Accelerating Progress In Improving Diets And Nutrition In Ethiopia

Ethiopia has witnessed significant reductions in child mortality, undernutrition, and communicable diseases, but more substantial and faster progress is still needed. The rise in obesity and in noncommunicable diseases, particularly in urban areas, is alarming and requires urgent policy and programmatic attention. Unhealthy diets drive both undernutrition and obesity and are the underlying cause of significant proportion of both communicable and non-communicable diseases. Maintaining the relatively high breastfeeding practices and increasing the diversity of diets will be critical to improving nutrition in Ethiopia. Implementation of effective nutrition messaging that shapes consumer behavior to adopt healthy dietary patterns, while bridging gaps in both the reach and the quality of such messaging is warranted. The health extension program, which is the cornerstone of the transformation of the health sector, may need to be redesigned in a way that improves its reach and the quality of the services it provides and minimizes the risk of burnout of frontline health workers. Interventions focusing on making healthy diets available, affordable, and accessible are urgently needed.

Ethiopia has witnessed significant reductions in child mortality, undernutrition and communicable diseases, but more substantial and faster progress is still needed. The rise in overweight and obesity and in non-communicable diseases, particularly in urban areas, is alarming and requires urgent policy and programmatic attention. Unhealthy diets are the drivers of both forms of malnutrition and are the underlying cause of significant proportion of communicable and non-communicable diseases. Maintaining the relatively high breastfeeding practices and increasing the diversity of diets will be critical. Implementation of effective nutrition messaging that shapes consumer behavior to adopt healthy dietary patterns, while bridging gaps in reach and quality of nutrition messaging is warranted. The health extension program that is the cornerstone of the health sector transformation may need to be redesigned in a way that improves reach, quality, and minimize the risk of burnout of frontline health workers. Interventions focusing on making healthy diets affordable, accessible and available are urgently needed.

Agriculture's vast potential to improve nutrition is just beginning to be tapped. New ideas, research, and initiatives developed over the past decade have created an opportunity for reimagining and redesigning agricultural and food systems for the benefit of nutrition. To support this transformation, the book reviews the latest findings, results from on-the-ground programs and interventions, and recent policy experiences from countries around the world that are bringing the agriculture and nutrition sectors closer together. Drawing on IFPRI's own work and that of the growing agriculture-nutrition community, this book strengthens the evidence base for, and expands our vision of, how agriculture can contribute to nutrition. Chapters cover an array of issues that link agriculture and nutrition, including food value chains, nutrition-sensitive programs and policies, government policies, and private sector investments. By highlighting both achievements and setbacks, Agriculture for Improved Nutrition seeks to inspire those who want to scale up successes that can transform food systems and improve the nutrition of billions of people.

We combine in-person survey data collected in February 2020 (i.e., just before the pandemic was declared) with phone survey data collected in March 2021 (i.e., one year into the pandemic) and August 2021 (i.e., approximately 18 months into the pandemic) to study how vegetable value chains in Ethiopia have coped with the COVID-19 pandemic. Focusing on the major vegetable value chain connecting farmers in East Shewa zone to consumers in Addis Ababa, we applied a cascading survey approach in which we collected data at all levels of the value chain: vegetable farmers, urban wholesalers, and retailers.

Driven by the fast spread of private irrigation pumps, there has been a rapid expansion of intensive vegetable cultivation in the central Rift Valley in Ethiopia, making it the most important commercial vegetable production cluster in the country. Supporting that “quiet revolution” has been an inflow of migrant laborers – paid through daily, monthly, or piecemeal contracts, with few employment benefits attached to them – and a gig economy as widely-used contractors organize, among others, mechanized land preparation, the digging of wells and ponds, seedling propagation, and loading of trucks. Almost 60 percent of the irrigated area is cultivated by medium-scale tenant farmers relying on short-term rental contracts. It seems that gig economies characterized by flexible contract arrangements implemented by outside contractors, which are increasingly fueling sophisticated sectors in developed countries, are important in these commercial agrarian settings in Africa as well. We further find that the COVID-19 pandemic has led to significant disruptions of this model, as seen by more limited access to services and the unavailability or high price increases in factor markets, especially for labor. We further note large but heterogenous price changes in output markets. The pandemic seems especially to have had important effects on the medium-scale tenant farmers as they depend relatively more than smallholders on outside inputs, labor markets, and these gig economies. However, on the other hand, they benefit more than smallholders from favorable output markets for vegetables.

Taking a food systems approach is a promising strategy for improving diets. Implementing such an approach would require the use of a comprehensive set of metrics to characterize food systems, set meaningful goals, track food systems performance, and evaluate the impacts of food systems interventions. Food systems metrics are also useful to structure debates and communicate to policy makers and the general public. This paper provides an updated analytical framework of food systems and uses this to systematically identify relevant metrics and indicators based on data availability in low- and middle-income countries (LMICs). The list of indicators partly overlaps with the Sustainable Development Goals (SDG) indicators, but these do not cover all aspects of the food system. We conclude that public data are relatively available on food systems drivers and outcomes, and on some, but not all, of the activities. With only minor additional investments, existing surveys could be extended to cove

Given the high prevalence of undernutrition among children in low income countries and the associated high human and eco-nomic costs (Hoddinott et al. 2013), improving nutritional out-comes must be an urgent priority. Improving nutrition is high on the policy agenda of the government of Ethiopia, as stated in the Growth and Transformation Plan II, which aims to reduce young child stunting levels from 40 percent in 2014/15 to 26 percent in 2019/2020. Lack of access to diverse diets is one of the underlying factors contributing to chronic undernutrition (Arimond and Ruel 2004, UNICEF 1998). Despite recent improvements, child stunting in Ethiopia remains widespread (CSA and ICF International 2017). Moreover, Ethiopian children consume one of the least diverse diets in sub-Saharan Africa (Hirvonen 2016). At the household level, food consumption baskets are dominated by cereals and pulses, while the consumption of animal-source foods and fruits and Vitamin A-rich vegetables is rare, especially in rural areas.1 Such monotonous diets are regarded as a major contributor to non-communicable diseases in Ethiopia (Melaku et al. 2016). Recent research suggests that the poor dietary diversity in ru-ral areas can be explained, at least partly, both by limited knowledge about the health benefits of diverse diets and by poor access to food markets. Households in areas in which food crop production is not very diverse but which have good access to mar-kets are found to have more diverse diets than do households in such areas but which have poor access to markets and, so, de-pend primarily on own-production for the food they consume.2 Yet, even with sufficient access to markets and knowledge on the benefits of diverse diets, poor households may simply be un-able to afford nutritionally rich foods (Warren and Frongillo 2017). Indeed, prices and affordability of nutritious foods remains a neglected area of research in efforts to understand poor dietary diversity in Ethiopia and elsewhere.3 In the analysis described here, we explore how prices and, consequently, the affordability of nutritious food have changed over the last decade in Ethiopia.