Life on the margins: the inequality of food and nutrition security RESPONSE AND MANAGEMENT: FOOD AID AND ASSISTANCE

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) UKSchools Team: Mary Doherty and Severa von Wentzel

January 2014

RESPONSE AND MANAGEMENT:

FOOD AID AND ASSISTANCE

Management of food security and supply

• Management of food security and supply, an age-old topic, became very topical in the 2000s because of – Economic concerns following food price shocks of 2006-2008– Environmental concerns such as climate change, soil

degradation and water– Health, particularly growing malnutrition including obesity

epidemic and related non-communicable diseases– Concerns with resilience of food supply; for instance, in the UK

after the lorry strike that brought the country to 5 days from shortages

• 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: “Food Security and Sustainability: One Can’t Make an Omelette Without Cracking Some Eggs” http://vimeo.com/24914046

Challenges• 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

International consensusThe focus is still largely on addressing undernutrition, not the double burden of malnutrition.

International management is increasingly needed to ensure food supply and security. 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).

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.

There is a growing scientific and political consensus on the need to focus on children under two.

Source: MSF “Food Aid System continues to fail malnourished children” http://www.msf.org/article/food-aid-system-continues-fail-malnourished-children

Millennium Development Goals

First Millennium Development Goal: reduce

by half the proportion of people who sufferfrom hunger between 1990 and 2015.(ftp://ftp.fao.org/docrep/fao/012/i0876e/i0876e02.pdf).

Based on the latest FAO undernourishmentestimates, this can be met if appropriate

actions are taken to reverse the slow down since 2007/2008.

Further info: Save the children, Ending poverty in our generation. https://www.securenutritionplatform.org/Pages/DisplayResources.aspx?RID=143MDG, Food and Agriculture: http://www.mdg-review.org/index.php/sections/38-food-aagriculture/56-mdg-food-and-agricultureSource: http://beijingcircles.files.wordpress.com/2010/09/mdgs-

large.jpg 6

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.

MDGs: sustainability and gender

“We have learned from the experience of the 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

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

Environmental sustainability and gender equality are key to meeting Millennium Development Goals.

“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)

Rome principles

The Rome principles 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 principle 1: Country OwnershipRome principle 2: Strategic coordinationRome principle 3: Comprehensive approachRome principle 4: Multilateral support and improvementRome principle 5: sustained financial commitment

Other core commitments: gender, environmental sustainability, transparencySource: http://www.one.org/c/international/hottopic/3930/

Action for students: Watch and make notes in your folder on the clip outlining the Rome principles, a blueprint for investment in food security:http://www.youtube.com/watch?v=jZdP3wZkcQY

Global initiativesL’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. • Video and article on food security policy and trade:

http://www.iatp.org/blog/201302/food-crisis-update-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

L’Aquila pledgesAccording 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/

New Alliance for Food Security and Nutrition

• “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.govhttp://www.aljazeera.com/indepth/opinion/2013/01/201312915630857878.html

contents

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:

Reducing and maintaining childhood wasting to less than 5%

Target 1:

Target 2:

Target 3:

Target 4:

Target 5:

Target 6:

40% reduction of the global number of children under 5 who are stunted

50% reduction of anemia in women of reproductive age

30% reduction of low birth weight

No increase in childhood overweight

Increase exclusive breastfeeding rates in the first 6 months up to at least 50%

Further info: Slideshow on SUN Framework. http://scalingupnutrition.org/resources-archive

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

Fortification of foods: Enabling access to nutrients through incorporating them into foods

Micronutrient supplementation:Direct provision of extra nutrients

Treatment of acute malnutrition:Enabling persons with moderate and severe malnutrition to access effective treatment

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

Education & Employment: Making sure children have the nutrition needed to learn and earn a decent income as adults

Health Care: Access to services that enable women & children to be healthy

Support for Resilience: Establishing a stronger, healthier population and sustained prosperity to better endure emergencies and conflicts

Nutrition-Sensitive Strategies Specific Actions for Nutrition

Nutrition-sensitive strategies increase the impact ofspecific actions for nutrition

TYPES OF AID AND ACTORS

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 )

• As malnutrition and its causes are complex, a multi-stake holder and multi-sectoral approach underpinned with better governance is required. Such an approach can meet multiple objectives such as nutrition, gender equality and sustainability.

• A multi-sectoral approach includes interventions in food systems, public health and education and needs to create an enabling environment.

– It includes broader interventions and direct nutrition-specific ones. Action is urgent for both types of interventions.

– It should be based on the “Three Ones”: “one agreed ... framework that provides the basis for co-ordinating the work of all partners; one national coordinating authority, with a broad multi-sectoral mandate; and one agreed national monitoring and evaluation system.

Source: http://scalingupnutrition.org/wp-content/uploads/pdf/SUN_Framework.pdf

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:• 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

Actors and their rolein sustaining life on the margins

Player + motive

Role in sustaining life of the margins Examples

Individuals e.g. Farmers

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

Fair Trade, substance farming, organic farming

Government

Stability

Funding for agricultural research and development (R & D) Creating political and economic conditions creating stability of food supply Response during times of crisis.

Often techno centric large scale projects e.g. China’s Great Green Wall, or UK overseas aid projects

TNCs

Profit

Research and investment into new farming methods and technologies Resource exploitation and trade in cash crops, fertilizers and farm machinery

for profit

GM Golden Rice Aro-biotech corporations such as

Monsanto (subsidiary of Pharmacia), Syngenta (merger between AstraZeneca and Novartis), Aventis, Dupont and Dow.

NGOs and Foundations

-Philanthropic

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

Research Organisations

Academic

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’

IGOs

Eg UNEP & FAO

Stability

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

Watchdog pressure groups

Environment

Research and information gathering and Lobbying of agencies World Resources Institute USA Coalition Food SUSTAIN

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?

* Randomised-control trial: specific type of experiment that is the gold standard for a clinical trial

Types of aid Emergency aid: Given in a country suffering from natural disaster or man-made disaster, which may include food, water, tents, clothing or rescue and medical teams.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.Tied aid: Money that comes with strings – a requirement to spend it a certain way or to follow a particular policy.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.Untied aid: No spending or policy proviso attached to money given.Multilateral aid: Given by multiple donors to a specific country, it may be collected by an UN organisation or an NGOBilateral aid: Given by one country directly to another.Source: http://www.geographybase.co.uk/IB%20Geography%20HL%20Disparities%20in%20Wealth%20and%20Development%20Revision%20Notes%20FINAL.pdf

Source: http://www.aidinfo.org/wp-content/uploads/2010/10/kharas-aid-architecture-diagram.png

Advantages anddisadvantages of aid

Source: http://www.geographybase.co.uk/IB%20Geography%20HL%20Disparities%20in%20Wealth%20and%20Development%20Revision%20Notes%20FINAL.pdf

Aid strategiesShort-term views 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 term3. Watch the Fairfood international clip “A Fair Future for food chain

workers: http://www.fairfood.org/videos/a-fair-future-for-food-chain-workers/

Aid actorsAid actors include: • Donors and international institutions• UN institutions such as World Food Program• NGOs (non-governmental organisation) actors

are independent of national governments.• 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-aidGreeley et al Effect of mass supplementation

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0044549URBAN SETTING RESPONSE http://www.cmamforum.org/Pool/Resources/Humanitarian-resp-in-urban-

settings-Disasters-Lucchi-2012.pdf

FOOD AID AND ASSISTANCE

Food aid versusFood Assistance

An emergency response is not designed to be sustainable, but rather to keep people alive. Food aid and assistance help build the basis for long-term food security. Both are particularly important in countries in protracted crisis.

“Food Assistance Programmes any intervention to address hunger and under nutrition (e.g., food stamps, WIC, food subsidies, food price stabilization, etc.).

Food Aid: International concessional flows in the form of food or of cash to purchase food in support of food assistance programmes. It constituted over 20% of global aid flows in the 1960s, but is now less than 5%. It started off in the 1950s with the US and together with Canada accounted for over 90% of global food aid until the 1970s when the United Nations World Food Programme (WFP) became a major player”

Further info: • 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• Slideshow on emergency response: http://www.unicef.org/nutrition/training/2.6/31.html• 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

Source: http://www.globalissues.org/article/748/food-aid

Problems with food aid

• “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)

The future of food aid

In the last decade there have been:• Many new response options and more flexible donor resources,

specifically a shift from food aid to cash and voucher assistance for a more effective food aid system.“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•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•Much broader livelihood responses•Greater focus on nutrition programming.

Further info: On the cluster approach, new global food security mechanism:“Aid policy: New mechanism to boost food security” http://www.irinnews.org/report/92846/aid-policy-new-mechanism-to-boost-food-securityOn “The future of food aid” http://www.irinnews.org/report/98469/analysis-the-future-of-food-aid

Source: Levine and Chastre et al “Missing the Point” http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/events-presentations/1422.pdf

Ways of minimising negative effects of food aid

• “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)

NUTRITIONAL EMERGENCIES

Nexus of strategiesand scales

There are no one-size fit all scaling up nutrition programmes. First, the risks and vulnerabilities need to be assessed in order to devise policies and implement interventions. 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 sectors

The combination of interventions needs to be put in place in a number of scales (international to local):• Long- and short-term strategies• Supply and demand-side strategies• International (Millennium Development Goals and their replacements after

2015; SUN; AGRA)

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/wp-content/uploads/2012/05/1000-Days-June-2013-Investment-in-Growth-Policy-Brief.pdf

Afar, Ethiopia – Nutritional intervention

Further info: http://www.msf.org.uk/article/ethiopia-isolated-and-malnourished-msf-treats-malnutrition-rural-afar

“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.

Nutrition interventionsare 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/G8-summit-briefing.pdf

Action for students: Watch “MSF Campaign for Effective Treatment” on therapeutic foods

and theiruse in Niger, Sahel http://www.youtube.com/watch?v=e-XMu1YzLsU

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 capitalBehaviour change interventions usually delivered on-on-one at the community through community nutrition programmes and such level,Including:

•Promotion of breastfeeding• Appropriate complementary feeding

practices (but not provision of food)• Proper hygiene notably hand

washing (Mason et al. 2006).

Micronutrient and deworming interventions that provide a range of supplements for:

• 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).

Complementary and therapeutic feeding interventions that provide:

• 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-Reviewed-Publications/ScalingUpNutrition.pdf

Core interventions for pregnant women

Source: 1000 days.org Preventing maternal and child malnutrition http://thousanddays.org/wp-content/uploads/2013/03/BEST_START_FA101011Infographic2.pdf

Core interventions forchildren under two

Source: 1000 days.org Preventing maternal and child malnutrition http://thousanddays.org/wp-content/uploads/2013/03/BEST_START_FA101011Infographic2.pdf

Timeline

Pregnancy and first 6 months

From 6 to 24 months

Source: 1000 days.org Preventing maternal and child malnutrition http://thousanddays.org/wp-content/uploads/2013/03/BEST_START_FA101011Infographic2.pdf

http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/Peer-Reviewed-Publications/ScalingUpNutrition.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.

Types of feeding programmes: General food distribution“General food distribution (GFD) When food insecurity is prevalent, sustainable economic and health development programs are often appropriate, targeting the most vulnerable populations. This is not a blanket coverage, and is most likely not used in large-scale emergencies.

GFD is used almost exclusively in large-scale emergencies, where there is an acute food shortage and / or food prices increase sharply (the two often go together). 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

m

Blanket feedingBlanket feeding This is deployed normally during a severe food crisis and also targets specific populations, normally extending non-discriminatory 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

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.

Therapeutic feedingprogramme

Therapeutic feeding program (TFP) TFPs are established to treat severely malnourished people, and to provide immediate relief to those of an emergency-affected population in danger of dying because of lack of food. Ideally, TFPs are 24-hour 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-and-Food-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.

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

NUTRITIONAL INTERVENTIONUK AND US

46

‘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 1944Top 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-the-uk-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/foodbank-

projects

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.

Source: http://www.trusselltrust.org/foodbank-projects

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&Ahttp://news.uk.msn.com/uk/food-stamps-in-the-uk-613888

DOUBLE STANDARD: NUTRIENT-DENSE AT HOME AND

SUBSTANDARD ABROAD50

“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 ATTENTIONhttp://www.starvedforattention.org/_inc/en/press/Malnutrition-Fact-Sheet.pdf

US on the edge of poverty

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;

“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

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

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-to-squeeze.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

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

Images: http://www.cbpp.org/images/chartbook_images/SNAP/4.4-SNAP.jpg

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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-For-Attention.pdf

• Critical view of US food aid - http://www.guardian.co.uk/global-development/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/

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_food_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 yearSource: MSF “Food Aid System continues to fail malnourished children” http://www.msf.org/article/food-aid-system-continues-fail-malnourished-children

Double standard“There is not enough emphasis on the types of foods included in aid

deliveries, inother words, the quality of food. Most current food aid programs for

developingcountries 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)

RIGHT TO FOOD:CASE STUDY INDIA

Right to food:India Food Security BillEstablishing 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_food-security_web.jpgHindustan 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-game-changer/Article1-1113348.aspx

India’s Food Security

contentsSource: http://si.wsj.net/public/resources/images/AI-BS054_STARVI_G_20120411054507.jpg

Right to Foodand 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

IndiaIndia has implemented some of the biggest food security schemes in the world during the post-independence decades.

Biraj Patnaik, “The Right to Food” http://infochangeindia.org/agenda/hunger-a-food-security/the-right-to-food.html

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).”

Photo: Angel Navarrete

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 andlasting 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 FoodAction 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=An9tNdGaITAArticle 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 (SAM).Photo: Stephanie Sinclair

Bihar State, India 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

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.

contentsPhoto: 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-squeezes-hunger

• ”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-india-23940298

• 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-game-changer/Article1-1113348.aspx

TEACHER RESOURCE SLIDES

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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

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

MDGs cannot be reached without paying urgent attention to nutrition and its determinants.

Source: http://www.hancindex.org/hanci2012/HANCI%202012%20infographic.pdf