Helen Keller International (HKI)

1. Building evidence base related to nutrition sensitive interventions, including bio fortified crops.

2. Support large-scale food fortification efforts in Burkina Faso (funding from government of Taiwan) folate and vegetable cooking oil with vitamin A.

1. On-track and on-going. HKI continues to make good progress on all non-financial commitments related to building the evidence base, with adaptations to any implementation challenges presented by COVID-19 surges and mitigation measures. Below we provide selective examples of HKI’s commitment to build the evidence-base for nutrition sensitive interventions.

Nepal: During 2021-2022, Helen Keller continued to implement homestead food production (HFP) activities in Nepal through the USAID-funded Suaahara program. This model introduces improved techniques for vegetable gardening and poultry production at the household level to increase yields and promote year-round production and consumption of nutrient-rich foods. The model establishes one village model farmer (VMF) per 16 households, on average, and they serve as a local resource with a model farm, and lead monthly discussions in HFP group meetings regarding agriculture and livestock techniques and linkages between agriculture and health and nutrition, as well as related gender and social issues. As of May 2021, Suaahara II had reached approximately 137,986 households in the 1,000-day period, including 90,194 households from the first phase of Suaahara. The Suaahara program responded to the Covid-19 crisis and lockdown by coordinating with Agriculture Knowledge Centers and municipalities to provide vegetable seeds to households which are severely food insecure, of lower socio-economic status, have limited access to agrovets, and have lost standing crops and vegetable seeds due to current floods and landslides. Since the Covid-19 related lockdowns have been lifted, the program has continued providing in-person advisory services on homestead gardening and backyard poultry farming, as well as providing referrals to government safety nets for extremely food insecure households. Moreover, the program is also prioritizing digital agriculture extension advisory services via mobile application (Krishi Guru) and Facebook Messenger to improve community's access to timely agriculture and livestock extension advisory services. Finally, Suaahara has supported the Ministry of Agriculture and Livestock development to develop a guidebook on nutrition sensitive agriculture targeted at programmers at all levels. This will help ensure that current and future agriculture programs contribute to closing existing diet-related nutrition gaps.

Bangladesh: During 2021-2022, Helen Keller Intl completed the final year of its Sustainable Agriculture and Production Linked to Improved Nutrition Status, Resilience and Gender Equity (SAPLING) program, which worked with over 53,000 poor households in Bandarban District of the Chittagong Hill Tracts. SAPLING’s focus on homestead food production and improved livelihoods led to an increased the number of hectares farmed using resilient techniques, improved family access to and consumption of nutritious foods, and increased the proportion of women meeting the minimum dietary diversity threshold. In response to COVID-19, SAPLING responded by providing virtual training and social behavior change messaging on protective measures, ensuring water access at clinics and other critical locations, and collaborating with local disaster management infrastructure and safety nets. As the intense lockdowns significantly impacted participant livelihoods, assets and savings, SAPLING prioritized continuity of interventions, adapting to virtual and social media platforms, mobile phone interactions or smaller group sizes for agricultural training and technical support, linkage meetings for market actors, savings and internal lending communities (SILC), and maternal and child health and nutrition (MCHN) activities. Helen Keller Intl also continued to build upon SAPLING’s work in a subset of the same target areas through the Bandarban Agriculture and Nutrition Initiative (BANI), which aims to reduce the impact of COVID-19 pandemic mitigation measures on incomes and food and nutrition security. BANI works to build the capacity of ~28,000 households on improved production practices and ~900 individuals specifically on strengthening income generating activities.

Vietnam. In 2021-2022, Helen Keller Intl completed a mixed-methods study to assess factors associated with sustained adoption of practices within non-emergency food security programming in northern Vietnam. Specifically, the study is assessing the sustainability of the following outcomes: (1) improved year-round production of micronutrient-rich foods; (2) improved consumption of micronutrient-rich foods and infant and young child feeding (IYCF) practices; (3) improved water, sanitation, and hygiene (WASH) practices; and (4) improved income generation from sale of excess household produce. Helen Keller followed up with households that participated in our Enhanced Homestead Food Production (EHFP) projects implemented several years earlier in Son La, Hoa Binh and Lai Chau provinces. The study results showed many EHFP households have continued to be able to produce year-round vegetables and fruits for home consumption. Although there was a significant decrease regarding the number of different vegetables, poultries owned, WASH practices, and household income from sale of surplus EHFP products, some changes in infrastructure have continued primarily due to sustained capacity of trained households and community facilitators and sustained linkages with national and local platforms.

Burkina Faso: In 2021-2022, Helen Keller Intl continued implementing and evaluating the impact of an integrated nutrition program in 60 villages located in Sissili province, which includes: (1) the cultivation of Orange-Fleshed Sweet Potatoes (OFSPs); (2) promotion of the production and consumption of Vitamin A-rich OFSPs through Village Model Farms that serve as a learning platform for participants; (3) promotion of optimal IYCF; practices by creating women's learning groups; (4) use of Husband Schools as a gender-transformative approach to empower women; and (5) enhancement of the economic status of women by introducing VSLAs. Achievements included the establishment of 61 Village Model Farms reaching 2,450 women with capacity building and agricultural inputs; establishment of 5,677 homestead gardens; capacity building and input support of 14 OFSP vine multipliers, leading to distribution of enough OFSP vines to plant at least 36.8 hectares; training of 834 Husband School participants on nutrition, agriculture and WASH practices; and the establishment of 52 savings groups with nearly 1,390 women that have received training and successfully saved over $63,200 by project end. Follow-on funding began in February 2022 to reinforce achievements in the original 60 villages as well as scale up the approach to an additional 40 villages.

In addition to the programs above, Helen Keller Intl continued to support nutrition-sensitive interventions in Senegal, Cote d’Ivoire, Mali, Myanmar, Niger, Nigeria and Sierra Leone.

2. The Burkina Faso fortification work was successfully completed in 2015. Helen Keller Intl is currently working to generate the necessary evidence and data needs to inform government decisions to fortify bouillon in Burkina Faso, Nigeria and Senegal. Helen Keller is: (1) helping to establish multi-stakeholder Country Working Groups (CWGs) in each country to identify research needs needed to inform policy decisions related to bouillon fortification; (2) assessing the contribution of bouillon consumption to total salt intake; (3) conducting formative assessment on stakeholder perceptions of bouillon fortification; and (4) undertaking a clinical trial, in coordination with UC Davis, to assess the effect of consumption of micronutrient fortified bouillon on nutrient intakes and micronutrient biomarkers in Ghana. During 2021-2022, harmonized regional standards for safe manufacturing of bouillon were reviewed and recently endorsed by ECOWAS (Economic Community of West African States) Council of Ministers; guidance on these standards are expected to be shared with member states in the coming months. After delays due to COVID-19, several studies related to sodium intake are anticipated to begin in the coming year in Burkina Faso, Nigeria and Senegal, along with the micronutrient fortified bouillon consumption clinical trial in Ghana.