AGRICULTURE-NUTRITION 
PROGRAMS:
WHAT HAVE WE LEARNED?

Marie T. Ruel
IFPRI

One Acre FundAndrew Westby

Marie T. Ruel, IFPRI 1



2000-2013: A DECADE OF REVIEWS OF 

AGRICULTURE AND NUTRITION 

PROGRAMS

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➢Ruel, 2001
▪ Agricultural programs (garden, HFP, livestock, aquaculture, mixed, cash cropping, dietary 

diversification) focus on vitamin A and iron

➢Berti et al. 2004
▪ Same types of programs; focuses on 5 types of capital

▪ Leroy and Frongillo 2007
▪ Animal production programs (aquaculture, dairy, poultry)

➢World Bank/IFPRI 2007
▪ Same types of ag programs; focuses on changing policy contexts and institutional frameworks

➢Leroy et al. 2008
▪ Focused on impact pathways approach

➢Masset et al. 2012
▪ Systematic review of same programs (VA meta analysis)

➢Girard, 2012
▪ Systematic review of same programs + biofortification (growth meta analysis)

▪ Ruel and Alderman, 2013 
▪ Review of reviews

Reviews of Ag-Nutrition Programs 
(2001-13)

Page 13



Key Findings

Evidence of impacts on 
nutrition is inconclusive:

Livelihoods, income, food security

Diet quality, women’s empowerment

4

Ag-nutrition programs 
have impacts on several 
underlying determinants 
of nutrition:

Likely due to weaknesses in design, 
targeting, implementation, evaluation

Except for vitamin A

Source: Ruel and Alderman, 2013, Lancet Nutrition Series



FINDINGS FROM 2018 REVIEW (2013-17)

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Ruel, Quisumbing and Balagamwala, 

Global Food Security, 2018



HKI Enhanced Food Production System

Package of interventions:
▪ Promotion of production diversity (focus 

on nutrient-rich foods); income (from sale) 

▪ BCC:

▪ To increase intake of nutritious foods

▪ To improve nutrition, healthy, hygiene practices

▪ Women’s empowerment activities

Ultimate goal: Improve nutritional status and health of 

children < 5y and women (esp. breastfeeding or pregnant)



45 New Papers (2014-17) 

➢17 from impact evaluations:

biofortification (3); homestead food production/home 
gardens (9); livestock (3); value chains (1); irrigation (1)

➢28 from association studies:

production/consumption diversity (11);  livestock (health 
and nutrition) (10); agriculture - women’s 
empowerment-nutrition (4); climate change & 
environment (2) 

Marie T. Ruel, IFPRI 7



Conclusions – NSA programs:

▪ WORK!  Better designed, targeted, implemented, evaluated

▪ Impacts on HH and individual (mom, child) diet diversity, MN intakes and 
status, knowledge & practices, child health— esp. when combined with 
BCC, women’s empowerment actions, WASH & MN-fortified products

▪ Impacts on child stunting are hard to achieve — even with strong 
programs and rigorous evaluations

▪ Question: Are programs becoming too complex and challenging to 
implement? (co-location vs. integration)?

▪ We recommend that NSA programs:
• Focus on improving access to/intake of high-quality diets for all household 

members rather than on reducing childhood stunting; measure outcomes along 
impact pathway (HH diet diversity, women’s empowerment, etc.)

• Be carefully tailored to specific context, culture, economic, food environment (esp. 
markets, nutrient gaps, gender roles)

Marie T. Ruel, IFPRI 8