By: Hoda El-Enbaby, Olivier Ecker and Jef Leroy
Maximizing agriculture’s contribution to improving rural household income and food security has been the main goal of many development programs and policies in developing countries for decades. More recently, interventions in agriculture have increasingly aimed at achieving additional development outcomes such as improving nutrition and health among farming households. Therefore, the question of how to make agriculture more “nutrition-sensitive” has attracted great attention by policy makers, program implementers, and the donor community. The IFPRI-Egypt Seminar “Improving Nutrition in Egypt: What is the Role of Agriculture and How do we Document Impact?” debated this question in the current context of Egypt.
Dr. Gamal Siam, Professor of Agricultural Economics at Cairo University, presented the role of agriculture in food and nutrition security in Egypt today. Siam provided evidence for the declining role of agriculture in Egypt in terms of GDP, employment, and trade. He also showed that agricultural land and water have been decreasing on a per-capita basis, which may increase the social vulnerability of the Egyptian population. Siam noted that, despite an increasing risk of social vulnerability, attention of national policy given to agriculture, and the food sector more broadly, has been declining in recent years. Moreover, he elaborated on possible reasons for the weak performance of the agricultural sector in Egypt, the bottlenecks for accessing more profitable food markets that farmers face, and the urgent need for improvements in Egypt’s agricultural and food policy. Siam emphasized the importance of improving institutions especially in research and development, extension, and rural finance, as well as of increasing investments in agricultural infrastructure, promoting contract farming, and exploring avenues for land consolidation to utilize economies of scale in agricultural production and marketing.
Given Egypt’s favorable production conditions and proximity to large export markets such as the European Union and the Gulf countries, agricultural policy reforms and agricultural development programs have great potential to contribute to increasing agricultural production and rural household incomes. Agricultural interventions can also improve nutrition, but they do not automatically lead to improved nutrition, as Dr. Olivier Ecker, Research Fellow in IFPRI’s Development Strategy and Governance Division in Washington, DC, emphasized. Ecker noted that growing evidence from rigorously conducted impact evaluation studies suggest that agricultural interventions tend to only improve nutrition—nutrition of children in particular—if they have specific nutrition goals and actions and if they focus on women. He explained that there are many factors influencing individual nutritional status (including diets, health, and care) and there may not be only one constraining factor. For example, in addition to increasing household incomes and improving food availability and access for the individual consumer, behavioral change in food habits and meal preparation may be needed. Ecker also noted that evidence on the impact of agricultural interventions on nutritional outcomes is still scarce generally and especially for Egypt and Middle Eastern countries. Moreover, existing evidence is largely based on small-scale programs in fairly controlled environments (such as home garden promotion projects); so far, evidence from large-scale, complex agricultural interventions and particularly for programs that promote agribusiness is missing.
Many available impact evaluation studies of nutrition-sensitive (agricultural) programs do not detect a nutritional impact. Two reasons are common for that: First, there is simply no impact on nutritional outcome indicators because of poor program design; and, second, the evaluation did not detect statistically significant effects because of poor study design. Dr. Jef Leroy, Senior Research Fellow in IFPRI’s Poverty, Health, and Nutrition Division in Washington, DC, discussed six key challenges in evaluating nutrition-sensitive programs. These challenges relate to the complexity of nutrition-sensitive programs; long impact pathways and time frames; differing priorities, expectations, incentives, and perceptions between program implementer, donors, and evaluators; trade-offs between program implementation constraints and evaluation rigor; independence of evaluators, and assessing benefits beyond the targeted program beneficiaries. As an example for long impact pathways and time frame, Leroy explained that for detecting effects on biological outcomes, such as child anthropometry, program exposure as long as 1,000 days may be needed. Yet, the time frames offered by donors are often short.
Why are solid impact evaluations difficult? Leroy discussed how important it is to embrace the complexity of nutrition-sensitive programs: evaluations should not be limited to quantify the program’s impact, but should also focus on identifying the impact pathways, and estimating the program’s cost. A key challenge problem with measuring impact is establishing what would have happened in the absence of the program, i.e. identifying a valid counterfactual. The gold standard approach is an experimental design in which subjects are randomly assigned to receiving the program or not. The random assignment ensures that the groups are comparable before the start of the program; differences in outcomes between both groups after participation in the program can then be attributed to the program. However, as Leroy clarified, experimental designs are not always feasible, or easy to implement. An alternative to experimental studies is quasi-experimental designs, where statistical techniques are used to create a valid counterfactual.
Understanding how and why programs have an impact, is as important as measuring the impact itself. Identifying the pathways to impact is key to understanding why impact occurred (or did not occur) and helps to improve program delivery. The final component of evaluation studies is to estimate the cost of the program, and its components. In final comment, Leroy emphasized two key requirements of successful and rigorous program evaluations: establishing a strong collaboration between implementers and evaluators and a solid understanding of the program (i.e. working with an evaluation framework).
Dr. Habiba Hassan-Wassef, Health and Nutrition Policy Expert, emphasized the importance of conducting rigorous impact evaluations for designing and implementing effective development programs and policy formulation. She further emphasized that more efforts by program implementers and donors, as well as researchers, should be devoted to exploring opportunities for scaling up existing nutrition-sensitive agricultural development programs. Hassan-Wassef noted that a key challenge in Egypt in this context, and in the nutrition sector more broadly, is the disconnect between the agricultural sector and the health sector, as government officials and other experts from these sectors seem to insufficiently communicate and coordinate with each other. She therefore called upon building institutional bridges between the sectors that help exchanging knowledge and form the basis for close collaboration.
Seminar participants reemphasized that the link between agriculture and nutrition is indeed very important but complex; they shared their experience on some of the challenges in their daily work on that issue. There was broad consensus among the seminar’s speakers and audience that more than one sector is need to join forces in order to effectively reduce malnutrition in Egypt.