Gardens for Health International

Case Studies
Agriculture, Food Security, Nutrition
​Bumbogo Health Center, Rubungo Health Center, Nyacyonga Health Center, Kayanga Health Center, Murandi Health Center, Kinigi Health Center, Shingiro Health Center, Gasiza Health Center
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 main objectives of our program are to integrate agriculture and comprehensive health education into the treatment of malnutrition, to advocate for policies and programs that include nutrition-focused agriculture in the treatment of malnutrition, and to provide technical assistance to partners interested in adapting our model and methodology for their communities.

Our work is fully integrated into the Rwandan public health system. By partnering directly with health centers and staffing field educators as part of clinical personnel, we are establishing a scalable model with an effective entry point: malnourished children at the point of care. In addition to our health center partnerships, we are working closely with the Government of Rwanda and with multi-national partners to improve the community level identification, treatment, and prevention of malnutrition in the districts in which we work.

Globally, malnutrition is one of the critical challenges of our day, however, in too many cases the system is equipped only to provide short-term interventions. We envision rural health systems in sub-Saharan Africa that equip patients with the tools to maintain health improvements over the long term. This requires a shift in the current treatment of malnutrition, away from reliance on costly short-term handouts and towards targeted investments in the knowledge and productivity of those most vulnerable to malnutrition. Our work is demonstrating that such a shift is not only possible, but also effective. 

Impact of project: ​

First, and most importantly, we are seeing lasting improvements in child health. 71% of children who enrolled in our program one year ago are now at a healthy weight-for-age.  We are primarily concerned with sparking lasing changes in child health, which we won’t see until we are able to track cohorts for a total of 36 months. However, this preliminary analysis gives us confidence that we are on the right track.

Not only do our results suggest that health outcomes are improving, but analysis of Household Dietary Diversity Score (HDDS), a proxy indicator for houseshold nutritional status, suggests lasting changes in consumption patterns as a result of our program. One year after enrolling in our program, 88% of families report that they consume four or more different types of food each day, and 18% report that they consume nine or more different types of food daily. Moreover, these findings suggest that families begin to consume a wider variety of foods in the first season, likely as a result of the education we provide, and that over time - presumably as they begin to harvest foods from their gardens - the upward trajectory in their diverse consumption continues.

Finally, we have seen that families who graduate from our program are likely to become agents of change at the community level and beyond. For example, some of our graduates have become Community Health Workers, serving on the front lines of preventative community based medicine.

Why this project is a Good Practice example: ​

Our work is focused on advocating for and implementing nutrition-focused agriculture for families who are suffering from malnutrition. We currently work in 8 partner health centers, helping 960 families each year to break the cycle of malnutrition and providing approximately 4,800 children the healthy food they need to grow and thrive. Our unique approach combines targeted agricultural assistance, comprehensive health education, and regular home visits, to ensure that families struggling with malnutrition receive the resources, education, and support to keep their children healthy over the long term.

Our home garden package is the core deliverable that we provide to families enrolled in our program and is focused on maximizing the nutrition impact by increasing food availability, providing agronomic and nutritional diversity, and promoting food self-sufficiency.  It includes three seasons of seeds and seedlings, 14 weeks of agricultural education and regular home visits. To achieve this goal, both the selection of crops we include, and the accompanying education we provide, are designed to leverage natural systems to increase production immediately and over the long-term. To this end we focus on the on-farm cycling of nutrients and the conservation of soil, alongside the provision of crops that promote household dietary diversity and crop biodiversity.

Impact Evaluation:

Impact evaluation in progress

Lessons Learned: ​

Too often, we see a development paradigm involving outside experts coming to a problem afflicted area, describing a problem and the prescribing a solution based on their cultural and educational lens. At Gardens for Health, we take a very different approach to addressing the challenge of malnutrition. We believe that in order to be truly effective over the long-term, we must meet families and communities where they are, and tailor our intervention to address each household’s specific needs and challenges. This process begins with our staffing model – our community outreach staff all come from the communities they serve, and are selected based on their leadership potential and the level of trust they have within the community.

The agriculture component of our program is designed to enable families to grow enough nutritious food to feed their children and keep them healthy – not only during our year-long engagement, but for the long term. We recognize that in order to empower families, it is critical that our home garden package incorporate individual preference into home garden design. To this end, we provide families with 6 categories of crops and ask them to select crops from options within each category. This approach encourages dietary diversity and crop biodiversity, while simultaneously allowing families to make decisions based on what they believe are most appropriate choices for their needs and abilities. It also leads to higher adoption over the long term.


Funders: Gardens for Health International

Primary Contact: Jessie Cronan, Executive Director, Gardens for Health International

Country: Rwanda

Project Dates: Started August, 2010. Scaling up to 20 health centers.

Interventions: Incorporate explicit nutrition objectives and indicators, Assess the context at the local level, Target the vulnerable and improve equity, Empower women, Facilitate production diversification, Incorporate nutrition promotion and education,

Target Population: Children under 5, Mothers, Parents, Rural households, Urban households, Women farmers,

Project Stage: Ongoing activities

Geographic Coverage: State/Province