Fostering an Enabling Environment for Nutrition-Sensitive Agriculture and Food Systems in Nigeria.

BACKGROUND: Although recommendations exist for making agriculture and food systems nutrition sensitive, guidance about how to successfully operationalize these recommendations within national institutions is limited. Over the 13 years from 2010 to 2023, there were several undertakings to strengthen the enabling environment for sustainable nutrition-sensitive agriculture (NSA) and food systems in Nigeria. Some studies were also conducted over the period to foster better understanding of the national enabling environment and facilitate effective actions. OBJECTIVE: This article documents successes and failures from Nigeria's experiences by reflecting on critical developments, events, policies, and programmes on Nigeria's journey toward advancing nutrition through agriculture and food systems; as well as findings from conducted studies. DISCUSSION: Successes include the existence of a Nutrition and Food Safety Division in the Ministry of Agriculture and an approval for a Nutrition Department, existence of an agriculture sector nutrition strategy, increased private sector engagement and commitment to nutrition-sensitive food systems, and increased funding for nutrition in the agriculture sector. Challenges especially remain for scaling up strategic, operational, and delivery capacity of both organizations and individuals involved in advancing NSA and food systems. Lessons learned include-institutionalizing NSA and food systems takes time; knowledge brokering is indispensable and requires several collaborating entities and stakeholders; and approaches used should be suited to available government capacity. CONCLUSION: More than a decade of efforts targeting different enabling environment factors has resulted in greater political commitment for nutrition within the agriculture sector and an improved enabling environment for NSA and food systems.

Advancing a Multisectoral Platform for Nutrition-Sensitive Agriculture in Nigeria: Reflections on Effectiveness and Lessons Learned.

BACKGROUND: Inadequate coordination mechanisms and capacity to coordinate are limiting factors for maximizing the ability of agriculture to improve nutrition in Sub-Saharan Africa. Effective coordination requires the availability of a platform for stakeholder convening, planning, operationalization of ideas, communication, and accountability. Nigeria's Federal Ministry of Agriculture and Rural Development established one such platform to support the institutionalization of nutrition-sensitive agriculture. Platform members include several departments within the Ministry, other ministries, and development partners. While the platform achieved key milestones and fostered collaboration, some gaps remained. OBJECTIVE: This study reports an assessment to understand the perspectives of members of the coordination platform and identify ways of increasing effectiveness. METHODS: Desk reviews of relevant documents and 18 key informant interviews were conducted. Documents and interview notes were coded and analysed to identify recurring themes. Themes were appraised using a nutrition coordination framework. RESULTS: Sufficiently understanding the nutrition role of representatives' own organization/department and the purpose of the coordination platform and its activities was important for success. The profile and seniority of representing officers also mattered. While the leadership of the Ministry was committed to advancing nutrition through agriculture, the coordination platform could improve its functionality through consistent leadership, increased seniority of member representatives, and appropriate communication. CONCLUSIONS: Multisectoral coordination platforms are necessary but do not alone achieve nutrition coordination. Effective leadership and investments in time, strategic orientation, and training are critical to achieving a shared purpose, individual sector fulfilment of nutrition roles, and additional coordination success factors.

Government Budget for Nutrition-Sensitive Agriculture in Nigeria Increased Following Development of Related Strategy.

BACKGROUND: Financial resources that are commensurate with the magnitude of malnutrition problem are requisite for effective interventions to reduce malnutrition. Understanding the amount and nature of sectoral investments in nutrition is important for advocating and mobilizing increased government budgetary allocations and release. OBJECTIVE: This study assessed trends in Nigeria's agriculture sector nutrition allocations and whether launch of nutrition-sensitive agriculture strategy and/or the COVID-19 pandemic may have affected these nutrition allocations. METHODS: Agricultural budgets from 2009 to 2022 of Nigeria's federal government were analyzed. Nutrition-related budget lines were identified using a keyword search and were then classified as nutrition-specific, nutrition-sensitive, or potentially nutrition-sensitive, based on defined criteria. Potentially nutrition-sensitive items were further screened. Budget lines finally included as nutrition allocations directly targeted improvements in nutrition or intermediate outcomes in pathways between agriculture and nutrition. Budget lines were summed, and these nominal values were adjusted for inflation (using the consumer price index for each year) to obtain real values. RESULTS: Nutrition allocations in the agriculture budget increased considerably even after adjusting for inflation and went from 0.13% of agriculture capital budget in 2009 to 2.97% in 2022; while the real value of total government agricultural budget declined. Large budgetary increases coincided with the development/launch of costed strategies with nutrition-sensitive agriculture components. Still, there were some missed opportunities to increase nutrition allocations. CONCLUSIONS: Existence of nutrition-sensitive agriculture strategies has facilitated increased nutrition funding and improved the enabling environment. There is need to optimize existing nutrition allocations while advocating for additional funds.

Building the Commitment of the Private Sector and Leveraging Effective Partnerships to Sustain Food Fortification.

The private sector is a critical partner in achieving the universally adopted Sustainable Development Goals (SDGs)-UNDP 2022. As part of a national strategy to address malnutrition (SDG2), Large-Scale Food Fortification of commonly consumed staple foods and condiments with vitamins and minerals is a proven intervention that requires the concerted engagement of multiple actors in a country's agri-food and public health ecosystems. Lessons from TechnoServe's Strengthening African Processors of Fortified Foods (SAPFF) Program, implemented from 2016 to 2022 in Kenya, Nigeria, and Tanzania with support from the Bill and Melinda Gates Foundation, provide essential learnings about how to effectively engage, motivate, and improve the food fortification performance of the industry in compliance with national standards, through capacity building, responsive technical assistance, and multistakeholder engagement that builds trust and accountability of industry in the fight against malnutrition.

Industry Self-Regulation of Food Fortification Compliance: Piloting the Micronutrient Fortification Index in Nigeria.

Sustaining large-scale and good-quality food fortification requires strategies that incentivize food processors to invest in and consistently meet national food fortification standards where they exist. A standardized Micronutrient Fortification Index (MFI) piloted in Nigeria has provided a ranking of fortified branded products for each participating company, based on a score aggregating the effectiveness and efficiency of the company's systems and levels of product fortification. The MFI has demonstrated the significance of brands as a focal point for investment and industry accountability in food fortification and the power of harnessing the competitive nature of businesses to drive their food fortification performance. The initiative started with a pilot consisting of well-known brands of 4 companies and has since expanded participation to 15 companies, representing 31 brands, having completed the first entire ranking cycle. The publicly listed brands on the Index now cover approximately 80% of the flour milling market, 40% of the edible oils market, and 88% of the sugar market in Nigeria, reaching an estimated 134 million people in the country in 2022 according to analysis by TechnoServe Supporting African Processors of Fortified Foods (SAPFF) program in Nigeria. The data inputs are made through company-owned digital portals, and the results are published on a secure, web-based public portal which also serves as a gateway for stakeholders to access related information on micronutrient fortification and food quality (https://technoserve-mfi.web.app/). The ultimate aim of the MFI is to serve as a leverage for private sector efforts to both digitalize quality assurance and business processes linked to industrial automation and to harness their competitiveness through voluntary participation in the Index to drive improved food fortification performance based on industry best practices and quality benchmarks.

Evidence-Based Design Process for Nutrition-Sensitive Agriculture Interventions: A Case Study of the Advancing Local Dairy Development Programme in Nigeria.

BACKGROUND: Nigeria is a significant contributor to the global burden of chronic undernutrition in children under 5 years of age. The undernutrition challenge constrains the productivity of rural households. This study was carried out among beneficiaries of the productivity-enhancing Nigerian Dairy Development Programme (NDDP) to guide incorporation of nutrition into the successor program-Advancing Local Dairy Development in Nigeria (ALDDN). Therefore, this study contributes to the literature about operationalizing nutrition-sensitive agricultural frameworks. OBJECTIVE: The study sought to determine potential entry points for improving the nutrition of smallholder dairy farmers (≤ 5 milk cows) with a focus on food system entry points. METHODS: Primary data were collected from 514 smallholder dairy households in Oyo and Kano states of Nigeria. Both quantitative and qualitative data were collected. Quantitative data collected included minimum dietary diversity for women, nutrition status, and socioeconomic characteristics of households. Qualitative data included information about sources of food, markets, and other food system characteristics. Quantitative data were analysed using descriptive statistical tools and correlation analysis, while common themes were identified from qualitative data. CONCLUSIONS: The study showcased men's important role in food purchase and consumption, particularly in Kano. Increasing opportunities and the ability of women to use nutrition education appeared necessary for translating knowledge into improved practices. The own consumption (i.e., the portion of the milk kept for households' consumption as well as diversification of foods produced for consumption); income; women's empowerment; and environmental sanitation pathways seemed to be the most feasible pathways for improving nutrition within the context of the study population.

Stakeholders, Relationships, and Coordination: 2015 Baseline Study of Needed Enablers for Bridging Agriculture-Nutrition Gaps in Nigeria.

BACKGROUND: Renewed efforts by the Nigerian government to address malnutrition have led to nutrition actions by several sectors, including the agriculture sector. However, the success of these actions depends on the characteristics of the stakeholders involved, including their relationships and coordination. OBJECTIVE: This article reports a 2015 study of nutrition-sensitive agricultural stakeholders in Nigeria that assessed what the stakeholders do, where they work and how they are organized to improve nutrition. The study provides a baseline for assessing progress and measuring stakeholder and coordination changes in the Nigerian nutrition-sensitive agriculture landscape. METHODS: Semi-structured interviews (n = 17) and focus group discussions (n = 2) were held with federal, state, and local government level stakeholders; reviews of stakeholder program documents were also conducted. RESULTS: The study identified 7 groups of nutrition-sensitive agriculture stakeholders and several coordination challenges. Political leadership, advocacy and provision of material and human resource support by nongovernmental organizations, and donor interest and funding have been vital for mobilizing nutrition-sensitive agriculture. Still, although stakeholders frequently highlighted that nutrition was an important consideration in their interventions, nutrition goals and activities and/or indicators to measure outcomes were not regularly communicated. Also, while coordination mechanisms existed, there appeared to be minimal actual cross-sectoral partnerships because of inadequate trust, competition, and conflicts over institutional turf and mandates. CONCLUSIONS: Needed enablers for improving nutrition-sensitive agriculture in Nigeria included improved stakeholder nutrition literacy, as well as enhanced stakeholder engagement facilitated by role definition, clarification, and consensus. Exploring different approaches to coordination may also be necessary.

Training to Build Nutrition Capacity in the Nigerian Agricultural Sector: Initial Assessment and Future Directions.

BACKGROUND: In response to calls to increase nutrition-sensitive agriculture (NSA), the Federal Ministry of Agriculture and Rural Development developed the Nigeria Agricultural Sector Food Security and Nutrition Strategy 2016-2025 (AFSNS). Capacity development activities to facilitate the AFSNS implementation subsequently commenced. OBJECTIVE: This study analyzed the processes and outputs of initial capacity development efforts, examined findings from the analysis using existing literature, and identified critical next steps for nutrition capacity development in the Nigerian agriculture sector. METHODS: The study reviewed documents including a proposal for nutrition training of agriculture sector actors, reports of meetings held among 6 resource persons who designed and/or delivered training, training reports, participants' pre- and posttraining assessments, and participants' training evaluation. Interviews were conducted with 2 resource persons involved in training design and delivery. Documents and interviews were coded and analyzed to identify emergent themes. Participants' pre- and posttests results were compared using paired t test in Stata 12.0. RESULTS: Knowledge and practice gaps were more extensive than had been anticipated. Training had some but limited effects on knowledge scores at the federal level. Modules addressing implementation practices had to be scaled down for participants to keep up with the learning pace. Existing literature indicates that such training would have been better planned as part of a broader sectoral nutrition workforce strategy, to facilitate greater tailoring of training to participants' job roles. CONCLUSION: Effective AFSNS implementation requires developing and operationalizing a comprehensive short-, medium- and long-term Agriculture Sector Nutrition Capacity Development Strategy for Nigeria.

Effect of health education intervention conducted by Primary Health Care workers on oral health knowledge and practices of nursing mothers in Lagos State.

Educational interventions on oral health care is traditionally carried out mainly by oral health workers in Nigeria. Despite the introduction of the National Oral Health Policy, oral health services/education is virtually non-existent in PHC centres in Nigeria. This study sought to determine the effect of a health education intervention delivered by Community Health Officers (CHO) on the oral health knowledge and practices of mothers attending a PHC centre in Lagos State. A pre-experimental, Before- After study design was employed. An interviewer- administered questionnaire was administered at baseline to assess the oral health care knowledge and practices of 267 mothers who enrolled in the programme. After enrolling the participants, CHO's previously trained commenced a health education intervention on oral health. The intervention, which consisted of 2 lecture sessions, a demonstration session and a return demonstration session, utilising flipcharts and health information leaflets spanned a six-month period. Oral health knowledge and practices of participating mothers was evaluated 3 and 6 months after the intervention commenced using a standardised checklist. Data entry and analysis was done using SPSS version 20, P-value of <0.05 was considered significant. The mean oral health knowledge score at baseline was 4.58 (±1.37) while at 3-month and 6-month postintervention the mean scores were 4.68 (±0.97) and 4.96 (±0.49), respectively. There was a statistically significant increase (P=0.000) in the mean knowledge scores at 6 months post-intervention. Mothers who were 36 years or older and those with more than 12 years education displayed significantly better knowledge scores (P<0.05). Most (78.3%) reported using cotton wool or foam with water for their infants' oral hygiene. By the second post-intervention visit, there was a significant change in the perception of the mothers on correct oral hygiene tool for infants (52.3%; P=0.000). Furthermore the percentage of mothers actually using toothbrush to clean their child's mouth (98.1%; P=0.000) had increased. The oral health knowledge of the participants increased significantly following the intervention especially at the 6-month evaluation. PHC workers can successfully carry out oral health educational interventions at PHC level. The greatest value will occur with reinforced repetition of the messages.