Chapter 6: Integrated Approaches to Achieve Economic and Nutrition Outcomes

Evidence suggests that integrating activities to improve livelihoods and nutrition for food insecure households can result in better outcomes than implementing them in isolation. Training on improved nutritional practices provides the knowledge base for better decision making, while the increased income from livelihood activities can both empower women to change household behavior and provide them the means to invest in and prepare more nutritious food.

However, attempts to design programs that integrate both objectives successfully remain in their infancy. Proper program design may contribute greatly to strengthening the links between improved livelihoods and nutrition. Greater understanding about what makes these programs work is especially critical to young women, who, in addition to playing the role of primary caregiver, are frequently disempowered economically. Fortunately, good practices in this sector are emerging.

Key Lessons Learned

  • Approaches to economic strengthening and nutrition activities must be based on an in-depth understanding of household roles and economics. An in-depth assessment of the cultural mores and economic relationships between household members can reveal opportunities to integrate activities. For example, under the Chemonics-led Nigeria MARKETS Program (see Box 6.1.1), Making Cents learned that young women control food purchase decisions, but a short-term coping mentality and their limited economic means inhibited them from making good nutrition decisions. The program used this information to develop its approach to both strengthening young women’s livelihoods and providing nutrition messages that informed their food purchase and preparation decision-making.
  • Integrated messaging and activities is essential to achieving results. Separating economic strengthening and nutrition messages dilutes overall program impact. Nutrition education alone does not provide the means and empowerment for young women to take control of decisions, and economic strengthening provides the empowerment but not the education. Focusing on the positive impact that good nutrition has on household productivity reinforces messages and provides the economic means to pursue changes in nutrition practices.
  • The economic empowerment of women, especially young women, appears to have a greater effect on improved nutritional outcomes than if the household gained additional income alone. As has been learned in other programs focused on adolescent girls, their involvement in economic activities can have a larger impact on their empowerment and attitudes of self-worth, then if they just earned more income. Programs that integrate nutrition and economic strengthening are observing the same conditions; when women are equipped with knowledge and skills that the community views as lacking, they gain a voice in household decision-making and, in turn, earn increased respect in the community. This is especially important for younger women who have not yet established themselves as a strong, independent voice, giving them the confidence to change traditional nutrition and household asset management practices.
  • The chance to obtain relevant business skills can be a key driver of initial attendance at trainings. While programmatic experience suggests that women tend to benefit in equal measure from business training and training on nutrition, many appear to be initially attracted by the opportunity to earn additional income from relevant business training. This increased income potential drives up attendance in business training relative to nutrition-specific programs.
  • Programs should consider carefully whether to focus attention on young women alone or on mixed gender and age groups. Focusing program activities on adolescent girls directly may have greater individual empowerment results, but still stymie overall changes in practices, because other members of the community do not value the changes. In Nigeria under the USAID MARKETS Livelihood and Household Nutrition activity, Chemonics and Making Cents targeted mixed age groups (young girls aged 16-25 with other women of child-bearing years) and included select members of the community in order to develop mentoring relationships and strengthen community buy-in to the program’s set of behavior change objectives.
  • Reaching girls early improves development outcomes. Evidence suggests1 that integrated programs that reach girls at an earlier age improve development outcomes. This appears to be due to two factors: first, that younger women tend to be more disempowered economically and therefore benefit more from the elements of the program that enhance economic empowerment; and second, nutritional impacts are greater when they reach mothers who have not yet borne children or who have children who are still very young.
  • Monitoring and Evaluation of integrated programs is more complex and should attempt to measure causality. While stand-alone economic development or health and nutrition projects allow a focus on outcome measurements, integrated programs add another level of complexity, in that practitioners try to understand the links between improved economic outcomes and improved health outcomes; and ideally to demonstrate not only correlation, but causality between these outcomes.

6.1.1 Noteworthy Resultes: Taking an Integrated Approach to Health and Livelihood Programming in Nigeria

The USAID-funded Nigeria MARKETS Livelihood and Household Nutrition activity, implemented by Chemonics and Making Cents, took an integrated approach to improving the livelihoods of young women and caregivers of orphans and vulnerable children in northern Nigeria. The program focused primarily on young women of child-bearing age, typically falling between 16 and 30 years of age. The activity was implemented from January to August 2010 and reached 4,000 women from vulnerable households in Northern Nigeria. The young women were trained in skills such as managing household assets and record keeping as well as basic business skills such as obtaining market intelligence and marketing. Local project partners received capacity building to be able to deliver training to women participants. The training focused on the interrelationship between the management of household assets and decision-making surrounding food

selection and preparation to maximize nutritional outcomes.

The program’s success was reflected in its initial results on both economic strengthening and nutrition measures. Two months following the training, over 86 percent of participants had adjusted their household investment practices to maximize business outcomes and changed how they sold goods based on a better appreciation of the market. The percentage of participants that considered nutrition as the number one factor in making food purchases rose from 4.9 percent to 38.8 percent; 57 percent of those participants indicating that they know nutrition can have a positive effect on income and productivity. Additionally, 95 percent of participants are investing in a homestead farm to diversify and improve food availability and utilization.