Action Against Malnutrition through Agriculture (AAMA)

Case Studies
Agriculture, Food Security, Nutrition
Helen Keller International (HKI), Nepal Technical Assistance Group (NTAG), in partnership with local NGOs and Government of Nepal
South Asia
Resource Publication Date:
December, 2013
Content Format:

This is one of 50 Harvesting Nutrition project case studies. Harvesting Nutrition was a contest held in 2012 and 2013 that showcased active projects working to improve the impact of agriculture and/or food security on nutrition outcomes. Co-sponsors were SecureNutrition, Save the Children UK, and the Global Alliance for Improved Nutrition (GAIN). Learn More.

Project Description: ​

The project goal was to reduce child malnutrition in the target districts. Through rigorous research methods the project planned to better understand how food security interventions combined with proven nutrition actions can produce substantial change in the quantity and diversity of food production, infant and young child feeding practices, anemia, and nutrition and health seeking behaviors of women and children in vulnerable households in the Far Western Region of Nepal.

The specific objectives of the AAMA program were to:

  • To improve the nutrition and health status of children under two years and pregnant and lactating women
  • To increase the accessibility and availability of micronutrient-rich foods for consumption by children under two years and pregnant and lactating women;
  • To increase the capacity of local NGO and district staff, female community health volunteers (FCHV) and community members to promote improved nutrition and agricultural practices; and
  • To develop an integrated food security and nutrition intervention that serves as a district wide model to scale-up (only one district). 

Impact of project:

​Comparing the findings from a baseline survey conducted before the start of the intervention to an endline survey conducted after the intervention, there was a significantly lower risk of underweight and anemia among women, as well as a lower risk of anemia in young children who were exposed to the interventions. There was, however, no significant improvement in child growth indicators.

The findings indicated a significant increase in the diversity of foods produced and consumed at the homestead – eggs, fruits and vegetables.  Families who perceived themselves as food secure improved from baseline to endline, as did women’s nutrition and health knowledge and consumption practices, particularly during pregnancy. The proportion of children 6-23 months old who were fed with a minimum acceptable diet also showed a significant increase. There was also a significant increase in household income from the sale of surplus commodities produced at the homestead.  

The governance strategy piloted in AAMA, strengthened the district and local government capacity to undertake the AAMA activities.  As it involved different government institutions (mainly health and agriculture), we believe this enhanced the ability of these local officials to manage multisectoral nutrition initiatives. A model was established for joint planning among government representatives from health, agriculture, livestock, planning, education and women’s development, coordinated by local government in line with the Multi-sector Nutrition Plan.

Local government bodies approved funding for activities introduced through AAMA. The village Model Farmers became Local Resources Persons nominated by local government officials to represent their communities and women farmer groups were registered with the local agriculture office making them eligible for savings and credit programs and other government programs.

Why this project is a Good Practice example:

​The evidence drawn from the project has played a major role in nutrition policy dialogue and program practice in Nepal. Recognizing its potential, the government of Nepal is working in partnership with the USAID mission and Suaahara project to replicate these strategies at scale to cover one-third of the country.

The interventions are directly supporting household food security, improved infant and young child feeding practices, improved agriculture practices and diversity encouraged through a ‘garden to plate’ initiative. Along with the enhanced homestead food production (HFP), the program integrates water, sanitation and hygiene, child health initiatives and maternal nutrition and health, including healthy timing and spacing of pregnancies.  These strategies are strengthened by a gender equity and social inclusion strategy, social behavior change communication and governance with a social mobilization component.

The governance and social mobilization is key to integrating nutrition through a multi-sector approach that will be owned and sustained by local communities and governments as partners in improving food security and nutrition in their villages. For example, in the three intervention districts, the local government bodies allocated almost $40,000 of their annual funding to HFP activities.  

The social mobilization aspect incorporated into the scale-up version of the governance process now includes an additional component that works with the disadvantaged community members. Through mobilization of the Community Awareness Centers in each Ward, an inclusive approach to food security and nutrition is activated within each village.  

Impact Evaluation:

Impact evaluation completed

Lessons Learned: ​

  • The combination of nutrition and agriculture enhances the adoption of essential nutrition actions and improved maternal health behaviors by providing a combination of knowledge, practical skills and inputs to women farmers with young children and encouraging their attendance in regular group meetings to guide and update them and providing opportunities for them to interact with and learn from each-other.   
  • Growing a few varieties of vegetables at the homestead is a usual practice on small farms in Nepal. With training, technical guidance and the availability of seasonal seeds, the quantity and diversity of the vegetables can increase substantially, providing availability of more nutritious food year-round.  
  • The backyard poultry was more difficult to introduce in some areas where chicken raising and egg consumption is not a usual practice for cultural reasons. More traditional practices such as open foraging left them to vulnerable prey. Families were then encouraged to build their own chicken coops and gradually learn how to care for and manage the chickens and to feed the eggs to their children.
  • A governance element is able to successfully engaged community participation and leverage budget allocations for the nutrition and agriculture interventions. Women HFP farmers are able to represent their communities as Local Resources Persons and influence village and district plans, substantiating the importance of integrated nutrition activities and the potential for sustainability. 
  • In areas where food insecurity and lack of market access are high, more time is needed for the anthropometric improvements.  Sanitation as well as hygiene practices may also improve impact.

Funders: USAID

Primary Contact: Pooja Pandey, Program director Helen Keller International

Country: Nepal

Project Dates: Completed

Interventions: Target the vulnerable and improve equity, Empower women, Incorporate nutrition promotion and education,

Target Population: Children under 3, Mothers, Rural households, Pregnant/lactating women (PLW),

Project Stage: Completed

Geographic Coverage: State/Province