Healthy diets and markets

Harnessing the farm-to-market value chain to deliver nutritious foods to those who need it most

Edited by Jessica Meeker
Meet the editor

Most of us have something in common. Whether we live in a city or the country, whether we’re rich or poor, whether we’re farmers or technology consultants, the majority of us buy our food from a shop or market. This means that, at least part of our diets are heavily dependent on what is available to us in these markets and on the price of those foods, among other things.


In South Asia it is increasingly recognised that most low-income households buy some or all of their food in markets. Even farm households frequently buy some of their food and dependence on markets is even greater for those who do not produce their own, such as landless or urban households.


Accessing more nutritious but expensive foods such as fruit and vegetables, meat and dairy can be a challenge for some families, particularly for lower income households who may find it harder to find safe and nutritious products or afford them.


Research under the Leveraging Agriculture for Nutrition in South Asia programme in Afghanistan, Bangladesh, India and Pakistan has provided insights into the ways in which nutritious foods can be delivered to the poor, exploring public and private approaches, different delivery systems and policy options. This guide provides an overview of this work with links to further suggested reading.

Meet the author

Maria del Mar Maestre Morales 

Get the content

Eldis content is published under a under a Creative Commons Attribution Unported (CC-BY) licence. You can embed this guide in your own website.

Embed this guide

Sourcing our diets: Agri-food value chains

Among the many initiatives that aim to increase food security, most focus on producing more food, without necessarily considering the nutritious quality of food. We often hear about what happens on the farm where food is grown, but to understand how to improve the food that is available for people to buy in the shops and markets, we also need to consider the steps involved in getting the food to them once it leaves the farm gate. For example, tomatoes that leave a farm may be bought directly by a neighbour who then consumes them. Alternatively the farm may sell its tomatoes to a wholesale fruit and veg supplier, who may then sell them to a manufacturer, who turns them into a tomato sauce, which is sold in jars to a supermarket.  


The pathway from farm to the consumer, comprising all the stages and processes necessary to make food available for consumption, is called a value chain. With globalisation food value chains are becoming longer with more actors, from the informal sector to small businesses and multinationals, involved in them and interacting together. This "hidden middle" of the chain is increasing in importance, gaining power over the processing and distribution of products.


So the functioning of the value chain post-farm gate is an important factor in ensuring healthy and nutritious diets. This is especially true for vulnerable populations who are at risk of poor nutrition, because often they live in areas where markets are poorly stocked, and options for nutritious foods are limited, or where the price of food is high, making nutritious food hard to afford for lower income families.


We need to understand more about how the steps in a value chain can contribute towards improving people’s nutrition. How do they work and how we can better harness them to help improve nutrition? To answer this we need to start understanding the challenges these complex food value chains present and also the many opportunities to intervene in the food system after the food leaves the farm that can help to improve people’s nutrition.


Introduction: value chains for nutrition in South Asia: who delivers, how, and to whom?
Institute of Development Studies UK, 2018
There is currently much talk of the private sector role in nutrition, and whether the state can better ‘shape’ the market to deliver nutritional outcomes. This article introduces an issue of the IDS Bulletin which presents research findings in this area developed by the consortium of research partners under the Leveraging Agriculture for Nutrition in South Asia (LANSA) programme.It is the first attempt at nutrition-oriented whole value chain research in South Asia, studying the supply and demand side of the agri-food chain.

Market pathways to improve diets

Recent research has been exploring how these value chains can be enhanced to deliver nutritious foods to those who most need it and what roles policy makers and private actors play or can play?


The researchers identified three main pathways through which value chains may be improved so that they deliver good quality nutritious food to consumers.


Changes in food demand: increasing access to or consumption of nutritious foods - so that families eat more diverse, more nutritious diets (for example through school meals, food vouchers, or indirectly through behaviour change activities and social marketing)


Changes in food supply: increasing supply of nutritious foods by producing and distributing foods with increased nutritional value, either via bio fortification or industrial fortification, or by improving the efficiency of links in the chain of a particular product (e.g. improving the collection of milk, or its transportation and distribution).  


Directly improving the value chain (the interface between supply and demand): through improving infrastructure, removing other distribution barriers or directly subsidized food distribution programmes by the government, donors, or other stakeholders. These approaches often involve both private and public sectors.


Markets for Nutrition
Leveraging Agriculture for Nutrition in South Asia, 2015
Making safe, nutrient-rich foods more accessible to people on low-incomes is one way to reduce micronutrient undernutrition (the lack of essential nutrients and minerals required by the body for healthy development). Efforts to integrate better agriculture and nutrition are focused on this goal, and many initiatives target low-income farm households.
Assessing food value chain pathways, linkages and impacts for better nutrition of vulnerable groups
Food Policy, 2017
In addition to targeting health and other areas related to undernutrition, a key priority is also the transformation of the agriculture and food sector. While patterns of crop and livestock production are widely expected to affect nutrition and the health of vulnerable groups, the evidence base for a positive impact, albeit growing, is still limited and sometimes inconclusive.This article offers insights into assessing the effectiveness of post farm-gate agri-food value chains at improving the nutrition intake of vulnerable groups.

Examples of markets for nutrition in South Asia

Interventions targeting the different pathways often work together to increase their impacts, such as changes in food supply combined with food demand, or improvements in the chain. They focus on the interdependent relationship between the consumer and the supplier.


The research focused on understanding the value chains from multiple perspectives as a first step before we can explore how to promote diet diversity or what incentives to use.


The most successful case studied was a public distribution programme in India which delivers food to pregnant women, lactating mothers and children. The programme engages with local cooperatives, private sector actors, state-owned companies and the community and this has been the key to their success. Engaging multiple actors, in particular local ones like the mothers of the children, ensures a transfer of knowledge and awareness, in addition to empowering local citizens. Public distribution models are successful pathways to ensure the target groups consume the food, as part of the common challenges faced are controlled, such as ensuring that the vulnerable population consumes the food – programmes are targeted - and is affordable – they tend to be free or subsidised. The challenge tends to be ensuring that funding does not stop.


In another example, we explored attempts to fortify the wheat value chain with micronutrients in Pakistan, to combat anaemia and vitamin A deficiency with limited success. Mandatory fortification of staple foods such as wheat or corn happens through industrial processes, and are designed to avoid traditional challenges like acceptability (you use a staple food), availability and affordability challenges – as supposedly all products will have the same nutritional quality on the market, regardless of the price. However, in Pakistan, poor families consume a product processed informally in small-scale local mills that cannot comply with regulations, hence the new fortified wheat is only consumed by middle class families. Policy makers did not take them into account when designing the policies.

Continue reading: So what have we learned?


Review of Agri-Food Value Chain Interventions Aimed at Enhancing Consumption of Nutritious Food by the Poor: India
Leveraging Agriculture for Nutrition in South Asia, 2016
Efforts to give a pro-nutrition focus to agriculture to address the problem of undernutrition in developing countries have predominantly focused on boosting production and/or consumption of nutritious foods by farm households. While this is clearly appropriate in countries where a large proportion of the poor have agriculture as their main source of livelihood, as in South Asia, it is increasingly recognised that a majority of the poor derive some or all of their food through markets.
Review of Agri-Food Value Chain Interventions Aimed at Enhancing Consumption of Nutritious Food by the Poor: Pakistan
Leveraging Agriculture for Nutrition in South Asia, 2016
How can agriculture play a more effective role in improving nutrition in countries with a high burden of hidden hunger and where an increasing proportion of the poor sources its food from the market? There is a need to understand how linkages between the farm and the consumer can be made to work for nutrition goals.This review paper examines the case of Pakistan, which has a relatively productive agricultural sector but which has experienced high and persistent rates of undernutrition.
Review of Agri-Food Chain Interventions Aimed at Enhancing Consumption of Nutritious Food by the Poor: Bangladesh
Leveraging Agriculture for Nutrition in South Asia, 2017
Bangladesh is primarily an agrarian nation. Most of the people of the country directly or indirectly depend on agriculture. Rural people are more involved in this sector compared to urban people. Agriculture is the single largest producing sector of the economy. The performance of this sector has an overwhelming impact on major macroeconomic objectives like employment generation, poverty alleviation, human resources development and food security.
Private business-driven value chains and nutrition: insights from India
Institute of Development Studies UK, 2018
Despite rapid economic growth, undernutrition rates in South Asia remain among the highest in the world. It is also seen that both rural and urban populations in developing countries are increasingly dependent on markets for food. This makes examining the potential of different agri‑food models to deliver nutritious foods relevant.This article examines the value chains of two fortified foods manufactured by private sector business in India using the conceptual framework in Maestre, Poole and Henson (2017), to understand their potential to reach economically poor households.
Going against the grain of optimism: flour fortification in Pakistan
Institute of Development Studies UK, 2018
Food fortification is a popular strategy for addressing ‘hidden hunger’, and staple foods are seen as promising, if unproven, vehicles for the delivery of essential micronutrients to poor people in developing countries. This article examines wheat flour fortification with iron in Pakistan as a case of technocratic optimism in the face of institutional constraints.An evaluative framework based on the analysis of entire value chains can provide a reality check on technocratic optimism.
Food distribution value chains under the Integrated Child Development Services
Institute of Development Studies UK, 2018
Globally, social provisioning of food is recognised as an important means to reduce the prevalence of malnutrition. Government food distribution programmes have potential for impact at scale in this context.
‘Milk for milk, water for water’: analysing Pakistan’s dairy innovation
Institute of Development Studies UK, 2018
Interventions in agri-food value chains are thought to potentially make important contributions towards enhancing agriculture’s role in nutrition. Some frameworks have begun to identify sets of requirements for pro-nutrition value chains. Pakistan’s dairy sector has been the focus of a business-driven innovation which introduced ultra-high temperature (UHT)-treated milk in aseptic packaging.This was expected to relieve existing constraints in production and distribution, raise incomes for producers, and increase the supply of an affordable nutrient-dense food to consumers.
Building dairy value chains in Badakhshan, Afghanistan
Institute of Development Studies UK, 2018
Considerable recent research has tried to link agricultural production and the distribution of nutrient-rich foods to consumption, and hence improved health, of nutritionally vulnerable population groups. However, we are still unsure how agri-food value chains can assure positive linkages between agriculture and nutrition. Badakhshan is a remote region of Afghanistan, where high rates of malnutrition prevail among vulnerable population groups.

Ultimately this is one part of the puzzle when it comes to tackling the nutrition problem in South Asia and the world more widely. Through this work we begin to gain more of an understanding of the value chains and the pathways through which we can aim to improve nutrition. It could be assumed from the pathways outlined above that if you increase the production and distribution of naturally nutrient-rich foods that this would lead to higher consumption, or that fortifying a product with micronutrients will lead to increased nutrition gains. However, we have learnt that those assumptions rarely hold true.


There is not one solution or one chain. Multiple actors have a role and we need a combination of strategies. To improve how these value chains deliver nutrient–rich foods – one must meet the needs of businesses (of all types and sizes) and nutrition/diet requirements and this involves trade-offs that are not easily negotiable.


To tackle the burden of malnutrition, strong policies are needed which incentivise healthier products while challenging less healthy ones.


The informal sector and local small businesses tend to be ignored or voiceless when designing policies – however they are key actors when feeding poor people. We need to engage more effectively with them. The solution lies with them and not the big multinationals.

Continue reading: Back to introduction


Business-based strategies for improved nutrition: the case of Grameen Danone Foods
Institute of Development Studies UK, 2018
There is increasing interest in the role that businesses can play in promoting the consumption of nutrient-dense foods as part of strategies to reduce the prevalence of micronutrient deficiencies in developing countries. To date, however, there has been little in-depth analysis of the extent to which viable business opportunities exist for nutrient-dense foods in the context of markets catering to communities.
Focus on gender, context, and evidence: CARE’s lessons learned
Institute of Development Studies UK, 2018
This article explores the most effective ways to influence nutrition through value chains, based on CARE’s long history in food and nutrition security.