Background of Nourish North Initiative

A study conducted in the Northern Province of Sri Lanka three years after the civil war (2012) revealed a higher prevalence of stunting (22.8%), wasting (18.3%) and underweight (29.2%) among children. The Nationwide Demographic and Health Survey (2016) of Sri Lanka has also shown that in the Northern and Eastern provinces there is a high prevalence of stunting (21-22%). Malnutrition among children is directly associated with low birth weight which is directly linked to the nutritional status of the mothers.

Nutritional deficiencies are not only the result of low food quantities consumed but also of poor dietary quality and diversity. Increasing dietary quality and diversity is an important aspect to improve the nutritional and health status of women and children. This requires agricultural production to be diversified so that a wide range of different types of foods are available and accessible to the poorer socioeconomic groups.

The recent surge in food prices has also contributed to the worsening of this situation. Limited availability of food commodities to households, reduces the dietary diversity thus resulting in micronutrient malnutrition among young women and children. Therefore, this initiative aims to break this cycle of malnutrition by improving competency among young women on ways to achieve nutritional adequacy and to enable diverse diet choices. This program will be implemented in selected rural areas in the Northern Province with the support of local health authorities.

Assessing dietary diversity & micronutrition adequacy in Northern Sri Lanka

In Northern Sri Lanka, we will pilot a community-based approach that engages the community women leaders as research partners. This ensures not only that cultural preferences (such as taste, ease of processing, suitability to preferred cooking methods, etc.) are taken into account, but that diets are the result of collaborative knowledge-sharing between researchers and the community members. The added benefit of participatory intervention is that results belong to the community which helps to ensure the uptake of knowledge once the intervention is complete. We will start with a baseline study of agricultural biodiversity that is available and accessible both on and off the farm – not just what is grown on the farm and in-home gardens but also wild foods and foods sold at the market. We will also interview women of reproductive age to find out their nutrition and diet knowledge and practices, and carry out a 24-hour recall to estimate the average nutrient intake of women in the study area households.

We’re considering multiple dietary diversity (DD) indicators for interpreting the baseline survey. There are individual-level, household-level and community-level indicators. Dietary diversity is a proxy measure of micronutrient adequacy among women of reproductive age. When looking at diet quality and diversity, it is important to consider food systems as a whole. This means considering all the complex dimensions of a food system not just what is in a diet: production to processing; the marketability of local foods; natural resource management; and resilience to external stresses such as climate change. Taking this perspective means we are better able to understand how interventions can contribute to food systems in a sustainable and healthy way.

Putting nutrition back on the menu

The important step is to train not only the village women leaders who would become the agents of change but also the members of women farmer’s societies who will provide additional support and ensure that the knowledge gained during the project will be incorporated into ‘standard’ agriculture practice. The training of the village women leaders consisted of two linked parts, one on nutrition and the second on agriculture capacity development. Both included aspects of capacity building on how to facilitate a village community group, how to mobilize and inform participants about the survey, and how to monitor progress. These sessions were connected by focusing on messaging around three key food groups – dark green leafy vegetables, vitamin-A rich fruit and vegetables, and legumes, and even more specifically, towards the keyset of foods from these groups selected by communities during the Participatory Identification of Intervention Approach (PIIA). Building this connection will ensure that the nutrition and agriculture components are directly linked.

From the first day of nutrition training, we will focus on developing new and adapted recipes with the village women that included the foods identified from the food focus groups. If they are willing to contribute food and cooking utensils towards the training for the cooking demonstrations, the development of recipes will eventually be included in the successive training plan. While we are budgeting to cover some costs, if each and every person are willing to contribute something, we only have to supply the cooking stoves and fuel. We hope that the village women leaders would also ask the women farmers' society members to contribute to their cooking demonstrations and to make the experience richer by using more diverse foods than those supplied by the society, and this proved to be the case. It also provided an opportunity for the communities to literally ‘buy in’ to, and develop ownership of, their innovation.

Putting nutrition data to work in the community

The next step will be returning to the villages to share the data with them using simplified diagrams and relevant pictures. We will discuss why these food groups are important for health and nutrition and will further elaborate on the concept of dietary diversity. We will engage them in a conversation on challenges faced in growing each category in their home garden. We will focus on developing the impact pathways to ensure greater consumption of these foods – through identification of the barriers and ways to overcome them at each step from planting material in the ground, to growing, harvesting and consumption.

The agricultural side will focus on strengthening the capacity of the participants to grow these foods, as well as seed saving and post-harvest storage. The nutrition side will focus on education about why these foods are important to eat and experimenting with innovative ways to cook, prepare and preserve them to increase their appeal and ultimately consumption. We also allocate time to visit the nearby farms where most decisions are based on agronomic factors such as cost of seed, market price or based on tradition.

Challenges in implementation

We do not foresee any significant problems that may impede the delivery of this project. Social issues such as choices in certain foods linked to the cultural and religious practices are common in the communities we work. e.g. vegetarian diet, halal food. We have a thorough understanding of these socio-religious and cultural practices and have always worked in such environments in a sensitive and culturally acceptable manner. The trainers and facilitators who are involved in this project will be well trained and recruited from local communities which would enhance community engagement.

Covid-19 pandemic is a significant health risk which could affect this program in many ways. Larger face to face gatherings may increase the risk of contracting the disease. The use of public transport during peak hours also poses a significant risk of contracting COVID-19. The national regulations may change from time to time which could affect the timeline of the project. Additional permission may be required before conducting community surveys and field training. The probability of full-scale lockdown is minimal as the country has already transitioned to an endemic stage.