Agriculture and Health: 
Crossroads and Challenges for Future Agricultural Development in Africa

Franklin J. Abamu and Kanayo F. Nwanze WARDA—The Africa Rice Center 01 B.P. 4029, Abidjan 01, Côte d’Ivoire Corresponding author e-mail: f.abamu@cgiar.org

A presentation at the
CORAF/WECARD Consultation on
“Science and Technology Strategies for Improved Agricultural Productivity and Food Security in Africa”
Dakar, Senegal, 10–12 February 2003

Contents

Abstract 
1. Introduction
        1.1 HIV/AIDS
        1.2 Malaria
2. Crossroads and Impact on Agriculture
3. Agriculture and HIV/AIDS: impact and opportunities
        3.1 Livelihood insecurity, migration and exposure to AIDS
        3.2 Food, nutrition and AIDS
        3.3 AIDS in the workplace
4 Agriculture and Malaria: impact and opportunities
5. Responding to the challenge—The CGIAR and WARDA approaches
        5.1 Working in Partnership
        5.2 Filling critical knowledge gaps
        5.3 Impact mitigation through agricultural technologies
        5.4 Information, awareness and sensitization in the workplace
6. Concluding remarks
Acknowledgement
References


Abstract

In recent years, health factors—notably HIV/AIDS and malaria—have had profound effects on Africa. From the manifestations of the impact of HIV/AIDS for example, Africa and the world at large has learnt that the disease is not ‘just a health problem,’ but a catastrophe to human development. 

HIV/AIDS and malaria are the top killers in Africa today. HIV/AIDS alone has killed more Africans than all our civil wars put together. The impact of the disease transects all sectors of human development in Africa—health, agriculture/food security, education and the military. HIV/AIDS shakes the foundation of African family integrity, community structures, and national stability and economic growth. Effects at the household level from an agriculture and food perspective, include the reduction (or complete loss) of family farm holdings and livelihood support foundation, delay in routine crop management activities, cultivation of marginal and less-fertile lands, adoption of less productive but less labor-demanding strategies, asset stripping for maintenance of livelihood standards and medical care; and removal of children from school to tend to crops/livestock or care-giving. Malaria, on the other hand, attacks mainly children and women, and the immediate impacts include the use of farm-time for care-giving, and exclusion of affected children from the family farm labor pool. 

Present and future agricultural research in Africa or for Africa must not ignore HIV/AIDS and malaria and must be poised to respond to the challenge. Agriculture and health have a bi-directional linkage. Downstream, adequate food, nutrition and dietary intake play critical roles in prolonging the lives of people living with HIV/AIDS, especially when they have no access to modern anti-retroviral (ARV) therapeutics. Technologies developed with HIV/AIDS and gender concerns in mind can empower women-headed or child-headed households affected by HIV/AIDS. At the ecosystem level, robust crop and livestock strategies can provide attractive livelihood to rural youths, which might in turn reduce rural–urban migration and risk of new infections. Proper use of wetlands and suitable crop management strategies has also been reported to reduce malaria risk. Upstream, narrowing of food-basket for the sake of higher productivity at the expense of nutrition may not be helpful in terms of the nutrition requirements of those living with HIV/AIDS. Loss of livelihood plays a catalytic role in triggering high-risk off-farm behavior. 

From an agricultural viewpoint, the paper presents the crossroads and impact of health issues—HIV/AIDS and malaria—on current and future food security. The paper draws from WARDA strategy aimed at positioning health on the agricultural research agenda, and which can serve as a starting model in developing a region-wide and sector-wide mitigation strategy. 

CORAF, national agricultural research and extension systems (NARES) and all stakeholders in African development must conceive an appropriate paradigm for our agricultural development that would be sensitive to issues affecting Africa today and that would remain relevant to future generations in a world affected by HIV/AIDS and malaria. The invitation of this paper to this forum is a bold step in the right direction, which needs to be built upon. 

Key words: Health, HIV/AIDS, malaria, agriculture, food security, mainstreaming, Africa. 


1. Introduction 

Human development in its broad sense is made up from individual and community wellbeing. For a community whose livelihood is supported by agriculture or agriculture-related activities, there should be no argument that health at the individual level cumulatively determines the health (or wellbeing) of the community, which in turn reflects on the well being of the state or nation. Economists might want to refer to this ‘wellbeing’ as Gross Domestic Product (GDP). Most communities in Africa depend on agriculture and agriculture-related activities for livelihood support. 

Agriculture and health are two sectors of human development with direct consequences on each other. However, these linkages have rarely been critically examined, perhaps because there were few perceived problems. Times are changing, however, and both agriculture and health sectors must now address their interlinkages, given the emergence of challenges such as HIV/AIDS and malaria, which are not only massive killers, but systemic wasters. Several other diseases are important, but this paper is limited to these two because of their magnitude and immediate impact on the agriculture and food security of the future. 

1.1 HIV/AIDS 

Since HIV/AIDS was first diagnosed in 1981, the disease has escalated at unprecedented rates and is now widely acknowledged as a catastrophe to mankind. HIV/AIDS is no longer just a medical issue, but a development crisis. Sub-Saharan Africa has been worst hit, accounting for 70% of the world’s HIV/AIDS cases (Fig. 1). Estimates suggest that by the end of 2002, some 25.3 million people on the continent were living with HIV/AIDS, while some 17 million have already died (UNAIDS, 2002). Most of those are (or were) in the ‘prime’ of their lives, in the age group 15 to 49 years old—the main labor force of agricultural economies.

Figure 1: Number of people living with HIV/AIDS in different regions and percentage of global epidemic.  Source: UNAIDS (2002).

HIV/AIDS statistics in West Africa are equally alarming. Seven countries are believed to have reached or surpassed 5% HIV prevalence in the general population (Fig. 2). AIDS epidemiologists indicate that 5% is the threshold after which significant proportion of population begins to succumb to the disease (UNAIDS, 2002). World-wide, some 5 million agricultural workers have died from HIV/AIDS related causes. In West Africa, Côte d’Ivoire and Burkina Faso could lose 24% and 20% of their work forces by 2020, if current infection rates continue unchecked (FAO, 2002).

1.2 Malaria

The effects of malaria on mankind date back to pre-history. Statistics on malaria can never be over-stretched. The disease and its vectors are ubiquitous in the tropics.

New concerns on the disease are emerging, however, due to interest in environment-management-based control approaches, the rapid development of resistance by mosquitoes to widely used insecticides, the increasing cost of developing new chemicals, logistical constraints involved in the implementation of residual-spraying programs, environmental concerns linked with the use of persistent organic pollutants, and possible linkages between irrigated agriculture and malaria (SIMA, 2002). Unlike HIV/AIDS which attacks mainly people aged 15–49, malaria attacks mainly infants and children aged 15 years or younger. Adults are not immune from malaria, but the debilitating effects are more severe on children. 

2. Crossroads and Impact on Agriculture

Two decades into its known existence, HIV/AIDS has affected all sectors of human development, including agriculture. The agricultural sector has been among the first sectors to reveal the symptoms of HIV/AIDS as a human catastrophe. An example and attestation is the recent food crisis that is affecting six countries in East and Southern Africa that are long associated with the pandemic: in 2001–2002, significant humanitarian and food crises were reported in Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe. In November 2002, several UN organizations met to review the crisis in Southern Africa and concluded that the food crisis is linked to the effects of HIV/AIDS.

Certain basic facts have been established about HIV/AIDS in Africa: (1) it attacks people 15–49 years old; and, (2) it is transmitted mainly heterosexually. As documented by, e.g., Mutangadura et al. (1999), and Topouzis and du Guerny (1999), HIV/AIDS is major threat to agriculture and food security, not because it attack crops or livestock, but because it reduces agricultural productivity and diminishes the availability of food via:

• direct loss of family labor (e.g. when an adult farm member is killed by HIV/AIDS); 

• reduced time for farming (e.g. time used for medical needs, care-giving or attending funerals); 

• asset-stripping (e.g. for medication needs), and consequently reduced reinvestment in agriculture; 

• knowledge loss and void in farmer generation; 

• adoption of non-suitable and less productive farming techniques; 

• reduction in area cultivated due to reduced labor; 

• cultivation of marginal and less productive lands; 

• lack of land for cultivation (e.g. in where young widows are, by tradition, not allowed to inherit their husband’s land). 

Research by WARDA in Côte d’Ivoire showed that food consumption dropped in a household after the male adult died (WARDA, 2002). Similarly, some 20% of rural families in Burkina Faso are estimated to have reduced their agricultural work or even abandoned their farms because of AIDS. In Ethiopia, AIDS-affected households were found to spend between 11.6 and 16.4 hours per week performing agricultural work, compared with a mean of 33.6 hours for non-AIDS-affected households (UNAIDS, 2002).

3. Agriculture and HIV/AIDS: impact and opportunities

3.1 Livelihood insecurity, migration and exposure to AIDS

Poverty and cross-border migration due to absence of sustainable livelihood ‘at home’ are top among factors contributing to the spread of HIV/AIDS in West Africa (UNAIDS ICT, personal communication).

Rural–urban migration is driven by failure of agriculture in rural communities or lack of attractive alternatives. Figure 3 has been inspired by a study conducted by CARE on migrant youths from a community in Niger. Some respondents indicated that they were forced to migrate to bigger cities to search for better livelihoods because of one or multiple years of drought followed by crop/livestock failure and complete loss of their livelihood support in the village. The chart is a direct challenge to agriculture and development, and showcases an opportunity for agriculture to contribute to ‘breaking the cycle’ of the spread of HIV/AIDS, for example in communities where the livelihood support system depends on agriculture. Diversification of livelihood opportunities through agriculture may then have a positive influence on reducing vulnerability to infection (Topouzis and du Guerny, 1999; Richards, 1999; Stillwaggon, 2000). 

3.2 Food, nutrition and AIDS

HIV/AIDS impact at the individual level is the acceleration of the vicious circle of inadequate dietary intake and disease progression. Research indicates that better nutrition could play a role in prolonging life following HIV infection, and nutritional status of people living with AIDS plays a large part in determining their current welfare with respect to morbidity (Haddad and Gillespie, 2001). 

At the crop and ecosystem level, nutritional intake is a function of the array of crop and livestock species available in the community basket. For example, researchers are increasingly curious about an apparent geographical convergence of the use of aflatoxin-vulnerable crops—groundnut and maize—and the severity of both malaria and HIV/AIDS in East and Southern Africa. Aflatoxins confer a short-term advantage on people through increased resistance to malaria, but can induce immuno-suppression, which may be linked to weakening of the immune system even before infection by HIV. 

Figure 3: Conceptual linkages among agriculture, food and nutrition intake and HIV/AIDS

The agriculture and health sectors should begin to study linkages between HIV/AIDS, nutritional status and micronutrient uptake in greater detail, especially for rural people with little or no access to high levels of medical attention as required by HIV/AIDS. HIV/AIDS patients require more protein and more energy (carbohydrate). Good nutrition that includes micronutrients reduces the chances of opportunistic infection, whereas malnutrition increases progression of the infection. 

3.3 AIDS in the workplace

Another dimension of the HIV/AIDS challenge is in the workplace.

The welfare of agricultural human resources in research institutions and extension services as it relates to HIV/AIDS must be an integral part of any mitigating strategy. Research staff and extension agents must be well informed and adequate policies must be developed for their protection. For example, WARDA has developed a draft policy for HIV/AIDS for all of its employees and, since 1999, WARDA has been proactive in conducting gender-sensitive HIV/AIDS awareness seminars on WARDA campus for all staff. 

To safeguard the agricultural research workforce, institutions in CORAF/WECARD should be encouraged to develop strategies toward addressing the impact or potential impact of the pandemic on their staff. Africa has passed the stage of denial, and information and sensitization are among the best practices to protect future researchers. 

4 Agriculture and Malaria: impact and opportunities

Cultivable wetlands have been reported as suitable breeding sites for Anopheles gambiae sensu lato, the main malaria vector in Sub-Saharan Africa. Wetlands also constitute a significant proportion of the landscape and are productive if developed for irrigated agriculture. 

Different reports have shown that the epidemiological impact of irrigated agriculture on malaria differs with respect to land use; here are opportunities for research intervention. 

WARDA investigated differences in malaria incidence between farmer households in communities where irrigated rice was cultivated and in others cultivating non-irrigated (i.e. rainfed) crops. In the irrigated zone, the transmission of malaria was fairly constant over the seasons at a low level, whereas in the non-irrigated zone, transmission was mostly below detection level during the dry season and high toward the end of the rainy season (Fig. 4). 

Figure 4: Year round incidence of malaria and entomological inoculation ratio (EIR) in irrigated and non-irrigated communities in Mali, 1996–1997.

Within an irrigated community, crop and land management strategies play significant roles in malaria control. For example, An. gambiae thrives in the shallow inundated fields during tillage, transplanting and up to the first six weeks of the growing period, when the canopy is not closed. Once the canopy is closed, An. gambiae is succeeded by other anopheline species, until the crop is harvested and land is open again. An inverse relationship is also reported between rice plant height and the population of An. gambiae in Tanzania. The drop in An. gambiae population density with plant growth is attributed to decreased light intensity available at the soil surface due to canopy closure. Intermittent irrigation is also associated with higher mosquito productivity than is permanent flooding. Therefore, it is of interest to agronomic research to look closely at such opportunities with a view to exploiting the relationships for human health improvements (WARDA, 2001; SIMA, 2002). 

5. Responding to the challenge—The CGIAR and WARDA approaches

Mindful of the importance of HIV/AIDS for agriculture and those whose livelihoods depend on it, the Consultative Group on International Agricultural Research (CGIAR) decided to intervene, in a move coinciding with the engagement of all sectors in the fight against an unprecedented threat to humanity (CGIAR, 2001). 

The response of the CGIAR has included the launch of the System-wide Initiative on HIV/AIDS and Agriculture (SWIHA), which is being convened and facilitated by WARDA. WARDA is also proactive in developing response capacity to the pandemic within the agriculture research and development sector in West and Central Africa. The WARDA strategy is based on the following pillars.

5.1 Working in Partnership 

The first step in responding to the challenge is the need to work in partnership with other stakeholders, especially the public and private health sector and social-development NGOs. WARDA, for example, has forged a new partnership with the UNAIDS Inter-Country Team for West and Central Africa, and ECODEV, an NGO in Côte d’Ivoire. 

In going into such partnerships, agricultural research must clearly understand its niche in the overall HIV/AIDS equation and must bring on board its existing infrastructure and linkages with national agricultural research and extensions systems (NARES), and connectivity and specific advantages in working with farmer communities. Table 1 is a summary of such infrastructures at WARDA and their outreach in West and Central Africa, which can serve as launch-pad for HIV/AIDS interventions. 

5.2 Filling critical knowledge gaps

While the HIV/AIDs statistics are mounting, there is a lack of knowledge on the vulnerability or resilience of the food-security and livelihood-support systems in our agricultural communities. The fact remains that rural communities provide the sinks for those affect by HIV/AIDS to return to for care-giving (e.g. Black, 1997). Implications are that care-giving further impoverishes an already desperate situation. CORAF and other agricultural institutions must begin to track such impacts, as this is one of the ways West and Central Africa can avoid the debilitating effects of HIV/AIDS on future food security. 

5.3 Impact mitigation through agricultural technologies

Part of the reason for WARDA and other agricultural research institution being involved in the HIV/AIDS arena is that their work has already been addressing issues related to poverty, lack of food and nutritional security, which are both the root causes and recipients of the impact of the problem. WARDA-promoted technologies that are relevant to the HIV/AIDS, especially with respect to labor-saving and cost-saving technologies, include the following.

5.4 Information, awareness and sensitization in the workplace

HIV/AIDS awareness and sensitization can be effective life-saving measures for workers in R&D institutions and extension agencies. However, the expertise for implementing HIV/AIDS sensitization does not have to come from within the agricultural sector, as there are other institutions with comparative advantage in this area. What is important is for the management of agricultural institutions to understand and accept the reality of AIDS and the knowledge that they can act against the pandemic. In WARDA, for example, through support from management, the medical faculty of a local university and skilled NGOs are consulted to undertake HIV/AIDS-sensitization seminars for all levels of staff. Workplace sensitization has been helpful in opening up sensitive areas and enhancing staff empowerment against the pandemic. 

6. Concluding remarks

6.1 Using wetlands for irrigated agriculture can modulate rather than increase malaria incidence

Whenever malaria is discussed in an agricultural forum, the preset notion is that irrigated agriculture increases the incidence of vectors and the disease. In communities where wetlands abound, the distinction has to be made between malaria situations when the wetlands are used versus when they are not used. 

Research at WARDA, conducted in partnership with several other stakeholders, investigated relationships between incidence of malaria in communities where adjacent wetlands are used or not used for rice cultivation. The study revealed the following, which are corroborated with independently reports elsewhere.

Vector populations are significantly high in the region irrespective of the land use strategy. 
Incidences of malaria and entomological inoculation were consistently lower in the village where the wetlands have been developed for irrigated rice cultivation than in the villages where nearby wetlands are not developed or used. 
In the communities where irrigated rice is cultivated, economic power per family is higher than in the non-irrigated community, awareness about malaria is also higher and more families sleep under bed nets. 
Rice-crop architecture and irrigation-water management can be used as strategies to further reduce breeding sites for An. gambiae in areas where wetlands are used for agriculture. 

6.1 Agriculture can contribute to reducing the spread and negative effects of HIV/AIDS in Africa

Fundamental understanding of HIV/AIDS in Africa and reasons for its debilitating effects has led us to conclude the following.

First, lack of sustainable livelihood, and food insecurity and poverty are factors fueling risky behavior and the spread of the disease in the continent. 

Second, the chronic effect of HIV/AIDS is the systemic crippling of the human and technological resource-base for successful agricultural production and food security, starting from a household level, to community and national levels. 

Third, adequate food and nutrition intake can delay disease progression, thereby playing a significant role in the health and wellbeing of people living with HIV/AIDS. 

Therefore, future agricultural R&D must be positioned to adequately respond to HIV/AIDS by doing more than we currently do, and in new ways. Donor agencies must also look beyond supporting conventional research and must not shy away from supporting efforts to undercut the HIV/AIDS from its fundamental roots—agriculture, food and livelihood insecurity. 


Acknowledgement


Work on HIV/AIDS as it affects agriculture would not have been possible without a clear vision and sustained encouragement and commitment from the senior managers of WARDA. WARDA’s HIV/AIDS activities are conducted under the umbrella of SWIHA, which has to date been funded solely by grants from the Government of Norway. 


References 

Black. M., 1997. Impact du VIH/SIDA sur les systèmes d'exploitations agricoles en Afrique de l'Ouest. FAO, Rome.

CGIAR, 2001. Proposal for a Global Initiative on HIV/AIDS, Agriculture, and Food Security (GIAAFS), facilitated by the Consultative Group on International Agricultural Research. Washington DC.

FAO, 2002. 

Haddad, L. and S. Gillespie, 2001. Effective food and nutrition policy responses to HIV/AIDS: What we know and what we need to know. IFPRI, Washington, DC. 

Mutangadura, G., D. Mukurazita, and H. Jackson, 1999. A Review of Household and Community Responses to the HIV/AIDS Epidemic in the Rural Areas of Sub-Saharan Africa. UNAIDS Best Practice paper, 1999. UNAIDS, Geneva. 

Richards, P., 1999. Hurry, we’re all dying of AIDS: linking cultural and agro-technological responses to the challenge of living with HIV/AIDS in Africa. Paper presented at the Conference on AIDS, Livelihoods and Social Change in Africa, Wageningen Agricultural University, 15–16 April 1999. 

SIMA, 2002. Malaria in irrigated agriculture. IWMI working paper 47. IWMI, Colombo, Sri Lanka. 

Stillwaggon, E., 2000. 

Topouzis, D. and J. du Guerny, 1999. Sustainable Agricultural/Rural Development and Vulnerability to the AIDS Epidemic. UNAIDS, Geneva and FAO, Rome.

UNAIDS (Joint United Nations Program on HIV/AIDS), 2002. Report on the global HIV/AIDS epidemic. Geneva, Switzerland

WARDA 2001.

WARDA, 2002. Mainstreaming HIV/AIDS into Agricultural Research and Development. Pages 46–52 in WARDA Annual Report 2001–2002. WARDA, Bouaké, Côte d’Ivoire.