Sandi McCoy, MPH, PhD University of California, Berkeley

1. Supporting the Health of Women Farmers through Economic and Food Security: An Evaluation of Tanzania’s National Agricultural Input Voucher Scheme Sandi McCoy, MPH, PhD University of California, Berkeley

2. Economic Empowerment and Health • Women’s economic empowerment (autonomy to earn and make decisions about money) is increasingly viewed as an important determinant of health • Economic insecurity constrains ability to refuse sex, negotiate condom use, and leave risky relationships (Dinkelman2007, Weiser 2007) • Central to decision to engage in sex work (Weiser 2007) • Complex risk environment shaped by economic security is recognized as a key driver of HIV transmission (Kim 2008)

3. Agriculture Self-Employment by Sex % of adults Sources: The World Bank. Agriculture for Development. Washington, D.C. 2007, The World Bank. Gender in Agriculture Sourcebook. Washington, D.C. 2009.

4. Constraints Faced by Women Farmers • Women own less than 2% of the world’s land • Unequal access to markets & inputs (e.g., fertilizer, seed varieties) • Less capital and less access to credit for investments • Less likely to benefit from agricultural extension services Sources: Rural Development Institute. Secure Land Rights: The Key To Building A Better, Safer World. Seattle, WA 2009, The World Bank. Gender in Agriculture Sourcebook. Washington, D.C. 2009.

5. Downstream Effects on Women Obstacles to productive agricultural livelihoods perpetuate: • Economic insecurity • Food insecurity • Poor health outcomes (e.g., malnutrition, HIV, STI, unintended pregnancy) • Poor education and health outcomes among children Sources: Rural Development Institute. Secure Land Rights: The Key To Building A Better, Safer World. Seattle, WA 2009, The World Bank. Gender in Agriculture Sourcebook. Washington, D.C. 2009. Miller CL,et al. Food Insecurity and Sexual Risk in an HIV Endemic Community in Uganda. AIDS Behav. 2010

6. Links to HIV, STI Vulnerability • Insecure land rights • Unequal access to inputs, markets & extension Source: USAID. Land Tenure, Property Rights, and HIV/AIDS 2009.

7. Tanzania’s National Agricultural Input Voucher Scheme (NAIVS) • In Tanzania, 24% of maize farmers use improved seeds, 20% use fertilizers, and only ~6% use both • Subsidy for fertilizer and improved seeds for maize and rice varieties for farmers in Tanzania: • Boost food production • Reduce prices of food staples • Increase incomes • Bolster food security • Program preferentially targets women farmers • Will reach 2.5 million farmers by 2011, focusing on areas of high maize and rice production potential

8. Tanzania’s National Agricultural Input Voucher Scheme (NAIVS) • Voucher for a discount on fertilizer and seeds for 1 acre • Village voucher committee (VVC) determines beneficiaries based on criteria: • Cultivate ≤1 hectare of maize or rice • Must be able to afford the top-up • Priority for women-headed households • Unclear how well targeting criteria are followed & whether women farmers indeed receive priority

10. Impact Evaluation (ongoing) • Village, VVC, agro-dealer, and household survey (3 year panel) • Impact on agricultural production and welfare at the beneficiary household level • Impact heterogeneity • Targeting efficiency is a major focus of the evaluation • Identifying eligible households •  village participatory process

11. Impact Evaluation (ongoing) • Village, VVC, agro-dealer, and household survey (3 year panel) • Impact on agricultural production and welfare at the beneficiary household level • Impact heterogeneity • Targeting efficiency is a major focus of the evaluation • Identifying eligible households •  village participatory process • Selection of beneficiaries •  random allocation of eligible farmers • Implemented in 2x2 factorial design in 140 villages

12. Innovation: Linking Across Sectors • Multi-sectoral partnership between agriculture & health • Expansion of household survey to include a “gender module” • Explicit focus on women and agriculture • Control over assets • Relationship power • Violence • Reproductive and sexual health of rural women farmers • Family planning • Sexual partners & sexual behavior • Health service utilization • Mixed methods approach: qualitative & quantitative

13. Questions of Interest • Does the impact of the NAIVS program differ by whether the household head is male or female? • Does the NAIVS program have an impact on access to health care, contraception, and/or sexual and reproductive health? • How much food insecurity do women farmers experience, especially widows and other female heads of household? • Is food insecurity associated with sexual risk behavior among women farmers? • To what extent do female farmers (heads of household) have autonomy as it relates to reproductive health decisions? Does the NAIVS program change this?

14. Project Team UC Berkeley • Lauren Ralph • Nancy Padian • Paul Gertler World Bank • Xavier Giné • Shreena Patel • MadhurGautum • David Rohrbach Ministry of Agriculture, Food Security, and Cooperatives • Dr. MbetteMsolla International Initiative for Impact Evaluations (3ie)

15. Program Basics: Vouchers • The subsidy is distributed through a voucher system. Farmers receive a pack of 3 vouchers: • 1 for basal/planting fertilizer - choice of DAP or MRP • 1 for top-dressing fertilizer – Urea • 1 for seeds – Maize Hybrid, Maize OPV, or Paddy • Farmers pay registered agro-dealers using the voucher + top-up amount • Agro-dealer redeems voucher at NMB for cash

16. Program Basics: Vouchers P-fertilizer Voucher: MRP (100kg) or DAP (50kg) Face Value = 25,000 • The quantity of inputs is for one acre of land • Each beneficiary receives the subsidy for 3 years • Each voucher has a face value (Tsh), which varies by region because of transportation costs Top-dressing Voucher: Urea (50kg) Face Value = 17,000 Seed Voucher: Maize Hybrid (10kg) or Maize OPV (10kg) or Paddy (10kg) Face Value = 11,000

17. Impact Evaluation: Design • The study is designed to be a 3-year panel survey so that the same respondents are interviewed for 3 consecutive years • The within-village comparison will be between NEW (2010) beneficiaries and eligible non-beneficiaries • The study is representative of the main program areas