Famine and Feast
Life on the margins: the inequality of food and nutrition security
RESPONSE AND MANAGEMENT:
FOOD AID AND ASSISTANCE
PowerPoint presentation by
Médecins Sans Frontières / Doctors Without Borders
(MSF) UK
Schools Team: Mary Doherty and Severa von Wentzel
March 2014
INTERNATIONAL
RESPONSE AND MANAGEMENT:
Management of food
security and supply
Management of food security and supply, an age-old topic, became very
topical in the 2000s because of:
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Economic concerns following food price shocks of 2006-2008
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Environmental concerns such as climate change, soil degradation and
water
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Health, particularly growing malnutrition including obesity epidemic and
related non-communicable diseases
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Concerns with resilience of food supply; for instance, in the UK after the
lorry strike that brought the country to 5 days from shortages
Source: “Food Security and Sustainability: One Can’t Make an Omelette Without Cracking Some Eggs” http://vimeo.com/24914046
Actors in the
international response
International food aid and assistance is driven in large part by:
• Donors and international institutions
• UN institutions such as World Food Program
• NGOs (non-governmental organisation) actors are
independent of national governments such as MSF, World
Vision, CARE and Catholic Relief Service
• World bank Formed at Bretton Woods in 1944,its remit is to
support developing countries.
• IMF Formed at Bretton Woods in 1944, it is in charge of
stabilising currencies and supporting weak economies
Further Info Critical view on the actors, politics and economics of Food Aid:
http://www.globalissues.org/article/748/food-aid
Greeley et al Effect of mass supplementation
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0044549
URBAN SETTING RESPONSE http://www.cmamforum.org/Pool/Resources/Humanitarian-resp-in-urban-settingsDisasters-Lucchi-2012.pdf
Rome-based
agencies
After the global food price hikes, there was a call to increase the
coordination of the Rome-based agencies and the focus on
improving the link between food assistance and food security.
Rome-based agencies is a short-hand for three United Nations’ agencies based
in Rome:
• World Food Programme (WFP): http://www.wfp.org/
Largest humanitarian organisation in the world that handles most of the
multi-lateral (involving more than 2 donors) food aid
• Food and Agriculture Organization (FAO):
http://www.fao.org/home/en/
• International Fund for Agricultural Development (IFAD): http://www.ifad.org/
Source: http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/6038.pdf
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Donors
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US – biggest donor, around 50% since 1980
EU and its member states
Canada
Japan
Non-DAC donors such as Kuwait, Saudi Arabia
and United Arab Emerites becoming more
significant. China and South Korea started
making substantial provisions of in-kind food aid
largely directed at North Korea in the 1990s.
Source: www.odi.org.uk/resources/docs/6038.pdf
contents
DAC and non-DAC
donors
The Organisation for Economic Co-Operation and Development’s (OECD)
Development Assistance Committee (DAC) serves as a discussion forum
on issues surrounding aid, poverty reduction and development. Member states
marked in yellow.
Image: http://en.wikipedia.org/wiki/File:DAC_members.svg
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Focus of food aid
and assistance
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The focus is still largely on addressing undernutrition, not the
double burden of malnutrition.
Food aid represents the majority of humanitarian appeals.
Constantly shifting contexts and needs in emergency and transitional
settings and growing funding requirements.
Further info
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CAFOD Aid Factsheet http://www.cafod.org.uk/Media/Files/Resources/Secondary/resourcepages/Factsheets Humanitarian Policy Group Food aid and food assistance in emergency and
transitional contexts: a review of current thinking – shift to food assistance and trends
http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/6038.pdf
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Case study success stories Nutrition report 2013. UN childhood nutrition report on 11 countries with
success in their childhood feeding programmes
http://www.unicef.org/media/files/nutrition_report_2013.pdf
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On “The future of food aid” http://www.irinnews.org/report/98469/analysis-the-future-of-food-aid
Source: http://www.globalissues.org/article/748/food-aid; http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publicationsopinion-files/6038.pdf; Levine and Chastre et al “Missing the Point” http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/eventspresentations/1422.pdf; HPG report
contents
Types of food aid (1)
Food aid and assistance: The terms and definitions used around food aid and food
assistance are not very clear and changing - clarity needs to be greater. The have changed, in
particular, to allow for the inclusion of the provision of cash for food-related purposes. The use
of cash-based transfers and vouchers has increased.
Programme Food Aid is almost always made up of in-kind direct transfers (see next slide) and
makes up the majority of US food aid.
Relief, or Emergency Food Aid Usually free food distribution during emergency situations as
a result of natural or man-made disasters. Not necessarily short-term, as countries can suffer
chronic food insecurity for long periods. It may include food, water, tents, clothing or rescue and
medical teams.
Project Food Aid This is food aid delivered as part of a specific project related to promoting
agricultural or economic development, nutrition and food security, such as food for work and
school feeding programmes. Relief aid and project food aid are usually distributed by the World
Food Programme (WFP), Non-governmental organizations (NGOs), and occasionally by
government institutions.
Development aid: Given to benefit the people and economy of a country, money is given to a
wide range or programmes and projects such as infrastructure and education.
Source:
http://www.geographybase.co.uk/IB%20Geography%20HL%20Disparities%20in%20Wealth%20and%20Development%20Revision%20Notes%20FINA
L.pdf; http://www.globalissues.org/article/748/food-aid#Whatisfoodaid; http://www.odi.org.uk/publications/3843-hpg-commissioned-reports
Types of food aid (2)
In-kind aid: Food grown in the donor country is distributed or sold abroad. Usually it is a
government to government transfer, where the recipient countries purchases the food
with money borrowed at lower than market interest rates.
Local and regional procurement: Purchases in and around the countries that need it.
Tied aid: Money that comes with strings - a requirement to spend it a certain way or to
follow a particular policy. What is monetization of food aid?
http://www.careinternational.org.uk/news-and-press/latest-news-features/2388-what-is-monetization-of-food-aid-fivequestions-on-food-aid-qmonetizationq-in-the-us-answered
Untied aid: No spending or policy proviso attached to money given.
SAPs (Structural adjustment programmes) Implemented by the IMF, aid or loans given if
a country followed SAPs. Aimed at boosting development and reducing corruption, they
were criticised for benefiting rich countries and corporations.
Multilateral aid: Given by multiple donors to a specific country, it may be collected by an
UN organisation or an NGO
Bilateral aid: Given by one country directly to another. Most non-DAC donors provide
assistance bilaterally from government to government assistance, but there is a paucity
of information on this.
Source:
http://www.geographybase.co.uk/IB%20Geography%20HL%20Disparities%20in%20Wealth%20and%20Development%20Revision%20Notes%20FINA
L.pdf; http://www.globalissues.org/article/748/food-aid#Whatisfoodaid
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Aid strategies
Short-term actions and supply-led strategies prevail over long-term policies as
most political attention is short-term. The wide spectrum of strategies includes:
• Fairer trade
• Reduced debt servicing
• Reduced subsidies to richer economies
• Less tied aid
• More community involvement
• Appropriate technology
• Infrastructure building
Action for students:
1. Discuss in pairs and make notes in your folder about what each of the
different strategies above entails refer to concrete examples and highlight
the desired outcomes.
2. Identify the strategies which are long term, short term
3. Watch the Fairfood international clip “A Fair Future for food chain workers:
http://www.fairfood.org/videos/a-fair-future-for-food-chain-workers/
4.
Read the CAFOD Factsheet on Debt and explain debt servicing
http://www.cafod.org.uk/Media/Files/Resources/Secondary/resource-pages/Factsheets
Food aid
and assistance trends
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Shift away from in-kind food aid to many new response options and more flexible
donor resources such as local and regional procurement away from aid sourced internally
in a donor country (except for USA). “People need different kinds of aid in different situations. If
food is not available in a flooded area, actual food supplies are the answer. In the case of chronic
shortages, experts suggest cash or vouchers, integrated into a broader social protection system, might
be the answer.” http://www.irinnews.org/report/97576/getting-food-aid-right
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More emergency and less programme and project aid. They can help build the basis
for long-term food security and can be particularly important in countries in protracted
crisis. An emergency response is not designed to be sustainable, but rather to keep people
alive.
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Major efforts to improve food security analysis, early warning, response analysis
However, there “remains little in the way of an evidence base about what works best under what
circumstances.” and little on recipient preference http://www.irinnews.org/report/97576/getting-food-aid-right
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Growing focus on nutrition programming and on the nutritional outcomes of food
assistance and linking of food assistance to nutritional outcomes. Growing scientific and political
consensus on the need to focus on children under two.
Source: http://www.globalissues.org/article/748/food-aid; http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinionfiles/6038.pdf
Graph: http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/6038.pdf
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Advantages and
disadvantages of aid
Source:
http://www.geographybase.co.uk/IB%20Geography%20HL%20Disparities%20in%20Wealth%20and%20Development%20Revision%20Notes%20
FINAL.pdf
Ways of minimising
negative effects of food aid
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“Depression of food prices in local markets, affecting local livelihoods: Buy food for distribution
from local markets.
Intercommunity conflict when food aid is targeted; friction between the agency and the
community: Involve communities in the selection of targeting methods and other aspects of
food distribution.
Hijacking of food for political purposes (e.g. feeding armies): Use a food commodity that only
the most needy will find desirable.
Households outside the immediate area leave their homes in order to be close to sources of
aid: Spread information about targeting criteria before aid distribution starts.
Change of attitudes and creation of unrealistic expectations; hindrance of traditional coping
strategies: Limit to the absolute minimum the time that free food aid is distributed, and replace
it with other forms of aid if necessary.
Friction between refugees or IDPs and local populations: Make sure that local leaders are
informed at all stages about the aid, and include the most vulnerable of the host population in
assistance interventions.
The market becomes flooded with food aid commodities, prices tumble and the food loses its
economic value: Target food aid as much as possible.
Reduced demand for local farmers' produce: Choose commodities that will not compete
directly with local production, or else purchase commodities in local markets.” (Source:
http://www.fao.org/docrep/008/y5815e/y5815e0a.htm)
Multi-sectoral
approach
“Malnutrition is often misunderstood by policymakers as simply a ‘lack of food’
problem. It is not. Rather, it is a complex multidimensional and intergenerational
problem and needs a multi-sectoral as well as direct and specific interventions.”
(http://www.financialexpress.com/news/tackling-undernutrition-challenges/1154970/0 )
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As malnutrition and its causes are complex, a multi-stake holder and multisectoral approach underpinned with better governance is required. Such an
approach can meet multiple objectives such as nutrition, gender equality
and sustainability.
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Most current policy responses focus on supply side (producing more), but
given global numbers of hungry this is not working on its own.
Consumerism and markets need to be accompanied by policies that help
rebalance power.
Source: http://scalingupnutrition.org/wp-content/uploads/pdf/SUN_Framework.pdf
Challenges to
coordinated response
International management is increasingly needed to ensure food supply and
security.
A multi-sectoral approach includes interventions in food systems, public health
and education and needs to create an enabling environment through broader
interventions and direct nutrition-specific ones. Action is urgent for both types
of interventions.
Challenges are to
• To sustain global commitment
• To boost country-level commitment
• To translate commitment into action
• To boost improvements in nutritional status and livelihoods
Source: http://download.thelancet.com/flatcontentassets/pdfs/nutrition_5.pdf
Linkages in the food security
architecture can be further
improved.
Source: http://www.aidinfo.org/wp-content/uploads/2010/10/kharas-aid-architecture-diagram.png
Governance:
coordination and coherence
In an effective, timely and comprehensive mechanism for governing and
coordinating food and nutrition security and sustainability, including food aid,
key stakeholders could:
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Address complex and interrelated issues and deeper underlying determinants
such as the quality of governance and institutions as well as issues relating to
peace and security. Fragile states have special needs.
Garner high-level support and political partnerships as a foundation for an
“whole of society” approach with “ownership” led by the governments, but
including civil society, parliaments and the private sector. Country-owned
strategies may not be possible in fragile states, so other actors must assume a
more activist role based on interim strategies.
Build a mechanism for “policy coherence”, timely policy co-ordination through
government-wide attention to unintended negative consequences on nutrition of
donor and recipient countries’ policies and interventions; for example, subsidies
for biofuels and food exports.
Source: http://scalingupnutrition.org/wp-content/uploads/pdf/SUN_Framework.pdf;
http://download.thelancet.com/flatcontentassets/pdfs/nutrition_5.pdf
International consensus
Initiatives such the UN REACH and the Millennium Development Goals have
been followed by the L’Aquila initiative and New Alliance for Food Security
and Nutrition and US Feed the Future, "1,000 days" campaign and “Scaling
Up Nutrition” (SUN).
The Committee on Food Security, UN High Level Task Force, New Food
Security Cluster and Food Assistance Convention have been active.
These are developed by government, academic, research institution, civil
society, private company, development agency, UN organisations and the
World Bank specialists and bring together countries suffering high levels of
malnutrition with major international food donors.
Further info:
“Aid policy: New mechanism to boost food security” http://www.irinnews.org/report/92846/aid-policy-new-mechanism-toboost-food-security
Source: MSF “Food Aid System continues to fail malnourished children” http://www.msf.org/article/food-aid-system-continues-fail-malnourishedchildren
Millennium
Development Goals
First Millennium Development Goal: reduce
by half the proportion of people who suffer
from hunger between 1990 and 2015.
(ftp://ftp.fao.org/docrep/fao/012/i0876e/i0876e02.pdf).
Based on the latest FAO undernourishment
estimates, this can be met if appropriate actions
are taken to reverse the slow down
since 2007/2008.
In Sub-Saharan African countries
levels of malnutrition are declining
very slowly, remain very high or are
growing, while there are have been
large declines across Asia, Latin
America and the Caribbean.
Further info:
Save the children, Ending poverty in our generation.
https://www.securenutritionplatform.org/Pages/DisplayResou
rces.aspx?RID=143
MDG, Food and Agriculture:
http://www.mdg-review.org/index.php/sections/38-food-a
agriculture/56-mdg-food-and-agriculture
Farming is key to Africa’s prosperity (supporting women
farmers)
http://www.irishexaminer.com/analysis/farming-is-the-key-toafricas-prosperity-262936.html
Source: http://beijingcircles.files.wordpress.com/2010/09/mdgs-large.jpg
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“We have learned from the experience of the
MDGs: sustainability and gender
Environmental sustainability and
gender equality are key to meeting
Millennium Development Goals.
MDGs. There have been huge successes, but
also gaps. I believe the new goals need
specific targets on hunger and nutrition. I
believe we need a strong emphasis on
agriculture, and in particular climate-sensitive
agriculture. I believe we need a stronger, more
specific approach on the rights of women and
girls.” - Irish Minister for Foreign Affairs and
Trade Eamon Gilmore
“Conserving the agricultural resource base and
livelihood security of the poor can be mutually
supportive in three ways. First, secure
resources and adequate livelihoods lead to
good husbandry and sustainable management.
Second, they ease rural-to-urban migration,
stimulate agricultural production from resources
that otherwise would be underused, and reduce
the need for food to be produced elsewhere.
Third, by combating poverty, they help to slow
population growth.” (UN Documents, Our Common Future http://www.un-documents.net/ocf-05.htm)
Image MDGs: http://www.unscn.org/files/Publications/RWNS6/report/SCN_report.pdf;
Source: http://www.irishtimes.com/news/world/fight-against-hunger-at-heart-of-irish-foreign-policy-says-eamon-gilmore-1.1362325
L’Aquila
Rome principles
The report on the 2009 G8 Summit in L’Aquila, Italy recognised the “the
combined effect of long standing under investment in agriculture and food
security, price trends and the economic crisis have led to increased hunger and
poverty in developing countries, . . . jeopardizing the progress achieved so far
in meeting the Millennium Development Goals.” (Joint Statement)
Leaders launched the L’Aquila Food Security Initiative (AFSI), which follows
the five Rome principles on sustainable food security. It call on donors to
draw up and implement development plans that respond to the needs of
developing countries and ensure that all actors are cooperate in their work to
achieve sustainable outcomes:
Rome principles: 1. Country Ownership; 2. Strategic coordination; 3.
Comprehensive approach; 4. Multilateral support and
improvement; 5: Sustained financial commitment
Other core commitments: gender, environmental sustainability, transparency
Source: http://www.one.org/c/international/hottopic/3930/;
http://www.g8italia2009.it/static/G8_Allegato/LAquila_Joint_Statement_on_Global_Food_Security%5B1%5D,0.pdf
Global initiatives
L’Aquila
The G-8 group of powerful nations made a L’Aquila commitment
signed by over 20 countries in 2009 in Italy to "take urgent action
to eradicate hunger from the world." It set out to invest $22 billion
in agriculture over three years based on the Rome Principles.
This reversed two decades of aid policies that neglected
developing country agriculture to invest in country-led programmes.
Instead of renewing the L’Aquila 2009, which was up in
May 2012, the New Alliance for Food Security and Nutrition and US
Feed the Future and was rolled out.
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Video and article on food security policy and trade: http://www.iatp.org/blog/201302/food-crisisupdate-main-drivers-of-price-volatility-still-not-addressed (16:45 min)
International Food Policy research Institute (IFPRI) Global Food policy Report 2012
https://www.securenutritionplatform.org/Pages/DisplayResources.aspx?RID=179
New Alliance for
Food Security and Nutrition
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“At the G-8 Summit hosted by President Obama at Camp David, African
heads of state, corporate leaders and G-8 members pledged to partner
through the New Alliance and, working with the African Union and Grow
Africa, lift 50 million people out of poverty in sub-Saharan Africa by
2022.”(http://feedthefuture.gov/article/fact-sheet-new-alliance-food-security-and-nutrition)
The New Alliance for Food Security and Nutrition private-sector-led
affords a lot more power to partnerships with the private sector,
multinationals like Monsanto and Yara.
Conditions imposed by donors give foreign firms greater access to Africa's
markets.
Source: http://www.aljazeera.com/indepth/opinion/2013/01/201312915630857878.html; Image: www.usaid.gov
http://www.aljazeera.com/indepth/opinion/2013/01/201312915630857878.html
Supporting global impact
Together, countries and supporting stakeholders are
collectively working to reach the global targets set out by the
World Health Assembly 2012 Resolution:
Target 1:
40% reduction of the global number of
children under 5 who are stunted
Target 2: 50% reduction of anemia in women of
reproductive age
Target 3: 30% reduction of low birth weight
Target 4: Increase exclusive breastfeeding rates in
the first 6 months up to at least 50%
Target 5: No increase in childhood overweight
Target 6: Reducing and maintaining childhood
wasting to less than 5%
Further info:
Slideshow on
SUN
Framework.
http://scalingupnutritio
n.org/resourcesarchive
Nutrition-sensitive strategies increase the impact of
specific actions for nutrition
Specific Actions for Nutrition
Feeding Practices & Behaviors:
Encouraging exclusive breastfeeding
up to 6 months of age and continued
breastfeeding together with
appropriate and nutritious food up to
2 years of age and beyond
Nutrition-Sensitive Strategies
Agriculture: Making nutritious food more
accessible to everyone, and supporting
small farms as a source of income for
women and families
Clean Water & Sanitation: Improving
access to reduce infection and disease
Fortification of foods: Enabling access
to nutrients through incorporating
them into foods
Education & Employment: Making sure
children have the nutrition needed to
learn and earn a decent income as adults
Micronutrient supplementation:
Direct provision of extra nutrients
Health Care: Access to services that
enable women & children to be healthy
Treatment of acute malnutrition:
Enabling persons with moderate and
severe malnutrition to access effective
treatment
Support for Resilience: Establishing a
stronger, healthier population and
sustained prosperity to better endure
emergencies and conflicts
International
agencies
Action for students:
Discuss in a group of four, elaborating on your answers:
1. Why is it necessary for international agencies to be increasingly involved in
ensuring food security?
2. What makes an approach purely evidence-based* as opposed to practice- or
opinion-based? What evidence matters (e.g., best evidence such as RCT*
versus best available evidence)? How do you get it? Why is there a classic
policy problem of gap between evidence and policy?
3. What makes an approach sustainable? Are there situations that call for an
approach that is not sustaianable?
4. Why does cost-effectiveness matter?
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Randomised-control trial: specific type of experiment that is the gold standard for a clinical trial
More on evidenced based versus opinion based policy making:
http://www.unece.org/fileadmin/DAM/stats/documents/2008/05/dissemination/wp.10.e.pdf
FOOD AID AND ASSISTANCE
NUTRITIONAL EMERGENCIES
Nexus of strategies
and scales (1)
• There are no one-size fit all scaling up nutrition programmes.
• The risks and vulnerabilities of a particular context need to be
assessed in order to devise policies and implement interventions.
• Adequate food and nutrition policies are essential to guarantee the
effectiveness of programmes and ensure sustainability. The link
between national and district, municipal and community policies is
crucial.
• The combination of interventions needs to be put in place in a
number of scales. Apart from nutrition intervention, others may focus
on addressing inequities and strengthening legal commitments and
health systems, for example.
Nexus of strategies
and scales (2)
• Successful ones addressing the particular
vulnerabilities and needs have secured:
• Political commitment,
• Evidence-based national policies and
programmes
• Trained and skilled community workers
cooperating with communities
• Effective communication and advocacy
• Integrated service delivery across multiple sec
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What works in
nutritional emergencies
“Proven solutions exist that can end the preventable child deaths and damage
caused by malnutrition. Investing in improved nutrition during the critical 1,000
day window can:
• Save more than 1 million lives each year;
• Boost a country’s GDP by as much as 11% annually;
• Build self-sufficiency--well-nourished children are more likely to continue their
education, have higher IQs, and earn up to 46% more over their lifetimes;
• Significantly reduce the human and economic burden of infectious diseases
such as malaria and HIV/AIDS, and chronic diseases such as diabetes; and
• Help end hunger and break the cycle of poverty.”
Source: 1000 days.org “Nutrition – An Investment in Growth” http://thousanddays.org/wpcontent/uploads/2012/05/1000-Days-June-2013-Investment-in-Growth-Policy-Brief.pdf
What does not
Factors behind low effectiveness of interventions
can include:
• Inadequate targeting;
• Lack of coordination and integration of
interventions;
• Distributed foods not appropriate in terms of
nutritional and micronutrient content;
• Weak education component.
contents
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Afar, Ethiopia –
Nutritional intervention
“When I see this child I feel very happy because the
grandmother and the rest of the community thought she
was going to die, but we saved her life and she is still
alive,” says Nabiyu Ayalew, MSF’s outreach nurse.
Further info: http://www.msf.org.uk/article/ethiopia-isolated-and-malnourished-msf-treats-malnutrition-rural-afar
Nutrition interventions
are cost-effective
“Evidence shows that nutrition interventions are some of the most cost
effective of any development intervention, saving lives and investing in
the future potential of children. Scaling up coverage of a minimum
package of direct nutrition interventions, identified by the Lancet
medical journal in 2008, could prevent a quarter of child deaths and
lower the prevalence of stunting —a condition limiting physical and
cognitive development caused by chronic malnutrition—by a third.”
Enough Food If Campaign “G8 Summit Briefing” http://www.bond.org.uk/data/files/G8summit-briefing.pdf
Action for students:
Watch “MSF Campaign for Effective Treatment” on therapeutic foods and their
use in Niger, Sahel http://www.youtube.com/watch?v=e-XMu1YzLsU
Strategies in classic emergencies
Quality
Coverage
NUTRITION
Acutely
Malnourished
At risk
General population
therapeutic
blanket
general distribution
FOOD AID
Food aid in
crisis situations
Source: http://www.fao.org/docrep/008/y5815e/y5815e0a.htm
Proven interventions (Lancet)
to reduce child mortality,
improve nutrition outcomes and protect human capital
Behaviour change interventions usually
delivered on-on-one at the community through
community nutrition programmes and such level,
Including:
Micronutrient and deworming interventions
that provide a range of supplements for:
Complementary and therapeutic feeding
interventions that provide:
• Promotion of breastfeeding
• Appropriate complementary feeding
practices (but not provision of food)
• Proper hygiene notably hand washing
(Mason et al. 2006).
• Children under the age of five (periodic
vitamin A supplements, therapeutic zinc
supplements to manage diarrhoea,
multiple micronutrient powders, and
deworming drugs)
• Pregnant women (iron-folic acid
supplements, as well as iodized oil
capsules where iodized salt is not
available)
• General population(iron fortification of
staple foods and salt iodization).
• micronutrient-fortified and/or -enhanced
complementary foods to prevent and
treat moderate malnutrition among
children 6–23 months of age
• community-based management of
severe acute malnutrition among
children under five years of age.
Source: Nutrition programmes as an investment and Source on Lancet study:
http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/Peer-ReviewedPublications/ScalingUpNutrition.pdf
Core interventions for
pregnant women
Source: 1000 days.org Preventing maternal and child malnutrition http://thousanddays.org/wpcontent/uploads/2013/03/BEST_START_FA101011Infographic2.pdf
Core interventions for
children under two
Source: 1000 days.org Preventing maternal and child malnutrition http://thousanddays.org/wpcontent/uploads/2013/03/BEST_START_FA101011Infographic2.pdf
contents
Timeline
Pregnancy and
first 6 months
From 6 to 24 months
Source: 1000 days.org Preventing maternal and child malnutrition
http://thousanddays.org/wpcontent/uploads/2013/03/BEST_START_FA101011Infographic2.pdf
Prevention is much better
than treatment – not to get
sick in the first place.
Preventative measures
such as cash transfers and
supplementary feeding are
far more cost efficient than
treating a malnourished
child and the loss inherent
in its curtailed future.
Yet, current spending
focuses on treatment.
http://siteresources.worldbank.org/HEALTHN
UTRITIONANDPOPULATION/Resources/PeerReviewedPublications/ScalingUpNutrition.pdf
Feeding Programmes
Source: http://www.who.int/nutrition/publications/en/selective_feeding_emergencies.pdf
contents
Types of feeding
programmes: General food distribution
General food distribution (GFD) is typically used in large-scale
emergencies, where there is an acute food shortage and / or food
prices hikes. GFD is usually not targeted.
Examples:
• GFD in Haiti after the earthquake in 2010
• GFD in typhoon affected areas in the Phillippines 2013. In such an
acute onset emergency, high energy biscuits are used.
General food distributions can become part of a country’s anti-poverty
programme in which case they are targeted to the poorest segments of
the population. Examples of ‘targeted’ GFD:
• US SNAP programme
• Brazil’s Fome Zero
Source: http://www.cdham.org/wp-content/uploads/2011/11/Chapter-12.-NGOs-and-Food-and-Nutrition.pdf
Blanket feeding
Blanket feeding This is deployed normally during a severe food crisis
and also targets specific populations, normally extending nondiscriminatory feeding programmes for pregnant mothers, under-5
children, elderly, and the sick, whether they are facing malnourishment
or not.
Often in conjunction with general food distribution, blanket feeding can
also exist independently. It targets the members of a population who
are at the highest risk of malnutrition (pregnant and breast feeding
women, children under 5, elderly, chronically ill) with foods that are
designed to meet their specific nutritional needs.
PlumpyDoz is used for blanket feeding.
Further Info: Alertnet “Milk in the Sahel; making a real impact on malnutrition”
http://www.trust.org/item/20140109120020-yg42e/?source=hpeditorial
contents
Supplementary
feeding programme
Supplementary feeding program (SFP) When malnutrition
rates extend over 15 percent and populations still need
assistance to fill gaps and in treating specific target groups,
NGOs will provide SFPs during the day to provide warm meals,
appropriate nutrients, and special foods for various parts of the
affected population. It provides supplemental foods to members
of the population who exhibit moderate levels of malnutrition
(defined by low middle arm circumference or low weight for
height) and are at risk for developing severe malnutrition. Most
SFP target pregnant and lactating women and children under 5
with energy dense fortified foods.
PlumpySup is used for SFP.
This child in Ethiopia is eating a special food supplement rich in
vitamins to help him gain weight.
© Juan Carlos Tomasi / MSF [Ethiopia] 2008
Therapeutic feeding
programme
Therapeutic feeding program (TFP) TFPs are established to treat severely
malnourished people, and to provide immediate relief to those of an emergencyaffected population in danger of dying because of lack of food. Ideally, TFPs are 24hour stations. In emergency settings, though, staff and supply limitations will often
prevent 24-hour operation.” (http://www.cdham.org/wp-content/uploads/2011/11/Chapter-12.-NGOs-andFood-and-Nutrition.pdf)
The vast majority of TFPs are run in regions where food availability is not the
predominant concern (e.g., Niger, Burkina Faso, Ethiopia, Democratic Republic of
Congo). TFPs are established in in out-patient clinics and in-patient hospitals areas
where childhood malnutrition is endemic due to a high burden of infectious disease
combined with poor diets that fail to meet young children’s specific nutritional
needs. TFPs may also be set up in emergency-affected populations where there is
a background level of endemic malnutrition that will get worse or where there is
reason to believe that the number of severely malnourished children will increase.
Ready to use foods (RUTF) are used in TFPs.
Therapeutic
ready-to-use food
Commercialised therapeutic RUF typically
takes the form of a peanut/milk-based paste
with all nutrients essential to treat severe acute
malnutrition. It comes in individually wrapped
airtight foil packets that are resistant to bacterial
infection and easy to distribute. The product has a
long shelf life, making it easy to store, transport
and to use in hot climates as an efficient way to
provide milk to children under three.
contents
MUAC
The nutritional status of a
child is checked by using the
MUAC (Middle-Upper-Arm
Circumference) bracelet at
an MSF therapeutic feeding
centre. The indicator gives
rough estimates of protein
(muscle) and energy
(subcutaneous fat stores)
that correlate with changes
in body weight in
malnourished children.
contents
Image: Harvaar
Karlsen
contents
Image: Stefan Pleger
contents
NUTRITIONAL INTERVENTION
UK AND US
57
‘Food stamps’
in the UK
Food stamps were last
issued during the Second
World War to address food
insecurity.
Right: a woman is handed food
stamps in office in Elephant and
Castle in south London in 1944
Top right corner: a shopkeeper
cuts out a coupon in a shop in
1940
Images: AP Photo
http://news.uk.msn.com/uk/food-stamps-in-theuk-613888
Action for students: What are some of the issues raised against moving to payment
cards? What are the issues with Foodbanks?
•
•
Read the BBC article “Numbers relying on food banks triple in a year ” http://www.bbc.co.uk/news/business-24536817
Watch the clip on UK Foodbanks and explain how these help address food insecurity. http://www.trusselltrust.org/foodbankprojects
Foodbanks in the UK
UK vouchers:
HealthyStart
• Programmes such as Healthystart (UK) or WIC (USA) address the problem
of nutrition security by providing a limited number of highly nutritious foods,
dairy, fruits, vegetables, fish, fortified foods for children.
• They intend to target the population subgroups most at risk of malnutrition
such as pregnant and breast feeding women and young children.
• Risk of malnutrition has increased with the economic downturn and the rise
in food prices in the UK.
Action for students:
1. Read about Healthystart vouchers http://www.healthystart.nhs.uk/
2. the Guardian’s “Food vouchers to provide emergency help but prevent
spending on alcohol”
http://www.theguardian.com/politics/2013/mar/26/payment-cards-emergency-assistance-food-stamps
2. MSN News 'Food stamps' to be issued in the UK: Q&A
http://news.uk.msn.com/uk/food-stamps-in-the-uk-613888
Source: http://www.trusselltrust.org/foodbank-projects
DOUBLE STANDARD:
NUTRIENT-DENSE AT HOME AND
SUBSTANDARD ABROAD
61
“The United States is sending food overseas to children that it would not feed
to its own citizens. This double standard needs to end.”
-STARVED FOR ATTENTION
http://www.starvedforattention.org/_inc/en/press/Malnutrition-Fact-Sheet.pdf
US on the
edge of poverty
“People have a lot of misimpressions about
hunger in America. People think it’s
associated with homelessness when, in fact,
it is working poor families, it’s kids, it’s the
disabled.”
- Maura Daly, a Feeding America spokeswoman
Action for students:
1. View Video on food stamps in the US by Center on Budget and Policy Priorities: off the
charts (Warning: video contains some graphic images of the effects of malnutrition and
hunger on children)
http://www.offthechartsblog.org/round-up-everything-you-need-to-know-about-snap/
2. Look at the slide show “On the Edge of Poverty, at the Center of a Debate on Food
Stamps”
http://www.nytimes.com/2013/09/05/us/as-debate-reopens-food-stamp-recipients-continue-to-squeeze.html?ref=opinion
3. Read the article with a partner and argue for or against the programme being scaled
down.
Image: SNAP Hotline http://www.hungercoalition.org/snap-campaign;
US Food
insecurity trends
Graph: The Atlantic, Republicans Try to Cut Food Stamps as 15% of U.S. Households Face Hunger
http://www.theatlantic.com/business/archive/2013/09/republicans-try-to-cut-food-stamps-as-15-of-us-households-face-hunger/279465/
Food stamps in the
United States of America
Fourteen and half per cent of US population faces chronic hunger
according to the US Department of Agriculture’s latest survey.
48 million people, nearly one in 7 people in America receive food stamps
at a cost of $72 billion.
SNAP - Supplemental Nutritional Assistance program is the official name of food
stamps.
WIC - The Special Supplemental Nutrition Program for Women, Infants, and
Children
EBT – Electronic Benefits Transfer cards which resemble debit cards, so can be
a more discreet way to use food vouchers.
SNAP image: http://www.fooddemocracynow.org/blog/2012/jun/13/farm_bill_jackpot_how_much_do_corporations_benefit/
On SNAP, WIC and EBT http://dcentric.wamu.org/2011/05/snap-wic-ebt-whats-the-difference/
Image: Government Issued debit card http://www.nytimes.com/2013/09/05/us/as-debate-reopens-food-stamp-recipients-continue-tosqueeze.html?ref=opinion
Image: We accept EBT http://www.republicreport.org/2012/how-big-corporations-cash-in-on-food-assistance-programs/
Latest agricultural survey http://www.ers.usda.gov/publications/err-economic-research-report/err155.aspx#.UjGXej-5bcs
SNAP
Images: http://www.cbpp.org/images/chartbook_i
mages/SNAP/4.4-SNAP.jpg
The U.S. Standard and
a double Standard
Action for students:
• Starved for attention The US standard and a Double standard
– Part I on WIC in US. Food Prescription Programme. ( million
on nutrient-dense foods. Part II “Gift of the American People” corn soy bean meal. http://www.starvedforattention.org/
• What is MSF calling for? Starved for Attention: What is MSF
calling for? http://www.doctorswithoutborders.org/publications/reports/2008/Starved-ForAttention.pdf
• Critical view of US food aid -
http://www.guardian.co.uk/globaldevelopment/2012/jul/18/corporate-agribusiness-us-food-aid
• Horn of Africa, Against Corn Soy Blend, Conflict in Kenya and
Somalia MSF Why do we have to wait for a nutritional crisis
http://www.starvedforattention.org/
contents
Food aid or dumping?
Food aid (in-kind commodities rather than
cash), has been misused to dump surplus
production and promote donor country
exports. Food aid for commercial
purposes and national political interests
can distort international trade and be
destructive to the recipients country’s food
security and economic development. It
can hurt poor farmers in LDCs by pushing
them to become importers for food
products that could be locally grown.
Action for students:
Why is food aid a trade issue? Why can
food dumping (e.g., during the cold war)
help donors more than recipients? Read
“Food Aid or Hidden dumping?”
http://www.oxfam.org/sites/www.oxfam.org/files/bp71_foo
d_aid.pdf
Image: http://www.oxfam.org/sites/www.oxfam.org/files/bp71_food_aid.pdf
Double standard, but
changes for the better
Many countries successfully address malnutrition at home with
strategies that target the most vulnerable and make sure they have
access to nutrient-dense foods, but send CSB abroad.
In the interventions in nutritional emergencies, MSF, World Food
Programme and other key food players use supplementary foods that
meet the nutritional needs of children as the cornerstone.
It has been established that most food aid today does not provide
appropriate nutrition to young children, and yet the global food aid
system largely continues to provide substandard foods to millions of
malnourished children every year
Source: MSF “Food Aid System continues to fail malnourished children” http://www.msf.org/article/food-aid-system-continues-fail-malnourishedchildren
Double standard
“There is not enough emphasis on the types of foods included in aid deliveries, in
other words, the quality of food. Most current food aid programs for developing
countries rely almost exclusively on fortified cereals made of corn and soy blend
(CSB), which may relieve a young child’s hunger, but do not provide
proper nourishment.
The US is the world’s largest food aid donor. It produces and ships hundreds of
thousands of tons of CSB and other fortified blended flours for use in nutrition
programs throughout the developing world, even though these foods are recognized
as nutritionally substandard for infants and young children.
CSB and other flours are not promoted in the US Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC) nutrition safety net program in
the US, which provides vouchers to low-income young mothers for the purchase
of nutritious foods like milk, fruits, eggs, etc…
The United States is sending food overseas to children [food with little
nutritional value ] that it would not feed to its own citizens. This double
standard needs to end.”
(Starved for attention, http://www.starvedforattention.org/_inc/en/press/Malnutrition-Fact-Sheet.pdf)
Problems with
food aid
Action for students:
In pairs, discuss US food in light of the points below.
Research US policy and food aid today. Are there any
changes?
•
•
•
•
•
“It is a donor-driven system
It promotes domestic interests of donor countries
It is a foreign policy tool
International institutions are driven by exporters
Development is not necessarily the objective”
(http://www.globalissues.org/article/748/food-aid#Themajorplayersinthefoodaidgame)
RIGHT TO FOOD:
CASE STUDY INDIA
Right to food:
India Food Security Bill
Establishing food as a legal right,
the scheme plans to subsidise food
for two-thirds of the Indian
population. It aims to provide grain
to 800 million poor people every
month.
Source: WSJ “Food Bill – Contours of debate”
http://www.livemint.com/r/LiveMint/Period1/2013/08/22/Photos/g_foodsecurity_web.jpg
Hindustan Times “Sonia's ambitious food bill wins LS vote; UPA gets its
'game-changer‘”
http://www.hindustantimes.com/India-news/NewDelhi/Sonia-s-ambitiousfood-bill-wins-LS-vote-UPA-gets-its-game-changer/Article1-1113348.aspx
India’s Food Security
contents
Source: http://si.wsj.net/public/resources/images/AI-BS054_STARVI_G_20120411054507.jpg
Right to Food
and India
The right to food, to increase food security is not a new idea and appears in
many international treaties. It is accepted as a framework for global action.
Article 25 of the Universal Declaration of Human Rights, which all United
Nations member states adopted in 1948, lists the right to food among a
state’s obligation: "Everyone has the right to a standard of living adequate for
the health and well-being of himself and his family, including food."
India has one of the worst track records in terms of childhood malnutrition, chronic
hunger and deprivation in the world, which are even higher than countries with
lower economic development.
In the Indian Constitution, Article 21 of the Indian Constitution about a fundamental
right to life and personal liberty provides the right to food, as repeatedly interpreted
by the Supreme Court. Article 47 holds the Indian state accountable to raise the
standard of nutrition of its people.
http://www.livemint.com/Opinion/eyfwQwQcLJKj9izhYQ7lUL/How-to-tackle-India8217s-hunger.html
India
India has implemented some of the
biggest food security schemes in the
world during the post-independence
decades.
Photo: Angel Navarrete
The programmes broadly fall into four categories:
• “Entitlement feeding (Integrated Child Development Services [ICDS], Mid-Day
Meal Scheme [MDMS])
• Food subsidy programmes (targeted Public Distribution System [PDS] including
Antyodaya and Annapurna Yojana)
• Employment programmes (National Rural Employment Guarantee Act
[NREGA], Sampoorna Grameen Rozgar Yojana, National Food for Work
Programme, Rashtriya Sam Vikas Yojana)
• Social security programmes (National Maternity Benefit Scheme, National Old
Age Pension Scheme and National Family Benefit Scheme).”
Biraj Patnaik, “The Right to Food” http://infochangeindia.org/agenda/hunger-a-food-security/the-right-to-food.html
Food Security
Programmes
While preventing large-scale famines such as Bengal 1943, the programmes “have been
unable to substantively address the problem of chronic hunger. This is not only because of gaps
in implementation, but also because...they do not provide for sustainable and
lasting livelihood options....
Concerted efforts have been lacking,(except in a few states ,for example, West Bengal,) to
undertake land reforms, give communities rights over natural resources, and address the
structural causes of poverty caste and gender discrimination have also been major contributing
factors.
On the contrary, the last two decades have witnessed:
•
an unprecedented alienation of indigenous people and other marginalised communities
from their land and other natural resources;
•
displacement due to industrial projects and large dams in rural areas; and
•
fundamental changes in the nature of poverty with unbridled urbanisation and the
disenfranchisement of large sections of urban populations.
•
global pressures on the Indian economy and the pursuit of deflationary, neo-liberal policies
by successive governments from the early 1990s have abetted in this pauperisation of millions
of Indians.”
Biraj Patnaik, “The Right to Food” http://infochangeindia.org/agenda/hunger-a-food-security/the-right-to-food.html
India Right to Food
Action for students: Write a brief report to explain India’s right to food
campaign and increasing political will over the last 10 years to address
key issues (e.g., access) and objectives. Include lessons India can
learn from other countries’ political commitment and convergence.
1.
Biraj Patnaik, Principal Advisor Commissioner to India's Supreme Court
MSF Starved for Attention 2008 Preliminary Address
http://www.youtube.com/watch?v=An9tNdGaITA
Article on “How to tackle India’s Hunger”
http://rtfckarnataka.blogspot.co.uk/2009/07/article-how-to-
tackle-indias-hunger-by.html
2.
Right to food campaign:
Notable judicial activism - http://www.righttofoodindia.org/
FAO on work in Brazil, Guatemala, India, Mozambique and Uganda
http://www.fao.org/docrep/014/i2250e/i2250e00.htm
3.
Clip on the Bihar school lunch poisoning in 2013. What are the risks and
what are the controls which should be in place to provide food on this
scale?
http://online.wsj.com/news/articles/SB10001424052702303448104579149293661052578
Bihar, India
Medecins Sans Frontieres is addressing India's unique nutrition issues
through mobile clinics, ambulatory therapeutic feeding centres (ATFC’s) and a
special emergency clinic to reduce the morbidity and mortality due to severe
acute
malnutrition
Photo:
Stephanie
Sinclair (SAM).
Bihar State, India
Bihar is one of the
poorest states in India
and there are high levels
of malnutrition in children
aged between six
months and five years. In
Darbhanga district, MSF
operates an inpatient
therapeutic feeding
centre for children in a
critical condition, and
several outpatient
centres, where those
with severe malnutrition
come for weekly medical
check-ups and receive
therapeutic food.
Action for students:
1. Watch the Starved for Attention clip on malnutrition in Bihar
State, India. Discuss why has the status quo existed for
many generations.
http://www.msf.org.uk/starved-attention-retell-story
contents
Photo: François Saint-Sauveur
India
Action for students: Read the articles or research your own on the right to
food debate in India to identify and record the objectives and issues
(e.g., corruption) with the bill.
• “Food rights and welfare squeezes: how do we free people from hunger?”
http://www.theguardian.com/global-development/poverty-matters/2013/apr/08/food-rights-welfare-squeezeshunger
•
•
”Is India’s food security bill the magic pill?” http://www.bbc.co.uk/news/world-asia-india-23159706
“In Business – Can India Afford the Food Security Bill?”
http://www.youtube.com/watch?v=UnIU0yzOzMY
“India cabinet approves food security bill March 2013”
http://www.bbc.co.uk/news/world-asia-india-21840572
•
“India upper house passes cheap food plan” http://www.bbc.co.uk/news/world-asia-india23940298
•
Hindustan Times “Sonia's ambitious food bill wins LS vote; UPA gets its
'game-changer‘”
http://www.hindustantimes.com/India-news/NewDelhi/Sonia-s-ambitious-food-bill-wins-LS-vote-UPA-gets-its-gamechanger/Article1-1113348.aspx
TEACHER RESOURCE
SLIDES
Bangladesh case study.
MDG 1: 50% reduction in undernourishment achieved and likely
same for underweight; MDG 4 (child mortality) achieved. MDG
5 (maternal health) on track to achieve (SUN 2011)
Progress towards
MDGs
MDGs cannot be reached without paying urgent attention to nutrition and
its determinants.
Graph: Progress towards meeting the MDG target across regions http://www.fao.org/publications/sofi/en/;
http://scalingupnutrition.org/wp-content/uploads/pdf/SUN_Framework.pdf
L’Aquila pledges
According to the ONE organisation report on accountability of
donors to the l’Aquila pledges, only 22% have been met. And
most are not on track to meet them within their pledge period.
Source: http://www.one.org/c/international/hottopic/3929/
contents
Source: http://www.hancindex.org/hanci2012/HANCI%202012%20infographic.pdf
Actors in international response
Player +
Role in sustaining life of the margins
Examples
Individuals e.g.
Farmers



Fair Trade, substance farming,
organic farming
Survival/ profit






Direct producers of food
Communities harbour stores of valuable local knowledge, coping strategies and
innovation
Their co-operation is critical to ensure environmental sustainability
Funding for agricultural research and development (R & D)
Creating political and economic conditions creating stability of food supply
Response during times of crisis.
Research and investment into new farming methods and technologies
Resource exploitation and trade in cash crops, fertilizers and farm machinery
for profit

Often techno centric large scale
projects e.g. China’s Great Green
Wall, or UK overseas aid projects
GM Golden Rice
Agro-biotech corporations such as
Community level support for farmers in the developing world
Education, training and skills providers
Many promote social equity, for instance female empowerment


Practical Action ,Water Aid
Emergency aid eg Medecins Sans
Frontieres

The International Alliance Against
Hunger
motive
Government
Stability
TNCs
Profit
NGOs and
Foundations
-Philanthropic
Research
Organisations
Academic
IGOs
Eg UNEP &
FAO
Stability
Watchdog
pressure groups
Environment





Monsanto (subsidiary of Pharmacia),
Syngenta (merger between
AstraZeneca and Novartis), Aventis,
Dupont and Dow.


Scientific research on new species and systems
Education and skills training of farmers


The development of HYVs by IRRI
AGRAs work on a ‘Green Revolution
of Africa’




Promote international co-operation
Implementation of global actions such as MDGs
Monitoring and research to identify problems and seek solutions
Development assistance and aid to the developing world

World Bank’s Global Response Food
Programme
1994 UN Convention on
Desertification

Research and information gathering and Lobbying of agencies




World Resources Institute
USA Coalition Food
SUSTAIN
MSF: Contact us or find out more
Visit our website: www.msf.org.uk
About MSF: http://www.msf.org.uk/about.aspx
Email us: schools@loondon.msf.org
Find us on facebook: www.facebook.com/MSF.english
Follow us on Twitter: www.twitter.com/MSF_UK
Follow us on You tube: www.youtube.com/user/MSFUK
The MSF movement was awarded the 1999 Nobel Peace Prize.
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