Intervention Co-creation to Improve Community-based Food Production and Household Nutrition in Small Island Developing States (ICoFaN)

One in five members of the United Nations are small island developing states (SIDS): 38 countries with a combined population of 61 million. The majority of these are poor, eligible for official development assistance, and over a quarter are 'least developed' countries. They have high burdens of malnutrition, including overweight and obesity alongside anaemia in women of reproductive age, and additionally some, such as Haiti, also have high burdens of childhood stunting.

Over the past 3 decades malnutrition in SIDS has been exacerbated by an increasing reliance on food imports, the majority of which are of low nutritional quality. SIDS Governments have committed to increasing the local production and consumption of nutritious food as a way of increasing food security and sovereignty and addressing the high burden of malnutrition related morbidity and mortality. This proposal is intended to add to the evidence base and research capacity to support these policy commitments.

The proposal builds on development work undertaken in partnership with the Universities of the South Pacific and West Indies in two SIDS: Fiji and St Vincent and the Grenadines (SVG) respectively. Through this work evaluation methods were developed and pilot data collected. In addition, relationships were established with two local and very well established NGOs, the Foundation for Rural Integration and Enterprise Development (FRIEND) in Fiji and Richmond Vale Academy in SVG.

In this proposal we will co-create community based interventions to improve local food production and consumption with these two NGOs and evaluate their impacts on household nutrition and household expenditures. Mixed methods will be used, including quantitative household surveys, qualitative in-depth group interviews and photo voice. The design of the interventions will be informed by preliminary work that identifies and appraises available evidence on current dietary intakes in those settings, and the nutritional value of locally produced foods. The design will also be informed by 'mapping' the food systems in Fiji and SVG. This will be done by engaging stakeholders from across the food value chain in a participatory process, including a workshop, in which the factors, and the relationships between them, contributing to the burdens of malnutrition will be drawn.

In addition, to the full development and testing of interventions in Fiji and SVG, new work will be undertaken in Haiti. In Haiti available dietary and nutritional evidence will also be collated and appraised, and stakeholders engaged in mapping the food system. Pilot data will be collected in the Nippes region of Haiti, including on household nutrition and the opportunities for increasing household and small holder food production as a means to improving nutrition. This work will inform the design of an intervention ready for further roll out and evaluation.

Relevance: One in five members of the United Nations are small island developing states (SIDS); most are eligible for official development assistance (ODA), and over a quarter are 'least developed' countries. SIDS share common development challenges, including vulnerabilities related to food insecurity and malnutrition. High proportions of the populations of the Caribbean and South Pacific lack access to 'sufficient, safe, nutritious food to maintain a healthy and active life', resulting in high rates of adult overweight and obesity and associate, anaemia in women and childhood stunting. SIDS also lack food sovereignty and are highly reliant on food imports. An urgent concern for social and economic development, governments committed to concerted action, and have committed to promoting nutritious local food production and consumption. Civil society organisations are highly active in supporting local communities in subsistence food production to positively affect their health and livelihoods but require substantial cross-sector support for sustainable impacts.

Who will benefit: Direct beneficiaries of this project will be civil society organisations who deliver community food production initiatives within the specific sites (Saint Vincent and the Grenadines and Fiji) and beyond across the region (including Haiti). Further direct beneficiaries will be governmental and non-governmental organisation as initiators and supporters of such initiatives. This includes governments in the selected countries but also regional policy-makers, including the Caribbean Community (CARICOM), the Caribbean Public Health Agency and the Pacific Community. Finally, our Caribbean and Pacific research partners (The University of the West Indies, of the South Pacific and State University of Haiti) will directly benefit from this project establishing new partnerships and new learning as part of a truly multi-disciplinary research team.

How will they benefit: As an intervention study, the short-term benefit will be to co-develop innovative community-based food production interventions with cross-sector partners to directly support the countries' commitment to promote local food production. The impact plan outlines how these will be engaged. The project also has a strong capacity building aim. There is an increasing interest in multi-level, complex interventions and natural experimental studies to evaluate 'real life' initiatives that tackle upstream determinants of health. The co-investigators and early career researchers will be involved in highly innovative methods development work; this will include local colleagues and postdoctoral researchers. Innovative approaches include participatory systems approaches with stakeholders for developing programmes and participatory visual approaches to involve communities in their evaluation. Researchers beyond the direct collaboration will have access to tools, conceptual frameworks and related guidance.

In the more medium term, with the successful establishment of a comprehensive programme of research, we can accumulate robust evidence for the interventions' impacts, including importantly potential unintended consequences at community or household levels, whether social, economic or other. With robust evidence, beneficiaries across sectors will be able to make a case for further collaborative work between researchers and civil society organisations to develop and evaluate such initiatives.