Making progress towards food security: evidence from an intervention in three rural districts of Rwanda.

Food security is achieved ‘when all people, at all times, have physical, social and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life’( 1 ). Despite global efforts to achieve the Millennium Development Goal 1 of halving hunger by 2015, over 800 million people were still estimated to be chronically undernourished in 2014 with the highest prevalence in sub-Saharan Africa, where approximately one in four people are undernourished( 2 ). Although Rwanda has made considerable socio-economic progress and poverty has been reduced by over 50 % in the two decades since the 1994 genocide( 3 ), challenges with household food insecurity and malnutrition remain. Over 43 % of childhood deaths in the country are attributed to malnutrition and 44 % of children under the age of 5 years are stunted( 4 ). The major cause of children’s chronic malnutrition in Rwanda is the inadequate quantity and quality of food consumed at the household level( 5 ). Seasonal difficulties in accessing adequate food persist for 51 % of households, with 14 % having constant problems all year round( 6 ). Food insecurity and malnutrition are complex problems that need to be tackled in a coordinated way with political commitment and leadership( 2 ). In this regard and in line with the 2011 Joint National Action Plan to Fight Malnutrition in Rwanda, Partners In Health (PIH) – a US-based non-governmental health organization operating in Rwanda since 2005 – launched in 2013 the Food Security and Livelihoods Program (FSLP) in three rural districts of Rwanda. The immediate goal of this initiative was to increase food accessibility and consumption for extremely poor and vulnerable households, with the long-term aim of reducing malnutrition and improving health. The multifaceted intervention package included a one-time capital investment including agricultural inputs support, assistance with small livestock projects, provision of microloans and nutrition education (Box 1). Box 1 Partners In Health/Inshuti Mu Buzima (PIH/IMB) Food Security and Livelihoods Program in Rwanda: intervention components Key component Details Promoting group work ∙ Participating households are encouraged to form small self-help groups (15–20 households based on proximity), with a goal of creating formal business cooperatives ∙ The groups manage access to small loans and rent additional land for farming businesses Trainings and support to increase the crop ∙ Composting and fertilizer use yields on household owned small land plots ∙ Ideal selection and rotation of crops, emphasizing vegetable production for home consumption and market ∙ Identifying and using quality seeds, with a focus on nutritional value ∙ Using best techniques of planting including seed application and spacing ∙ Pest and diseases management Land renting and horticulture business promotion ∙ Programme participants are encouraged to rent additional land (as a group) and focus on growing high-yielding crops for income generation Small livestock rearing ∙ Participating households are encouraged and trained on poultry rearing (chickens and rabbits) as well as other easy-to-raise animals like pigs, sheep or goats Promoting voluntary savings and group loans ∙ Each member of the self-help groups is encouraged to come in the meeting with a small amount of savings every week, which creates a group treasury for loans Training and mentorship on business planning and management ∙ Ongoing trainings and follow-up coaching are offered to the self-help groups to support innovative income-generating ideas Access to microloans for expansion of farm business and off-farm income generation ∙ Programme participants within their groups apply for small (individual or group) loans with a low interest rate during the first year with the microloans package of Partners In Health, while transitioning to community-based microfinance institutions and banks Nutritional knowledge transfer ∙ Trainings on basics of nutrition and diet preparation ∙ Community cooking demonstrations ∙ Tailored trainings and mentorship for pregnant women, including diet, breast-feeding and child complementary feeding ∙ Household hygiene and sanitation View it in a separate window In the present study we aimed to measure the impact of the FSLP on the Household Food Insecurity Access Scale (HFIAS) score (Box 2) score and household Food Consumption Score (FCS; Box 3) to assess whether food security had improved during a 12-month period. Specific objectives of the study were to: (i) describe baseline demographic and socio-economic characteristics of the 600 households selected in three rural districts; (ii) assess changes in the HFIAS and FCS after a one-year implementation of integrated food security interventions; and (iii) identify associations between selected socio-economic factors and the changes in HFIAS and FCS. Box 2 Household Food Insecurity Access Scale (HFIAS) score as a measurement of food access The HFIAS is a nine-question tool developed and validated by the Food and Nutrition Technical Assistance to assess household food insecurity, and looks at three key domains experienced in households during the previous month: 1. Stated anxiety and uncertainty about food. 2. Household experience with quality of food (variety and preferences). 3. Insufficient household food intake (quantity). The nine questions are as follows, referring to the past 30 d: Q1. Did you worry that your household would not have enough food? Q2. Were you or any household member not able to eat the kinds of food you preferred because of lack of resources? Q3. Did you or any household member eat just a few kinds of food day after day due to lack of resources? Q4. Did you or any household member eat food that you preferred not to eat because of lack of resources to obtain other types of food? Q5. Did you or any household member eat a smaller meal than you felt you needed because there was not enough food? Q6. Did you or any household member eat fewer meals in a day because there was not enough food? Q7. Was there ever no food at all in your household because there were not enough resources to get more? Q8. Did you or any household member go to sleep at night hungry because there was not enough food? Q9. Did you or any household member go a whole day without eating anything because there was not enough food? Each question’s score depends on how frequent the household has lived with that situation in the past 30 d: ‘never happened’=0; ‘rarely’ (once or twice)=1; ‘sometimes’ (three to ten times)=2; or ‘often’ (more than ten times)=3. A total score for the household ranges on a scale from 0 to 27. A higher HFIAS score is indicative of poorer access to food and greater household food insecurity. Prevalence of food insecurity is further categorized as follows: 1. Food secure: if (Q1=0 or Q1=1) and all other questions=0. 2. Mildly food insecure: if (Q1=2 or Q1=3 or Q2=1 or Q2=2 or Q2=3 or Q3=1 or Q4=1) and (Q5, Q6, Q7, Q8, Q9=0). 3. Moderately food insecure: if (Q3=2 or Q3=3 or Q4a=2, Q4=3 or Q5=1 or Q5=2 or Q6=1 or Q6=2) and (Q7=0 and Q8=0 and Q9=0). 4. Severely food insecure: if (Q5=3 or Q6=3 or Q7=1 or Q7=2 or Q7=3 or Q8=1 or Q8=2 or Q8=3 or Q9=1 or Q9=2 or Q9=3). Box 3 Food Consumption Score (FCS) measurement tool FCS is a composite score based on varieties of food consumed by a household during the week before an interview (developed and validated by the World Food Programme): , where X i is the frequency of food consumption (=number of days on which food group i was consumed during the past 7 d) and A i is the weight of food group i. The following weights were validated to be applied to food groups based on the energy, protein and micronutrient densities of each: meat, milk and fish=4; pulses=3; staples=2; vegetables and fruits=1; and sugar and oil=0·5. Aggregated scores are categorized as follows: 1. poor food consumption (FCS=0–21); 2. borderline food consumption (FCS=21·5–35); and 3. acceptable food consumption (FCS>35).