Development Projects," SCN 81/5c.
B.N. Okigbo, "Introducing Nutritional Considerations into Research and Training in Farming Systems,', SCH 81/5h.
P. Pinstrup-Andersen, "Nutritional Consequences of Agricultural Projects: Conceptual Relationships and Assessment Approaches," SCN 81/5d.
F.T. Sal, "Systematic Considerations of Health and Nutrition in Agricultural and Rural Development Programmes and Projects," SCN 81/5b. (Published in the Food and Nutrition Bulletin, 3, no. 3 [July 1981 ]: 6.)
Marie Angélique Savané, ""Implications for Women and Their Work of Introducing Nutritional Considerations into Agricultural and Rural Development Projects," SCN 81/5f. (Food and Nutrition Bulletin, 3, no. 3: 1)
M,S. Swaminathan, "Introducing Nutritional Considerations into
Agricultural and Rural Development," SCN 81/5e. (rood and
Nutrition Bulletin, 3, no. 3: 30,)
World Food Council, "Food Strategies," SCN 81/59.
1. P. Pinstrup-Andersen, Norha Ruiz de Londono, and E. Hoover, "The Impact of Increasing Food Supply on Human Nutrition:Implications for Commodity Priorities in Agricultural Research and Policy Anner. J. Agric. Econ., May 1976, pp. 131-142,
2. G.H. Beaton and H. Ghassemi, "Supplementary Feeding Programmes for Young Children in Developing Countries, "report prepared for UNICEF and the ACC Sub-committee on Nutrition (Oct. 1979).
3. C.H. Shah, "Food Preferences and Nutrition: A Perspective on Poverty in Less Developed Countries," Indian J. Agric. Econ., 35 (no. 1):1-39 (1980).
4. J. I. Guyer, "Household Budgets and Women's Income," Working Paper No. 28, African Studies Center, Boston University (1980).
5. Food and Agriculture Organization of the United Nations, "Introducing Nutrition in Agricultural and Rural Development," paper prepared by FAO for the 6th session of the Committee on Agriculture, COAG 8116 (December 1980).
6. P. Pinstrup-Andersen, "Nutritional Consequences of Agricultural Projects: Conceptual Relationships and Assessment Approaches, "World Bank Staff Working Paper No. 456 (May 1981).
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