FAO-EU Joint Workshop to promote the workshop to promote the uptake and dissemination of the MDD-W Integration and scaling up of the MDD- W module into the Household Budget Survey (HBS) in Tajikistan Tajikistan team : Mr. Abduvali Qulov-AoS; Dr. Sherali Rakhmatulloev MHSP Dr. Sabir Kurbanov- Consultant Tajikistan faces the huge burden of undernutrition, overnutritionand micronutrient deficiencies Only country in Central Asia not met MDG for halving proportion of hungry people by 2015 25% childrenstuntedchildren and 10% wasted 53% Under 5 and 59% women of reproductive age are iodine deficient 24% women are anaemic 38% women overweight and obese, with higher rates in urban areas Source: AoS 2012; 2015 1
Tajikistan is committed to improving the quality and diversity of people diets, but information is lacking Improvement of nutrition status of population (women and children) became priority of the country (support from donor communities, SUN initiative) Government has prioritized setting up of national information systems for nutritional information and requested AoS to collect representative information FAO supported Tajikistan for mapping and assessing available nutrition assessment capacity to collect food based nutrition information AoShas a long history of conducting Household Budget Survey (HBS) at national level So far, HBS in Tajikistan does not include any nutrition module or dietary information at individual or household level Integrating MDD-W into the HBS would: provide a simple proxy indicator for measuring dietary diversity allow investigation of associations between socio-economic and demographic factors and diet adequacy Change in poverty according to TLSS 1999, 2003, 2007 and 2009 90 82 80 70 60 50 73 53.5 47.2 40 30 20 10 0 1999 2003 2007 2009 2
Basic poverty results, Tajikistan 2015 overall poverty extreme poverty 35.8 37.3 39.4 35.2 31.3 20.4 22.3 16.8 20.6 19.6 17.5 23.2 15.2 9.1 9.4 10.2 dushanbe sughd khatlon RRS GBAO rural urban Tajikistan Evolution of poverty based on national estimation 37.4 35.4 32 31.3 20 18 16.8 15.2 2012 2013 2014 2015 Уровень бедност Уровень крайной бедности 3
Project Objective To build nationwide capacity (human and institutional) in collecting, analysingand interpreting MDD-W data at national level, to allow country ownership of the tool Project design and implementation The project was implemented in 3 Phases: I. Preparatory phase Capacity mapping at country level financing for conducting three training courses and three pilot studies. II. Capacity development and adaptation of the MDD-W tool A 5-day training course for enumerators and AoSstaff; Adaptation of MDD-W questionnaire to local context (food variety, selection and dietary habits) III. Design and implementation of the pilot study Selection of HBS households for dietary diversity interview with women of reproductive age (15 to 49 years); Data collection and logistics; Data analysis & Report writing -Supported by Food Systems and Nutrition Division, FAO, Rome 8 4
Project Overview Operation Modality: MDD-W integrated into the National Household Budget Survey;Dietary Diversity questionnaire was adapted to local context through key informant meetings and focus group discussions; Responsible Entity: Agency of Statistics of Tajikistan (AoS) with the support of FAO Duration: 3 years (2014-2016) Budget and financial support: initial cost for all three phases of MDD-W was ~USD 28 000 over 3 years, provided by the EU (Approximately 11-12 USD$ per woman) Geographic Coverage: Nationwide including rural and urban areas (Dushanbe city; Rayon Republican Subordination; Khatlon, Sughd and GBAO regions) Number of women : [> 1000 WRA] Project outputs Capacity developed and dietary diversity tool adapted to the local context: A total of 3 training courses were conducted and 66 AoSpersonnel were trained Pilot studies, data collection and data management A total of 3 pilot studies were conducted, dietary diversity data were collected from 1032 women across all regions of the country 10 5
Key Findings: A. Median dietary diversity of women 40.0 35.0 30.0 Percentage % 25.0 20.0 15.0 10.0 5.0 Sughd Dushanbe RRS GBAO.0 1 2 3 4 5 6 7 8 9 10 MDD-W Dushanbe, RRS and GBAO Year Region MDD-W Median 2014 Khatlon(n= 331) (WDDS) 6.0 2015 Sughd(n= 286) 7.0 2015 Dushanbe (n=133) 7.4 2015 RRS (n=202) 6.5 2015 GBAO (n=80) 5.9 11 Key Findings: B. Percentage of women that did not meet the minimum dietary diversity 40.0 35.0 Cut -off Percentage % 30.0 25.0 20.0 15.0 10.0 5.0 Sughd Dushanbe RRS GBAO.0 1 2 3 4 5 6 7 8 9 10 MDD-W Dushanbe, RRS and GBAO Region % of women the cut-off % of women < cut-off Sughd(n= 286) 95.5 4.5 Dushanbe (n=133) 98.0 2.0 RRS (n=202) 88.0 12.0 GBAO (n=80) 86.0 14.0 12 6
Key Findings: C. Least consumed food groups by cut-off group SFG-10 Other fruits SFG-9 Other vegetables SFG-8 Other vit A-rich veg. and fruits SFG-7 Vitamin A-rich DGLV SFG-6 Eggs SFG-5 Flesh foods SFG-4 all dairy SFG-3 Nuts and seeds SFG-2 Beans and peas SFG-1 All starchy staples 0 10 20 30 40 50 60 70 80 90 100 Total sample Equal or above cutoff Below cutoff Nuts and seeds 8 % 9 % 0% Eggs 31 % 35 % 5 % Beans and peas 52 % 54 % 14 % 13 Key Findings: D. Consumption of nutrient-dense foods Fruits and vegetables Animal-source food Nuts / beans SFG-10 Other fruits SFG-9 Other vegetables SFG-8 Other vit A-rich veg & fruits SFG-7 Vitamin A-rich DGLV SFG-6 Eggs SFG-5 Flesh foods SFG-4 all dairy SFG-3 Nuts and seeds SFG-2 Beans and peas SFG-1 All starchy staples 0 10 20 30 40 50 60 70 80 90 100 Sughd Dushanbe RRS GBAO Women in the GBAO region consumed less nutrientdense foods Fish was consumed by only 2% of the women 14 7
Key Findings: E. Association between dietary diversity and rural/urban areas SFG-10 Other fruits SFG-9 Other vegetables SFG-8 Other vit A-rich veg. and fruits SFG-7 Vitamin A-rich DGLV SFG-6 Eggs SFG-5 Flesh foods SFG-4 all dairy SFG-3 Nuts and seeds SFG-2 Beans and peas SFG-1 All starchy staples 0 10 20 30 40 50 60 70 80 90 100 Rural Urban Women living in rural areas had consumed less nutrientdense foods compared with women living in urban areas 15 Key Findings: F. Association between dietary diversity and household income (HHIEq) SFG-10 Other fruits SFG-9 Other vegetables SFG-8 Other vit A-rich veg. and fruits SFG-7 Vitamin A-rich DGLV SFG-6 Eggs SFG-5 Flesh foods SFG-4 all dairy SFG-3 Nuts and seeds SFG-2 Beans and peas SFG-1 All starchy staples 0 10 20 30 40 50 60 70 80 90 100 Low HHIEq Medium HHIEq High HHIEq Women of lower income had consumed less nutrientdense foods compared with women of higher income 8
Conclusions and recommendations (1) AoS completed 3 pilot studies in all five regions of country (Khatlon, Sughd, Dushanbe, RRS and GBAO). The median dietary diversity was relatively high between 6 and 7 (with the lowest in GBAO 5.9). These data indicates an adequate dietary diversity in the majority of the women (data collection was during harvest season). It is recommended to repeat data collection during lean season or during periods of low food bioavailability. Dietary diversity score could significantly vary by season. However, findings indicates that main group foods consumed by all WRA were starchy staples and vegetables. The less consumed food groups were nuts, beans and eggs. By promoting the consumption of these food groups the dietary diversity of the women could be improved 17 Conclusions and recommendations (2) There were direct correlation between household income and living in urban areas. To obtain additional valuable information, a joint analysis of dietary diversity and HBS (food insecurity, poverty rate, food availability) is recommended In order to obtain national representative nutritional data for decision making it is recommended to undertake a nationwide implementation of the dietary diversity integrated into the HBS: covering different seasons; different geographic regions and; different socio-economic groups. 18 9
.Other possible associations A joint statistical analysis of MDD-Wand HBSdata provides valuable information on how the dietary diversity of women is affected by: household food insecurity; food availability; poverty rate (see example below) Food insecurity MDD-W HHIEq Rural area Poverty rate Region Food availability Median Median n (%) % Sughd 7.00 898 39 23.1 Dushanbe 7.35 850 0 19.9 RRS 6.47 756 80 37.8? GBAO 5.91 526 74 37.3 Poverty rate, AoS2015 Women of higher income and living in urban areas of lower poverty rate showed to have a higher dietary diversity 19 Key Success Factors Political commitment on nutrition progress lacking nutrition indicator. Integration of nutrition indicators into National sustainable development strategy 2016-2030 Goal 3- food security and improvement of access of population to quality of food. Country ownership of the MDD-W indicator: Integration of MDD-W indicator as one of the modules into the ongoing national initiative (HBS) Adapted for use throughout the country Institutional & human capacity are developed for data collection, analysis, M&E and reporting. Relatively low cost survey compare to classic methodologies, easy to integrate to existing HH survey modules 10
Opportunities Existing and ongoing nationwide HH survey (HBS) Existing capacity of field staff on data collection Integration of MDD-W into any national or sectoral policies and actions on food security and nutrition surveys. Resource mobilisation for data collection and refresher training for staff Challenges Limited Financial capacity of stakeholders on motivation of field staff at grassroots levels To many other priorities of the country MDD-W a proxy indicator, does not provide quantitative measurement of dietary intake Policy and Programming Implications Regular data collection will allow identification of regions and population groups at high risk of malnutrition; Policymakers can use this information to tracknutrition progress, target setting and advocacy Accelerate education programme at rural areas specifically targeted for women to broaden their understanding of the nutritional health benefits of a diverse diet; Promotion of home gardens; Strengthen linkages between AOS and other key stakeholders (MoH, MoA, MoEd); Strategic policy targeting, research and investment can play a significant role towards improving rural household dietary diversity and household food security 11
Policy and Programming Implications Based on results of MDD-W MHSP has initiated revision of existing nutrition training guidelines and curriculums; MDD-W module will be integrated into forthcoming nutrition survey ( in 2016); MDD-W Indicators also included as a key indicator under Goal # 3 of Country Development Strategy 2016-2030 Plans to follow-up/scale up (1) National Integration from 2016 onwards, ensuring sustainability of project Use of data set for monitoring of nutrition status of women Conduct MDD-W survey in different seasons of the year Publish results of MDD-W Survey on quarterly-based Food Security bulletin of the AoS Widely disseminate results of MDD-W among key stakeholders- MOHSP, Institute of Nutrition, MoAgr 12
Plans to follow-up/scale up (2) Approximate implementation cost of MDD-W will be following (2 times per year, in USD): Support human resources - $ 7950 Transportation expenses $ 3800 Admin and operation cost of MDD-W ( data analysis, M&E, data quality control $ 3600 TOTAL cost per year: ~$ 15350 Acknowledgements Tajikistan team would like to thank: EU-FAO project Improve Global Governance for Hunger Reduction and Support the strengthening of the National Food Security Information System in Tajikistan for financial support of project FAO-ESNA Team for technical support: Warren Lee, Claudia Lazarte, Theodora Mouratidou, Saba Marzara and Giorgia Nicolo Ташаккури зиёд! Thank You! 13