Case study Cost of the cheapest adequate diet and households ability to afford it Lindi Rural District / Tanzania. Introduction

Transcription

1 Case study Cost of the cheapest adequate diet and households ability to afford it Lindi Rural District / Tanzania Introduction This paper presents a case study from Tanzania comparing the cost of the cheapest adequate diet with households ability to afford it according to wealth status. Within the Tanzania context, the study objective was to determine what it would take to ensure that all households are able to afford a quality diet, particularly for children under two, in Lindi Rural District 1. The purpose was to feed into two related broader debates: the reduction of chronic malnutrition 2 and the design of social protection systems. In Tanzania, despite national economic growth, the prevalence of stunting remains high nationally (37.7% 3 ) and is particularly concerning in Lindi Region (54.4%). Under the Poverty Reduction Strategy 4 framework and as part of a social protection package, there is an opportunity to address this. At a global level, this case study is part of a multi-country initiative examining households ability to feed themselves adequately. It aims to provide evidence in support of expanded and improved investment internationally to reduce malnutrition and in particular enable households to access an adequate diet. The first section of this paper presents an overview of the study area to set the context. It then describes the methods used before discussing the cost of the cheapest adequate diets. This is followed by a discussion on affordability: what type of households/wealth categories can afford an adequate diet and other minimum nonfood needs. 1 Data used here are from studies conducted in 2006 and Multiple factors contribute to chronic malnutrition and each deserves attention. Amongst these, access to a quality diet is of particular importance for several reasons: It has often been overlooked, with priority given to meeting minimum energy requirement by most development actors It is essential to prevent the occurrence of chronic malnutrition and its irreversible effects in children under two The financial implications of ensuring access to a quality diet are rarely debated yet are crucial for planning effective responses 3 Source: DHS MKUKUTA Tanzania - 1 -

2 Overview of the area Overview of wealth and household economic profiles This case study focuses on the central part of Lindi Rural District where agriculture is the main economic activity. With a rainy season from about December to April and deep fertile soil, the area produces: - cashew nuts, coconuts and sesame as the main cash crops - maize, sorghum, cassava, rice and pulses (pigeon peas and cow peas) as the main food crops. Nevertheless, Lindi Rural District is one of the poorest areas in Tanzania: Lindi Region ranks second to last according to both the Basic Needs Poverty Line 5 and the Food Poverty Line. Wealth and poverty at household level are determined by several factors, namely: labour power, ratio of active members to, access to land and tree ownership. The Household Economy Analysis (HEA) in 2003 described typical better off, middle and poor households. The 2006 IHEA (Individual HEA) study 6 refined the 2003 results and provided a detailed picture of common household profiles within the very poor and extremely poor categories. Key characteristics of these households are presented in table 1. Table 1: wealth breakdown, household profiles and key economic characteristics Profile/group Proportion of households Better-Off 8% Middle 23% Poor 35% Very Poor 27% Extremely Poor 8% Characteristics 4+ acres of land trees 2-4 acres trees 1-2 acres of land 5-20 trees 1.5 acres 0 10 trees < 1 acre 0 5 trees Examples of extremely poor households Ex A young female headed household with 2 to 3 Labour poor 0.75 acres cultivated Some receive assistance Example of a very poor household: An active couple with 3 to 4 low active/ ratio 1.5 acres An active elderly with 1 to 2 Labour poor 0.5 acres cultivated 5 Household Budget Survey, 2000/01. 6 See report Tackling extreme poverty The role of cash transfers and complementary social protection measures, Save the Children, 07 for further information on the methodology and the IHEA results. Tanzania - 2 -

3 Malnutrition amongst children 6 59 months At the bottom of the wealth spectrum ( very poor and extremely poor ), labour is the main limiting factor. Despite the lack of labour power, their main source of cash income remains agricultural labour. At the other end of the ladder, middle and better-off households earn most of their income from the sale of their own production. Key health and nutrition indicators The level of poverty is also illustrated by the health and nutrition indicators presented in table 2. Lindi Region has the highest prevalence of stunting and anaemia in the country. Overview of households dietary patterns Table 2: Examples of health and nutrition indicators for Lindi Region (DHS, ) Maternal mortality rate 750/100,000 Under five mortality rate 90/1000 Incidence of malaria 36% Prevalence of HIV/AIDS/STI 5.7% Height for age (<-2 SD) 54.0% (<-3 SD) 14.7% Weight for height (<-2 SD) 2.6% (<-3 SD) 0.0% Weight for age (<-2 SD) 23.4% (<-3 SD) 4.3% Prevalence of anaemia 88.2% A typical meal (for lunch or dinner) has two elements : the staple food and the sauce. The traditional staple dish is ugali a stiff porridge made of cereal (mainly maize) or cassava flour. Beside cassava and maize, households might also consume wild roots (mingoko seasonally available), sorghum (common) and rice (can be considered as a luxury staple). The staple is traditionally served with a sauce or stew. Sauces can be classified into four main types according to their core item: green leaves, fish, pulses and meat. The choice of staple and stew depends on individual preferences and, more often, on seasonal availability and purchasing power. Cereal porridge or boiled cassava are common for breakfast. Key features of dietary diversity and feeding frequency amongst children under two The majority of children below two years are breastfed. Food frequency and diversity surveys (exhaustive sampling) conducted in March (pre-harvest) and July (post-harvest) 06 reported that 95.9% and 88.8% of children 6 to 23 months were breastfed in the 24 hours prior to data collection in Lindi Rural District. The types of complementary food given to children are presented in figure 1. Eggs and dairy products do not or hardly feature in the diet. Less than a third of children consumed meat/poultry/fish in the 24h prior to the study. Tanzania - 3 -

4 Percentage of children Figure 1: proportion of children who consumed various food groups in the 24h prior to the survey by season 100,0 80,0 60,0 40,0 20,0 March (pre-harvest) July (post-harvest) 0,0 Grain/root/tuber Legumes and nuts Dairy products Eggs Meat/poultry/fish Vit A rich veg/fruits Other fruits/veg. Food cooked with oil/coconut Fortified food The study highlighted that children s diet is influenced by seasonality, wealth and age. Unsurprisingly, the diet tends to be better immediately after the harvest (July) compared with prior to the harvest (March): - more children are fed fruits/vegetables (e.g. oranges) 7 and legumes/nuts (cow peas and pigeon peas) 8. - overall, frequency of feeding is better than before the harvest with a larger proportion of children fed frequently enough (43.8% and 73.6% of children had an appropriate feeding frequency at pre-harvest and post harvest times respectively) - overall, dietary diversity is better as more children consume more food groups (52.1% and 92.3% of children benefited from an appropriate dietary diversity at pre-harvest and post harvest times respectively) The proportion of children fed frequently enough decreases with age as children require complementary food more often (for example, 90.0% are fed frequently enough at preharvest time amongst the 6-9 months while only 22.5% are amongst the months). Feeding frequency is also influenced by wealth status: the proportion of children fed frequently enough is higher amongst middle/better-off households (100.0%) compared with the poorer category (65.2%) at post harvest time. This might be linked to time available as poor mothers are possibly more involved in labour activities. They are also possibly less able to benefit from the improved food availability post harvest. The difference in feeding frequency between the two broad wealth categories is not statistically significant before the harvest. It might be that the seasonal hardship takes precedence over the wealth differential in influencing feeding frequency as even middle/better-off mothers have to spend time away from the child in productive activities and 82.4 % of children consumed fruits/vegetables in the 24h prior to the survey at pre-harvest and postharvest time respectively and 50.6 % of children consumed legumes/nuts in the 24h prior to the survey at pre-harvest and postharvest time respectively Tanzania - 4 -

5 Method to calculate the costs of cheapest acceptable diets A diet is considered acceptable for an individual when it covers both the micro and macronutrients requirements 9 for that particular individual circumstance. The cost of the cheapest adequate diets was calculated using linear programming (excel spreadsheet). The programme calculates the cheapest diet acceptable using two standard databases and three sets of locally specific data. The two databases were set by WHO: food nutrient contents and individual nutrient requirements. Guided by these standards, the programme is able to determine the cheapest adequate diet when given : - a list of locally available foodstuffs and prices per season - household composition (s) for whom the diet is required - the maximum amount of each food that various household members can consume so that amounts recommended by the programme remain realistic. As food availability and prices vary according to season, the year was divided into two broad seasons 10 : the period prior to the harvest which exhibits high prices in comparison with the post-harvest period. The high price season roughly extends over a five months period from about December to April. The remainder of the year is considered the low price season. Based on IHEA results and in order to calculate nutrient requirements, a specific household profile with five members was considered 11. Results for children under two are presented both independently (because of their specific requirements) and as part of the entire household. Other less typical household profiles are also considered within the affordability section. Maximum amounts of each food and food types for different age groups were first determined as a maximum percentage of the Recommended Daily Allowance (RDA). For example, the energy contribution made by leafy vegetables to the diet of a 12 to 23 months old child cannot exceed 5% of the RDA (see annex 1 for list of maximum percentages of RDA). Secondly, this set of international maximum amounts was adapted, when necessary, to locally specific conditions and constraints (see details in Costs of cheapest acceptable diets section). Three levels of diets were developed: - the lowest cost physiologically acceptable diet - the environmental diet with the additional constraints of what is environmentally feasible - and finally the cultural diets factoring in cultural barriers, local customs and preferences. These various diets are presented below for a child aged months and a typical household. 9 According to WHO standards 10 The year could have been further sub-divided into four seasons i.e. two main seasons and two transition periods. 11 It is composed of two adults and four children. Both adults are vigorously active and are between 30 and 59 years old. The man weighs 50 kg. The woman weighs 45 kg and breastfeeds the youngest child who is between 12 and 23 months old. The two other children are in the following age groups: 3 to 4 and 7 to 8 years. Tanzania - 5 -

6 Cheapest physiologically acceptable diet Costs of cheapest acceptable diets The diet contents and costs presented in table 3 and 4 represent the lowest possible amounts of cash to buy an adequate diet in the villages studied during both low and high price seasons. Table 3: The cheapest physiologically acceptable diet for a day for a child aged months based on food available in the area according to seasons Food Weight/day/(g/day) Low price season (post-harvest) High price season (pre-harvest) Sorghum, couscous 101 g/day - Cassava, dried flour - 52 g/day Coconut, grated - 40 g/day Pigeon pea - 81 g/day Leaf, cowpea g/day Leaf, cassava 121 g/day - Sesame, seed 28 g/day - Breast milk On demand (estimate 549ml/day) Cost Tsh/day Tsh/day Seasonal variations mentioned earlier are illustrated above: the cheapest adequate diet costs around 30% before the harvest than after it (42.50 compared with Tsh/day). Table 4: The cheapest physiologically acceptable diet for a day for a household of 5 including a child aged months based on foods available in the area according to seasons Food Weight/day/(g/day) Low price season (postharvestharvest) High price season (pre- Sorghum, couscous 1774 g/day 1650 g/day Cassava, dried flour - 75 g/day Coconut, grated 411 g/day 451 g/day Pigeon pea - 81 g/day Leaf, cowpea 1229 g/day 121 g/day Leaf, cassava 121 g/day 1229 g/day Sesame, seed 28 g/day - Peanuts 377 g/day 377 g/day Fish, small and dried 66 g/day 66 g/day Breast milk On demand (estimate 549ml) Cost Tsh/day Tsh/day The four main ingredients recommended by the programme are sorghum (cheaper than maize), micronutrient-rich green leaves (often free), coconut and peanuts. 12 Indicative exchange rate for 2006: USD 1 = Tsh 1190 Tanzania - 6 -

7 Cheapest environmentally feasible diet The diet recommended above is problematic because it is unlikely that the population would be able to collect the very high amounts of cassava and cowpea leaves suggested by the programme (note these have been selected because they can be found for free). We have set an arbitrary limit of a maximum of 250g of free green leaves being collectable per day and reran the programme. We have reduced the maximum amounts of leaves proportionally in the children and other household members diets equally (see conversion table used in annex 2). Table 5: The cheapest adequate diet for a day for a child aged months based on foods available in the area that we believe will be possible for households to access (environmental diet) according to seasons Food Weight/day/(g/day) Low price season (postharvestharvest) High price season (pre- Sorghum, couscous 87 g/day - Cassava, dried flour - 50 g/day Coconut, grated - 40 g/day Pigeon pea 37 g/day 87 g/day Leaf, amaranth 36 g/day 75 g/day Leaf, cassava 24 g/day 4 g/day Leaf, cowpea 6 g/day - Tomato 30 g/day - Sesame, seed 19 g/day - Breast milk On demand (estimate 549ml) On demand (estimate 549ml) Cost Tsh/day Tsh/day Table 6: The cheapest adequate diet for a day for a household of 5 including a child aged months based on foods available in the area that we believe will be possible for households to access (environmental diet) according to seasons Food Weight/day/(g/day) Low price season (postharvestharvest) High price season (pre- Sorghum, couscous 1787 g/day 1650 g/day Cassava, dried flour - 73 g/day Coconut, grated 411 g/day 451 g/day Pigeon pea 37 g/day 87 g/day Leaf, amaranth 1006 g/day 1304 g/day Leaf, cowpea 6 g/day - Leaf, cassava 24 g/day 4 g/day Tomato 30 g/day - Sesame, seed 321 g/day - Peanut 71 g/day 377 g/day Fish, dried, small 66 g/day 66 g/day Breast milk On demand (estimate 549ml) On demand (estimate 549ml) Cost Tsh/day Tsh/day Tanzania - 7 -

8 Cheapest culturally acceptable diet However, it is unlikely that the population will actually accept the above diet because: certain items are considered as famine foods, this means a food that is eaten only when the household is desperate, at least partly because they consider it to be unpalatable. e.g.: sesame seeds the monotony of the staple, particularly in the low-price season as the diet suggests that households only eat sorghum for every meal. Therefore, the programme was re-run with additional constraints: - sesame was excluded - a minimum amount of 250g of each of the two cheapest staples (cassava flour or sorghum) was to be selected 13. This amount was shared amongst households members according to the proportion of energy they each consume of the total. For example, the programme was set so that the diet of the 12 to 23 months old child includes a minimum of 22g of each of the two cheapest staples (see conversion tables in annex 3 and 4). The results are presented in tables 7 and 8. Table 7: The cheapest culturally acceptable diet for a day for a child aged months according to seasons Food Weight/day/(g/day) Low price season (postharvestharvest) High price season (pre- Sorghum, couscous 22 g/day 22 g/day Cassava, dried flour 29 g/day 28 g/day Coconut, grated 32 g/day 38 g/day Pigeon pea 88 g/day 87 g/day Leaf, amaranth 58 g/day 70 g/day Leaf, cowpea 6 g/day - Leaf, cassava - 5 g/day Peanut 2 g/day - Breast milk On demand (estimate 549ml) On demand (estimate 549ml) Cost Tsh/day Tsh/day Table 8: The cheapest culturally acceptable diet for a day for a household of 5 including a child aged months according to seasons Food Weight/day/(g/day) Low price season (postharvestharvest) High price season (pre- Sorghum, couscous 1437 g/day 1437 g/day Cassava, dried flour 256 g/day 255 g/day Coconut, grated 443 g/day 449 g/day Pigeon pea 118 g/day 117 g/day 13 The same amount was selected for both as their energy contents are within the same range : 332 Kcal/100g for the sorghum couscous and 314 Kcal/100g for cassava flour. Tanzania - 8 -

9 Ratio cost of cheapest adequate diet/income Ratio cost of cheapest adequate diet/annual income Leaf, amaranth 1287 g/day 1299 g/day Leaf, cowpea 6 g/day - Leaf, cassava - 5 g/day Peanut 387 g/day 385 g/day Fish, dried, small 66 g/day 66 g/day Breast milk On demand (estimate 549ml) On demand (estimate 549ml) Cost Tsh/day Tsh/day It is important to mention that the costs discussed here do not include necessary ongoing expenditure on items required for cooking other than food (such as firewood/charcoal). Affordability The ability of households to afford an adequate diet is discussed here for the lowest cost diet possible amongst the three presented above: the physiologically acceptable diet. Left-hand columns in table 9 presents the annual cost of the cheapest adequate diets for different household sizes and profiles. These are compared with annual income (the monetary value of food produced plus cash income) for the different wealth profiles/groups. Figure 2 shows that the annual income of the better-off, middle and poor households exceeds the cost of the cheapest diet. The latter is equivalent to 76%, 29% and 17% of their combined food and cash income for the poor, middle and better off households respectively. These represent two thirds of the total number of households. Figure 2: Difference between annual income and cost of the cheapest physiologically acceptable diet expressed as a proportion of annual income for poor to better off households Figure 3: Difference between annual income and cost of the cheapest physiologically acceptable diet expressed as a proportion of annual income for examples of very poor and extremely poor households 80% 160% 70% 140% 60% 120% 50% 100% 40% 30% 20% 10% 0% 80% 60% 40% 20% Poor Middle' Better-off' 0% Old woman + 2 children Old woman + 1 child 2 active + 4 children 2 active + 3 children Young woman + 3 children Young woman + 2 children Tanzania - 9 -

10 Examples of extremely and very poor profiles Within the very poor and extremely poor examples presented in figure 3, the household headed by an old woman cannot afford the cheapest adequate diet even with a single dependant. As for the other profiles (couple with 3 to 4 children and young woman with two to three children), it varies with the number of. For example, the income of the couple with three children appears to be marginally higher than the cost of the cheapest adequate diet whereas it is lower when this type of household has four. The diversity of profiles within these wealth groups combined with the level of precision that can be realistically expected from our data makes it difficult to reach a conclusion for the poorer third of the population. For some, income is lower than the cheapest diet, for others it is higher but in any case they are borderline. Table 9: comparison of households income with the cheapest diet and minimum non-food needs for a one-year period Annual cost of the cheapest physiological diet 14 (Tsh): Annual food + cash income 15 (Tsh) Ratio cost of diet/inc ome Annual cost of the cheapest adequate diet 16 and minimum acceptable non-food basket 17 (Tsh) Ratio cost of diet and minimum acceptable non-food basket/income Better-Off (5 members) 1,657,000 17% 20% Middle (5 members) 274, ,000 29% 333,000 35% Poor (5 members) 360,000 76% 92% Active couple with 4 Active couple with 3 Young woman with 3 Young woman with 2 Active elderly with 2 Active elderly with 1 dependant 346, % 412, % 297, ,000 92% 333, % 231, % 288, % 197, ,000 81% 247, % 176, % 226, % 126, , % 180, % 14 At 2006 prices 15 Adjusted with inflation and food income converted into cash at 2006 prices. 16 At 2006 prices 17 The minimum acceptable non-food basket was calculated for a period of one year (see details in annex 5). Tanzania

11 Examples of Extremely and very poor profiles Purchasing power (relative to the cost of the cheapest adequate diet) can also be illustrated by comparing the cost of the diet with the daily wage potential of different types of poor households as contract labour is an important source of income for these (see table 10). Table 10: : comparison of the daily labour wage with the cost of the cheapest diet Active couple with 4 Active couple with 3 Young woman with 3 Young woman with 2 Active elderly with 2 Active elderly with 1 dependant Average cost of an adequate diet/day Typical income from contract labour/day Ratio cost of diet/income 949 Tsh 63% 1500 Tsh 752 Tsh 50% 634 Tsh 85% 750 Tsh 437 Tsh 58% 482 Tsh 96% 500 Tsh 395 Tsh 79% Daily labour wages appear to generate a higher purchasing power compared with all income sources combined. However, the availability of contracts remains a constraint. In addition to the adequate diet, a minimum spending on non-food items is required. The combined costs of the cheapest diet and the minimum acceptable non-food basket are presented in table 9 (right hand columns). The combined costs are equivalent to 35% and 20% of middle and better-off households respectively. All the other groups/profiles cannot afford the minimum acceptable for non-food and the adequate diet as their income levels are below the threshold required. Shortfalls range from 79% of the annual income for the active elderly with two to 8% for the upper poor group. Around two thirds of households are below the income level required to meet the combined costs described above. Tanzania

12 Annex 1: list of maximum percentages of RDA Staples 120 Dairy 100 Fats 30 Fish 20 Fruit 8 Leafy vegetable 5 Pulses 50 Meat 20 Eggs 20 Breast Milk 20 Annex 2: Conversion table used for free green leaves month 3-4 years 7-8 years Adult male Adult woman Lactating Total Original maximum based on RDAs Proportion of total from age group 0, , , , , , New maximum (g) Annex 3: conversion table used for cassava month 3-4 years 7-8 years Adult male Adult woman Lactating Total Original maximum based on RDAs Proportion of total from age group 0, , , , , , New minimum (g) Annex 4: conversion table used for sorghum month 3-4 years 7-8 years Adult male Adult woman Lactating Total Original maximum based on RDAs Proportion of total from age group 0, , , , , , New minimum (g) Annex 5: cost of the minimum non-food items for a household of 5 for a year Minimum cost of non-food items for 5 people/year (Tsh) Salt 1800 Clothes Soap 7500 Kerosene 8320 Matches 6240 Utensils 2000 Education Health 2250 Tools 1500 Sleeping material 3250 Lotion 2800 Social contribution 2000 Total (Tsh) Tanzania