MSU Agricultural Economics  Research > Food Security III > Policy Syntheses > No. 57



James Tefft, with Fatimata Ouattara, Christopher Penders, Mbaye Yade, Daouda Keita, Valerie Kelly, and John Staatz

Food Security II Cooperative Agreement between U.S. Agency for International Development Global Bureau, Economic Growth and Agricultural

Development Center, Office of Agriculture and Food Security and Department of Agricultural Economics, Michigan State University

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BACKGROUND: USAID/Mali, through the Food Security II Cooperative Agreement with the Department of Agricultural Economics of Michigan State University (MSU), is supporting research and outreach activities aimed at strengthening the links between agricultural productivity growth and improved child nutritional status in Mali. A key focus of the work is on understanding how income growth resulting from increased agricultural productivity interacts with non-income factors to affect child nutritional status. This work is being jointly implemented by MSU, the Institut du Sahel (INSAH) and the Malian Ministry of Health. One of the aims of the project is to strengthen the capacity of the Ministry's newly created Food and Nutritional Monitoring Division (DSSAN) to carry out multi-disciplinary studies to monitor and identify ways of improving child health and nutrition in the country. This paper summarizes some of the preliminary findings of this ongoing work. Summaries of earlier findings and a description of the project are available at:


Future research will include the study of opportunities for and processes required to create an integrated, multi-sectoral, community-based approach to improving nutrition.

FINDINGS: Has Malnutrition Worsened in Mali? In 1996, the results of the second Demographic and Health Survey (DHS II) in Mali showed that rates of child malnutrition had worsened since the first survey (DHS I) in 1989. This announcement, coming at a time of strong economic growth following the devaluation of the CFA franc, focused the government's and development community's attention on the reasons underlying this seeming paradox. In the first phase of USAID/MSU/INSAH/Ministry of Health's project on the Linkages between Agricultural Growth and Improved Child Nutrition in Mali, analysis of available data showed that 1) differences in the samples used in DHS I and II (rural/urban mix, age distribution of children, month of data collection) make them difficult to compare and thus conclude that child malnutrition has increased; and, 2) contrary to popular perception, agricultural growth has actually been quite variable over the last ten years, concentrated primarily in the cotton and rice sectors and generated by a relatively small percentage of better equipped farmers using improved farming practices. Although aggregate national cereal production covers Mali's estimated food requirements, well over half of rural households still do not produce sufficient food to meet their needs. Their food security depends on regular access to income and proper functioning markets that supply food at affordable prices throughout the year.

Even if households have the means to produce or purchase food, children's dietary intake is ultimately determined by the family's and primary caregiver's desire to obtain and use foods to meet their nutritional needs. Children's health also has a major effect on their nutritional status and is affected by their exposure and susceptibility to disease and the care provided to them.

Although children's nutritional status may not have actually worsened over the last fifteen years, there is little disagreement over the fact that child malnutrition remains a serious problem in Mali. Improving child nutrition depends on both agricultural productivity growth that generates higher real incomes and regular access to food, and integration of nutritional interventions (to strengthen proper feeding and care giving practices) in the package of basic services offered by community health centers. Neither higher income nor improved practices can by themselves lead to a sustainable improvement in children's nutrition.

Household-level Factors Affecting Nutritional Status. Preliminary analysis of data collected in the first stage of the qualitative component of the study (based on a limited sub-sample) focusing on feeding and care practices and mothers' time allocation suggests that numerous factors other than higher household income play a determining role on children's nutritional status:

These initial findings confirm results of similar studies conducted in Mali on feeding and care practices. While the relative importance of these factors to children's nutrition will be become clearer when analyzed with data from subsequent rounds of this qualitative study and an on-going weekly income-expenditure-anthropometrical survey, these preliminary findings draw attention to several issues:

Statistical analysis of the DHS data shows correlation of both increased mother's and father's education with improved child long-term nutritional status, as measured by height-for-age. Initial cross-country analysis of 10 DHS studies for several West African countries appears to suggest that fathers' educational level (likely correlated with household income) may be somewhat more important in the poorest countries, while maternal education may have a greater effect in countries with slightly higher per capita incomes. One potential explanation is that paternal income/education is important in helping raise living standards to a point where the family can meet minimum caloric levels. In countries where basic needs are more secure, maternal education is (relatively) more important in influencing the composition of diet and use of health care. In any case, this finding reinforces the

suggestion of other studies that nutrition education messages need to be targeted at several family members, not just mothers.

The cross-country work also shows that holding wealth and other factors constant, mothers with a healthier upbringing, who are subsequently taller, have healthier, better nourished children. This suggests an important intergenerational effect and a long-term payoff to efforts to increase access to food and nutrition education. The discouraging news is that there is no evidence that mothers' nutritional status has improved over the past generation in West Africa; average height-for age has stagnated or declined in most of the DHS West African countries.

Community-level Factors Affecting Nutritional Status. Preliminary findings from the community component of the study also highlighted the importance of higher incomes for increasing the effective demand for health care services. Broad-based demand for cost-recovery health care is essential to the financial viability of community health centers.

Over the last five years, the Ministry of Health and development partners have focused human and financial resources on expanding the availability of community health care throughout Mali, building and equipping new clinics. Community health centers have initially focused most of their efforts on providing curative services and improving immunization coverage. There has been relatively less attention given to the preventive and promotional components (i.e., nutrition) of the basic package of health care services advocated by the Ministry of Health. Most nutrition interventions have been implemented through short-term, donor-financed projects focused on feeding and care practices, micronutrients, vaccinations and child illness. While often obtaining good results, these actions have had limited success in institutionalizing the processes required to sustainability integrate nutrition interventions into the basic package of health services.

Finding sustainable financing mechanisms to pay for nutrition interventions implemented by community health centers presents a major challenge to Mali's health system. It is highly unlikely in the short term that families and caregivers will be willing and able to pay for nutritional services or that the Ministry of Health could expand central funding to community health centers. The most promising financing option would appear to be for rural communes to use their local fiscal authority and development mandate to develop a sustainable tax system to pay for these interventions. Implementing this type of system depends, however, on a dynamic rural economy capable of generating broad-based income growth that is prerequisite for an expanded tax base.

1. *Work for this summary was conducted under the Food Security II Cooperative Agreement (PCE-A-00-97-00044-00) between Michigan State University and the United States Agency for International Development, through the Office of Agriculture and Food Security in the Economic Growth Center of the Global Bureau (G/EGAD/AFS). Supplemental funding for this research was also provided to the FS II Cooperative Agreement by USAID/Mali.

Tefft and Penders are Specialists (International Development), Staatz is professor, Kelly is associate professor (International Development), and Yade is assistant professor (International Development) in the Department of Agricultural Economics at Michigan State University. Ouattara is a nutritionist at the National Public Health Research Institute (INRSP) and Keita is the survey manager at the Institut du Sahel. The views expressed in this document are exclusively those of the authors.