Assessing influencing factors in the school
food environment using Photovoice in Addis
Ababa, Ethiopia
Ursula Trübswasser1, Elise Talsma1, Megan Loeffen1,
Kaleab Baye2, Selamawit Ekubay2, Edith Feskens1
1Wageningen University and Research, 2Addis Ababa University
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
Addis Ababa 2010
Addis Ababa 2018
Hypothesis
www.annualreviews.org Creating Healthy Food Environments C-1
Figure 1
An ecological framework depicting the multiple influences on what people eat.
Macro-level
environments
(sectors)
Physical
environments
(settings)
Social
environment
(networks)
Individual
factors
(personal)
Home
Work sites
School,
after school
Child care
Neighborhoods
and communities
Restaurants and
fast food outlets
Supermarkets
Convenience and
corner stores
Cognitions
(e.g., attitudes,
preferences,
knowledge,
values)
Skills and
behaviors
Lifestyle
Biological (e.g.,
genes, gender,
age)
Demographics
(e.g., income,
race/ethnicity)
Access
Availability
Barriers
Opportunities
Outcome
expectations
Motivations
Self-efficacy
Societal and
cultural norms and
values
Food and
beverage industry
Food marketing
and media
Food and
agriculture policies
Economic systems
Food production
and distribution
systems
Government and
political structures
and policies
Food assistance
programs
Health care
systems
Land use and
transportation
Practices
Legislative,
regulatory, or
policy actions
Family
Friends
Peers
Role modeling
Social support
Social norms
Behavioral
capability
Story.qxd 02/14/2008 08:17 PM Page C-1
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ow
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ww
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on
ly.
Story M, Kaphingst KM, Robinson-O’Brien R et al. (2008) Creating healthy food and eating environments: policy and environmental approaches. AnnuRev Public Health 29, 253–272.
Methods
Public school in Addis Ababa • 15 students 15-19 years• Owned smart phone• Boys and girls
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
Assessment of objective food environment
• Food and drink advertising• Availability of certain foods
in 60 food outlets• Photos of 138 kiosks
Photovoice: Assessment of perceived food environment
Students’ participation in the research
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
Analysis of qualitative information
• Codebook based on hypothesis• Analyzed photographs• Analyzed interviews and
discussion transcripts• Identified themes• Conducted word/code counts
is associated with
is part of
is a is a
is associated with
create awareness
It can make people realize that there are also good and hygienic markets that they can find fruits.
It relates to me in that I really love and enjoy eating fruits. My favorite fruits is banana. Moreov…
It will make people realize that their life/health should be a priority, that they should not buy co…
type of food outlet
area deprivation
outlet sanitation and hygiene
neighbourhood sanitation and hygiene
ban certain food outlets
Because the women selling the coffee has nowhere else to do it that is appropriate.
Mekoyah-Not looking down on jobs-IMG_20181111_234732.jpg
available food outlets
Mekoyah-FruitsIMG_20181128_153541.jpg
that they should not buy coffee from a place like this just because the price is cheaper.
food price
hope for healthier food
ignorance
affordable outlets
Coffee is being sold to customers in such a dirty setting/area.
limited livelihood options
I also used to sell injera on the street to make a living sometime in the past.
regulating food outlets
I see a lady who is selling Injera on the street.
hardship
I hope that these women will get a safe and appropriate place to sell their goods and change their l…
To win her daily bread. Earn some income to support herself and her family
I hope that in the future we will have even better fruit markets in our neighborhood.
It can teach them that anyone can make it only takes time, patience and hard work to get to where we…
hope people will eat more healthy
I hope to see these people given a safe and clean place to sell their goods and better materials to…
It actually disgusts me.
Mekoyah-Business-IMG_20181111_234631.jpg
Different types of fruits and vegies are be sold at the market. Many people had gathered in the are…
Mekoyah-Dirty place-IMG_20181124_111628.jpg
She is striving with whatever she has to earn a living.
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
Themes emerging from the study
1.Individual factors: “not rotten” = healthy
2.Social factors: “we have no say”
3.Physical factors: “it disgusts me”
4.Macro factors: “we go for cheap stuff”
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
1. “not rotten” = healthy
2. “we have no say”
“my mom cooks everything for me.” – Student 07
“We have no say in what we eat or want to eat. ““Our moms forces us to eat the food we don’t even like to eat…”“you can choose what to eat when you move out and live in your house”
Solutions “…if our moms could ask us for our food preference”“….teaching our parents whatever knowledge we have”
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
3. “it disgusts me”
“We use garlic in our day to day diet. If there’s no water available when we prepare food we might just peel the garlic and use it without washing it”
Solutions
“ I hope that these vendors would be removed and stopped from selling such bananas”
“I hope that these types of food become available in packed forms...”
“I love Banana I really love it. Whenever I go to buy there I see things which I don’t like and I return back without buying bananas” – Student 16
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
4. “we go for cheap stuff”
“Usually cheap foods are unhealthy. Healthy foods are expensive…we go for cheap stuff sold on the streets. Had both healthy and unhealthy food the same price we wouldn’t buy cheap food we would have options.”- Student 10
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
If you had 10 Birr what would you buy?
0
2
4
6
8
10
12
14
SSB or candy Fruit Fried streetfood
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
What is available, visible, advertised?
0
10
20
30
40
50
60
70
80
90
Dark greenleafy
vegetables
VitA rich FV Vegetable Fruit SSB-Candy
Available Visible Advertised
Sugar-sweetened beverages/Candy
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
“We were free”
“Expressing our feelings
without stress”
“it was fun”
“I learned a lot of things while
having fun”
“The way we could
participate”
“It made me think and give
more attention to things”
“It helped me improve my
food choice”
“Working together”“Discuss freely”
“It is easier to describe things
using pictures than talking”
“I like the unity”
“It helped me look deeper
in my living environment”
“Learned about basic
research skills”
“I was happy since I can
describe my living situation
through these pictures”
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
Thank you
Thank you to Agriculture for
Nutrition and Health fir
funding this study
PROJECT NOTE 01 | JANUARY 1 2015
Ethiopia
A4NH COUNTRY CONSULTATION NOTE | OCTOBER 2015
The CGIAR Research Program (CRP) on Agriculture for Nutri-
tion and Health (A4NH) responds to the global challenge of im-
proving food security, nutrition, and health. CGIAR has a long leg-
acy of building global food security, but ensuring consumers can
access enough healthy, affordable, and safe food requires a per-
spective that encompasses far more than agricultural productiv-
ity.
In August 2015, A4NH submitted a pre-proposal for a second, six-
year phase of the program to begin in 2017. A full proposal will
be submitted in March 2016 for approval. This brief describes
what A4NH is building on in Ethiopia for its second phase.
FEATURED A4NH PROJECTS BY FLAGSHIP
FLAGSHIP 1: BIOFORTIFICATION
Biofortification builds on the strong track record of the Har-
vestPlus program. During Phase I of A4NH, HarvestPlus transi-
tioned from development to delivery phase. During Phase II, the
flagship will deliver outcomes at scale (reaching 20 million farm
households by 2020) and conduct research to fill key evidence
gaps and to learn lessons from delivery for future research and
scaling. As part of building an enabling environment for biofortifi-
cation in the future, the flagship will engage in policy analysis and
advocacy at national and international levels and build capacity
of key research and development partners to mainstream biofor-
tification in their research and programming.
In 2015, HarvestPlus expanded its activities to Ethiopia, including
it as one of the nine target countries.
Projects that informed Flagship 1 work in Ethiopia • Nutritional Quality Assurance and Enhancement Net-
work (NQAEN)
Led by the International Potato Center (CIP) and funded by A4NH,
HarvestPlus, and the International Center for Tropical Agriculture
(CIAT), the NQAEN aims to build and strengthen capacities to en-
able researchers in different target regions worldwide to conduct
accurate and cost-effective assessment of micronutrient content
of sweet potato and potato, to guarantee food safety of bioforti-
fied clones by keeping low levels of antinutrients in target envi-
ronments, to contribute to building evidence that minerals of bio-
fortified sweet potato and potato clones and their products are
bioavailable for the human body, and that phenolics in sweet po-
tato and potato have a health promoting role.
FLAGSHIP 2: FOOD SAFETY
The flagship on Food Safety conducts targeted research on
specific food safety issues as well as by generating evidence on
what approaches are likely to work and how an enabling environ-
ment for innovative approaches to food safety can be achieved
and sustained in informal markets. The high priority food safety
issues for Phase II are biological contamination of perishable
products and aflatoxins in staple crops. The flagship will scale-up
successfully piloted solutions alongside rigorous monitoring and
impact evaluations to increase understanding of the incentives,
capacity, and enabling policy environment required for successful
delivery at scale. At the same time, it will continue to generate
evidence on food safety risks, and their assessment, communica-
tion, and management. In close collaboration with the CRPs cov-
ering livestock, fish, and grain legumes, this flagship will reach
tens of millions of consumers, millions of farmers, and thousands
of market agents working in priority countries in Africa and Asia.
Projects that informed Flagship 2 work in Ethiopia • Aflatoxin coordination across CGIAR and gap filling ded-
icated to Ethiopia
Led by the International Livestock Research Center (ILRI) and
funded by A4NH, this project aims to assess the level of aflatoxin
contamination in dairy value chains in Ethiopia, identify research
gaps in aflatoxin research, and provide evidence, risk assess-
ments and best-bet interventions for policy makers.
Farmers sort tomatoes in Ethiopia. Credit: S.Bachenheimer/World Bank
Additional slides
Number of photographs in the course of
the pilot487 PhotosPhotos students took
Selection during interview
Photos to discuss in one FGD
92 Photos
45 Photos
Select in one FGD for all 3 research questions
3 Photos
x 2 FGD 7-8 PhotosSelected photos for every
research question
analyzed
Main findings – adolescents’ diets
0
2
4
6
8
10
12
14
16
18
Recommendations
Availability of healthy foods at school through canteen/mobile sellers
Advertising of unhealthy foods not on the school property
School canteen guidelines and covered eating area: involve students
Giving students a platform and involving parents
Water supply and soap at toilets
Nutrition education in the school: safe ≠ healthy
Study conducted
in April 2019
Public school
Private school
Assessed:- External school food
environment (outlets, advertising)
- Internal school food environment (food provision, curriculum, awareness…)