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

Life on the margins: the inequality of food and nutrition security RESPONSE AND MANAGEMENT: FOOD AID AND ASSISTANCE PowerPoint presentation by Mdecins Sans Frontires / Doctors Without Borders (MSF) UK Schools 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 Cant 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 consensus The 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 LAquila 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 suffer from hunger between 1990 and 2015. (ftp://ftp.fao.org/docrep/fao/012/i0876e/i0876e02.pdf).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. Further info: Save the children, Ending poverty in our generation. https://www.securenutritionplatform.org/Pages/DisplayRe sources.aspx?RID=143 https://www.securenutritionplatform.org/Pages/DisplayRe sources.aspx?RID=143 MDG, Food and Agriculture: http://www.mdg-review.org/index.php/sections/38-food-a agriculture/56-mdg-food-and-agriculture Source: 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;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-1.1362325http://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) 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 Ownership Rome principle 2: Strategic coordination Rome principle 3: Comprehensive approach Rome principle 4: Multilateral support and improvement Rome principle 5: sustained financial commitment Other core commitments: gender, environmental sustainability, transparency Source: 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 initiatives LAquila The G-8 group of powerful nations made a LAquila 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 LAquila 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)http://www.iatp.org/blog/201302/food-crisis- update-main-drivers-of-price-volatility-still-not-addressed International Food Policy research Institute (IFPRI) Global Food policy Report 2012 https://www.securenutritionplatform.org/Pages/DisplayResources.aspx?RID=179

LAquila pledges According to the ONE organisation report on accountability of donors to the lAquila 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://scalingupnutritio n.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 of specific 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 ) (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://scalingupnutrition.org/wp-content/uploads/pdf/SUN_Framework.pdf http://download.thelancet.com/flatcontentassets/pdfs/nutrition_5.pdf

Actors and their role in sustaining life on the margins Player + motive Role in sustaining life of the marginsExamples 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. Chinas 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 A ro-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 Banks 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 NGO Bilateral aid: Given by one country directly to another. Source: http://www.geographybase.co.uk/IB%20Geography%20HL%20Disparities%20in%20Wealth%20and%20Development%20Revision%20Notes%20FI NAL.pdf

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

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

Aid strategies Short-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 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/

Aid actors Aid 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-aid Greeley et al Effect of mass supplementation http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0044549 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-settings- Disasters-Lucchi-2012.pdf

FOOD AID AND ASSISTANCE

Food aid versus Food 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 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 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- righthttp://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-securityhttp://www.irinnews.org/report/92846/aid-policy-new- mechanism-to-boost-food-security On The future of food aid http://www.irinnews.org/report/98469/analysis-the-future-of-food-aidhttp://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 strategies and 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 countrys 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, MSFs outreach nurse.

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 malnutritionby 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 their use 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 capital Behaviour 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 623 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 for children 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/HEALTHN UTRITIONANDPOPULATION/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 countrys anti-poverty programme in which case they are targeted to the poorest segments of the population. Examples of targeted GFD: US SNAP programme Brazils Fome Zero m

Blanket feeding Blanket 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 feeding programme 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)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 childrens 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 INTERVENTION UK 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 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-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-24536817http://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/ http://www.healthystart.nhs.uk/ 2. the Guardians 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

DOUBLE STANDARD: NUTRIENT-DENSE AT HOME AND SUBSTANDARD ABROAD 50

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 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;http://www.hungercoalition.org/snap-campaign People have a lot of misimpressions about hunger in America. People think its associated with homelessness when, in fact, it is working poor families, its kids, its 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/ 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/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/http://dcentric.wamu.org/2011/05/snap-wic-ebt-whats-the-difference/ I mage: Government Issued debit card http://www.nytimes.com/2013/09/05/us/as-debate-reopens-food-stamp-recipients-continue-to- squeeze.html?ref=opinionhttp://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/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-5bcshttp://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 Agricultures 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_ihttp://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/ 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 countrys 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-malnourished- children

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 childs hunger, but do not provide proper nourishment. The US is the worlds 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 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_food- security_web.jpg http://www.livemint.com/r/LiveMint/Period1/2013/08/22/Photos/g_food- security_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-ambitious- food-bill-wins-LS-vote-UPA-gets-its-game-changer/Article1-1113348.aspx

Indias 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 states 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. 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 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 Indias 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 http://www.youtube.com/watch?v=An9tNdGaITA Article on How to tackle Indias Hunger http://rtfckarnataka.blogspot.co.uk/2009/07/article-how-to- tackle-indias-hunger-by.html 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/http://www.righttofoodindia.org/ FAO on work in Brazil, Guatemala, India, Mozambique and Uganda http://www.fao.org/docrep/014/i2250e/i2250e00.htm 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 (ATFCs) 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. contents Photo: Franois 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 Indias food security bill the magic pill? http://www.bbc.co.uk/news/world-asia-india-23159706 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 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

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.pdfhttp://www.fao.org/publications/sofi/en/ MDGs cannot be reached without paying urgent attention to nutrition and its determinants.

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