Transforming Africa's Food Systems through Nutritious Diets Policy

1. Access to nutritious diets as a policy indicator for Africa’s agricultural transformation and healthy food systems Daniel Bruce SARPONG University of Ghana CANDASA TEAM Anna Herforth Nutritionist, Tufts University William A. Masters Professor, Tufts University (PI) FulgenceMishili Senior Lecturer, Sokoine University, Tanzania Yan Bai Doctoral Student, Tufts University Kate Schneider Doctoral Student, Tufts University StevierKaiyatsa Govt. of Malawi KalyaniRaghunathan IPPRI-India FantuBachewe IFPRI-Ethiopia Derek Headey IFPRI, USA 6THAfrican Conference of Agricultural Economists 2019, Abuja: 25 September 2019

2. Access to nutritious diets as a policy indicator in Africa Background introduction| methods & data | results IANDA (2015-2017) CANDASA (2018-2020) • Indicators of Affordability of Nutritious Diets in Africa developed several new metrics (CoRD/CoNA) • IANDA conducted a landscape analyses of food price data collection at national and global level to understand collection, dissemination and its use in decision making • Engaged with stakeholders in Ghana/Tanzania, building the metrics using Ghana/Tanzania existing data and exploring integration into food price monitoring system

3. Access to nutritious diets as a policy indicator in Africa Background introduction| methods & data | results IANDA (2015-2017) CANDASA (2018-2020) • Changing Access to Nutritious Diets in Africa and South Asia builds directly on IANDA and ARENA at IFPRI • Refining and publishing CoNA/CoRD methodologies • Researching the CoNA/CoRD in India, Malawi, Ethiopia, Tanzania, Ghana, Myanmar (exploring Nigeria, Nepal) • Researching how access to nutritious diets changes based onshifts over time and space in food prices, wages and upstream determinants such as infrastructure and GDP • How food prices are associated with diet and nutritional status, where data are available • Continued contact with Ghana government stakeholders on integrating the new metrics into her food price monitoring

4. Access to nutritious diets as a policy indicator in Africa introduction| methods & data | results Structure of presentation • With that background, I briefly give the motivation for the IANDA/CANDASA project • describe some of the methodsdeveloped and some general results, and end by • talking about the policy dialogue process, where CANDASA is trying to integrate the new metrics into Ghana food price monitoring (as this demonstrates utility and use of the new metrics)

5. Access to nutritious diets as a policy indicator in Africa motivation | methods & data | results In the key area of agriculture-nutrition linkages, metrics are inadequate *Nutritious food to meet dietary needs Not just staple prices or income; not just staple food availability but access to nutritious diets. We don’t track diet quality well enough. We also don’t track food access well enough.

6. Access to nutritious diets as a policy indicator in Africa motivation | methods & data | results Agriculture, Food Systems and Nutrition • Agriculture and food systems can make nutritious diets more available and affordable. • But, governments and projects typically don’t have an information system that tracks prices of nutritious diets. • Countries can use existing food price monitoring systems better to understand availability and prices of nutritious foods. • International agencies could monitor these across countries.

7. Access to nutritious diets as a policy indicator in Africa motivation | methods & data | results Why measure the cost of nutritious diets? • Rural and urban food markets are changing rapidly • from own-production to use of markets • from generic commodities to branded, packaged foods • lower cost of starchy staples relative to milk, eggs, meat, fruit & veg • higher earnings, allowing more choice among affordable foods • To monitor change, we need new kinds of price indexes • existing indexes focus on trade, producer prices, or the cost of living • we add nutritional data, to measure the cost of a healthy diet • comparison to earnings reveals affordability at each time and place • Measuring access to nutritious diets can guide intervention • where do diet costs exceed earnings, so transfers are needed? • which foods & nutrients drive costs up, so access can be improved? • are some foods already accessible at low cost, but under-consumed? • Mal-nutrition challenges in Africa prevalent hence the need to have mechanisms to track progress from diverse disciplines Photo by Anna Herforth at Nsawam market, Ghana

8. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results How might we measure the cost and affordability of a nutritious diet? • For foods actually consumed, a very long history • Fleetwood (1707) food price index = 5 ‘quarters’ of wheat, 4 ‘hogsheads’ of beer • Lowe (1823) different baskets for different socioeconomic groups • Jevons (1865), Laspeyres (1871) and many others lead to modern CPI • For affordability of dietary energy, a long history and wide use • Playfair (1821) chart of wheat prices and wages from 1565 to 1821 • Sukhatme (1961) and FAO’s Prevalence of Undernourishment in calories • Drewnowski (2004) measure of energy cost ($/kcal) and density (kcal/kg) • For nutrient adequacy, more recent history and many specific uses • Stigler (1945) linear programming to compute least-cost diets • USDA Thrifty Food Plan for US nutrition assistance (1975, 1983, 1999, 2006) • SCUK Cost of Diet tool (2009) and FANTA et al. Optifood(2012) for aid programs • Now, diet diversity in terms of functional food groups • Obtaining at least one food from each of at least 5 different groups …or nutritional scoring in terms of many attributes • Weighting foods by a healthy-eating score, e.g. 1 to 100 …or recommended diets for specific food baskets • Including specific quantities of particular food categories, e.g. dietary guidelines

9. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results We construct food price indexes representing least-cost diets for nutrient adequacy and daily subsistence at each place and time • All essential nutrients required for long-term health Cost of nutrients = min. { C = Σipi × qi } least-cost combination of foods With:Σiaie× qi  = Edaily energy balance Σiaij × qi ≥ EARjestimated average requirements Updated to address dietary transition: Σiaij × qi ≤ ULjupper limits for toxicity Σiaij × qi ≤ AMDRj,u×E/ej Σiaij × qi ≥ AMDRj,l ×E/ej • Parameter values are Dietary Reference Intake (DRI) requirements for the US and Canada, last revised by the Institute of Medicine in 2011 • Use a total of 20 nutrients and 35 constraints, omitting DRIs for Vitamin D & cholesterol due to synthesis in the body, and iodine & molybdenum due to lack of nutrient composition data • Baseline is woman 19-30, can adjust for age, sex, pregnancy & lactation • Baseline is ~2000 kcal/day, can adjust for physical activity level Comparison is just subsistence energy from starchy staples • within acceptable macronutrient distribution ranges

10. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results Our measures differ from traditional indexes which are a weighted sum of many prices Food CPI: fCPI= ∑ipiqi , where pi and qi are prices and quantities consumed weights each price by quantities actually chosen

11. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results To measure affordability,we include only the least-cost foods • Cost of Calories (CoCa): • CoCa = Mini{piqi} where aieq i = E, aieis energy content of foods, and E is energy requirement of people the one least-cost energy source • Cost of Diet Diversity (CoDD): • CoDD = Min5{min{pi1}, min{pi2}, …, min{pim}}  the least-cost way to include at least one food from at least 5 food groups • Nutritious-food CPI (NPI): • NPI = ∑ipini , where ni is a food’s health score, egNuVaL from 1 (worst) to 100 (best) weighting each price by its nutritional value

12. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results To measure affordability,we FOCUS on two least-cost food indicators (1) • Cost of Nutrient Adequacy (CoNA): • CoNA = MiniΣipiqi, where aijq i > EARjand aieq i = E aijis nutrient content of foods, EARj is nutrient requirement of people  the least-cost combination of m foods to meet n nutrient needs (Uses data on (a) the price of each locally available food, (b) its nutrient composition, and (c) nutrient requirements in terms of both lower and upper limits) • Cost of Nutrient Adequacy (CoNA): • CoNAmeasures the minimum cost of using locally-available foods to obtain enough of all essential nutrients needed for an active and healthy life • CoNA shows the minimum cost of achieving minimum nutrient adequacy for a target population

13. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results To measure affordability,we FOCUS on two least-cost food indicators (2) • Cost of a Recommended Diet (CoRD): • CoRD = ∑jpijqj , where pij = min{pij} and qj = requirement for j={1,…, m} categories  weights each price by quantities in the recommended diet, without substitutions Calculated by selecting the lowest-cost foods within each group, in sufficient quantities to meet each recommendation. Use data on (a) the price of each locally-available food (b) its edible portion and water content, and (c) the target quantity needed to meet recommendations • Cost of a Recommended Diet (CoRD): CoRD measures the minimum cost of using locally-available foods to meet dietary recommendations (based on National food-based dietary guidelines which specify the quantity of each food group needed for both nutrient adequacy and prevention of diet related non-communicable disease within culturally acceptable diet

14. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results Nutrient needs vary over the life course and across people We use average requirements, to meet needs of a median healthy person -- We also compare to recommended daily allowances (RDAs), to meet needs of almost all people (97.5%) Our base case is an adult woman -- We also compare across individuals, to meet needs of whole households Source: Calculated from Institute of Medicine (2011), Dietary Reference Intakes. https://www.ncbi.nlm.nih.gov/books/NBK56068.

15. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results Least-cost diets measure the cost of nutrients and calories relative to a country’s overall price level Nutrient adequacy costs over half of the international $1.90 poverty line and is twice as expensive as daily energy US$/day at 2011 PPP food prices Darker: Cost of nutrient adequacy Lighter: Cost of caloric adequacy $1.90/day 50% ($0.85/day) • Source: Alemu et al. (2019), Cost and affordability of nutritious diets at retail prices: Evidence from 744 foods in 159 countries calculated from World Bank ICP data. Results shown are daily cost of adequate nutrients (in black) and subsistence calories from starchy staples (in gray), using locally-available foods at retail prices reported to the ICP, converted from local currency units at each country’s average price level for all food. Nutritional adequacy is computed based on U.S. and Canada Dietary Reference Intake (DRI) estimated average requirements for calories and 17 essential nutrients to sustain a healthy adult woman, as well as upper limits for toxicity and acceptable macronutrient distribution ranges.

16. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results Least-cost diets identify hotspots, with high cost of nutrients relative to the cost of daily calories from starchy staples Nutrient adequacy costs over 3x the cost of subsistence in many low-income countries (and in many high-income countries too) Cost of nutrients/ cost of calories Source: Alemu et al. (2019), calculated from World Bank ICP data on food prices and DRI data on nutrient requirements.

17. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results In poorer countries all food prices are relatively high, compared to earnings and non-food prices Price levels relative to all household expenditure Source: Alemu et al. (2019), calculated from World Bank International Comparison Project (ICP) data.

18. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results In the poorest countries, nutritious diets would cost a large fraction of all household expenditure Cost of nutrient adequacy relative to all household expenditure Cost of nutrients/ all expenditure Source: Alemu et al. (2019), calculated from World Bank International Comparison Project (ICP) data.

19. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results The cost of a recommended diet (CoRD) depends on price and quantity per day For Ghana, with the average of all items in each food group (except dairy), total cost would be US$0.75/day The required portions from each food group cost between $0.15 and $0.25 per day (Ghana 2015) Ghana prices not available for dairy Cost per day

20. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results In Ghana, Cost per serving (nominal USD, Ghana 2015)

21. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results Ghana MoFA has updated its national food price monitoring system to allow calculation of new metrics • In 2016, MoFA collaborated with IANDA to review their food price monitoring list. The list lacked sufficient diversity of nutrient-rich foods to calculate nutritious food price indexes. • 22 foods added in all; Such as: several dark green leafy vegetables; some fruits; two additional beans/seeds; meat and fish in the form typically bought by consumers • MoFA-SRID piloted the expanded list and made the decision to institutionalize it. • Expanded Food list Questionnaire sent to all 10 regional offices and 20 major selected markets have started using it • Weekly Market Price Reports are now generated for the expanded food list since July 2017 • MoFA can use these indicators for decision-making toward a more nutritious food system • Could see where, and when, nutritious diets are too expensive • MoFA-SRID is continuing to roll out the expanded food list nationwide • Ghana Statistical Service is exploring reporting the new indicators as national statistics

22. Access to nutritious diets as a policy indicator in Africa motivation| methods & data | results The project has helped Ghana MoFA expand price data collection to include more diverse foods Ghana’s Weekly Market Price Reports now include the additional foods marked in red, for all major markets

23. Policy dialogue for use of new price indexes in Ghana • Since 2016 IANDA/CANDASA has worked with Ghanaian authorities (GSS, MoFA) to help officials use the new price indexes within their routine food price monitoring • There is government interest, but support is needed • To help introduce new metrics, an informal “Nutritious Food Prices Analysis Support Group” to be hosted at the University of Ghana’s Institute for Statistical, Social & Economic Research (ISSER) • This is to allow government statistical officers to meet regularly with local economists and other stakeholders, before and after release of new data, to discuss the significance and interpretation of each indicator • Meetings will begin later this year • POLICY OBJECTIVE? Measuring access to nutritious diets to guide intervention

24. Thank you! Details here: https://sites.tufts.edu/willmasters Co-authors: Robel Alemu, Yan Bai & Kate Schneider, PhD students, and Steven Block (Tufts University); Anna Herforth (Consultant); Daniel Sarpong (University of Ghana); Fulgence Mishili (Sokoine University, Tanzania); Stevier Kaiyatsa (Government of Malawi); Derek Headey, Fantu Bachewe & Kalyani Raguthanan (IFPRI) This research is supported by USAID through the Rutgers University Feed the Future Policy Consortium (USDA award # TA-CA_15_008), and by UKAid with the Bill & Melinda Gates Foundation through the CANDASA project (OPP1182628) Food price measurement is not easy Photo: Anna Herforth, 2017

25. The CANDASA Research Team