HEA, Nutrition Analysis and Cost of Diet

 

HEA and Cost of Diet

The Cost of the Diet is an innovative method and software developed by Save the Children UK to better understand the extent to which poverty affects nutritional status. The aim of the Cost of the Diet tool is to estimate the amount, combination and cost of local foods that are needed to provide individuals or families with their average needs for energy and their recommended intakes of protein, fat and micronutrients.

The results from the Cost of the Diet can be compared with income and expenditure data generated by a Household Economy Analysis from the same livelihood zone. The affordability of a nutritious diet for each of the wealth groups (very poor, poor, middle and better-off) can then be estimated. This information can be used:

 

• to assess if poverty prevents poor households from obtaining a varied, nutritious diet;
• to estimate the size of cash transfers for social protection programs intending to have an impact on nutrition through the diet, and;
• to model the impact of potential interventions on improving the affordability of the diet.

What can HEA tell us about dietary quality?

HEA assessments are most frequently used to tell us about whether households are able to access enough of their total food energy requirements, i.e. the minimum number of calories needed to survive. However, it is possible to use HEA baseline information to provide details on macro-nutrients and to estimate the adequacy of a diet in terms of fat and protein.

HEA’s ability to look at dietary diversity and micro-nutrients is more limited. It is not possible to make statements about the percentage of minimum micro-nutrients requirements a household has access to using HEA, but it should be possible to make tentative statements about the risk of micro-nutrient deficiencies by considering the presence or absence of certain key foods in the diet.

What can HEA tell us about the causes of malnutrition?

Malnutrition has multiple causes and therefore understanding the reasons for malnutrition in a particular context are a key part of determining how to reduce malnutrition in both the short and long term.

 Because the HEA framework provides an excellent basis for understanding whether households are obtaining sufficient access to food, HEA assessments can help contribute to a discussion about causes of malnutrition by either factoring out or in this key determinant. Where HEA has found that people are unable to obtain their minimum food requirements, and at the same time malnutrition has been observed in the same area, it will be possible to say that food insecurity is at least one of the active causes of malnutrition. Refining this analysis further depends on how comparable the HEA and nutrition survey data are.

In addition to indicating whether food security is likely to be a cause of malnutrition, HEA baselines include other nutrition indicators, such as expenditure on healthcare, water and soap, and the workload of a mother within the households through an understanding of labor roles. These can suggest avenues for further investigation related to other aspects of the malnutrition causal framework.

 

[Note that it is important for HEA practitioners to be aware that while being able to access 2,100 kilocalories per day is necessary for ensuring good nutritional status, it is not in itself sufficient. Malnutrition could still arise if the diet did not contain the right balance of foods with adequate micronutrients, or if healthcare or access to clean water was limited.

What can HEA tell us about the risk of acute malnutrition?

HEA can be a useful aid in predicting the risk of acute malnutrition associated with food security. This is because HEA does not simply report current food insecurity, but allows for predictions to be made about the impacts of shocks and hazards on the food security of different population groups in the future. Where we predict that some population groups will face a food deficit in future, we can usually say with confidence that, in the absence of an external intervention, we can expect to see malnutrition increasing.

However, because of the multiple causes of malnutrition – a number of which are not covered by HEA assessments – it is recommended that such predictions are made in a collaborative way with other actors who may have information on the other causes of malnutrition. VACs in Southern Africa are a good potential forum for this, while the FSAU in Somalia currently uses this approach within the “Integrated Food Security and Humanitarian Phase Classification” (IPC).

For more information on HEA and nutrition analysis please see Chapter 7 of the Practitioner’s Guide to HEA.