Nutrition Capacity Assessment of Agriculture Extension Services in Nigeria.

BACKGROUND: Achieving meaningful malnutrition reductions in Nigeria and other high-burden countries requires sustained improvements in diets, mediated through nutrition-sensitive agriculture and food systems. Yet, the capacity to design, plan, implement, and monitor such nutrition-sensitive systems is very limited, including within agricultural extension services delivery. Understanding existing capacity of actors required to implement nutrition change is crucial for effective capacity development. OBJECTIVE: This study assessed the nutrition capacity of agriculture extension agents (AEAs) in Nigeria and the capacity of their organizations and the institutions within which they operate. METHODS: The study assessed 31 extension training materials for inclusion of recommendations for nutrition-sensitive agriculture. Structured interviews and focus group discussions were conducted with 23 extension agents and were coded and analyzed for major themes. RESULTS: Training materials hardly included nutrition objectives and or nutrition-related services to be delivered. Some nutrition-related services were being delivered, including promotion of biofortified crops and nutrient-dense crops and animals, home gardening, food safety, and dietary diversification. However, these services were limited, and service delivery was unstructured, nonuniform, and inconsistent. Numbers of AEAs are quite inadequate while available AEAs had high workloads, are poorly motivated, and had limited funding, supervision, and logistics capacity to perform roles. Physical security was also a challenge for service delivery. Further, complementary activities in other sectors that were necessary for adequate delivery of nutrition-sensitive agriculture did not always exist. CONCLUSION: Extensive development of nutrition capacities of extension agents appears unlikely to achieve nutrition-related changes if limiting institutional and organizational capacity deficits are not addressed. PLAIN LANGUAGE TITLE: Capacity of Agriculture Extension Agents in Nigeria to Deliver Nutrition Services. PLAIN LANGUAGE SUMMARY: Reducing the significant burden of malnutrition in Nigeria requires increased availability and consumption of foods that are nutritious and free from harmful substances. To produce such foods, farmers need adequate nutrition and food safety knowledge and skills. The production of such food will also need to support nutrition in other ways, including increased women's empowerment. Extension agents traditionally support farmers to adopt new methods of food production and/or processing that support increased food yields. These agents can also be used to deliver services that will address nutrition if they have the necessary knowledge and skills. This study assessed the capacity of agriculture extension agents in Nigeria to deliver nutrition services, in order to determine how to increase their capacity to deliver these services. The results from the study are that the extension agents do not have sufficient knowledge and skills to deliver nutrition services, and that their organizations and the wider context in which they work do not have the capacity to enable them to deliver nutrition services effectively. For instance, the organizations do not have sufficient numbers of staff and do not provide current staff with adequate means of transportation to visit farmers. Insecurity is high and so extension agents are unable to visit farmers frequently because of the potential threats to their lives. The study concludes that effectively using extension agents to deliver nutrition services will require not just training of the extension agents but also improvements in organizational capacity and contextual factors.

The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities.

Large-scale food fortification (LSFF) is a cost-effective intervention that is widely implemented, but there is scope to further increase its potential. To identify gaps and opportunities, we first accessed the Global Fortification Data Exchange (GFDx) to identify countries that could benefit from new fortification programs. Second, we aggregated Fortification Assessment Coverage Toolkit (FACT) survey data from 16 countries to ascertain LSFF coverage and gaps therein. Third, we extended our narrative review to assess current innovations. We identified 84 countries as good candidates for new LSFF programs. FACT data revealed that the potential of oil/ghee and salt fortification is not being met due mainly to low coverage of adequately fortified foods (quality). Wheat, rice and maize flour fortification have similar quality issues combined with lower coverage of the fortifiable food at population-level (< 50%). A four-pronged strategy is needed to meet the unfinished agenda: first, establish new LSFF programs where warranted; second, systems innovations informed by implementation research to address coverage and quality gaps; third, advocacy to form new partnerships and resources, particularly with the private sector; and finally, exploration of new fortificants and vehicles (e.g. bouillon cubes; salt fortified with multiple nutrients) and other innovations that can address existing challenges.

'FAN the SUN brighter': fortifying Africa nutritionally (FAN) - the role of public private partnership in scaling up nutrition (SUN) in West Africa.

The scaling up nutrition (SUN) policy framework requires extensive public­private partnership (PPP). Malnutrition is multi-dimensional and should engage multi-sectoral platforms. The SUN policy however did not fully embrace the dynamics of harnessing PPP. The objectives of the present paper are to highlight the reasons for the apprehension around PPP and illustrate how effective coordination of PPP in West Africa has contributed to implementing large-scale food fortification with micronutrients as a complementary nutrition intervention. The experience of Helen Keller International (HKI) in scaling up food fortification was emphasised with understanding of the factors contributing to indifference by the international community to private sector contribution to SUN. The roles of different stakeholders in a PPP are elucidated and the process linked to who, why and how to engage. The private sector provides direct nutrition services while the public sector creates the enabling environment for the private sector to thrive on social values. Through this approach fortified vegetable oil and wheat flour are now reaching over 70% of the population in West Africa. As a neutral broker HKI coordinated and facilitated dialogue among the different stakeholders. The core competencies of each stakeholder were harnessed and each partner was held accountable. It concludes that multi-sectoral relationship must be transparent, equitable and based on shared mutual interests. The rules and values of PPP offer opportunities for SUN.

Results of Fortification Rapid Assessment Tool (FRAT) surveys in sub-Saharan Africa and suggestions for future modifications of the survey instrument.

BACKGROUND: Food fortification has been increasingly recognized as a promising approach to prevent micronutrient deficiencies. The Fortification Rapid Assessment Tool (FRAT) was developed to assist public health program managers to acquire the information needed to implement an effective mass food fortification program. Multiple countries have conducted FRAT surveys, but information on results and experiences with the FRAT tool has been available only at the national level. OBJECTIVE: To summarize the findings of the FRAT surveys previously conducted in sub-Saharan Africa. METHODS: Surveys from 12 sub-Saharan African countries (Burkina Faso, Cameroon, Congo, Guinea, Malawi, Mali, Mauritania, Mozambique, Niger, Rwanda, Senegal, Uganda) were identified. Information on consumption patterns for wheat flour, vegetable oil, sugar, and bouillon cubes was reviewed and summarized. RESULTS: Most surveys found that a moderate to high proportion of women reported consuming wheat flour (48% to 93%), vegetable oil (44% to 98%), sugar (55% to 99%), and bouillon cubes (79% to 99%) in the past 7 days, although consumption was more common and more frequent in urban areas than in rural areas. Similarly, the reported amounts consumed during the previous 24 hours were generally higher in urban settings. CONCLUSIONS: The FRAT instrument has been successfully used in multiple countries, and the results obtained have helped in planning national food fortification programs. However, the recommended sampling scheme may need to be reconsidered, and the guidelines should be revised to clarify important aspects of fieldworker training, implementation, data analysis and interpretation, and reporting of the results.

Thriving public-private partnership to fortify cooking oil in the West African Economic and Monetary Union (UEMOA) to control vitamin A deficiency: Faire Tache d'Huile en Afrique de l'Ouest.

BACKGROUND: In sub-Saharan Africa, more than 42% of children are at risk for vitamin A deficiency, and control of vitamin A deficiency will prevent more than 600,000 child deaths annually. In the West African Economic and Monetary Union (UEMOA), an estimated 54.3% of preschool-age children are vitamin A deficient and 13% of pregnant women have night blindness. OBJECTIVE: To project the achievements of this West African coalition. METHODS: This article documents the achievements, challenges, and lessons learned associated with the development of a public-private partnership to fortify vegetable oil in West Africa through project reports and industry assessments. RESULTS: National-level food consumption surveys identified cooking oil as a key vehicle for vitamin A. Stakeholders therefore advocated for the production of fortified vegetable oil at large scale, supported industrial assessments, and reinforced the capacity of cooking oil industries to implement vitamin A fortification through effective coordination of public and private partnerships tied with standards, regulations, and social marketing. Strong alliances for food fortification were established at the regional and national levels. Stakeholders also developed policies, adopted directives, built capacity, implemented social marketing, and monitored quality enforcement systems to sustain fortification for maximum public health impact. The synergy created resulted from the unique and complementary core competencies of all the partners under effective coordination. The initiative began with the 8 UEMOA member countries and now includes all 15 countries of the Economic Community of West African States (ECOWAS), plus Cameroon, Tanzania, and Mozambique, forming a sub-Saharan Africa-wide initiative on food fortification. All members of the Professional Association of Cooking Oil Industries of the West African Economic and Monetary Union (AIFO-UEMOA) now fortify edible oil with vitamin A. Through multisector cooperation, an estimated 70% of the population has access to vitamin A-fortified edible oil in participating countries. CONCLUSIONS: Sustainable fortification of cooking oil is now a reality in all UEMOA countries.