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close this bookOvercoming Global Hunger (WB)
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View the documentAppendix 1 - overcoming global hunger: an issues paper
View the documentAppendix 2 - addressing hunger: a historical of international initiatives
View the documentAppendix 3 - lessons of experience: twelve case studies
View the documentAppendix 4 - ending hunger soon: concepts and priorities
View the documentAppendix 5 - hunger and the world bank: an NGO perspective


Appendix 1 - overcoming global hunger: an issues paper

The problem of hunger can be broadly divided into two types, viz, (1) famines, and (2) endemic deprivation famines kill millions through starvation and epidemic diseases, endemic deprivation can affect hundreds of millions through debilitation and illness, increasing mortality rates and shortening people's lives.

One of the problems that makes the task of the prevention of famines and hunger particularly difficult is the general sense of pessimism and defeatism that characterizes so much of the discussion on poverty and hunger in the modern world.

There is, in fact, little factual basis for such pessimism and no grounds at all for assuming the immutability of hunger and deprivation Yet those unreasoned feelings dominate a good deal of public reaction to misery in the world today.

Amartya Sen

The Objectives

The Conference on Overcoming Global Hunger set four goals:

· To identify the major elements or an effective strategy to reduce world hunger and the political, economic, and institutional actions needed to implement it

· To build a consensus on the priority actions that would form the core of such a strategy

· To help the World Bank rethink the actions it is taking and define the actions it is prepared to take to reduce hunger
· To raise awareness in North America about the seriousness of global hunger and the actions that can be taken to overcome it.

This paper supports the goals of the conference by:

· Reviewing the experience of previous hunger initiatives to identity what we have learned from them and why, even though progress has been made, they have not resulted in actions commensurate with their objectives. Hunger has not been overcome.

· Clarifying the issues involved so that we can understand the efforts to overcome hunger in the short, medium, and long term within the larger political, economic, and social contexts within which specifications need to take place.

· Identifying the actions the World Bank is taking that contribute to the reduction of hunger, and the actions that the Bank could take to support a larger effort to overcome hunger

· Identifying an action program that has reasonable prospects for success

· Highlighting some major issues this conference could resolve.

The Larger Perspective

The conference is not taking place in a vacuum

Many earlier conferences with similar objectives have preceded it Some established bold goals, such as the World Food Conference in 1974, which proposed to eradicate hunger and malnutrition within a decade. While such efforts have achieved a great deal, they have fallen far short of overcoming hunger. Many governments and organization the United Nations (UN) and bilateral and nongovernmental entities-are concerned with overcoming hunger. Major research institutions now work actively on hunger issues. These combined efforts have contributed significantly to the reduction of hunger in some parts of the world, but many complex issues remain unresolved. These range from the level and kinds of actions needed to increase food production to the size and types of programs needed to improve food consumption and nutrition These in turn involve even more complex economic, social, and political considerations. Because some countries have made remarkable progress in overcoming hunger while others have not, overcoming hunger clearly depends on decisions made at the national level, and also at the local, community, and household levels However, other decisions need action internationally While there is a shared concern to overcome hunger, different groups have different perceptions about which of the multiple issues that influence hunger deserve priority, particularly about how the larger economic, social, and political factors impinge on hunger.

Sen has juxtaposed famine and endemic deprivation as the two essential dimensions of hunger Famine is acute and dramatic, but involves a relatively small proportion of the hungry: tens of millions. Endemic deprivation is largely hidden, but accounts for most of the world's hungry: hundreds of millions. To this we can add malnutrition caused by specific nutrient deficiencies and a lack of knowledge about nutrition. Thus hunger has three elements:

· Starvation a life-threatening condition caused by insufficient food that is generally associated with acute situations like famine.

· Chronic hunger or undernutrition: a persistent lack of calories (food energy) that may impair the ability to lead a fully healthy and active life.

· Other forms of malnutrition: a pathological condition resulting from the inadequacy (or excess) of calories, protein, and micronutrients, often in combination with diseases, parasites, and inadequate knowledge about nutrition.

While these elements define hunger, food security, as defined by the Bank and discussed in a companion paper by the International Food Policy Research Institute (IFPRI), is "access by all people at all times to enough food for an active and healthy life.”

Among the chronically hungry or undernourished three useful distinctions are important for policy and action The largest subgroup among the chronically undernourished consists of small farmers, landless rural workers, and urban nonprofessionals. In normal times people in this group subsist. They typically spend the bulk of their incomes on food, so a rise in the price of food or a fall in their incomes deepens their food curity. Another group among the chronically undernourished is the unemployed Adults may work when employment opportunities exist, but their incomes are not sufficient to satisfy their families' dietary requirements. Frequent illnesses further limit their employment capacity A third subgroup is the chronically ill, the aged, the crippled, and the orphaned, who are still less able to earn enough money to support themselves.

People in the first group can take part in the economic development process. The unemployed, the second group, remain at the fringe of economic development. Poverty marked by chronic undernutrition, poor health, unsanitary drinking water, large families, and crowded housing increases their vulnerability to infectious diseases, stifles their motivation, and reduces their capacity to work and study For them, development at the aggregate level offers little relief. An increase in total food production may not improve their nutritional status by much, because they would still not have enough money to buy the food. People in the third group will have to rely- on direct help, including such basic assistance as free food, housing, and health care.

How Many People Are Hungry

Estimates about how many people are hungry differ, but more for reasons of methodology and definition than disagreement about essentials The Food and Agriculture Organization of the United Nations (FAO) has calculated that in 1988 to 1990, 786 million people faced chronic undernutrition in developing regions, or 20 percent of their populations (table 1). Most of these people—528 million are in Asia. the next largest group— 168 million—is in Africa The FAO's calculations suggest a significant drop in the proportion and absolute number of chronically undernourished people in developing countries: from 36 to 20 percent and from 941 to 786 million since 1970.5 The most dramatic decline was in the Far East from 751 to 528 million people, and from 40 to 19 percent of that region's population In Africa, despite a small decline in the proportion of malnourished, the absolute number has risen dramatically, from 101 to 168 million Both the proportion and absolute numbers in the Near East and Latin America are relatively smaller. In both regions the proportion has declined from near 20 to 12 and 13 percent, but the absolute numbers have remained relatively unchanged.

Table 1. Prevalence of chronic undernutrition in developing regions. selected years.



Chronic undernutrition

Total population (millions)

Proportion of total population (percent)

Number (millions)














Far East













Latin America













Near East

























786 .

a Twenty-two countries with a population of less than 1 million are excluded from these totals The combined population of these countries represents 0.6 percent of the fatal population of the developing countries.

Source: FAO, Statistic Division, World Food Supplies - and the Prevalence of Chronic Undernutrition in Developing Regions as Assessed in I 992 (Rome FAO, 1992).

The figures cited represent the lower limit of the hungry. Hunger in the industrial world and in some seventy-two countries with populations of less than 1 million is excluded, as is the impact of famine. The upper limit is indicated by the World Bank's estimates of poverty (table 2). In 1989 1,133 million people were poor at a poverty line of US$1 per day per person The geographical distribution of the poor is similar but larger than that of the chronically malnourished for obvious reasons: hunger is a prime reflection and indicator of extreme poverty.

Why Are People Hungry?

The reasons why people are hungry differ IFPRI's companion paper suggests a conceptual framework that integrates a number of these factors and portrays the long-term relationships between root causes and symptoms of hunger. Poverty, for example, including natural and man-made shocks, is a root cause of hunger The framework also depicts the broad interactions between policy failures, resource poverty, disasters, and the population transition that impact on hunger Within this context, the main reasons why people are hungry are lack of assets and resources to produce enough food, lack of income to buy enough food, and lack of specific essential nutrients and knowledge These conditions are in turn affected by the natural resource environment and the economic and social environment in which the hungry live. These influence the level and distribution of assets and incomes; the level and nature of employment; and the availability of social services, especially health, housing, water supply, and education. They also influence the degree to which people participate in government and economic decision making, including decisions relating to how hunger can be overcome.

Table 1 Estimates of the magnitude and depth of poverty in the developing world, 1985 and 1990


Number of poor


Poverty gap index














East Asia and the Pacific







Eastern Europe







Latin America and the Caribbean



22 4




Middle East and North Africa .







South Asia







Sub Saharan Africa







Note: the poverty estimates are for eighty-six countries representing percent of the population in developing countries. have been updated from those used in the 1990 World Development Report and are based on national household sample surveys from thirty-one countries, representing roughly 80 percent of the population on of developing countries, , and on an econometric model to extrapolate poverty estimates to the remaining fifty-five countries. The estimates do not include Indochina or the Former Soviet Union The poverty line is US$31.3 per person per month at 1985 prices. It is derived from an international survey of poverty lines and represents the typical consumption standard of a number of low-income countries The poverty line in local currency is chosen to have constant purchasing power parity across countries based on 1985 purchasing power below the poverty line The poverty gap Index is the mean distance below the poverty tine (zero for the nonpoor) expressed as a percentage of the poverty fine. See Martin Ravalion, Gaurarv Datt. and Dominique van de Walle, 'Quantifying Absolute Poverty in the Developing World," Review of Income and Wealth 37 (1991): 345 61. for details of the methodology. The updated estimates are documented in the source publication.

Source: World d Bank, Implementing the World Bank's Strategy to Reduce Poverty (Washington, D.C: World Bank. 1993), 3-7.

Solutions to overcome hunger thus encompass a wide array of issues and possible actions At the most direct level these include the following:

· Actions to deal with droughts and other disasters that can lead to famine.

· Actions to provide essential nutrients such as vitamin A and iodine and the education to be aware of the need for these vital elements in the diet

· Actions to increase access to food through improved incomes, employment, technology, and so on, and through food transfers or other measures that increase entitlements to food.

· Actions to increase and sustain food production in the world, within countries, and at the household level. These actions influence the total supply and price of food for all consumers, and the supply of food available to hungry people (if they are farmers or farm workers) Most of the world's hungry are farmers, farm workers, or others in rural areas. Their direct access to food and to incomes is thus closely linked to increased food and agricultural production.

At a more complex level are such issues as:

· The functioning of the world economic system and its impact on equity, that is, on income, asset, and food distribution

· The functioning of the world food system and its implications for food production, consumption, and trade in and between industrial and developing countries, and thus for hunger

· The balance of resource allocation and use between industrial and developing countries, including the relevance of industrial country consumption patterns (life styles), both as they currently affect global food and income distribution and their implications as a long term guide to future growth and consumption patterns

· The relationship between the need for efficient household, local, and national food self reliance relative to the need for an efficient and smoothly functioning world market.

The concern with global hunger is most often stimulated by short-term phenomena such as famines, which activate people's humanitarian concerns, or by disruptions in the world food supply, which spark Malthusian anxieties of a world running short of food While these are important elements of the hunger problem, they are in a sense transitory. When the anxiety diminishes people tend to feel that the problem has been solved. However, the major cause of hunger is what Sen calls endemic deprivation, for which the solutions have less to do with global food production and more to do with poverty and inequality, economic and employment growth, and distribution within countries and in the world as a whole. These issues involve a much more complex set of considerations Among groups concerned with hunger, however, there are strong, divergent views on these issues, which affect policy recommendations and action proposals.

Recently, some other concerns have become prominent on the same agenda as overcoming hunger The following paragraphs discuss these issues.

The global food balance looks adequate in the aggregate and points to a progressively improving food situation in the industrial and developing world through 2010 for those with an effective demand for food, that is, the resources to produce it or the income to buy it But this masks the people who are chronically malnourished and lack the essential elements of an adequate diet As the World Development Report of 1990 recognizes: “The burden of poverty is spread unevenly among the regions of the developing world, among countries within those regions, and among localities within those countries "7 Two issues are involved One is recognition that greater equity in the distribution of assets needed to produce food or income would result in less hunger. This view focuses on the redistribution of existing resources as a means to overcome hunger. The other issue emphasizes that raising hungry people's commend over food through more productive employment and higher incomes will raise people out of poverty and reduce hunger, which focuses on the future. Each approach has strong proponents. Overcoming hunger now and in the future requires greater attention to equity in people's access to food and the resources to produce it, and to measures to enable them to escape from poverty. Proponents of each approach will need to find ways to reconcile their differences if a consistent approach to overcoming hunger is to be achieved.

Sustainability has become an increasingly pressing concern for viable approaches to development, and is particularly important for overcoming hunger. The prevalence of hunger among poor farmers and their families, often in environmentally fragile regions, makes clear the link between unsustainable natural resource exploitation and meeting household food needs. The 1992 World Development Report highlighted this link: "Alleviating poverty is both a moral imperative and a prerequisite for environmental sustainability The poor are both victims and agents of environmental damage." More important, however, is the dependence of the incomes, and hence of the command over food, of most of the world's hungry on agriculture, often in the most environmentally stressed areas. Thus environmental degradation is an important hunger (and poverty) issue. Actions to achieve sustainable development and reduce hunger have to reinforce one another if the world is to achieve a sustainable reduction of hunger and a sustainable environment in the larger sense.

Overcoming hunger will not be achieved solely by donors, governments, or concerned outsiders. The poor who are hungry must be key players, not only as recipients of assistance, but as producers. The poor are disenfranchised in every sense, which means a global agenda to overcome hunger will have to find ways to enable the poor to produce their own food or the income needed to buy food. This inevitably involves questions of human rights and the development of civil society Ensuring that the poor participate in the design of programs and projects to alleviate their own hunger is far from common practice. As antihunger efforts increasingly focus on people who are excluded and marginalized, the issue of participation and empowerment becomes increasingly crucial to their success.

Securing the full participation of women is also essential to overcome hunger Women and children suffer the most from hunger Women are not only central to the preparation and distribution of food within households, but in many parts of the world, especially in Africa, they are the major producers of food. Often the key entry point in targeted food and nutrition interventions is through women to their children. Finding ways to enhance women's participation in food production is equally important Legal issues, as well as issues of access to land, credit, and other inputs, are involved not only to produce food, but to generate other sources of income, and to share fully in the marketing and distribution of food.

These larger concerns with equity, sustainability, participation, and the role of women need to be seen in two perspectives. Each is an objective in its own right, and the reasons for pursuing each go well beyond the concern with overcoming hunger Each also has dimensions that relate directly to overcoming hunger Identifying these direct and indirect links and clarifying how they help reduce hunger is essential, and should be an important objective of this conference. The issue need not be one of tradeoffs or of confrontation between these concerns and the goals of overcoming hunger, but should concern integration and phasing. Some of these concerns can only be adequately addressed in the longer term. Others are directly relevant.

Two other elements of the larger perspective need to be clarified. One is the political nature of the hunger problem; the other is the practical possibilities for action.

People often see the hunger problem in its direct food production or nutrition dimensions, but it also has important political dimensions. People are hungry because they are poor, and because they are poor their participation in the political process is weak. At some point, all solutions for overcoming hunger, no matter how seemingly technical, must face the reality that transfers of income or resources, either to consume or produce food or to gain access to other sources of income and social services, are needed. Access to these economic and social opportunities are ultimately issues of the functioning of political systems. Proposals for overcoming hunger often call for political will, but how to achieve this is left vague. This conference can seek to clarify how to develop a basis for political action at the national and international levels that is commensurate with the objective of overcoming hunger.

Despite this huge package of issues that obviously impinge on hunger, and must in some way be resolved, overcoming hunger also involves many practical actions that can be put in place even if larger social and political factors can only be changed slowly. These actions form the basis of the action program discussed later.

Previous Hunger Initiatives

Overcoming hunger has been a recurring theme for decades The paper Addressing Hunger: A Historical Perspective of International Initiatives (appendix 2), reviews some of these Progress has been significant. Global food production has increased faster than population, and food consumption has improved (see section, "Time Frame for Reducing Hunger") Hunger has been reduced both absolutely and proportionately in many developing countries, but the goal of eradicating world hunger remains elusive. Why?

Earlier Hunger Initiatives

Overcoming hunger was a central issue at the time of the establishment of the FAO in 1945, when a proposal was made and rejected to establish a world food board to ensure adequate food for all.

Concern with slow food production growth in developing countries and food shortages in South Asia, China, and the former U.S.S.R in the mid 1960s led to a number of major conferences held in the United States concerned with food and hunger. Among the more significant were the Strategy for the Conquest of Hunger by the Rockefeller Foundation (1963), The World Food Problem by the U.S. President's Science Advisory Committee (1967), and Overcoming World Hunger by the American Assembly (1969). These resulted in detailed studies of the causes of hunger and related food problems and proposals to overcome these problems These undertakings contributed to some degree to the green revolution, which produced dramatic increases in food production and reductions in hunger in South and Southeast Asia and in Latin America in the 1960s and 1970s The FAO also established Freedom from Hunger nongovernmental organizations (NGOs) in the 1960s with networks that continue to operate in Asia and elsewhere.

The green revolution and the mid-1960s emphasis on expanding food production and the availability of agricultural inputs such as fertilizer worldwide, which these initiatives contributed to, resulted in dramatic global food surpluses by 1970. Real world food and fertilizer prices were at historical lows in 1970 and food seemed abundant These global food surpluses led to dramatic cutbacks in production by major industrial food producing countries by 1971 These cutbacks coincided with sharp, mostly weather induced, shortfalls in food production in the former U.S.S.R, Africa, and Asia in 1972 to 1973, and with the first oil crisis This combination of events, which caused a nearly 200 percent increase in world food and input prices, shortages of internationally traded food supplies, and a dramatic drop in food aid, resulted in the world food crisis of 1972 to 1974.

The World Food Conference, held in Rome in November 1974, was the culmination of worldwide concern with the world food crisis. It brought together leaders of 130 countries, officials of the major UN and bilateral agencies, and representatives of concerned NGOs It gave rise to the most comprehensive effort ever to address the global food and hunger problem. Its twenty major resolutions covered nearly all aspects of world food production, consumption, and trade The conference adopted the Universal Declaration on the Eradication of Hunger and created the World Food Council, the International Fund for Agricultural Development (IFAD), and the Consultative Group on Food Production and Investment The world food crisis also spawned a new generation of NGOs, such as Bread for the World and the Hunger Project in the United States. The International Food Policy Research Institute was also created at that time.

Despite the comprehensive framework of recommendations and Institutions put in place by the World Food Conference and the network of new hunger- and food-centered NGOs and research centers that emerged, the intense worldwide concern with the food and hunger problem subsided as the global food supply improved after 1974. The newly created UN institutions lacked effective support, and most were gradually abandoned or marginalized IFAD is one of the few surviving entities The major recommendations, especially the Universal Declaration on the Eradication of Hunger, became dead letters. Progress has been made on many fronts, but more outside than inside the framework created by the World Food Conference, and the goal of eradicating hunger had clearly not been achieved.

Recognizing this, and concerned that action be initiated on at least the most serious hunger problems, two conferences were convened. The 1989 Bellagio, Italy, conference proposed a sharply focused objective to reduce hunger by one half in the 1990s through four "achievable goals," namely, to (a) eliminate deaths from famine, (b) end hunger in half of the world's poorest households, (c) cut malnutrition in half for mothers and small children, and (d) eradicate iodine and vitamin A deficiencies. The International Conference on Nutrition/ held in Rome in December 1992 and attended by representatives of 159 countries, adopted the World Declaration on Nutrition, which also had as its central element the pledge to eliminate, before the end of this decade (a) famine and famine-related deaths, (b) starvation and nutritional deficiency diseases in communities affected by natural and man-made disasters, and (c) iodine and vitamin A deficiencies .

Accomplishments of Earlier Hunger Initiatives

The earlier attempts to overcome hunger have resulted in a number of significant accomplishments. First, they testify to the continuing concern of many people, governments agencies, and NGOs to overcome hunger. This concern waxes and wanes, however, and ways have yet to be found to galvanize it into effective and sustained world action to eradicate hunger. Second, they reflect a conviction that overcoming hunger is achievable. For some this should be through more equitable distribution of existing "adequate" food supplies, with the emphasis on equity and redistribution of existing world resources, incomes, and food, because food is a basic human right or a humanitarian obligation. For others it is because of a belief that what needs to be done and what is needed to do it is reasonably well understood. Third, they have generated a large body of analysis on how to identify who is hungry, why, and what can be done, and a number of strong research and NGO groups have emerged to support and expand this effort. Fourth they have achieved real progress. Per capita world food production and consumption have increased and world food prices have declined. Even more important, hunger has been reduced. Fifth, they have clarified the causes of hunger and how it can be reduced. During the past thirty years many countries, such as Indonesia, Malaysia, the Republic of Korea, and Thailand, have demonstrated how an emphasis on growth using the talents and resources of the poor, with strong reinforcing social services, sharply reduces poverty and hunger Other countries, such as China, Sri Lanka end parts of India, have demonstrated that even though people remain poor, reducing hunger significantly is possible International agencies have also devised approaches to development that shift the focus toward poverty reduction or address specific hunger-related problems, for example, the World Bank's orientation toward poverty reduction, the United Nations Children's Fund's (UNICEF's) program of oral rehydration, and IFAD's effort) to alleviate rural poverty and target specific hunger groups. A large number of grassroots institutions and NGOs are also now in place that directly help the hungry and seek to empower em to solve their own food problems. All these efforts show that hunger can be reduced though multiple measures: growth that is well distributed and uses the resources of the poor, public action that assures adequate social services even where growth is constrained, and actions targeted directly at the hungry.

Despite these successes, however, the goal of overcoming or eradicating hunger remains elusive. Why the hunger gap persists despite progress is the central issues Some of the reasons for this lie in the difficult lessons that have been learned from past initiatives.

Difficult Lessons If Learned from Earlier Initiatives

The first lesson learned from past initiatives is that them is little support for such global mechanisms to reduce hunger as either a world food board or a world food council. The reasons for this deserve careful thought. They probably have less to do with the lack of support such mechanisms received, although this is one factor, than the [act that multiple and complex issues are involved and decisions need to be made at many levels. Expecting a global mechanism to bridge this gap is probably unrealistic, and therefore the goal of eradicating hunger through such mechanisms is not taken seriously. Nevertheless, a vacuom exists at the international level if a global effort is to be mounted to overcome hunger and an outstanding issue remains: what mechanism is needed and can work that will focus the multiple efforts of others to overcome global hunger?

The second lesson is that hunger problems are country specific. within countries they also have regional-, community-, and household-specific elements. At the country level issues range from national economic and social policies to details such as land ownership and distribution, agricultural techniques, and the types of social services that are needed to reach the hungry.

The third lesson is that many problems have to be resolved at multiple levels. Some of these problems are large and complex: governance, equity, approaches to development Others are technical, but often complex as well: which actions produce the best results in the specific circumstances?

The fourth lesson is that overcoming hunger is clearly not a one-dimensional problem It is not simply an issue of food and its allocation. Many different approaches to overcoming hunger are relevant and work. How fast growth takes place and how equitable it is are major factors. Hunger has been reduced quickly in those countries in East Asia where growth has been rapid and has used the resources of the poor, where the benefits have been equitably distributed, and where social services such as health and education have been supported. The proportion of East Asia's population living in poverty fell from a third to a tenth between 1970 and 1990. Although the population increased by 40 percent in these countries, the number of poor decreased by 60 percent The absolute poor in six East Asian countries numbered 380 million in 1970 and 150 million in 1990. Not only were 230 million poor lifted out of poverty, but another 425 million people were added to the population and are living above the poverty line By contrast, Africa's hunger and poverty problems are getting worse, in large measure reflecting the lack of growth.

However, experts recognize that growth by itself is not enough. Some countries have experienced rapid growth, but its distribution was not equitable and it was not supported by growth in social services, for example, Brazil, whereas other countries have {ailed to grow very rapidly, but have achieved significant improvements in health and in hunger reduction, for example, Sri Lanka.

The fifth lesson is that despite the improved knowledge about who is hungry and how hunger can be reduced, many differences persist among practitioners and policymakers. One reason for this is that the concern about hunger often centers on food as "the staff of life." Like water and air it is essential for life. Food is a basic human right and therefore on equity and humanitarian grounds it should be provided to everyone . This is a powerful driving force behind many hunger initiatives, and was the basis for the World Food Conference's declaration to eradicate hunger. In practice, however, food is a commodity. Access to it is largely a function of income and asset distribution, as well as of the functioning (or malfunctioning) of food production and marketing systems From this perspective, access to food is governed by the same factors that govern access to any other commodity. It is for this reason that hunger and poverty arc so closely linked. The vision of global hunger, which seems so dear in terms of the basic human right to food, quickly balloons into a larger settee of political, economic, and social issues that go to the very heart of political and social systems, and on which there is less agreement. There are important differences between approaches to overcoming hunger that rely on the redistribution of existing food, income, or assets and those that stress the need to enable people to earn enough to afford the commodity food.

Another major issue separates those who emphasize food self-reliance at the local or national level and these who stress the role for a well functioning world market for food. Resolving this issue involves a major effort to reconcile the advocates of two valid approaches.

The final lesson is that global action on hunger requires multiple decisions at many levels. Unless governments put in place mechanisms to identify the hungry and initiate actions to reduce hunger, little can be accomplished. At the same time, unless the international community is prepared to support national efforts and to address those hunger issues that are influenced by international action, national efforts will be constrained. Currently, mechanisms focused on overcoming hunger are weak at both levels.

Time Frame for Reducing Hunger

How one deals with reducing hunger depends on the time frame within which this objective is sought. If, as the World Food Conference proposed, the intent was to eradicate hunger in a decade, then a high priority would have had to be placed on direct interventions and equity actions. Actions would also have had to include proposals for dealing with some extremely difficult situations, such as what to do in war and conflict situations, what to do in cases where government support and policies were lacking, and what to do in the most intractable hunger areas. If the intent is to overcome hunger eventually, as part of a broadly based growth strategy, then a broader array of tools is available, but many people would remain hungry.

There are three broad, overlapping, approaches to reducing hunger: (a) through economic growth, (b) through poverty reduction, and (c) through public provisioning. Dr and Sen have reduced these to "growth mediated security" and "supported security” In practice, all these approaches have had their successes and failures. The following section describes how the World Bank approaches the reduction of hunger through these three approaches. Here we are concerned with the issue of a tune frame to overcome hunger in the short, medium, and longer term.

Table 3 illustrates the relationship between the short-term, medium-term, and long-term actions needed to end hunger.

Such a time frame brings into focus the degree to which the effort to reduce hunger needs to be incorporated into longer-term concerns with growth and poverty reduction. While it recognizes that some elements of hunger reduction can only be achieved by long-term solutions, it concentrates attention on the actions needed to reduce hunger to the maximum extent well before long-run solutions are achieved. However, this does not mean that elements of both long-term and short-term actions are not part of the solution, and inevitably shifts the balance of concern toward equity, entitlement, and intervention solutions.

Table 3. Continuum of actions to reduce hunger


Famine relief

Food security

Poverty elimination

Time scale


1-10 years. near to medium value

10-50 years, long term


Feeding centres

Vulnerable areas

Whole country


Distribution of food aid

Entitement direct intervention

Production, economic growth, poverty reduction

Long-Term Measures

Three things are of overriding importance for overcoming hunger in the long term:

· Sustained economic growth works when it uses the resources of the poor and is equally distributed.

· Public policies that support human resource development and expanded social services (poverty reduction or support-led security) also work.

· Sustained increases in food (and agricultural) production work.

Growth. Examples of dynamic growth-led poverty reduction in Asia have already been cited. Clearly growth by itself is not enough, but it is nevertheless essential. Why does economic growth matter? Growth reduces hunger to the extent that it (a) reduces income poverty, that is, the poor are active participants in the growth process; and (b) is used to finance public support in key areas where markets work poorly, notably, in the provision of basic health, nutrition, and education services. Such an approach is more directly linked to concerns with empowerment and equity than might appear on the surface. While growth alone does not ensure the reduction of poverty or hunger, there are many examples of where it has, Asia being a notable one. Africa is an example of where lack of growth has impeded progress in increasing food production, in generating more employment and higher incomes, and in providing public revenues to support improved social services.

Poverty reduction and support-led growth. Evidence also exists that in countries such as Sri Lanka or in parts of countries such as Kerala, India, where incomes are low and growth has been slow, but there is a high degree of equity or targeted social programs focusing on food, health, and education, hunger has also been reduced and human life greatly extended. Actions in these areas include those health, education, nutrition, and other social services that sustain human life and build human capacity to enable people to participate in the development process.

Increasing agricultural and food production. One important factor in the reduction of hunger in the past three decades, and also an indicator of the future, is the longer-term development of the supply of and demand for food. The World Bank recently reviewed the pattern of food production and consumption over the past thirty years and the outlook to the year 2010. The analysis shows that growth in food production continued to exceed population growth during the past thirty years. World per capita cereal consumption has increased by 20 percent since 1960, and in developing countries it increased by 36 percent. Cereal yields continue to increase faster than population growth, while the amount of land used for cereal production has declined: since 1950, 90 percent of the increase in cereal production has come from yield increases.

The analysis also found that the demand for food is not growing as fast as in the past, and as a result, the period of greatest stress on the world's food production capacity may have passed. During the 1970s, world cereal consumption increased by an average of 2 7 percent per year, but during the 1980s it slowed to 1.7 percent per year despite a decline in real world cereal prices of more than 40 percent. By 2010 world cereal consumption is expected to slow further as incomes grow, consumption patterns change, and world population growth slows.

Diets in developing countries haste also changed dramatically during the past thirty years. Per capita calorie supplies in developing countries increased by 27 percent with rising real incomes and declining commodity prices. Asia, which accounts for 59 percent of the world's population, has seen the greatest improvement in diets, while Africa, which accounts for 12 percent of the world's population, has had the fewest gains. World population growth slowed from 2.06 percent per year during 1965 70 to 1.74 percent in 1990, and is projected to fall to less than 1 percent by 2025. The countries being left behind present the greatest challenge. Most of these countries are in Africa and the problems are economy wide.

The prices of basic staples such as cereals are expected to continue to decline relative to other consumer prices and relative to incomes. By 2010, real wheat prices are projected to decline by 33 percent, real rice prices by 31 percent, and real maize prices by 21 percent The declines in real food prices have helped large numbers of the poor achieve food security in recent decades, and their continued decline will underpin much of the anticipated progress in future decades. It is the lowered real price of such basic energy-supplying food commodities that provides the simplest market related means of reducing hunger, even if it adds to the economic viability challenge faced by small-scale agricultural producers who derive some of their cash income through the sale of such grains. World cereal consumption is projected to grow by about 1.4 percent per year, with developing countries increasing their cereal consumption by 2.2 percent per year. To achieve these consumption levels, however, cereal imports by the developing countries are projected to increase from 87 million tons in 1990 to 210 million tons by 2010, continuing the trend toward increased imports that started in the 1960s.

These are simply projections however. They do not deal directly with those who are left hungry nor do they take account of the random elements that contribute to food insecurity, and the raise other issues as well.

First is the need for sustained support to agriculture, including increased support to the Consultative Group on International Agricultural Research (CGIAR) and to national research centers (see box 1).

While the pattern of past and possible future growth underscores the contribution of sustained agricultural growth to overcoming hunger, the projections also raise long-term issues. One is the implied underlying pattern of future growth, which reflects developing countries' adaptation to the consumption patterns of the developed world. This has clearly happened and is projected to continue, but many argue that such a growth pattern is not sustainable. Where does the truth lie?

Another concern is that projections of growing food consumption in developing countries indicate increases in imports from the industrial countries. While this reflects a more fully developed world market for food, some question whether it is feasible, sustainable, or desirable. These projections argue strongly that it is. Others argue that it is not.

Short-Term Measures

Much of the concern with hunger is focused on short-term problems: droughts, floods, natural disasters, and civil and military conflicts. Both the Bellagio conference and the International Conference on Nutrition proposed that ending death from famine should be a specific near-term goal. These conferences provide good examples of ways to address the problems of people experiencing these disasters. Ending death from famine should be an essential short-term component of a hunger reduction strategy.

In recent years, many, including Dr and Sen and IFPRI have undertaken major research on how droughts affect those who experience them and how their impact of these events can be kept from resulting in famines. The World Food Programme (WFP), the FAO, and many bilateral agencies are also well equipped to act quickly. The basis for action to avoid famine includes having in place early wanting systems, supporting traditional coping strategies, ensuring against loss of assets, and, most important, sustaining entitlements (see also the accompanying IFPRI paper, Ending Hunger Soon: Concepts and Priorities).25 Many NGOs are actively involved in such relief efforts. The outstanding issues remain: how to deal with famines driven by conflict and how to overcome national policy neglect.

Traditionally the Bank has viewed these problems largely as relief efforts for which other UN and bilateral agencies are better suited. This position is changing, although the pre-eminence of other agencies is recognized In Africa, where famine remains a serious recurring event, the Bank is rethinking its approach to the problems of drought as a guide to new policy and lending actions.

Box 1. Research to sustain long-term food production

Another recent World Bank study finds that meeting the doubled food demand that is anticipated by 2030 seems feasible, but that given the increasingly constrained resource base, supporting agriculture will require substantial productivity gains. Fundamental to meeting the challenge of increasing agricultural productivity will be better application of existing (but underused) knowledge about resource management, and the development of new agricultural technologies and knowledge.

Among the incentives that would encourage farmers to adopt improved technologies and methods, none is more important than the allocation end protection of property rights In a addition as technologies become more sophisticated, educating farmers and strengthening extension systems is essential, not just to increase production, but to find better ways to use increasingly scarce water supplies The spread of practices such as conservation tillage and integrated pest management demonstrates that environmentally friendly and economically attractive technologies offer practical alternatives to regulation and subsidies in controlling the environmental costs of agriculture.

Even if existing knowledge is fully exploited, the availability and quality of land and irrigation water will be insufficient to meet demand. Plant genetic resources and climate change are less immediate constraints on increasing global output Further expansion of cropland by perhaps 25 percent and of irrigated land by 5{) percent may be possible, but will have high environmental and other costs. New knowledge will be necessary.

Experience over the past few decades has demonstrated that the generation of new knowledge is the most potent and least costly way to improve productivity The expansion of knowledge through research and development will need to encompass human capital, institutional innovation, and new technology New and higher-yielding cultivars of plants will be needed, aloe:, with farming systems research that Focuses on integrating livestock and crop activities as well as forest and aquatic resources, and on modifying the physical environment in which plants grow, for example, measures that conserve soil moisture and permit more continuous cultivation on the infertile, acidic soils common in many tropical areas.

Deliberate and sustained investment in agricultural research and development has never been more important Yet expenditures for agricultural research are stagnating or shrinking, both nationally in most parts of the world, and internationally. Research must address the increasing constraints posed by the environmental consequences of agricultural development. The Consultative Group on International Agricultural Research (CGIAR) is placing much greater emphasis on agricultural resource systems and on relatively neglected areas, such as forestry, pest manage meet, and soil conservation and irrigation, to complement the more traditional focus on commodity programs These changes by the CGIAR need to be reinforced and matched by commitments to strengthen national research systems in these and more traditional direction Such investments feature long gestation periods, yet have yielded high rates of return It will only be through continued investment in the agricultural knowledge (education, research, and extention) systems of the developing countries that long-term food security can be safely approached and achieved.

Source: Crosson and Anderson, Resources and Global Food Prospects: Supply and Demand for Cereals to 2030.

The response to the 1992 drought in southern Africa illustrates that action to deal with droughts, famines, and other disasters need not wait on further research. The combined efforts of countries and international agencies to respond to that drought is a good example of how effective action can forestall the famine consequences of a major drought. Without these efforts, a major famine could have been expected in southern Africa in 1992-93. That it did not occur was a major achievement.

The fact that war and other conflicts are a major cause of femme poses important issues for the Bank and other organizations Often Bank operations are halted in such cases. Other agencies and NGOs have been on the leading edge in dealing with the food problems of people facing these conflicts, but these conflicts still impede action in most cases.

Medium-Term Measures

While long- and short-term approaches to overcoming hunger are essential, a realistic attempt to overcome hunger must concentrate on actions that complement these long- and short-term elements, but focus on action that will have a large impact in a relatively short time Many such actions exist, and they are discussed in the section, "An Action Agenda to Overcome Hunger".

Current World Bank Actions to Address Hunger

Actions by the Bank address hunger in the three ways cited earlier, that is, through (a) economic growth, (b) poverty reduction, and (c) public provisioning Bank approaches also include specially targeted actions to address such issues as nutrition, food security, gender, and safety nets.

A long-standing focus of the Bank has been to support countries' economic growth by financing productive investments (loans and International Development Association credits) Whether for infrastructure, industry, agriculture, power,, and so on, the objective is to increase the production potential and the growth of incomes in developing countries, and thereby contribute to the reduction of poverty and hunger. Over time, Bank lending has spread to other sectors, such as health, education, nutrition, urban housing, and water supply, which may have a more direct impact on hunger, but not necessarily a greater impact The reason why economic growth matters was discussed earlier. While appropriately designed growth strategies alone do not ensure the reduction of poverty or hunger, there are examples where they have done so When done well, economic growth that uses the resources of the poor not only empowers them, but also enables them to participate.

The Bank has long recognized that growth alone is not the sole measure of development In the early 1970s the Bank shifted its efforts toward poverty reduction, particularly through its rural development and health and human services projects. By the end of the 1980s these efforts had crystallized into a decisive shift toward poverty alleviation By means of such publications as the World Development Report 1990, Assistance Strategies to Reduce Poverty, and the Poverty Reduction Handbook, the Bank has demonstrated that "the basic mission of the World Bank and the core of its assistance program is the reduction of poverty The Bank's strategy is based on supporting labor absorbing growth and systematic investment in the development of human resources, especially among the poor. It also includes supporting well targeted transfers and social safety nets These are actions that reduce hunger.

Recognizing that action at the country level is essential, the Bank is committed to preparing country poverty assessments in all developing countries, most of which will be completed in 1994 These assessments provide the basis for developing the two-part strategy described earlier. They analyze and make recommendations on the following:

· Extent and nature of poverty in each country

· Effectiveness of economic management (short term and long term) in generating growth that makes productive use of labor. Adequacy of government efforts to provide basic social and infrastructural services to the poor

· Extent, effectiveness, and affordability of social safety nets.

Based on these poverty assessments, the Bank is designing assistance strategies to support poverty reduction that will shape both the volume and composition of its lending The volume will be linked to a country's efforts to reduce poverty, and the composition will support these efforts.

Simultaneously, but within the context of its poverty reduction strategy, the has initiated a number of other programs directed at reducing hunger, improving nutrition, or achieving food security.

Nutrition Interventions.

Nutrition projects are one of the main direct ways the Bank acts to reduce hunger and malnutrition, specifically targeting nutrition services (including food) to the poorest and most vulnerable elements of populations. In these projects women play a central role both as beneficiaries and as project providers or administrators. Nutrition lending has increased exponentially since 1987. Total project resources mobilized for nutrition in Bank-financed projects increased from US$49 million in fiscal 1987-89 to US$894 million in fiscal 1990-92 Projected nutrition lending in fiscal 1993-95 is US$1.2 billion.

This rapid growth in nutrition lending reflects research findings that show the negative consequences of malnutrition The Bank recognizes that while economic growth is essential to long-term growth and poverty reduction, for most countries to achieve significant progress for the lowest-income groups though growth alone will take more than a generation. More direct support is needed Increasing incomes, even among low-income groups, is also insufficient. A series of IFPRI studies demonstrates that behavioral issues and health and environmental factors are also critical in determining nutritional status Awareness that the Bank needs to consider the consequences of adjustment operations on nutrition and to provide compensatory programs to the most needy has also played a role. After some years of experimentation, the Bank has supported successful models for nutrition projects with a demonstrated impact, for example, the Tamil Nadu Integrated Nutrition Project, which has reached 2 million women and children in 20,000 villages, has reduced the prevalence of severe malnutrition by 55 percent.

Food Security

The Bank has directly addressed hunger in Africa through its food security initiative launched m 1989. In The Challenge of Hunger in Africa, the Bank defined food security as "access by all people at all times to enough food for an active and healthy life," a condition that some 200 million Africans lack today. The initiative set out a five-point program of action:

- Preparing specific action programs to promote food security in each Sub-Saharan country

- Giving priority to projects and policies that raise the incomes of the food insecure and dampen fluctuations in food prices and supplies

- Strengthening the institutional capabilities of African Governments to manage food security programs

- Increasing the effectiveness of food aid, which includes improving the preparation and coordination of responses to emergency food situations

- Making more systematic efforts ' to identify the people at risk of food insecurity.

The initiative also proposed that a partnership be formed among donors, NGOs, and African governments to support comprehensive policies and programs for food security.

As a result of this initiative the Bank has learned much about the hunger problem and what can be done about it. It has also learned some of the sobering lessons discussed earlier The Bank has earned out food security studies in a dozen African countries, from which have emerged a number of food security strategies. The Bank has also supported food security projects in six countries: Benin, Burkina Faso, Cameroon, Madagascar, Mozambique, and Rwanda (see box 2). Depending on the specific circumstances of each country, these projects include income generating components targeted on the food insecure, such as public works, nutrition interventions targeted on the food insecure; support for early warning systems, capacity building to identify the food insecure and to design programs and projects to reach them; agricultural activities targeted on the food insecure; and improved uses of food aid for food security. Many of these projects involve reliance on local community action and NGO support The Bank has also undertaken an analysis of food aid in Africa with the WFP and an analysis of droughts as they affect people and economies. From these efforts the bank has learned a number of lessons.

While food security strategies are essential to identify problems in specific countries and to make proposals for action, they can be costly if done well, have often lacked national or beneficiary inputs, and do not by themselves result in action. The resources devoted to such strategies within the Bank and within countries must compete with the resources devoted to other strategies: environmental, agricultural, forestry, and so on. Given the current overwhelming demands on staff and resources, the feasibility of launching separate food or hunger strategy studies is limited and thus the needed analysis may need to be included in poverty assessments.

The greatest impact on food security, given the Bank's operational orientation, is achieved when analysis is combined with the design and implementation of food security projects Such projects focus the attention and resources of both governments and Bank staff and managers on the issue of food security, and they are the vehicle through which concrete results can be achieved Projects also provide the Bank with the possibility to support developments on the ground and at the same time to fund the analysis needed to go further.

An Action Agenda to Overcome Hunger

Overcoming hunger requires action in the short, medium, and long term, at multiple levels, in multiple directions, and by many actors Governments must take the lead, complemented by NGOs and supported by external agencies The following agenda focuses first on immediate steps that can be taken that will have a high payoff, and then considers priority longer-term actions that are needed to improve small farmer output or raise the purchasing power of the poor.

Drought-Rellated Famines

The response to slow onset disasters (for example, drought) that result in famines should be substantially improved. A more collaborative effort by the UN agencies, international financial institutions, and NGOs is needed to:

· Integrate a drought response strategy into the country assistance strategies and project designs of drought prone countries or regions

· Strengthen countries' capacity to prepare for and mitigate drought. This will reduce the need for emergency relief and smooth the transition from drought to recovery

· Improve lending instruments to provide greater flexibility for foreign exchange require meets associated with famines.

Box 2 - The Rwanda food security project

The food crisis in Rwanda is the result of the interaction between scarce land and a growing population, which is leading to exhaustion of the soil, smaller farm size, poorer harvests, and increased incidence of plant disease Income earned from coffee, which varies with the world market price, also shapes the magnitude and intensity of the food crisis.

Population density is among the highest in the world, with 300 people per square kilometer Increased fragmentation of the land is taking place and is also making high demands on agriculture (intensification and specialization) The labor force is growing by 90,000 people per year, the majority of whom will have to find their main source of income outside agriculture, but nonagricultural jobs are scarce Rwanda has reached a stage where virtually all tillable land is cultivated. Hence, increased production is dependent on intensification to increase yields The issue of food security in Rwanda will be increasingly dominated by the overwhelming need to create jobs and income outside family agriculture.

Food availability in Rwanda has increasingly depended on cross border imports from neighboring countries: Burundi, Tanzania, and Uganda. Food is available in the region and much of it is being officially and unofficially imported into Rwanda The food security action plan for Rwanda recommended (a) harmonizing economic policies among neighboring countries to increase the efficiency of interregional trade, (b) improving the performance of the small enterprise sector (formal and informal) to broaden the sources of employment and income creation, (c) developing a nutrition policy, (d) supporting intensive agriculture and policies to halt further fragmentation of the land, and (e) strengthening early warning and emergency preparedness systems.

In support of this action plan the Bank has financed a food security project with (a) food aid and nutrition components, (b) labor-based public works components, (c) microenterprise and development components, and (d) social surveys to enable improved targeting of future interventions The objectives are to improve the food security and social welfare of the poor improve the government's capacity to monitor food security, and initiate a long-term poverty alleviation strategy.

Other World Bank-supported food security projects include the following.

· Republic of Cameroon Food Security Project, February 1991
· Burkina Faso Food Security and Nutrition Project, June 1992
· Madagascar Food and Nutrition Project, February 1993
· Republic of Mozambique Food Security Capacity Building Project, April 1993
· Benin Food Security Project, appraised June 1993.

Source: World Bank Rwanda Food Security and Social Action Project (Washington, D C: World Bank, 1992)

Immediate Actions to Address Chronic Hunger

As a follow-up to the World Development Report 1593, the goals of the September 1990 World Summit for Children, and the December 1992 International Conference on Nutrition, countries need help to prepare, implement, and finance action plans for synergistic, low-cost, hunger-reducing health and nutrition interventions A few specific low-cost interventions are relatively easy to implement and can have an immense impact on the health and nutritional well-being of poor people, especially women and children. These include the following.

· Reducing vitamin A, iodine, and iron deficiencies through fortification, supplementation, and dietary modification

· Expanding childhood immunization coverage from 80 to 95 percent

· Implementing low-cost programs for controlling parasitic infections that cause anemia and malnutrition.

These services should be linked to nutrition education through community-level delivery. Such action plans would be sharply targeted on the most cost-effective interventions similar to the successful UNICEF program on oral rehydration There is no reason why all developing countries should not achieve comprehensive coverage of their populations within five to seven years.

Targeted food assistance programs should be mounted that provide food entitlements to children and to entire families whose children and mothers have been identified as malnourished in health posts, schools, or other social programs through growth monitoring Entitlements should preferably be provided in the form of food stamps, free ration cards, or vouchers (see, for example, the Chile and Honduras case studies) unless direct food supplements can be shown to be more effective and efficient }food assistance delivered to undernourished mothers and children at health posts combined with nutrition and health education is particularly effective, especially as the impact can be closely monitored (see Chile, Tamil Nadu, and Zimbabwe case studies) Close collaboration in these interventions is needed between UNICEF, the WFP, the World Bank, and community-based organizations and NGOs.

Food aid is a valuable tool to overcome hunger, and it is often preferable for it to be monetized, and the counterpart funds made available to finance food entitlements These interventions should be supported by assistance for nutrition education and the provision of micronutrients and health services. The WFP and contributions from bilateral food aid donors are essential in this effort The Committee on Food Aid Policies and Programs is one institution through which to develop such programs.

Where the potential for income generation is poor, help can be provided to finance employment generation programs along the lines of the Botswana Food-for-Work Program or the largely self-targeting Maharashtra Employment Guarantee Scheme.

Actions to Address Chronic Hunger in the Medium Term

In development projects, and especially in adjustment lending, it is essential to encourage employment-intensive growth as the most powerful approach to reducing poverty in the medium to long run. Governments should be encouraged to undertake measures that.

· Promote macroeconomic stability and open ness of the trade regime

· Eliminate direct and indirect taxation of the farm sector to encourage domestic food production and rural income and employment growth

· Eliminate anti-employment taxes and credit subsidies

· Reduce the extent of direct and indirect labor taxation and increase cost-effective, labor intensive infrastructure construction.

Countries should be encouraged and assisted to mount income generation programs in rural and urban areas, including following specific key actions.

Much can be done to focus government extension and research on the needs of small farmers to help overcome hunger, both to produce more food and to generate more income to do this Specifically this includes.

· Continued emphasis on small farmer extension and other agricultural programs targeted at the poor

· Strong support for national agricultural research systems, with special emphasis on the farming systems characteristic of the poor

· Intensified support for the CGIAR to undertake research on food commodities that are particularly important in the consumption and production of the poor, and on policies and programs intended to help small farmers, and especially poor women farmers.

Within the context of overall financial sector reform, increased attention should be given to policies and programs that provide small loans to the rural and urban poor, particularly women, along the lines pioneered by the Grameen Bank in Bangladesh, and more recently by the Foundation for International Community Assistance (FINCA) in Latin America and the Freedom from Hunger Campaign (FFHC) in Africa Programs of the Grameen type combine credit with the provision of advice and public education on sound nutrition and health practices, family planning, and sanitation External aid agencies should encourage the exploration and establishment of programs that address the credit and savings needs of the self employed poor In particular, donors could.

· Explore the possibilities for establishing funding mechanisms to support micro-credit schemes One beneficiary of such support could include the program for establishing and supporting Grameen Bank replicators, FINCA's village banks, or their equivalents world wide (see FINCA and FFHC case studies)

· Provide grants to NGOs that are experimenting with new ways to reach the poorest and hungriest people.

Group-based micro-enterprise credit is often most appropriate for situations of high population density, landlessness, and a thriving urban or rural nonfarm economy. In some countries it is being tested in an urban setting. Such credit, however, is more difficult to manage in more sparsely populated and highly risky agroclimate zones such as the semi-arid tropics. Nonetheless, informal credit mechanisms that could be fostered exist even in these areas (see Indonesia case study).

Actions to Achieve Sustained Long-Term Poverty Reduction

Reform measures to reduce fiscal and monetary imbalances, reduce market distortions, and promote efficient public management are essential to foster economic growth (see World Development Report 1951 for a detailed exposition of successful development strategies). Development practitioners recognize that such measures may have a short-term negative impact on the poor and the hungry unless special compensating actions are undertaken Consequently, it is imperative that every effort is made to protect and help such vulnerable groups (see box 3), including:

· Protecting primary health, nutrition, and targeted food assistance programs from cuts

· Increasing targeted compensatory expenditures for vulnerable groups through safety net actions, including social funds and public works employment programs, where basic food prices are likely to rise

· Improving the targeting of food subsidies to the poorest and most vulnerable groups

· Introducing cost effective strategies and financing plans to stabilize the prices of the most essential staple foods under conditions of large temporary international price shocks. Expanding the access of the poor to credit to enable them to acquire assets so as to become productive.

For the rural poor, who comprise the largest segment of poor people in the world, the key to income generation is getting land, because they have no assets other than their labor. Having land not only allows them to produce income and food for themselves, but also allows them to tap commercial bank credit and to be integrated into broader social networks, thereby allowing them to withstand droughts and other shocks better. By shifting assets to poor rural people, we can give them a buffer. Moreover, in low-wage countries, large farms tend to have lower productivity and to employ fewer workers than small farms Therefore land reform can improve the efficiency of agricultural production and help absorb increasing labor forces (see World Development Report 1990). Land reform in countries with highly unequal land distribution can use market assisted programs to make agricultural land available to the landless. The African National Congress is considering such a land reform option in South Africa, where the party proposes to transfer land to the victims of apartheid during a five- to ten-year period.

There are critical areas in which the line between hunger and environmental sustainability is most sharply drawn In such cases too communities need special assistance to tackle their critical natural resource management problems (see the Niger case study).

Issues for Discussion

Widespread agreement exists that persistent chronic hunger is primarily a consequence of extensive continuing poverty The experiences of the past twenty-five years indicate clearly which development strategies have been successful and which have not, both in raising per capita incomes generally, and in achieving a reduction in poverty specifically These were discussed in some detail in the world development reports for 1990 and 1991 The persistence of considerable poverty in many countries is caused not so much by a lack of knowledge about what measures need to be adopted, but rather by a failure to adopt sound economic and social policies and to implement them with persistence and determination The reasons for this are weak Institutions and capacities, political blockages and disagreements, and poor governance A lack of natural resources and a harsh climate are drawbacks, but not insuperable obstacles, as the Republic of Korea has dramatically demonstrated.

Box 3 Addressing hunger in structural adjustment

One of the most sensitive areas where reducing hunger and achieving growth impinge concerns structural adjustment operations Ensuring that the macroeconomic environment is right for sustained growth is important for the long-term development of a country, but this concern with the long term must not eclipse actions urgently needed today to overcome hunger An important principle in adjustment operations is that, at a minimum, there should be no net losers among the hungry. How this might be done in two key areas of adjustment is described below.

Maximizing Benefits

Stress the creation of employment for unskilled workers in hunger prone areas and seasons (there may be opportunities for incentives to encourage investment in such schemes).

· Provide vocational training programs, extension services, and credit that would help the ultra-poor take advantage of the opportunities in cases where devaluation has increased the opportunities for domestic production.
· Ensure that where agricultural incentives are improved, that marginal farmers also benefit through special programs introduced to overcome constraints (for example, access to credit' labor constraints at critical seasons). This particularly applies to women farmers.
· Gear agricultural extension and other services toward helping improve household nutritional status.
· Ensure that when adjusting relative prices, goods produced or consumed by the poorest are favored
· Ensure that priority is given to provision of primary health care in hunger prone regions, that services are free to the ultra-poor, and that adequate stress is given to appropriate nutrition education and to reducing diarrhea! disease through such measures as improving sanitation when restructuring health services
· Ensure that stress is given to improving vocational education, adult literacy, and other programs that develop human capital, and therefore the income earning capacity of the ultra-poor when restructuring education services
· Ensure that agricultural services give priority to extension services that are of special value to marginal farmers, particularly women farmers.

Protecting the Hungry from Shocks

· Adjustment programs should include monitoring of the impact of reform measures on the poor and, within this, focus especially on the nutritional status of vulnerable groups and on the income levels of the ultra-poor
· Whenever an adjustment measure might create hardships for the ultra-poor, the cost to specific population groups should be calculated and studies conducted to identify the most effective mechanism for ensuring that at least an equivalent benefit is provided Such a study should involve consultation with the vulnerable groups themselves, who should also be involved in the execution of the compensatory program to ensure minimum leakage to local elites and others.
· When cuts in subsidies are required, they should be concentrated on those subsidies enjoyed mostly by the better off (for example, those provided for rail and air travel, energy, and certain kinds of foods)
· When subsidies are cut, those used significantly by the ultra-poor should be retained wherever possible
· When expenditure cuts require reduced services, those that benefit the hungry should be retained, and when adjustment programs lead to increased food prices, additional measures are required to ensure that the poor are compensated.

Even though economic growth does result in a reduction of poverty, and hence of hunger, growth alone will not be enough to overcome malnutrition and food insecurity, as can be seen from the experience of Indonesia. Specific targeted interventions are also needed to address chronic hunger, protein and micronutrient deficiencies, and transitory food shortages.

To achieve a rapid reduction in global hunger, a number of issues need to be resolved.

· Countries need to establish a focal point to initiate and coordinate a well-articulated strategy for overcoming hunger Because hunger reduction is multisectoral, such a focal point must succeed in coordinating actions that are the responsibility of several sectoral ministries which is inherently a difficult task. Where should such a focal point be located to be effective?

· External agencies have a major role to play in providing food and financial aid to countries with hungry populations To be effective they too need to establish a focal point capable of achieving a coordinated and pro-active response How can they best do this?

· How can a global program to overcome hunger be given sustained global support? If a world food board or world food council is not the answer, what is the answer?

· A great range of direct interventions is possible, but resources are inevitably limited. Which interventions are the most cost effective? Which set of interventions is best adapted to a particular country's circumstances? In general, answering these questions will require a systematic economic and social evaluation of these interventions and a knowledge of country conditions that can only be acquired through household surveys like those now being undertaker in Africa as a follow-up to the Social Dimensions of Adjustment Program, and the Living Standards Measurement Study surveys being carried out elsewhere. How can this process be accelerated?

A division of opinion exists between those who stress growth and poverty reduction as the best means of addressing poverty, and advocates of direct interventions that stress empowerment, equity, and the right to food. Both groups are working in the same direction to a great extent Are these two options alternatives or complementary actions?

· If hunger reduction in the short term involves food or cash transfers to the poor, what share Of government and international budgets should be devoted to this goal?

· How can existing knowledge about how to prevent famines be applied in Africa, and especially to avert slow-onset (drought) disasters?

· Given that in a number of countries poor governance leads to a lack of leadership concern about hunger, what can be clone to give hunger alleviation greater priority in government agencies in those countries?

· Because food is both essential to sustaining human life and a commodity, how can these concerns be brought together? The first emphasizes social and political analysis, the latter economic analysis Important methodological differences as well as value judgments are involved. How can each concern inform the other?

· How can the need for empowerment, which places a high priority on household, community, and national food self-reliance, be more effectively linked with the equally important need for an expanding and well-functioning world food market? Both are essential for overcoming hunger worldwide. Both need to be efficient, sustainable, and equitable

· What is the place of overcoming hunger in the context of development and poverty reduction? If overcoming hunger is to have a high priority, how can this be realistically achieved?


1 Amartya Sen Public Action to Remedy Hunger (London The Hunger Project, 1990).

2. Sen, Public Action to Remedy Hunger.

3 World Bank, The Challenge of Hunger in Africa (Washington, D.C: World Bank, 1988), 3. The companion paper referred to is Ending Hunger Soon: Concepts and Priorities, in this volume.

4 P. Berek and D Digman, Food Security and Food Inventories in Developing Countries (Wellington, Oxfordshire, U.K. CAB International, al, 1993).

5 In part this decline reflects the inclusion of countries, in particular China, that were not included in earlier FAO estimates. If excluded, the proportion of the malnourished would have fallen from 31 to 21 percent but the number would have increased from 536 to 579 million between 1970 and 1989 FAO, State of Food and Agriculture (Rome FAO, 1992), 21.

6 Donald O. Mitchell and Merlinda D Ingco, The World Food Outlook (Washington D C: World Bank 1993).

7 World Bank, World Development Report 1990 "Washington, D C: World Bank 1990), 2.

8 World Bank, World Development Report I992 "Washington, D C.: World Bank, 1992), 7.

9 See Bread for the World, Hunger 1994 (Silver Spring, Md: Bread for the World, 1993).

10 Sterling Wortman and Ralph W. Commings, Jr, To Fred This World (Baltimore, Md: Johns Hopkins University Press, 1978), 85.

11. U.S. Department of Agriculture, The World Food Situation and Prospects to 1985 (Washington, D.C: U.S. Department of Agriculture, 1974).

12. The Bellagio Declaration Overcoming Hunger in the 1900s (Bellagio, Italy, November 1989).

13. FAO and World Health Organization, International Conference on Nutrition and Plan of Action far Nutrition (Rome FAO and World Health Organization 1992).

14 World Bank, World Development Report 1990; World Bank, 1990 Assistance Strategies to Reduce Poverty (Washington, D.C.: World Bank, 1991); World Bank, Poverty Reduction Handbook (Washington, D.C: World Bank, 1992).

15. UNICEF, Chila Malnutrition: Progress toward the World Summit for Children Goals (Geneva: UNICEF, 1993).

16. IFAD, The State of Rural Poverty (New York: New York University Press, 1993).

17 Bread for the World, Hunger 1994; United Nations Development Programme, World Development Report 1993 (New York UNDP, 1993).

18. World Bank, The East Asian Miracle (Oxford: Oxford University Press, 1993); Frieda Johansen, Poverty.

Reduction in East Asia, World Bank Discussion Paper 203 (Washington, D C: World Bank, 1993).

19 World Bank, World Development Report 1990, chap 3.

20. UN Declaration on Human Rights.

21. Jean Dr and Amartya Sen, Hunger and Public Policy (Oxford: Oxford University Press, 1989).

22 World Bank, World Development Report 1990, chap. 3.

23. Amartya Sen, "The Economics of Life and Death, Scientific American (May 1993); Dr and Sen, Hunger and Public Policy, chap. 10.

24. Pierre Crosson and Jock R Anderson, Resources and Global Food Prospects: Supply and Demand for &reals to 2030, World Bank Technical Paper no. 184 (Washington, D.C: World Bank, 1992).

25. Jean Dr and Amartya Sen, The Political Economy of Hunger, vol. II, Famine Prevention (Oxford: Oxford University Press, 1990).

26. World Bank, World Development Report 1990; World Bank, Assistance Strategies to Reduce Poverty World Bank, Poverty Reduction Handbook The quote is from Assistance Strategies to Reduce Poverty, 5.

27. Joy Miller Del Rosso, Investing in Nutrition (Washington, D.C: World Bank, 1992).

28. World Bank, The Challenge of Hunger in Africa (Washington, D.C, 1988).

29. The FAO has also prepared a number of food security strategies in African countries, namely, in Chad Niger, Tanzania, and Zambia.

30. See World Bank, World Development Report 1990.

31. World Bank, World Development Report 1991 (Washington, D.C. World Bank, 1991).

32. World Bank, World Development Report 1990.

Appendix 2 - addressing hunger: a historical of international initiatives

Hunger has been the focus of international policy pronouncements and conferences for a long time Development institutions such as the World Bank, the International Fund for Agricultural Development (IFAD), the World Food Programme (WFP), the Food and Agriculture Organization of the United Nations (FAO), and the United Nations Children's Fund (UNICEF), along with governments and nongovernmental organizations (NGOs), have emphasized the hunger focus of their assistance programs This cursory review of the history of hunger initiatives can only touch on some of its highlights. It attempts to explain why some dimensions of hunger have been more successfully addressed than others and some institutional frameworks have worked better than others.

There are three basic manifestations of hunger and malnutrition (a) starvation, which is a life retaining condition caused by insufficient food that is generally associated with acute situations like famine; (b) chronic hunger or undernutrition, which is caused by a long-term intake of calories that is insufficient to cover nutritional needs; and (c) pathological conditions, which result from inadequate consumption of calories, protein, and micronutrients, and are often found in combination with infections and inappropriate nutritionrelated behaviors.

Major conferences, such as the World Food Conference or the World Nutrition Conference, as well as development organizations and donor governments, deplore hunger in all its manifestations and recommend remedies for its eradication. Often, however, actions are selectively applied to only the more readily tackled forms of hunger While this is understandable and may well be the cost effective thing to do, one must be on guard that this should not become a "smoke-screen" (unintentional or otherwise) that obscures the failure to act on the most difficult manifestation of hunger, chronic undernutrition.

The world has made progress toward eradicating starvation and some forms of malnutrition, but less (and some might say very little) toward alleviating chrome hunger and food insecurity. The reason is that one can address starvation and malnutrition through relatively short-term superficial interventions that do not significantly alter prevailing economic and power structures. The alleviation of chronic hunger, by contrast, requires politically far more difficult solutions. Chronic hunger is a reflection of poverty, and therefore of the existing distribution of wealth and power within a country.

Hunger initiatives arc directed toward different audiences. This review covers primarily initiatives emerging from institutions or conferences intended to provide blueprints for action This selective emphasis on action oriented initiatives does not imply that we underestimate the value of hunger initiatives that reach out to the much broader audience of public opinion.

Without support from public opinion and political pressure, both in rich and poor nations, the implementation of specific action initiatives would have little chance. Thus, many of the conferences and organizations covered in this review may well have made important additional contributions through their impact on creating public awareness "Media events" directed exclusively to broader audiences are of immeasurable value. These include such events as Live Aid, Band Aid, and the less glamorous, but perhaps even more influential continuous educational work of (often church-related) NGOs. Such humanitarian-oriented initiatives increase the availability of resources from private and public sources for relief aid and give governments an incentive to act.

In recent years developmental and humanitarian orientations have converged noticeably Humanitarian-oriented efforts, properly administered, do increase resource mobilization significantly. Authorities are increasingly aware that development is a prerequisite for the prevention of future, more severe emergencies Those concerned with development now recognize the need for remedial action or safety nets for those families suffering from hunger today.

Many different proposals for addressing the hunger problem have been made These can be classified into two broad headings as shown table 1. The first group is the macro solutions, which aim at changing the environment in which all people, including the hungry, live They include measures that are intended to increase or stabilize global and national food supplies by promoting food production, trade, and stockholding They also include measures to increase the wealth of nations.

The second group, poverty-oriented solutions, emphasizes the inadequacy of purchasing power and attempt to improve directly the present living conditions of people who are hungry either by enabling them to earn higher incomes with which to procure more food, or by enabling them to pro duce more food, or both Efforts generally rely upon ways to increase poor households' access to more adequate and higher-quality diets, primarily through gains in income from all sources, but also through nutrition education and nutrition related health programs.

Agricultural or supply-oriented solutions view hunger as a symptom of inadequate performance by the agricultural sector, either globally or in particular nations. Those solutions that concentrate on increases in GNP view hunger as the result of poor performance by national economies as reflected in national per capita income.

Preventing starvation arising from natural or man-made calamities or eliminating a particular malnutrition problem usually calls for direct delivery (last column of table 1) The solutions to tackle chronic hunger are much less obvious and will be duly noted later.

Table 1 Classification of hunger solutions.


Poverty-oriented household




Increasing supply

Increasing supply

Increasing consumption

- Research sod extension

- Production and research

- Emergency and drought relief

- Conservation of natural resources

- Imports

- Feeding and nutrition programs

- Postharvest food loss elimination.

- Stocks

- Subsidized food ration

Stabilizing supply

Stabilizing supply

Improving nutrition and well-being

- Stocks

- Stocks

- Information and education

- Early warning

- Trade

- Micronutrient supplements

- Research

- Sarty warning

- Access to adequate water and sanitation.

Increasing consumption and improving distribution

- Food market intervention.


Level of income

Increasing production

- GNP growth

- Small farmer

- Aid in money or in kind

- Resource-poor regions

- Employment programs

Stability of income

- Human resource development

- Food compensatory financing facilities

- Grain reverses

Income distribution

- Social security

- Unemployment insurance

- Food subsides or vouchers .

Starvation, Famine, and Emergency Relief.

The number of people affected by famine, an estimated 15 to 35 million, is small compared with the close to 1 billion people who suffer from a more chronic form of hunger. Since the 1950s the incidence of famines has shifted from Asia to Africa One estimate suggests that the population of countries reported to be affected by famine has declined from a peak in 1957-63, with a yearly average of 788 million people, to 264 million in 1978 84. This downward trend continued during the next seven years (1985-91), when the population of famine-plagued countries averaged 141 million. In 1992 famine was reported only in Somalia and the Sudan, with combined national populations of 35 million.

International and national emergency relief efforts to combat starvation and famines have been extensive and relatively successful Natural disasters used to claim millions of lives Today, outside of Africa, with few exceptions only people who are subject to ruthless neglect or active pursuit by their own governments arc threatened with starvation Intolerance of famine caused by natural or manmade disasters is one of the most striking accomplishments in the international community struggle against hunger.

With the important exception of Africa, famines resulting from natural causes have become less frequent and severe, but not because climates and food production have become more stable. More efficient transportation and better communications have improved international and domestic preventive and relief operations In addition, the greater effectiveness of trade as a stabilizer and stronger international and national solidarity, backed up by public action, have reduced the ravages of famine.

In Africa, by contrast, drought-related disasters are occurring with greater frequency and impact. Estimates of deaths in Africa during the 1980s range from 400,000 to as high as 2 to 3 million for the 1983 84 drought alone In 1991, 23 million people were seriously affected by drought in Africa. Indeed, between 1987 and 1989 nearly 58 percent of all food aid for disaster relief was shipped to Sub-Saharan Africa.

Relief Agencies, Early Warning Systems, and Food Aid

Several international agencies are involved in relief activities. Since 1992, the United Nations (UN) Department of Humanitarian Affairs, under which the Office of the UN Disaster Relief Coordinator and the UN Disaster and Rehabilitation Office operate, has been responsible for coordinating international relief and assisting countries with disaster prevention and preparedness. Under its authority is a revolving fund of US$50 million and a register of stand-by worldwide capacities to ensure rapid and coordinated response by the organizations of the UN system.

Effective early warning systems at the international, regional, and national levels have averted or mitigated the effects of natural disasters, especially those caused by local harvest failures. The FAO's Global Information and Early Warning System, an international information network that relies on such sources as satellite convenied data and reports provided by NGOs, anticipates and assesses severe food shortages throughout the world. It provides assessments on a regular and an alert basis, largely in terms of national food balance sheets and food import gaps oriented to provide information to food aid donors. The Famine Early Warning System, funded by the U.S. Agency for International Development, provides detailed agricultural information, but geographic coverage is relatively limited. The System d'Alertes Precocious, established by the European Economic Community and implemented by an NGO, has been particularly effective in Chad and Mali A number of separately funded early warning systems now exists in Africa.

Emergency food aid is the primary means by which the international community responds to disasters. In 1990, approximately 32 percent of food aid for emergency purposes was provided through the WFP. In addition, the WFP made procurement, transport, and monitoring services available to bilateral donors, whose contributions accounted for some 15 percent of emergency food aid Food aid distributed by the NGOs from their own resources and from those of the bilateral donor programs accounted for more than one third of the total. Other multilateral programs distributed the balance.

The International Emergency Food Reserve, established in 1975, is a reserve for which participating donor countries pledge in advance to make grain available when the WFP alerts them that such aid is necessary to avert starvation in the face of nonrecurring natural disasters or wars. It is the only international mechanism specifically designed to respond to food emergencies. Relief for long-term refugee operations is handled under a special fund separate from the International Emergency Food Reserve.

Response of the World Bank and NGOs

Since its earliest days, the World Bank has responded to emergencies by providing advice and financial assistance, mostly through emergency recovery loans, the modification of existing loans (notably the reallocation of funds to critical investments of the Bank's existing lending program for the country related to emergency relief), or both Bank policy specifies that ale emergency recovery loans and, when appropriate, other investment operations in disaster prone countries, should include disaster prevention and mitigation components, such as the installation of early warning systems and studies to prepare a disaster prevention strategy and develop the institutional framework best suited to implement it.

The importance of NGOs in international responses to famine is unparalleled. The nature of NGOs has permitted them, at times, to side-step some of the thorny issues of national sovereignty. The role of the private voluntary agencies, particularly CARE in Somalia, is a dramatic example of the growing commitment to eradicating starvation and of the sophistication of modern relief efforts in terms of capacity to distribute large volumes of food quickly in a hostile environment. In many countries, particularly in Africa, the authorities see the NGOs as effective in the responsibilities that they assume, namely, targeting food distribution to vulnerable groups, engaging in emergency water and sanitation activities, helping displaced people, and supporting the recovery of agriculture.

Alleviating Malnutrition

Earlier we noted the three basic manifestations of hunger and malnutrition starvation, chronic hunger or undernutrition, and the pathological conditions resulting from inadequate consumption of calories, protein, and micronutrients, often in combination with infections and inappropriate nutrition-related behaviors. One of the essential characteristics of the latter is that while it is often symptomatic of poverty, some of its effects can be dealt with quite effectively with modest resources and without major improvements in the economy. Indeed, Alan Berg writes:

Although malnutrition is closely linked to a country's level of economic development, nutritional improvements need not await development... Addressing the underlying causes of poverty remains a vitally important development objective. But the time required to reach the most impoverished and the immediacy of the malnutrition problem argue for a continuing direct attack on nutrition deficiencies as well.... Efficacious and affordable measures are at hand.

The remedies for malnutrition can cure some of the effects of the lack of access to an adequate diet and circumvent the causes. Malnutrition interventions, frequently financed with international assistance, include highly targeted food distribution and supplemental feeding programs for mothers and children, food supplements, fortified foods, and nutrition education. These measures are efficacious, and they are sometimes supported by powerful national interests precisely because the measures reduce human suffering, yet do not threaten existing political and economic structures.

Foreign Assistance Agencies

International attention to the problem of malnutrition in large populations led to the establishment of the Sub-Committee on Nutrition, a forum in which all UN and bilateral aid agencies exchange information and issue pronouncements about the nature and causes of and remedies for malnutrition.

In the forefront of supporting measures to alleviate malnutrition over the years have been UNICEF, the World Health Organization (WHO), the FAO, and several bilateral assistance agencies, particularly the US. Agency for International Development. In recent years, the World Bank has also become an active participant.

One of the earliest successes of nutrition intervention was the promotion of salt ionization, which began in the 1950s through organizations such as the WHO and UNICEF. While the practice has been adopted throughout the world, political indifference has prompted lack of compliance, and in many developing countries endemic goiter remains a serious problem.

Iron deficiency is the most widespread nutrient deficiency in the world. Despite the recognition of its contribution to morbidity and mortality from infectious disease, its damage to effectiveness in education, and its direct effect on work productivity, consensus on an appropriate, easy technology to prevent it is lacking. As interventions to prevent iron deficiency have held a low priority on national and international nutrition agendas, the fortification of foods, including beverages, salt, and sugar, is rarely adequately implemented.

Attention to the significance of vitamin A was previously limited to the severe ocular manifestations of xerophthalmia and keratomalacia, but recent research has established a relationship between vitamin A status and mortality and morbidity in young children from infectious diseases. The WHO and UNICEF have strongly promote the distribution of vitamin A palmitate to all children up to two years old in countries at risk of vitamin A deficiency. This program has been well administered and aggressively pursued, and has met with considerable success However, success has been limited by the extremely poor infrastructure in some risk areas and the possibility of incomplete protection because of the difficulty of ensuring that children receive adequate dosages.

The major nutritional intervention efforts of the 1960s were the FAO, WHO, and UNICEF applied child nutrition programs. The three external agencies collaborated in sponsoring programs that would involve the ministries of education, health, and agriculture and included school and home gardens, nutrition education, and supplementary feeding. In at least forty countries, demonstration communities were carefully selected and external resources were provided to supplement those available from the government While the pilot programs were for the most part successful, the governments lacked the resources to extend these programs nationally.

In the 1960s nutritional rehabilitation and mothercraft centers, with their emphasis on nutrition education, came into vogue. Community weight-for-age surveys were conducted to determine which children were suffering from moderate to severe malnutrition. Supplementary feeding was combined with maternal education.

Antedating all other nutritional interventions, supplementary feeding programs have been by far the most prevalent. Food aid made readily available from large donor surpluses supplied these programs. UNICEF, as well as CARE, CARITAS, and other private voluntary agencies, provided food aid to school feeding programs and mother and child feeding centers. Despite their relatively high counterpart costs in terms of storage, transportation, and personnel, host governments usually welcomed these programs.

World Bank Nutrition Initiatives.

Nutrition became an object of World Bank attention in the 1970s as part of its basic needs approach. At the time, Bank staff were concerned about the potentially harmful effects of malnutrition on the mental development of hundreds of millions of children. While there was much uncertainty about what could be done, arguing that malnutrition should not be a central concern for a development agency became difficult.

Later, a new professional consensus established that often malnutrition is not caused by inadequate protein intake, as earlier studies had emphasized, but by insufficient food energy. With this understanding, malnutrition could no longer be regarded as just another disease that could be cured by administering the appropriate medicines or vaccines. Furthermore, the work of two Bank economists—Selowsky and Reutlinger— showed that even if the cost of increasing poor people's food consumption to meet caloric requirements were not low, highly targeted subsidized food programs could show positive economic benefit-cost ratios. Discrediting the notion that there was necessarily a tradeoff between growth and poverty alleviation justified the implementation of policy interventions that provided minimum adequate food, health, education, and shelter for specific groups.

In the mid-1970s the World Bank began to explore how it might contribute to the improvement of nutrition. A learning-by-doing approach was adopted for large nutrition projects in Brazil, Colombia, India (the state of Tamil Gnat), and Indonesia. Each included components for institution building, a food subsidy program, and nutrition education. Later the Bank decided that it should try to incorporate nutritional concerns into agricultural and rural development projects, and that improvements in nutritional status should become an objective and part of the design of health projects. The thrust of the Bank's nutrition programs concentrated on its particular advantage in drawing officials' attention to problems, assisting in planning, furthering the development of project analysis, and providing enough resources to make significant interventions possible. Recent years have seen the development of a sizable portfolio of nutrition operations in the Bank.

Recent International Conferences

Recently, several major conferences have concluded by endorsing targets for reducing malnutrition. While having little direct bearing on reducing malnutrition as such, development practitioners see target setting as useful in establishing international priorities, providing a yardstick against which to measure progress, and influencing the budgetary allocations of international and national donors. Substantial efforts would be needed to achieve these goals. According to the UN Administrative Committee on Coordination/Sub-Committee on Nutrition's Second Report on the World Nutrition Situation 1992, the rate of improvement in the nutrition situation is generally far below that needed to meet internationally agreed goals.

The nutrition goals of the World Food Council's 1989 Cairo Declaration, later incorporated into the UN international development strategy for the 1990s, called for, among other things, the elimination of major nutritional deficiency diseases. The Bellagio Declaration of 1990 proposed nutrition goals, including the eradication of iodine and vitamin A deficiencies, along with cutting hunger in the poorest households by half in ten years.

The UNICEF 1990 Children's Summit also set nutrition goals to be achieved by 2000 that were subsequently endorsed at the WHO/FAD 1992 International Conference on Nutrition. These goals included reducing iron deficiency in women by one-third of 1990 levels, virtually eliminating iodine deficiency disorders and vitamin A deficiency, promoting exclusive breast-feeding for the first four to six months of a child's life, and reducing severe and moderate malnutrition of children under age five to one-half of 1990 levels.

Chronic Hunger and Undernutrition and Food Insecurity

Chronic hunger persists: nearly 1 billion people silently suffer from chronic hunger. Today about as many people as in the 1970s do not earn enough money to secure an adequate diet. Progress in alleviating hunger has certainly fallen short of the targets set by numerous forums that have been convened to give expression to the global communitys abhorrence of the persistent presence of chronic hunger To be sure, there have been dramatic success stories, particularly in Asia. Unfortunately, hunger has become more severe in many other countries, predominately in Africa.

Chronic hunger has been the target of many pronouncements and initiatives. It is not our intention here to evaluate whether all or any of these initiatives have been effective in reducing hunger. Sorting out the positive and negative consequences of deliberately pursued policies and actions and of uncontrollable factors in the environment on the observed outcome would be a major undertaking. The best we can hope to accomplish is to record the approaches that have been tried and to speculate why, in our opinion, some have worked better than others so as to distill some lessons.

The World Food Conference and Its Aftermath

The World Food Conference held in Rome in 1974 is widely claimed to have been a major milestone in drawing attention to the hunger problem in developing countries. However, did this conference put the train on the right track or actually derail what could have been a promising beginning?

Although subsequently billed as a major hunger initiative, the World Food Conference was actually convened as a reaction to a sharp rise in world food prices (together with the prices of many other commodities), which were misinterpreted as an indication of an impending supply scarcity. At the same time, the framers of the Club of Rome formulated their pronouncements of doom. Managers of the economies of the industrial as well as the developing countries become concerned about the inflationary effects of food prices and their political consequences.

With Malthusian fears in the air, the conference identified inadequate food production in the developing countries and flaws in the international commodity markets as major contributors to hunger Its resolutions were designed to address these culprits. In so doing, the conference endorsed much of the supply initiatives that dominated international hunger dialogue in the ensuing decades Despite the adoption of the Universal Declaration of the Eradication of Hunger, which proclaimed that "every man, woman and child has the inalienable right to be free from hunger and malnutrition in order to develop fully and maintain their physical facilities," the fate of the poor people afflicted with hunger was not central to the conference deliberations.

The first resolution of the conference report declared that agricultural production in developing countries should grow at an annual rate of 4 percent. To supplement inadequate production in developing countries, the conference recommended that food aid donors "provide commodities and/or financial assistance that will ensure in physical terms at least 10 million tons of grain as food aid a year, starting from 1975. As a means of increasing stability in the world grain market, the conference endorsed the establishment of an international coordinated system of national al grain reserves, the provision of additional assistance to developing countries to establish these reserves, and the conclusion of international negotiations for a reserve system agreement.

The conference also established three international organizations to deal with the hunger problem: the Consultative Group on Investment in Food Production, the FAO Committee on World Food Security, and the World Food Council. All these organizations were either meant to address food supply issues or ended up doing so for a good part of their existence The relationship between hunger and poverty was only tangentially addressed.

The Consultative Group on Investment in Food Production. The Consultative Group on investment in Food Production went out of business soon after it was founded, but not because of a lack of interest in investment in food production To the contrary, by that time the World Bank, under the leadership of its activist president Robert McNamara, had already reshuffled its portfolio of investments and otherwise expanded the resources going into agriculture and food production Moreover, once IFAD was funded, the consultative group had little reason to exist.

The FAO Committee on World Food Security. The FAO Committee on World Food Security was set up to assess the world food security situation During the early years of its existence, one of its major preoccupations was monitoring the level of world cereal stocks as compared with consumption The committee considered that stocks equivalent to 17 to 1X percent of consumption were the minimum level required for world food security. In addition, during its annual meetings, at which delegates convene to discuss the world food situation and measures to address hunger, the committee is presented with reports for its consideration on various FAO initiatives with more or less relevance to hunger and food security.

In recent years, the committee has given much attention to the FAO's Food Security Assistance Scheme and the Global Information and Early Warning System. The Food Security Assistance Scheme provides developing countries with technical and financial assistance to design and implement food security strategies. This assistance frequently includes improved data and information networks, food stocks, and programs to increase production. .

In 1985 the FAO unanimously approved the World Food Security Compact, which reaffirmed "a moral commitment to achieve the ultimate objective of ensuring that all people at all times are in a position to produce or procure the basic food they need The compact marked an important departure by the FAO from its earlier definition of world food security, with its emphasis on global food supplies and stocks, to one that focused more on the victims of food insecurity By 1991 the FAO Council had endorsed the following.

Food security was becoming less a problem of global food supplies, overall stability and global stock levels as such, but more a problem of inadequate access to food supplies for vulnerable groups resulting from, inter alia, lack of purchasing power.

World Food Council The general assembly established the World Food Council as a coordinating mechanism for initiating policies pertinent to food production, nutrition, food security food trade, food aid, and related matters The council was to review, guide, and coordinate the conduct of food and hunger actions by multilateral agencies, national governments, and the international community as a whole and to act as a political advocate for the world's hungry poor. By nominating ministers of agriculture as delegates, governments had in mind a council that would link agricultural development, as the primary instrument to reduce hunger, to economic and social policy and political considerations. While its mandate was to promote initiatives to reduce hunger, the council primarily discussed policies that met the interests of agricultural producers in both the industrial and developing countries, for example, how to expand markets or how to make production more profitable. Proposals centered on food aid and food stocks and on how to promote greater self-sufficiency, even at a high economic cost.

For years the council supported the need for larger, internationally agreed, nationally held stocks This was a dubious proposition from several perspectives, particularly as the proposals never confronted the issue of mismatches in costs and benefits to participating nations. Most of the proposals implied large benefits from additional stocks for food importing nations, while the food exporting countries were to bear the costs of holding the stocks. However, an even more important weakness of these proposals was that global stocks would have done very little to alleviate hunger, because the primary causes of food shortages in low-income, drought prone countries are bad harvests within their own borders and a shortage of foreign exchange and purchasing power in the hands of many of their households. The final collapse of the discussions contributed to the erosion of the council's credibility and prestige.

By the early 1980s, when it became clear that countries would not be able to agree to an internationally coordinated system of grain reserves, the council finally turned its attention to an initiative more closely related to the hunger issue: the poverty of nations. Following up on the writings of several economists at the World Bank and the International Food Policy Research Institute in the late 1970s, the council asked the International Monetary Fund (IMD) to establish a cereal financing facility.

An extension of the IMF compensatory financing facility became operative with the 1981 IMF Cereal Derision, which enabled the IMF to provide assistance to members to finance temporary increases in the cost of cereal imports Its purpose was to protect domestic food consumption levels in the face of shortfalls in domestic food production or increases in world cereal prices As it turned out, the extended Cereal [Financing Facility was not used much for various reasons, mainly its unfavorable credit terms, the extensive availability of food aid on better terms and the inviolability of upper limits on the IMF's country allotments.

One of the most significant World Food Council proposals was to establish national food strategies in the developing countries. The strategies were premised on the belief that regardless of the possible losses fin economic efficiency, a country could eliminate hunger within its borders only by producing enough food domestically to meet its food requirements The strategies, which the UN General Assembly endorsed in 1981, were intended to be a means "by which a country can achieve food self sufficiency through an integrated effort to increase food production, improve consumption and eliminate hunger They were intended to link consumption needs more directly to production observes, emphasize the integration of policies and project activities, sustain adequate priority for the food sector, facilitate national decisions related to the food sector, and increase and coordinate international assistance.

While some of the studies underlying the preparation of the strategies are valuable additions to the understanding of countries' food systems, the central perception underlying the strategies—that hunger can be eliminated through food self-sufficiency and that importing food while exporting agricultural commodities is bad for food security—was flawed Fortunately, the council did not have the resources or authority to implement these strategies, but the plans embodying them made it more difficult to develop and fund plans that would have genuinely addressed hunger.

Beginning in the mid-1980s, the council attempted to redirect the focus of international initiatives from supply-oriented actions to actions that directly addressed poverty-related hunger through the Beijing, Cairo, and Cyprus initiatives. The perception that structural adjustment and stabilization programs were having an adverse impact focused renewed attention on the vulnerability of the food security of certain segments of the population. At one of the consultations called by the council during 1987, the participants considered a proposal to compensate 50 million of the poorest households in countries undergoing structural adjustments Half of the package's estimated cost of US$5 billion could have been funded with food aid (equivalent to 15 million tons of cereals) The participants further suggested that part of the cash component be obtained through partial debt forgiveness by donors and multilateral banks While little progress was made toward implementing this proposal, it did galvanize thinking about the effects of economic adjustment and stabilization programs upon the very poor and the need to provide interim compensation to protect them from deeper poverty and greater hunger and malnutrition.

The council's Cyprus Initiative enphased the urgent need to protect the poor and vulnerable from the specific hardships posed by structural adjustment programs and their associated fiscal constraints. The view emerged that.

The elimination of hunger, malnutrition and poverty requires special policy attention; and that neither economic growth, important as it is, nor market forces by themselves will spread the burden of adjustment and distribute the benefits of development in the equitable way needed to protect the poor and improve their situation in the foreseeable future.

Unfortunately, the calls for effective programs to alleviate the twin predicaments of hunger and poverty and the requests for resource transfers yielded only declarations. Agriculture ministers had neither the interest, the expertise, nor the authority to implement such action. Proposals such as the use of vastly expanded food aid programs to provide short- and long-term assistance to the hungry, as originally proposed in the Cyprus Initiative, were rejected. Food supply considerations formed the basis for the opposition to these proposals, that is, would the food aid be harmful to exporting countries supplying commercially transacted food? Would the food aid be harmful to the producers of marketed food surpluses in recipient countries?

With its narrow focus on food supply and market issues, the council was never able to become a true advocate of initiatives broad enough to encompass the problem of hunger.

Food Aid and the World Food Programme

The World Food Programme plays a unique role among agencies concerned with the alleviation of chronic hunger. It promotes its own brand of strategies, primarily in its role as the convener of the Committee on Food Aid, while at the same time it has command over sizable resources to implement a great variety of programs As already noted, the WFP is the front-line agency in implementing emergency hunger relief programs and, together with UNICEF, is also supporting many programs designed to reduce malnutrition. But what has been its contribution and, more generally, what has been the contribution of food aid to the alleviation of chronic hunger?

Contrary to what might be inferred from public pronouncements, a relatively minor share (23.4 percent in 1989-90) of food aid is used in child feeding programs, income transfer, or employment programs. For the most part, food aid is used for balance of payments assistance (57 percent in 1989 90) and, to a lesser extent, for emergency relief (l? percent in 1989-90) The failure of food aid to make a more significant contribution to the alleviation of chronic hunger is disappointing for a number of reasons.

While conceived primarily as a means for surplus disposal, political support for continued food aid derives increasingly from organizations advocating the alienation of hunger. Seen in this context, it is disappointing that the WFP (or more precisely, the Committee on Food Aid) has not been able to provide more leadership to turn food aid into a major instrument for alleviating chronic hunger.

The low utilization of food aid for programs that directly contribute to the reduction of chronic hunger is disappointing given that development practitioners now widely accept that food aid can be, and under many circumstances should be monetized. With monetization as a viable option, money derived from the sale of food aid could be used, for instance, for granting credit to peasants in locations and seasons in which it would have been useless, or even counterproductive, to transfer food to them Now that food aid can foe used effectively for programs specifically designed to benefit the poor, there is little justification for untargeted food aid.

Development Agencies: IFAD and the World Bank

The impact of development agencies, such as the World Bank and IFAD, on the alleviation of world hunger is less a consequence of what they say and more of what they do or fail to do However, this does not mean that their influence is exclusively, or even primarily, related to the relative success of their investment projects The World Bank, for instance, attempts to influence macroeconomic and microeconomic public policies and actions through its annual World Development Report and numerous economic and sector policy papers.

One of the most promising initiatives of the FAO World Food Conference in 1974 was the founding of the International Fund for Agricultural Development because it rested on an explicit understanding that hunger should be addressed by focusing financial assistance on investments that directly benefit the hungry IFAD became operational in 1977 "to finance projects primarily for food production m the developing countries. Unfortunately, an excessive concern with the food supply during the first decade of IFAD's existence probably limited its effectiveness in terms of combating hunger.

Later, IFAD's original mandate was more broadly interpreted to encompass investments that lead to the alleviation of rural poverty IFAD's experience taught the fund to aim at the productive potential of the poorest in their specific social and economic circumstances. It has learned, through considerable field experience, that investment for the poor is a good investment, and that it can have a larger economic as well as social impact than if deployed elsewhere .

The World Bank's approach to hunger has evolved over the years in response to changing external conditions and institutional factors Not surprisingly, the Bank's actions often reflect more than one approach.

In its early years, the World Bank primarily promoted policies and projects to increase the growth in national product The assumption was that national authorities could subsequently attend to poverty and hunger according to their own political philosophies. Also, based in part on its experience with the reconstruction of wartom European economies, the Bank initially stressed the development of the industrial sector and related infrastructure.

With the arrival of Robert McNamara in 1968, the Bank's priorities rapidly shifted into new directions. For one, McNarnara, with much support from his chief economist, Hollis Chenery, promoted a quantum jump in lending This strategy was consistent with the then popular growth models, which suggested that slow growth of developing country economies could be "fixed" by transferring more resources to close the "resources gap".

Concurrently, the Bank began to pay more attention to the agricultural sector because of industry's limited capacity to expand rapidly, the renewed flair-up of Malthusian scares about food and population growth, and the promising reports about technological breakthroughs in agriculture the green revolution As a result, lending to agriculture increased significantly in the Bank's portfolio, and the Bank led in the establishment and administration of the Consultative Group on International Agricultural Research which by all accounts turned out to be one of the most successful international technical assistance ventures. The phenomenal growth in grain productivity has certainly mace a major contribution to the abundance of food in markets and the observed decline in food grain prices during recent decades This growth in productivity is linked to sustained investment in international and national agricultural research relevant to basic food production.

Thus the Bank, like the World Food Conference, confronted hunger with measures that promoted agricultural production to ameliorate a potential food supply shortage Yet the imperative to expand agriculture quickly led the Bank to realize that increasing food production in developing countries is highly complex, because it requires increasing the productivity of a multitude of poor peasants.

In the early 1970s the Bank initiated its integrated rural development projects, which were primarily intended to increase the agricultural productivity of peasant farmers through the provision of improved agricultural inputs and of new extension and social services. This was consistent with the basic needs approach To carry out these projects, the Bank commissioned numerous policy and research papers on employment, land reform, low-income housing, population and health, nutrition and education, and extension.

From the outset, it was clear that the integrated rural development projects would not directly benefit the landless or near landless, but the Bank expected them to benefit from increased demand for labor and from better access to basic social services in rural areas. The basic needs approach did not significantly alter the Bank's conviction that projects, including integrated rural development projects, designed primarily to benefit the rural poor should meet the usual cost-benefit criteria. While this approach facilitated program implementation, it became dear, at least in hindsight, that the criteria may have restricted the flow of benefits to the poorest.

The concept of integrating multisectoral public services under the umbrella of a single rural development project turned out to be organizationally unworkable The activities intended to enhance human capital were frequently foregone when line ministries of education, health, and so on were reluctant to be "integrated" into predominately agricultural projects. Hence, the contribution of integrated rural development to the alleviation of hunger, even in rural areas, remained at best modest.

Another reason for the early demise of rural development projects was the growing realization that development generally was not well served by a complex, centralized planning approach that relied for its implementation on a smoothly functioning bureaucracy and large public investments. This skepticism, which coincided with worsening economic conditions in the industrial countries and hence reduced growth in the Bank's resources, sharply decreased further funding for integrated agricultural projects.

In the 1980s development theories tended to advocate greater reliance on market forces and less on planning and government interventions. As for agriculture, development experts recognized that reducing the implicit and explicit taxation on the sector practiced in many countries could be far more beneficial to the sector than large public investments. Bolstered by the success stories of a few (small) countries in East Asia, the decade opened with renewed optimism about the potential for rapid growth that would sweep away poverty and food shortages.
Some in the Bank were less optimistic about the rapid transformation of countries into well functioning market economies and the unfolding, of unprecedented, high growth rates. In addition, there was evidence that economic growth trickles down so slowly that even under the most optimistic assumptions of growth in national income and food production, poverty and hunger would not be swept away for a long fume. These concerns, reflected in a 1986 Bank policy paper, that neither increased national economic growth nor ample food supplies at the global or national levels would eliminate poverty, were not new. As early as 1956, an economist with the FAO wrote in a paper discussing food stocks: "Malnutrition is a chronic problem. The main cause of undernutrition and malnutrition is poverty, lack of consumers' purchasing power."

Amartya Sen captured most eloquently the dichotomy between the same emerging perspectives and those perceptions to which many international organization continued to ad here: "The relentless persistence of famines and the enormous reach of world hunger, despite a steady and substantial increase in food availability, makes it imperative for us to reorient our approach away from food availability and towards the ability to command food.

Reutlinger and Selowsky had also previously drawn attention to the relationship between malnutrition and poverty in preparing quantitative estimates of the extent of hunger "That undernutrition is a function of absolute poverty is self-evident But estimates of the global magnitude of calorie deficiency in the developing countries have usually been made by reference to highly aggregated per capita data."

In its policy paper on poverty and hunger, not only did the Bank demonstrate unequivocally the relationship between hunger and the lack of adequate purchasing power, but it also asserted emphatically that the long-held belief that increased domestic production would lead to greater food security had to be discarded and replaced by policies that addressed the plight of the poor. The document states:

Although far too many people eat too little, the energy deficit in their diets represents only a small portion of the food energy consumed in most countries. Increasing the food supply would not eliminate this problem, since it would not necessarily improve the incomes and the purchasing power of the poor. This is why international support should focus on policies and investments that would improve the distribution of benefits by raising the real income of people facing chronic food insecurity and stabilizing access to food for people facing transitory food insecurity.

The document concludes that the lack of food security is a lack of purchasing power that is not necessarily eliminated with food self-sufficiency. In the long run chronic food insecurity is eliminated through economic growth, and in the short run through measures to redistribute purchasing power to those who are undernourished The document stresses that searching out only the most cost effective measures for implementation is essential.

Consistent with the view expressed in the policy paper on poverty and hunger, the World Bank's World Development Report 1990 and Poverty Reduction Handbook emphasized the need to maintain macroeconomic policies that placed a high priority on creating employment, introducing measures to increase the participation of the poor in growth and to reach resource-poor areas, delivering social services to the poor, and providing special income transfers and safety nets. The Bank present lending portfolio and economic and sector work are beginning to reflect these perceptions.

The Bank's focus on Africa in the late 1980s confronted it with the hunger problem particularly forcefully. Here was a continent in which population growth exceeded the growth in food production without compensating growth in the purchasing power of people and nations For a while some of the food deficit was made up by food aid, but it became clear to all that the growing dependency of countries for their physical survival needed to be addressed with urgency.

The Bank's prognosis and prescriptions, written up in a special report, The Challenge of Hunger in Africa: A Call to Action, were discussed prior to and during publication in several ad hoc international meetings hosted by the Dutch government. The recommendations for specific actions included the following:

· Preparing specific action programs to promote food security in each Sub-Saharan country

· Giving priority to projects and policies that raise the incomes of the food insecure and dampen the fluctuations in food prices and supplies · Strengthening the institutional capabilities of.

African governments to manage food security programs

· Increasing the effectiveness of food aid, including improving preparation and coordination of responses to emergency food situations

· Making more systematic efforts to identify the people at high risk of food insecurity.

The Bank is now putting these recommendations into practice, but with far fewer resources than are required A particularly noteworthy feature of this initiative was the active dialogue between the Bank, other international organizations and government-to-government aid programs, and NGOs. The positive outcome was to demonstrate that such meetings, held in an informal atmosphere, can establish a useful encounter between people working on hunger in widely different institutional settings.

Implementation of the envisioned active collaboration among the many agencies concerned with hunger in Africa fell short of expectations The lesson might be that expecting too much collaboration is unrealistic. Work on hunger ties in with a host of other agendas that are quite different for each organization. It is perhaps natural that each organization should pursue, and be seen to pursue, those strategies that appeal to their own particular constituencies.

Nongovernment Organization

Apart from their invaluable role in international feeding programs (involving approximately US$25 billion of food annually), the NGOs, because of their on-the-ground presence and first-hand knowledge of the needs and the interests of the poor, have been extremely important in keeping the focus of development on the hungry. NGOs demonstrate a variety of approaches to addressing hunger and poverty The administration of food aid programs, including food-for work and nutrition programs, continues to be the primary commitment of some of the largest NGOs, such as CARE and Catholic Relief Services Others provide services for developing small and micro enterprises Inspired by the Grameen Bank of Bangladesh, small scale credit programs have become popular among NGOs end their donors Still others are heavily involved in advocacy and education, and are directing their attention more toward policy and macroeconomic issues.

In addition to channeling sizable voluntary contributions (about US$2 billion each year), the NGOs' advocacy work has been important in increasing foreign assistance flows to the poorest of the poor. The NGOs have learned from field experience that food relief is not the answer to chronic food insecurity. As a consequence, Bread for the World and other NGOs have become champions of assistance targeted directly to the poor Their strong advocacy of peasant agriculture has at times obscured their appreciation of the role that domestic and international markets could play in efficiently providing and stabilizing food supplies. Today awareness is growing that national food self-sufficiency may not, in all cases, be a reasonable goal.

Major Conferences of the 1990s

Recent conferences, including the UNICEF Children's Summit (1990), the Rio Conference on Environment and Development (1992), and the International Conference on Nutrition (1992), all addressed hunger and endorsed recommendations and targets for its elimination or reduction The UNICEF summit introduced new concepts to the dialogue on hunger that included (a) providing services to the very poor, (b) building capacity, and (c) empowering the poor. In particular, the summit recommended disseminating knowledge and support services to increase food production so as to ensure household food security.

The World Declaration on Nutrition, adopted by 159 participating countries at the FAD/WHO International Conference on Nutrition in December 1992, stated that "there is enough food for all and that inequitable access is the main cause [of hunger and malnutrition". Poverty and the lack of education, which are often the effects of underdevelopment, are the primary causes of hunger and malnutrition".

In the opening address of the conference, the secretary-general of the United Nations judged food and nutritional security to be the most crucial issues for world peace and security. He placed nutrition in the forefront of national strategies that put human beings as individuals at the center of the development process The UN's role would be to mobilize international awareness and concern and contribute to technical efforts.

The UN Conference on environment end Development, held in Rio de Janeiro m 1992, highlighted the international concern for sustainable development and environmentally sound management of natural resources According to Agenda 21," which sets out the aims of the conference, sustainable agriculture, characterized by political will; proper economic analysis of environmental impacts; appropriate incentives, such as prices, share rights, and effective participation; Institutional flexibility, and complementary infrastructure, such as transport, storage, credit, and research, are needed to address world hunger.

Chapter 14 of the agenda, which concerns food security, states that increases in food production improve food security only if they are sustainable. Policies to foster sustainable agricultural growth should include provisions that avoid fragmentation of landholdings; develop and transfer appropriate technologies; and improve harvesting, storage, processing, distribution, and marketing Voicing a concern frequently raised by the NGOs, the agenda called for strengthening rural organizations to decentralize decisionmaking Chapter 32 maintains that a farmer-centered approach is key to attaining sustainable agriculture in the developing and industrial countries.

Concluding Remarks

Starvation from natural disasters has virtually disappeared from the face of the earth, although in some countries people still die from hunger because of the actions of ruthless governments. International awareness and efforts have been responsible for the progress made in eliminating outright starvation. Advances in transportation, communications, and mass media have facilitated international responses to famine.

Modern medicine and the effective, hard work of a dedicated cadre of international civil servants and other professionals have made some progress in reducing the prevalence of malnutrition caused by micronutrient insufficiencies, lack of awareness about nutrition, and poor public services and social infrastructure.

However, not enough has been accomplished to reduce undernutrition or chronic hunger. This is not because of a lack of growth in national products or food production In most countries these have grown at the same or higher rates than population, in themselves laudable accomplishments Chronic hunger persists for two reasons Some would place all the blame on lack of political will. Measures to overcome poverty do fail m part because of the inherent resistance to dismantling and rearranging the prevailing legal and economic power structures within a country. But we believe that another important reason for the failure has been the dearth of workable and cost effective ways to reach the poor. Many of the past hunger initiatives failed to confort the problems poor people face with practical and realistic solutions.

Consensus is growing that poverty is hunger's root cause and that governments need to deliver social services to the poor, not only to improve their present Living conditions, but also to empower them to shed their poverty. However, there is much less agreement on the appropriate mix of resources—food, water; land, credit, improved technology, training, markets, and so on-and on how to transfer these resources to enable the poor to augment their ability to acquire or grow the food they need.

The challenge for the international community is to learn new ways of providing assistance, consonant with the decentralization process many countries are undergoing, directly to the very poor. International assistance should be sufficient to combat chronic hunger effectively without waiting for economic development to eradicate poverty.


1. Robert Chen and Robert Kates, "World Food Security: Prospects and Trends, Climate Changes and World Food Security" (Unpublished manuscript, July 1993).

2. Edward Clay and John Borton, "Food Security and Disasters in Africa: A Framework for Action" (Unpublished paper written for the World Bank, June 1991).

3. Clay and Borton, "Food Security and Disasters in Africa.

4. Alan Berg, Malnutrition: What Can Be Done? (Baltimore: Johns Hopkins University Press, 1987), 4.

5. Berg, Malnutrition.

6. Nevin Scrimshaw, Effects of Food and Nutrition Assistance to Developing Countries (Ithaca: Cornell Food and Nutrition Policy Program, 1991).

7. Robert Chen, I. Datt, and Martin Ravallion, Is Poverty Increasing in the Developing World? Policy Research Working Paper no. 1146 (Washington, D C: World Bank). Strictly speaking, the estimates refer to an income criterion. Yet, if income properly reflects changes in real income, these poverty measures are a good estimate of the chronically hungry, because food represents a high share of expenditures.

8. Thomas Weiss and Robert Jordan, The Global Food Conference and Global Problem Soloing (London Praeger Publishers, 1976).

9. Conference Report Resolution XVIII. For most of the decade, the 10 million-ton goal was not achieved, but since 1984 food aid has exceeded the target, reaching nearly 12 million torts in 1992 However, under the Food Aid Convention, donors remained committed to 7.6 million tons.

10 FAO, Report of the Conference of Council of FAO, Twenty-Third Session, November 9-28, 1985 (Rome: TAO, 1985), 35-39.

11. FAO, Report of die Council of FAO, Ninety-Ninth Session, (FAO: Rome, 1991), 21.

12. Shlomo Reutlinger, "Food Insecurity Magnitude and Remedies," World Development 6 (1978): 797-811.

13. World. Food Council, National Food Strategies: To Eradicate Hunger (Rome World Food Council, 1982), .

14. World Food Council, The Cyprus, Initiative against Hunger in the World, WFC19892 (World Food Council: Rome, 1989), 2.

15. Resolution XIII of the conference report.

16. Idriss Jazairy, M. Alamgir, and T. Panuccio, The State of world Rural Poverty (New York: New York Press, 1992).

17. Operations Evaluation Department, Rural Development: World Bank Experience, 1965-86 (Washington D.C.: World Bank, 1988).

18. World Bank, World Development Report 1986 (Washington D.C.: World Bank, 1986).

19. World Bank, Poverty and Hunger: Issues and Options for Food Security in Developing Countries (Washington, D.C.: World Bank, 1986).

20. Gerda Blau, Functions of a World Food Reserve: Scope and Limitations (Rome: FAO, 1956), 5.

21. Amartya Sen, Hunger and Entitlement (Forssa: United Nations University, World institute for Development Economics Research, 1987), 17.

22. Shlomo Reutlinger and Marcelo Selowsky: Malnutrition and Poverty: Magnitude and Policy Options. (Baltimore Johns Hopkins University Press, 1976), 3.

23. World Sank, Poverty and Hunger, 17.

24. World Bank, World Development Report 1990 (Washington, D.C: World Bank, 1990); World Bank, Poverty Reduction Handbook (Washington, D.C: World Bank, 1993).

25. World Bank, The Challenge of Hunger in Africa. A Call to Action (Washington, D.C: World Bank, 1988),.

Selected bibliography.

Anderson, Jock, Robert Herdt, and Grant Scobie 1988. Science and Food: The CGIAR and Its Partners. Washington, D.C. World Bank.

Brown, Lester 1991. Saving the Planet.- How to Shape an Environmentally Sustainable Global Economy New York: Norton Publishers.

Cohen, Mark, ed 1993 Hunger 1994: Transformating the Politics of Hunger. Silver Spring, Md.: Bread for the World.

FAO. 1973 World Food Programme, A Story of Multilateral Aid, 3rd ed. Rome.

FAO. 1979 FAO Principles of Surplus Disposal and Consultative Obligations of Member Nations. Rome.

FAO. 1985 Food Aid for Development: Three Studies Rome.

FAO. 1990. Towards Better Nutrition for All: Preparing for the International Conference on Nutrition Rome.

FAO Committee on World Food Security 1974. "Draft Evaluation of World Cereal Stock Situation." CCCP:GR 74/11. Rome.

FAO Committee on World Food Security 1979 Outcome of the Negotiating Conference for a New International Grains Arrangement: Implications for World Food Security and Proposals for Implementing the International Undertaking CFS: 79/8. Rome.

FAO Committee on World Food Security 1979 Action Taken to Adopt a National Cereal Strategy CFS:79/4 Rome.

FAO Committee on World Food Security 1983. Assessment on the World Food Security Situation and Stock Situation and the Short-Term Outlook CFS 83/2 Rome.

Goreux, L M. 1977 "Compensatory Financing: The Cyclical Pattern of Export Shortfalls" IMF Staff Papers 24 (November):633.

Islam, Nurul 1989 "Undernutrition and Poverty: Magnitude, Pattern and Measures " Paper presented at the World Food Conference, Iowa State University, Ames.

McNerney, J.J. 1978. Developments in International Food Policy. Commonwealth Paper no 9. London: Commonwealth Publishers.

Ravallion, Martin. 1987. Markets and Famines. Oxford: Clarendon Press.

Ravallion, Martin. 1987. 1989 Is undernutrition Responsive to Changes in Incomes? World Bank Working Papers WPS 303. Washington D.C.: World Bank.

Reutlinger, Shlomo, and Pellekaan van Holst 1986. Poverty and Hunger: Issues and Options for Food Security in Developing Countries. Washington D.C: World Bank.

Schiff, Maurice, and Alberto Vald 1990. The Link between Poverty and Malnutrition: A Household Theoretic Approach. World Bank Working Papers WPS 536. Washington, D.C: World Bank.

Sen, Amartya 1977 "Starvation and Exchange Entitlement A General Equilibrium Approach and Its Application to the Great Bengal Famine." Cambridge Journal of Economics 1:33-60.

Sen, Amartya 1977 1981 Poverty and Famines An Essay on Entitlement and Deprivation Oxford: Oxford University Press.

Sen, Amartya 1977 1985. Poverty and Hunger Research Memorandum, no RM-102:1-31. New York: Williams College, Center for Development Economics.

Simon, Arthur 1975. Bread for the World New York: Paulist.

Talbot, floss 1990 "The Four World Food Agencies in Rome " Ph.. D. diss. Iowa State University.

World Food Council 1979 World Food Security for the 1980's: Report by the Executive Director WFC/1979/5 Rome.

World Food Council 1987. Consultation on the Impact of Economic Adjustments on People's Food Security and Nutritional Levels m Developing Countries Thirteenth Ministerial Session in Beijing. WFC/1987/2/Add 1. Rome.

World Food Council 1989 The Cyprus Initiative against Hunger in the World WFC19892. Rome.

World Food Council 1989. The Views of the Non Governmental Organizations as Presented to the World Food Council.

WFC/1989/2(Part II/Add.3) Rome.

WFC 1991. Focusing Development Assistance on Hunger and Poverty Alleviation. Rome.

World Food Programme. 1977. Assessment of Food Aid Requirements and of Food Aid Targets for Cereals Possible Approaches WFP/CFA:3/7-B Rome.

World Food Programme. 1978 Interim Report on the Assessment of Food Aid Requirements Including the Question of Food Aid Targets WFP/CFA 5.5-B Rome.

Appendix 3 - lessons of experience: twelve case studies


The twelve case studies presented in this paper represent only a few of the broad range of public policy interventions available to governments and other actors that could effectively reduce poverty and hunger. Some obvious interventions are not represented here, such as those addressing food insecurity. Many different types of interventions are available to reduce the burden of hunger and poverty; the choice depends on country and regional conditions. The success of the examples cited here illustrates the enormous scope for expanding the use of such interventions globally, particularly employment guarantee schemes, credit and microenterprise programs, nutrition programs for women and children, and food subsidy and food coupon schemes targeted at the poor. Despite the diversity of the examples selected, all the case studies illustrate several basic conditions for success, namely:

· Political awareness and a willingness to commit resources
· Multisectoral collaborations from the ministerial to the district level
· Community participation and ownership of the program.

Obviously, in some areas and some countries these elements play a stronger role than in others. Four important features of successful interventions emerge from these case studies:

· Targeting. The Tunisian food subsidy program and the Maharashtra employment guarantee scheme both underscore the meets of self-targeting mechanisms. In the former, targeting has been achieved by directing subsidies at "inferior goods" that are bought disproportionately by the poor. In the latter, self-targeting occurs because of the manual nature of the work and the low wage rates. In both cases the interventions are designed as a safety net for the very poor. The Honduras food coupon program illustrates how geographical and anthropometric criteria can be used for targeting. In this case, in schools with an incidence of malnutrition of more than 60 percent all mothers automatically receive food coupons.

· Focusing on women. Today development practitioners increasingly accept that in many respects women are the most important actors in improving the health and nutrition of their children, and thus that investments in education' health, and nutrition for women have a strong multiplier effect. Virtually all the case studies show that programs directed at women work effectively, and that women are central players in reducing hunger and poverty. Moreover, far more women than men are below the poverty line. In the rural areas of South Africa, for example, 80 percent of the population live below the poverty line, and of those, 80 percent are women. For this reason, many of the credit and microenterprise schemes focus on providing credit to women, for, example, Freedom from Hunger's credit with education scheme, the Foundation for International Community Assistance village banking program' and the Aga Khan Rural Support Program. High repayment rates, successful development of microenterprises, increases in income and savings, and the social empowerment of women characterize all these projects. Programs do not have to be exclusively focused on women for them to participate fully, as illustrated by the Maharashtra employment guarantee scheme, where between a third and half of the participants are women.

· Achieving sustainability. A major objective of all programs to assist the hungry must be to promote sustainable improvements in income capacity so that poor communities can become more self-reliant In many communities the key to this is providing people with small Loans to purchase productive assets and support microenterprises. A remarkable expansion of village banking is occurring across the developing world, in part inspired by the remarkable achievements of the Grameen Bank in Bangladesh, whose methods are now being replicated elsewhere. This paper cites several other examples. These credit programs show that poor communities can successfully use and repay loans at market rates of credit. Programs can be low-cost and sustainable if they build pragmatically on existing community structures, as illustrated by the international Fund for Agricultural Develop meet's income-generating project for marginal farmers and the landless in Indonesia. A common element is the reliance on the solidarity of small groups, which ensures a high repayment rate. As the Freedom from Hunger credit programs show, village banking can go well beyond the provision of credit to Compass and facilitate a range of public education and community development activities that are mutually reinforcing.

· Doing better with what one has. The case studies illustrating targeted health and nutrition interventions underscore the considerable possibilities for improving families' nutritional status at existing levels of household income or food consumption. This is achieved primarily by reducing the burden of infection, improving feeding and care patterns for infants and young children, and enhancing basic knowledge about nutrition.

The purpose of this paper is merely to be indicative. There is a wealth of experience to draw on. Although few programs have been as rigorously evaluated to determine their cost effectiveness as decision makers might wish, enough has been done to show the way. We hope that the case studies will be an inspiration for new initiatives, but we should remember that the success of any scheme depends largely on adapting a promising design concept to specific local social, political, and cultural circumstances. Experimentation and structured learning from pilot schemes, accompanied by rigorous evaluation and effective dissemination of the findings, must be encouraged.

Indonesia: Economic Growth, Equity, and Hunger

Indonesia's remarkable success in reducing the incidence of hunger and poverty during the past fifteen years stems from policy objectives to ensure that the population at large shared the gains of rapid economic growth.

The Strategy

Between 1976 and 1990, the number of Indonesians in poverty defined as those unable to purchase about 2,100 calories per day and a minimum amount of essential nonfood goods—fell sharply from 54 million (roughly 40 percent of the population) to 27 million, just over 15 percent of the population. These figures reflect success in reducing poverty in both rural and urban areas. The percentage of poor people in rural areas fell from more than 40 percent in 1976 to roughly 14 percent in 1990, and in urban areas from just under 40 percent to about 17 percent. Moreover, since 1978 severe malnutrition among preschool children has fallen substantially.

Development practitioners generally agree that Indonesia's success in reducing hunger and poverty is rooted in the following:

· Policies that have fostered rapid economic growth During the oil boom of the early 1970s the economy grew at an annual rate of more than 11 percent, but growth dropped to roughly 5 percent per year between 1982 and 1987 because of oil shocks and global economic crises. Since the introduction of structural reforms in the late 1980s the economy has grown at an average rate of 75 percent per year. Consequently, per capita income has increased more than tenfold during the past two decades, from US$50 per year in 1967 to US$570 per year in 1990.

The high priority given to increasing agricultural and food output. Not only has agriculture been a prune contributor to the economy's growth— agricultural output grew at an average annual rate of 3.7 percent between 1969 and 1990- but Indonesia's success in keeping food output ahead of the population growth rate of 2.1 percent means that today Indonesia boasts the highest daily calorie supply 2,675 calories per capita per day of all low-income countries. Yet until the late 1970s Indonesia was the world's largest rice importer, spending a quarter of its foreign exchange revenues on rice imports. Rice self-sufficiency was one of the primary goals of the country's economic development plan, and this was successfully achieved in 1985, when rice imports [elf from 2 million tons to only a few thousand tons.

· "Pro poor" policies, such as the heavy subsidies placed on rice for consumers. The government held rice prices constant in real terms for about twelve years, from 1974 to 1986. As a result, with rising incomes rice consumption per person increased by about 30 percent, from 100 kilograms per person per year in the late 1960s to around 145 kilograms in the late 1980s.

This mix of policies has been effective in sharply reducing the number of hungry and poor. Today hunger is concentrated in particularly vulnerable households. Chief among these are households that rely on seasonal wage labor and suffer from shortfalls during the slack period, and poor households that are especially susceptible to hunger during periods of drought other factors that lead to low agricultural output.

Despite the large gains made in raising incomes and reducing hunger, however, infant mortality rates remain high and childhood malnutrition is still widespread This reflects the persistent burden of diarrhea! diseases, acute respiratory infections, malaria, micronutrient deficiencies, and suboptimal breastfeeding and weaning practices. Vitamin A deficiency has been eliminated as a public health problem in all but two of the fifteen provinces, but iron and iodine deficiencies remain widespread. The country infant mortality rate of 64 deaths per 1,000 live births is well above that of other Association of Southeast Asian Nations countries and of such low-income countries as China and Sri Lanka.

Lessons Learned

Indonesia's development policies combining growth, increased food availability, and poverty reduction have been central to the substantial reduction in severe malnutrition However, continuing high rates of moderate and mild malnutrition, both of which have serious developmental implications for young children, and the persistence of micronutrient deficiencies, indicate that economic growth is necessary, but not necessarily sufficient by itself to eliminate malnutrition as a hindrance to development.

Despite its remarkable achievements in recent years, Indonesia still faces huge challenges: it is a low-income country, living conditions need to be improved for the 15 percent of the population that lives below the nationally-defined poverty line, pockets of hunger persist in some regions, and large public investments are needed to improve health and nutrition standards.

El Salvador: Village Banking

In El Salvador, the Foundation for International Community Assistance (FINCA) has been developing an extensive network of village banks since l991. The program has evolved into the largest credit program for the poor in Central America. The village banking network provides small loans to self employed borrowers, 95 percent of whom are women.


The peace process in El Salvador has only just begun after nearly twelve years of civil war. While large portions of the population are excluded from full participation in the national economy, the country cannot aspire to lasting peace Today, tens of thousands of Salvadoran families remain trapped in severe poverty with their children threatened by malnutrition and disease In the aftermath of the civil war, FINCA has sought to build a national credit program that could contribute to the reconstruction of the country.

FINCA is a network of nongovernmental organizations (NGOs) that operate village banking programs in Latin America and Africa.

April 1994 the FINCA network comprised 2,058 village banks worldwide These banks, which are entirely managed by the borrowers, process more than 2.2 million loan payments a year at an average repayment rate of 97 percent.

In El Salvador, FINCA's Centro de Apoyo a la Microempresa (CAM) began its village banking operations in June 1991 with a seven-year grant from the U.S. Agency for International Development. The objective of the village banking program is to provide extremely poor families with self-employment loans ranging from US$50 to US$300 CAM, which is an affiliate of FINCA international, was created as an independent NGO whose board of directors comprises representatives from El Salvador's private sector and local NGOs.


By April 1994, after less than three years of operations, CAM was operating 975 village banks serving 29,550 families, or more than 150,000 people The program has encountered a seemingly limitless demand for village blanking services among poor communities. CAM now offers village banking services in all 14 geographic departments, including 45 of 109 municipalities within the former war zone. It is currently expanding its coverage at a monthly rate of 48 new village banks, or 1,250 borrowers. El Salvador has an estimated 600,000 extremely poor people, and by 1998 CAM aims to provide services to more than 90 percent of them.

In April 1994, CAM's village banking portfolio totaled US$2.7 million, with an average loan size of US$90. The repayment rate was 99.4 percent. Borrowers are charged interest and training fees at a flat monthly rate of 3 percent of the loan. Savings deposits in the village banks amounted to US$1,140,917 At the dose of the first quarter of 1994, CAM was operating at 102 percent self sufficiency.

Program Design

The borrowers' participation in managing the credit system is one of the most important features of FINCA's village bank model. Village banks, whose membership ranges from twenty to fifty individuals, function as autonomous informal credit associations that manage all loan transactions A democratically appointed management committee governs each village bank. At the outset, the membership determines the by-laws for the operation of the bank using guidelines pro vided by FINCA. The bank's members meet weekly to conduct loan transactions, discuss business matters, and give each other moral support. FINCA "promoters" or extension workers visit weekly to provide training to both the management committee and the borrowers and to oversee operations.

Village banks have two sources of capital. The first source is from outside the community. Local FINCA intermediary institutions extend group loans to the village banks in four-month loan cycles. Borrowers make weekly installment payments that are collected at village bank meetings. The installments are calculated as a quota or lump sum that comprises payment on loan principal and interest and a savings deposit. In the case of CAM, the first group loan is equivalent to US$50 multiplied by the number of borrowers. In subsequent loan cycles CAM increases the line of credit to the bank in direct proportion to the accumulated savings deposits.

A village bank's second source of capital is community savings. The membership deter mines how it will use the savings deposits Most village banks decide to keep an emergency reserve and on-lend the balance of their savings to bank members. This practice allows community net savers to finance net borrowers at interest rates that the membership sets. These rates are generally higher than those FINCA charges Savers thus realize a substantial dividend on their deposits.

CAM's delivery system is organized as follows. Each CAM promoter typically services ten village banks Promoters work as members of a field office team. The team services from 60 to 240 banks Regional bank offices, of which four now operate in El Salvador, supervise the field offices. The central office in San Salvador is charged with overseeing management, training, and administrating the flow of funds through the system CAM collects cost and revenue data at each organizational level.


According to CAM sample surveys, most borrowers are single mothers, many of whom lost their husbands in the civil war. A borrower typically supports four or five dependents and has less than three years of education. Most borrowers live in a one-room dwelling without electricty. Water is usually head-carried for distances of up to a kilometer. At the outset of the project, the family income of most participants was less than US$2.33 a day.

According to a recent external evaluation survey of 386 borrowers conducted by the US Agency for International Development, the average increase in sales and income was 160 percent and 145 percent, respectively, among borrowers who had participated in the program for more than one year More than 70 percent of surveyed borrowers reported that they had increased their purchases of medicines and food since joining the program, and 60 percent reported that they were making significant contributions to family decisionmaking.

In the words of Franciscan Rajas, one borrower. "When you have been as poor as I have been, there is a lot of shame. Even when I was a child, people wouldn't look at me I guess they were afraid I would ask them for something I feel safer now I sleep calmly at night because I am not so worried about how to pay back a moneylender. I don't have to prostrate myself to anyone.”

Lessons Learned

Some of the key issues that FINCA faces in developing CAM and other village banking programs can be summarized according to the different organizational levels of its program.

Borrowers. Impact evaluation data show that average village bank borrowers substantially increased their income and empowerment from participation in the program FINCA programs need, however, to analyze better how borrowers can continue to grow The issue of integrating nonfinancial services such as marketing and production assistance needs more scrutiny as the number of borrowers expands and borrowers increase the level of sophistication of their businesses.

Village banks. There are areas where the bank operation model can be improved. Techniques for helping members manage their savings need to be constantly reviewed and refined The evolution of the banks as they mature after several years of operations needs to be more clearly defined so that they can adapt their services to the changing needs of their membership.

Intermediary organizations. The most important challenge FINCA intermediary organizations such as CAM face is balancing their need to promide quality service with their need to expand CAN' experienced the most rapid expansion of services in the history of microenterprise institutions in Latin America Such an expansion places extraordinary pressure on internal management and financial control systems. The growth in CAM's portfolio has sometimes outpaced its development of such systems. CAM's management has now reamed to strike the right balance between expanding its services and introducing adequate systems to support the expansion.

Also, as FINCA intermediary organizations expand, they need to identify new sources of capital at a time when bilateral foreign assistance is decreasing. For this reason, FINCA intermediaries are increasingly accessing loan capital from commercial banks and international financial institutions. FINCA intermediaries need to develop new systems and skills to manage lines of credit from such sources.

West Africa: Credit with Education for Women

Freedom from Hunger's review of formal research studies and program experience shows that a combination of financial resources and nutrition and health education provided to very poor women has the most direct impact on chronic hunger and malnutrition among women and children) Credit with Education is a program strategy designed to provide integrated financial and educational services to bolster the self-help capabilities of women in very poor rural areas. Because of the high levels of food insecurity and malnutrition, most programs supported by Freedom from Hunger are in West Africa.

Program Design

Credit with Education uses a village banking approach, which is a decentralized version of poverty lending well suited to reaching dispersed communities in rural areas. Credit is provided to self-managed credit associations of approximately thirty women as a four-month group loan that can be rolled over and increased in proportion to members' savings The women take out individual loans to carry out income generating activities of their choice to increase their personal and family incomes and savings. Weekly meetings of these credit associations provide a forum to address credit association management, basic microenterprise development problems, and hunger related issues Learning sessions on health and nutrition address five important issues: (a) birth spacing, (b) breast-feeding, (c) infant and child nutrition, (d) management and prevention of diarrhea, and (e) immunizations. Baseline surveys, focus group studies, and the nonformal problem solving techniques used during the weekly learning sessions draw attention to specific barriers to change Field staff provide credit association members with information and counseling as they facilitate problem solving.


In early 1989 Mali became the first field program site in which the Credit with Education strategy was introduced In the last four years, the program has lent approximately US$300,000 to poor village women living in two arrondissements southeast of Bamako, the capital city. In 1991 the program's 99.9 percent loan recovery rate and clientele of more than 1,000 poor rural women convinced the Banque Nationale de Developpment Agricole to provide loan capital to the program at a concissionary interest rate of 6 percent without requiring a reserve fund. As of June 1993, 1,762 members were organized in 65 credit associations with an outstanding loan portfolio of US$51,413 and an average loan size of US$34. The small average loan size reflects the extremely low per capita incomes of the households reached by this program.

Nutritional assessments in the Mali program area indicated a widespread tendency for late introduction of weaning foods and high levels of malnutrition among weaning-age children For this reason, the nonformal health and nutrition learning sessions facilitated at credit association meetings have stressed good infant and child feeding practices, particularly during weaning.

Evaluations of the Mali program have demonstrated a positive impact on the participants' quality of life. Figure 1 provides summary results from a survey conducted in conjunction with an independent evaluation that highlight the program's diverse benefit. Credit Association members indicated that their incomes and savings had increased, that they had learned about the appropriate timing of weaning, and that they were empowered and enjoyed greater bargaining power in their families. Eighty-five percent of the members felt that the health and nutrition of their preschool children had improved.

A Credit with Education program that started in Honduras in 1990 produced similar results Other Freedom from Hunger Credit with Education programs are operating in Bolivia (1990), Burkina Faso (1993), Ghana (1992), and Thailand (1989).

Figure 2 presents survey results using a larger sample conducted by Freedom from Hunger in the Credit with Education program in Thailand Credit association members demonstrated superior knowledge and adoption of steps to prevent and manage diarrhea! episodes. Program participation also seemed to provide some protection during a recent drought, because credit association members were less likely to report a deterioration in their families' diets, and per person weekly food expenditures were greater in members' families than in nonmembers' families despite their comparable socioeconomic status.

In 1993 Freedom from Hunger and the Credit Union Network of Burkina Faso started to replicate and extend the model developed in Mali. Credit with Education is being added to the services provided by existing financial institutions (credit unions) to achieve quick, cost-effective implementations as well as a network for rapid expansion. Figure 3 shows the organizational structure of the programs in Burkina Faso and Mali for comparison. Note that existing financial institutions (not guaranteed by Freedom from Hunger) are the sources of credit for all Credit with Education programs currently operating in West Africa.

Figure 1. Results from the Mali evaluation.

Figure 2. Results from the Thailand survey.

Lessons Learned

Freedom from Hunger is demonstrating that Credit with Education can be scaled up to a high performance level, creating an increasingly self-financing mechanism that cost-effectively serves growing numbers of people. Credit with Education is designed to cover expenses with revenues from the interest and fees collected Table 1 shows the projected expenses and revenues for a single credit union (caisse populaire) in the Credit Union Network in Burkina Faso and the regional office that supports a cluster of credit unions.

Financial self-sufficiency can be achieved using realistic growth scenarios for the number of credit associations and borrowers, the volume of loans, the service fees collected, and the costs of operating the program. Projections indicate that each participating credit association will become self-financing within four years and that each regional office will cover its costs with in six years. Similar projections for the Mali program show much slower approach to self-financing, reflecting the difference between working with an NGO focused solely on delivering Credit with Education versus a financial institution that adds Credit with Education to its services.

The self-financing feature of the Burkina Faso program allows the Credit Union Network (and its funding partners) to start up Credit; with Education in many credit unions around the country without accumulating a massive fiscal burden. By becoming financially self-sufficient, each field unit relieves the regional office and the central office of the responsibility for endless funding of recurrent costs.

Pakistan: The Aga Khan Rural Support Program and the Empowerment of Rural Women.

The mountainous northern regions of Pakistan, populated by about 1 million people, are climatically extreme, ecologically fragile, and scarce in natural resources. The population is of mixed ethnic and religious origin and speaks a variety of languages, ranging from Wakhi, an archaic Iranian dialect, to Balti, a Tibetan dialect. The people of the region are farmers who depend on glacial melt to irrigate their small fields carved out of the mountainsides. Until the 1970s the region was ruled by small, princely states that survived largely by levying taxes on the farmers or on caravans traveling the Silk Route.

Figure 3. Credit with education partnerships in Burkina Faso and Mali.


In 1982, a time when the old social order was in disarray, the Aga Khan Rural Support Program (AKRSP) was established in northern Pakistan The AKRSP's objective was to file the institutional vacuum created by the dissolution of dozens of tiny states by mobilizing rural populations into village level organizations These have since been instrumental in helping communities plan their own development Today the AKRSP has almost 3,000 village and women's organizations in its program area, covering a population of more than 90,000.

For the women of northern Pakistan, the AKRSP has changed their lives significantly The women of the region have a difficult life, bearing up to 10 children, often working harder than the men both on and off the farm, and with only 3 out of every 100 being able to read and write Women's lives revolve either around the household or the village. Cultural constraints prevent women from being able to sell produce in the region's few markets or from owning property Consequently, they have little power in making decisions pertaining to land use and financial resources.

The AKRSP's aim is not only to help women increase their agricultural and related production, but, perhaps more important, to enable them to realize their strengths and capacities by participating in women's organizations. Members of the 600 women's organizations feel that the AKRSP's most significant contribution has been the saving program initiated for women Having their own money has increased their status, and has led to increased personal pride and power.

Village women form women's organizations to save money and to learn skills from the AKRSP in agriculture and related fields. The program's provision of agricultural and livestock inputs has led to improvements in women's nutritional status as well as in their incomes. In northern Pakistan women's diets depend not only on the seasonal availability of food, but also on cultural practices prevalent in the region Although women are responsible for all activities related to food, they are also the last to eat meals, having served the children and men first Food taboos for women are common Women are often anemic because of frequent child bearing, and a large percentage of women consume Less that 70 percent of the recommended daily nutrition requirement The opening up of the region to the rest of the country through the Karakoram Highway and the resultant expansion of local markets has also meant that farmers place more emphasis on selling produce than on producing the food necessary.

Table 1 Burkina Faso Credit with Education program, financial summary and six-year projections at two organizational levels, fiscal 1994 -99.


Fiscal 1994

Fiscal 1995

Fiscal 1996

Fiscal 1997

Fiscal 1998

Fiscal 1999

Caisse Populaire

Total credit associations







Total borrowers







Loans made each year







Loans outstanding end of year






728, 130

Interest income







total costs







Net surplus(deficit)







Expenses covered by income

0 06






Cost per dollar lent







Total caisses populaires







Total credit associations







Total borrowers







Loans made each year







Loans outstanding, end of year

37,1 16






Interest income







Total costs







Net surplus deficit







Expenses covered by income




0 57



Cost per dollar lent







Source: Freedom from the data. for a balanced diet This reflects both women's lack of knowledge about nutrition and the pressure they face in meeting household requirements through their incomes.

Two major activities that the AKRSP emphasized are training women in vegetable cultivation and poultry rearing, including the provision of improved inputs. In the past ten years the cultivated land area has increased a total of 6 percent, with an increase of more than 100 percent in the amount of land under vegetable cultivation The land has been developed by the construction of water channels built by the village organizations.

Poultry rearing is also a traditional women's activity and is increasingly becoming the region's main source of meat Women's organization members have been trained in poultry disease control and improved management practices. Ten years ago the average number of poultry birds per farm was 5 1. During the past ten years this number has increased to 12.3, representing an increase of 141 percent.

One of the most significant changes in the lives of members of women's organizations is that they are now eating many more varieties of vegetables and consuming more poultry products than they were ten years ago. Whereas they only used to grow two vegetable varieties, they now grow more than fifteen types of vegetables. Similarly, the increase in the number of poultry birds has meant that they are consuming more than double the amount of poultry and eggs.

Impact statistics do not capture the essence of the AKRSP's message and its success, which is a result of the strength of the women's organizations There are simpler and perhaps more efficient ways to increase consumption and improve nutrition. However, the AKRSP's investment is not only in vegetable seeds or in poultry birds, but in the 600 women's organizations of northern Pakistan. More than 10,000 village specialists trained by the AKRSP are independently providing services to villagers, with more than 90 percent of them being paid by the villagers themselves Women have set up poultry enterprises and are contributing to the education and improved health of their children through increased household incomes They hold regular meetings of their organizations and they are saving money. Real per capita incomes of the region show a 94 percent increase since the inception of the program compared to 26 percent for the rest of Pakistan. Over the year's the women's organizations have saved PRs 19 million. Today women are much more involved in making decisions relating to land use and the allocation of financial resources. They are realizing their strength by being members of women's organizations and experiencing significant personal and collective growth.

Illustrative of the change in society’s attitude toward women are the shifting distinctions and boundaries in occupations traditionally viewed as male The transfer of accounting skills to women and the fact that women are managing the affairs of their organizations are positive signs of their enhanced capabilities and their potential to plan for their own development.

Lessons Learned

The change in the status of women in traditional areas such as northern Pakistan is not rapid. The program has encountered resistance by men to the concept of organizing women into strong and vocal groups The women's organizations of northern Pakistan still have a long way to go before they develop capacities that will enable them to make decisions completely independently of men. Income generation has been the first step toward women's empowerment. In most women's organizations participants are using their money for productive activities, and are thus increasing their capital However, women are also demonstrating an increasing awareness of investments in the social sector and are paying for education and health services for their daughters.

The large village-level network of community based development organizations has lent a form of cohesion to activities undertaken by the villages of northern Pakistan. Villagers' increased capacity to design and implement their plans in a democratic manner has been the strength of these organizations. The "development partnership" that the AKRSP offered to the people of northern Pakistan leas given them the confidence to tackle many of their problems on their own The goal must be to invest in building up the capacities of poor communities. Then village organizations will be able to carry on the process.

Indonesia: Rural Credit for Marginal Farmers and the Landless

The objective of the Rural Credit for Marginal Farmers and the Landless Project is to increase the incomes of the rural poor in six provinces of Indonesia It is also intended to provide the rural poor with a mechanism and institutional framework for accessing available government and other services, such as the agricultural extension system and the formal rural banking sector, by organizing them into groups.

After three years' operation, the project has succeeded in the following.

· Increasing the incomes of the poor by 41 to 54 percent.

Training and building up groups to enable them to gain access to credit, services, and the means for self-reliant development.

· Forging an institutional structure capable of continuing the poverty alleviation program on a cost-effective and sustainable basis

· Linking groups of the poor to a bank with a wide network of rural branches and providing credit on terms that are both replicable and sustainable

· Providing a cost-effective model, methodology, and institutional framework for poverty alleviation that can be replicated nationwide

· Increasing the beneficiaries' empowerment, confidence, and self-reliance.

Roughly 2,000 villages from 53 districts in the 6 provinces were selected to participate in the project More than 15,00{) groups of the poor have been formed with an average membership of 10 or 11 households each, which amounts to a total of 160,000 families in just three years. Given the project's strong performance, it is likely to meet its target of forming 32,750 groups within the next two years, covering around 327,500 households or approximately 2 million rural poor people.

Project Design and Implementation

The project's aim is to form small groups that are socioeconomically homogenous. These are used as focal points for training, credit, and income generating activities It has been successful in creating relatively strong groups with internal dynamics and personalities of their own. Most women were found to prefer women's groups to mixed groups.

Thus, while the project had envisaged that 20 percent of ale groups would be women's groups, in practice the figure is 35 percent.

Above all the project has succeeded in targeting the poor Rigorous targeting of the beneficiaries has been undertaken to ensure that no household with an income equivalent of more than 320 kilograms of rice per person per year (the poverty yardstick) is included. This is verified by a survey of preselected poor villages and households. These screening processes have succeeded in identifying the poor, although not always the most severely impoverished.

The project's intent was that group members should undertake one common income-generating activity, although up to three are allowed. Although this has raised practical difficulties in some Locations, working together on a common enterprise has induced greater group confidence and cohesion, and has facilitated economies of scale in input supply, production, and marketing The members of 83 percent of the groups undertook a common activity, but carried it out on an individual household basis, while the remaining 17 percent of groups used their access to credit for joint enterprises Many of the groups also undertook social service activities as a group, which has advanced their standing in their communities.

The project has also been effective in training both beneficiaries and project staff Field-level extension workers train the beneficiaries in the skills they need to manage their groups and microenterprises, while the extension workers are themselves specially trained for this purpose The mid-term evaluation of the project found that the training was quite strong in all fields except nonfarm, microenterprise development, in which the field-level extension workers lack expertise.

Another major factor accounting for the project's success is its institutional foundation The field-level extension workers set up the groups and train them, while their parent agency, the Ministry of Agriculture, is responsible for project management At present, only 21 percent of the extension workers in the project locations have been drawn into project work, and they are supposed to devote only 30 percent of their time to such activities. This decision to base project staffing on the pattern of an existing agency with a vast field network (Indonesia has more than :30,000 field-level extension workers) implies that project activities can be expanded and replicated at relatively low cost. Moreover, as project credit is provided through the normal banking system, project expansion or replication is unlikely to face any great costs or difficulties.

Project Impact

An important achievement of the has been its ability to instill a sense of self-reliance among the members of poor rural groups and to demonstrate their creditworthiness. They have already accumulated Rp 700 million in compulsory savings. Moreover, all of them have accumulated additional voluntary savings totaling more than Rp 300 million.

Credit is provided by the Bank Rakyrat Indonesia, the largest rural bank in the country As the executing bank, it lends to the groups without demanding collateral at the near-market rate of 21.15 percent per year. Lending packages and procedures have been tailored to the poor, while staff have been trained by the project for banking with the poor The repayment rate of 99-5 percent (after three loan cycles) makes this the most successful credit program in the country, if not the region.

The groups and individual beneficiaries are given assistance in microenterprise development to boost their economic activities. Here the results have been mixed. While many groups have set up profitable enterprises, especially in trading, agroprocessing, and handicrafts, many are still stagnating in low-paying activities such as fattening livestock One reason for this is that the field-level extension workers trained in agriculture are not equipped to help the groups with their nonfarm activities. Another obvious reason is the difficulty of finding profitable nonfarm income learning activities in poor rural areas with an undifferentiated economy.

Of the groups receiving credit, 367 have formed associations This two-tier system seems to evolve more naturally in areas with high concentrations of the poor, where many groups are formed in a single village, as m West and East Java and on the island of Lombok. The main reason for the emergence of the associations seems to be to implement particular activities that exceed the capacity of the groups Such functions fall into three main categories: (a) financial intermediation, (b) purchase and supply of inputs, and (c) marketing Despite their recent origin (all of them are less than one or two years old), the success of these associations, especially in the field of financial intermediation, has been impressive. For example, many of the associations collect the loan repayments of their member groups in advance and re-lend the funds to members mainly as short-term loans at interest rates of up to 5 percent per month, chiefly for petty trading. This has resulted in high rates of profit and savings. Thus the Association Sinar Harapan in Lombok—in existence for only one year—has already generated internal savings of more than Rp 1,088,500, and through profits from loans for petty trading has accumulated a fund of Rp 2.5 million For reasons of institutional viability and economies of scale, these associations may well develop into the main service organizations of the poor, providing the institutional base for credit, for services, and for self help activities.

In heavily populated poor villages, where in some cases more than 90 groups have been formed in a single village, each with a membership of more than 1,000 people, the social and institutional impact on the community is bound to be strong over time, especially in those villages where associations have been formed. Thus, the project may be said to be empowering the rural poor to a significant extent.

In terms of its socio-psychological impact, the beneficiaries claim that for the first time they are recognized by the community, are approached rather than overlooked by local government functionaries, and, most important, feel that they can improve their lives through their own efforts as a group The individual and group saving of the poor have helped to give them this greater sense of confidence as well as collateral for credit in the future. Indeed, the Bank Rakyat Indonesia has confirmed that it would be prepared to continue lending to the groups without collateral (at market rates of interest) even after the project was over.

The project envisaged that credit would be disbursed only for activities approved in the group business plans. However, in practice the loans have been used to finance a number of other small income generating activities, and even for consumption purposes. The beneficiaries have also been using their second and third loans to additional new activities, thereby adding to and diversifying their income streams. Although loan repayments are being made in full and on time, they do not necessarily originate from the activity financed by the loan. Thus in practice the project is financing a portfolio of activities by the poor (including consumption), but with excellent results in terms of credit repayment and increased incomes. Consequently, the project may switch to portfolio lending for the poor based on their actual cash flow and their 99.5 percent loan repayment rate.

Similarly, project credit has tended to flow mainly into nonfarm- or nonland-based enterprises, mainly because the beneficiaries have little or no land. When credit is targeted to the rural poor, they will inevitably channel the funds to those activities that are the most feasible and profitable for them Hence, when the poor are accurately targeted, the credit activities also seem to be automatically targeted. In this case, 97 percent of the activities financed by project credit are of a nonfarm nature (We have included livestock rearing by the landless, with the livestock fed from fodder cut from the commons, and the few cases of sea fisheries as nonfarm activities ).

Some 82 percent of the groups claimed that they had increased the volume of their production as a result of project credit, while 65 percent said that the quality of their production had improved In some cases these changes were accompanied by diversification, differentiation, expansion, and modernization of production. Moreover, 79 percent of the groups noted indirect effects on production through improved input supply and marketing There are also some cases of a change in production relations. Many respondents stated that whereas prior to the project they had been wage laborers, they were now' self-employed.

Given the difficulties in measuring improvements in income, the data reported here must be viewed as a rough approximation. The midterm evaluation estimated income increases per household at 41 to 54 percent This is a significant increase considering that project credit has only been available for three years. The extent of the increase in incomes has varied according to the different locations.

With regard to institutions, the project has had a profound impact at three levels:

· The project has pioneered an essential institutional building block for poverty alleviation programs in Indonesia at a time when government interest in such programs is high by means of its creation of groups of the rural poor

· The project has shown that an agricultural extension agency can, with some training, provide a widespread institutional network to sustain a countrywide poverty alleviation program. This also implies that the program can be doubled or tripled at short notice, and at little additional cost.

· The project has had an institutional effect on the largest rural bank in the country, which has changed its attitudes toward and rules and procedures for lending to groups of the poor, and has now accepted that lending to the poor at market rates of interest is both feasible and profitable.

Concerning the project's economic sustainability, many of the microenterprises are still at a stage of low productivity, but many others are profitable and have obtained access to higher levels of technology and higher value markets. It is in the area of microenterprise development, however, that the project still has a long way to go. Other technical resources will have to be brought in to ensure better performance in this field.

With respect to financial sustainability, the cost per beneficiary is estimated at only US$1 per month. This cost will decrease as the number of groups increases and they become more self-sustaining The estimate excludes credit costs, but given that credit is to be at market rates of interest (at the conclusion of the project), this will not pose a financial problem for replication or sustainability.

As a result of the groups' excellent credit performance, the executing bank is now prepared to expand credit to groups of the poor in other areas on the same terms. It is also prepared, m the future, to continue providing credit to the groups (without collateral) at the market rate of interest prevailing at that time Credit should, therefore, he sustainable, because the poor have proved that they can operate under these conditions.

Lessons Learned

The project's organizers learned a number of valuable lessons First, it is possible, and indeed necessary, to organize the poor into groups to help themselves and receive services. Second, these groups can be financed by providing credit without the need for expensive handouts Third, the poor are creditworthy and have a better repayment record than other credit recipients, and therefore credit is sustainable Fourth, existing institutional structures can be used to provide a low-cost and effective means to organize and train the poor Finally, the means are available to make such a program of poverty and hunger alleviation relatively cost effective, replicable, and sustainable.

India: Maharashtra Employment Guarantee Scheme

Among developing countries, the best known and by many accounts the most successful example of direct public efforts to reduce absolute poverty in rural areas is the Employment Guarantee Scheme (EGS) in the Indian state of Maharashtra.


Initiated in response to the severe drought in Maharashtra in 1972-73, since the mid-1970s the EGS has aimed at providing unskilled rural employment on demand, as embodied in its slogan magel tyala kam (whoever asks for work will get it) EGS projects create or maintain rural infrastructure through small-scale irrigation, soil conservation, reforestation, and rural road building. Wages are set in the form of piece rates stipulated for a number of specific tasks, such as digging, breaking rocks, shifting earth, and transplanting.

Given the attention it has received in development policy debates, it is surprising that the common perception of the EGS as a successful poverty alleviation program is backed up by relatively little careful research The basis for this perception is perhaps to be found in several distinctive and promising features of the scheme as described in the following paragraphs.

First, the scale of the EGS is impressive: average monthly participation during 1975 89 was about 500,000 people. In an average year during the latter half of the 1980s, at a cost of about US$1 per day, it provided about 130 million person days of employment in a state with a rural work force including cultivators- of about 20 million (see table 2) Another notable achievement is that with the exception of the last few years, the scheme's scale has been sustained for nearly two decades. Since 1990, the EGS has been substantially reorganized to focus on integrated development at the village level It is also being coordinated with other programs on watershed development, horticulture, and well construction. However, little is known about the effects of these recent changes, and this account refers mostly to the period up to about 1990.

Second, EGS projects are designed to be highly intensive in their use of unskilled labor. Labor costs have typically accounted for more than two thirds of variable costs, even higher than the stipulated minimum of 60 percent (see box 1).

Third, the EGS has also been an important avenue of employment for women Their share in total participation has ranged from about one third to a half, with a median of about 40 percent Several factors have contributed to this, including the close proximity of work sites to villages, the provision of basic child care (often employing an elderly woman from among the participants), and the fact that EGS piece rates do not discriminate between the genders (although differentials in time wages remain because of differences in the type of work and because women often work fewer hours than men).

Fourth, and perhaps We most striking feature or the EGS is its guarantee of employment, although the legal guarantee is restricted to the provision of unskilled manual work within the district (see box 2). The district covers a large area: apart from Greater Bombay, Maharashira has twenty-nine districts with an average area of about 10,000 square kilometers. In general though, the EGS has sought to locate work sites within the same panchayat samrti area (typically a small cluster of contiguous villages).

Table 2. Summary data on the EGS, 1978/79-1990/91.


Employment (millions of person cloys)

Share of female labor attendance (percent)

cost per person day (RS at 1990-91 prices)

Share of wages in total costs (percent)



















































1988 89















- Not available

a Refers to the financial year, April to March.

Source: Compiled from monthly progress reports on the EGS published by the Planning Department of the Government of Maharashtra. Bombay. .

Finally, the employment guarantee is closely linked with another attractive feature of the EGS, namely, its ability to operate as a self-targeting scheme. This avoids the costly, and in some instances infeasible, alternative of means testing. Self-targeted schemes work on the general principle that the benefits net of costs of participation are such that only the poor would wish to participate. In the EGS self targeting works by combining a low wage rate and a manual work requirement. Breaking rocks or performing similar physical labor for a low wage is unlikely to be attractive to anyone but the poor.

Impact: The EGS and Poverty Alleviation

Since the mid-1970s absolute poverty in Maharashtra has declined more rapidly than in India as a whole. While this may be consistent with expectations, how much of the decline in poverty in Maharashtra can be attributed to th. EGS is not known. The critical issue in assessing the performance of the EGS is its cost effectiveness in alleviating poverty- relative to alternative policies supported by the same gross budget. Even within the narrow dimension of income or consumption poverty, this is a difficult question and one that the literature has not addressed adequately. However, some evidence is available.

Box 1. How the EGS works: the main provisions

All adults living in villages and small municipal towns of Maharashira arc guaranteed employment under the EGS The guarantee is only for unskilled manual work within the district. Transport facilities or expenses are to be provided if the worker must travel more than 8 kilometers There is also provision for on-site facilities such as potable water, creches, and first-aid.

Those looking for employment must register for work under the EGS with the locally designated official. Employment is to be provided within fifteen days of demand, failing which the state is obligated to pay a nominal unemployment allowance New works can be started at the authorization of the district collector if at least fifty laborers become available [or work and they cannot be absorbed by any ongoing works.

With the exception of some canal works involving rock cutting, EGS works arc required to have an unskilled wage component of at least 60 percent.

The EGS is financed in large part through a number of special taxes levied mainly on the urban sector, including a professions tax, an additional tax on motor vehicles, an additional tax on sales tax, a surcharge on land revenue, a tax on irrigated agricultural land, and a tax on nonresidential urban lands and buildings Additional funding comes from a matching contribution by the state government equal to the net collection from the special taxes

Box 2 Does the EGS guarantee employment?

The statutory guarantee is for unskilled manual work within the district. At the district level the guarantee has probably been honored, but given the size of most districts, this does not imply that EGS employment is necessarily accessible to all those who need it More challenging for the EGS is to accommodate the demand for locally accessible employment, for which travel costs (pecuniary and nonpecuniary) are not prohibitive. One cannot assume that this Stronger, and ultimately more meaningful, form of guarantee has always been met Indeed, there are several documented instances of laborers' organizations having to agitate (with varying success) for the initiation of EGS projects in specific areas.

In recent years the guarantee aspect seems to have come under particular pressure This is in the context of the doubling of the piece rates paid by the EGS in May 1988 in line with a doubling of statutory minimum wage rates in agriculture During the year following the wage increase, employment actually fell by about one-third, even one might have expected higher wages to draw more laborers to the EGS Careful econometric modeling of monthly labor attendance during the preceding thirteen years revealed that contrary to official claims, the good crop year of 1988-89 accounted for only a small fraction of the fall in employment More than 80 percent of the decline could be attributed to the rationing of EGS employment, and in the twelve months following the wage increase the EGS met only two fifths of the demand for local employment. Statutory wage increases can be politically attractive, but without an accompanying commitment of the necessary budgetary resources to sustain assured employment, they may not be in the interests of the poor.

For a detailed discussion see Martin Ravallion, Gaurav Datt, and Shubham Chaudhuri "Does Maharashtra's Employment Guarantee Scheme Guarantee Employment? Effects of the 1988 Wage Increase," Economic Development and Cultural Change 41 (2) (1993).

The poverty alleviation impact of the EGS depends on (a) the scheme's success in screening the poor from the nonpoor among potential participants (targeting), (b) the size and distribution of net income gains to the participants, and (c) indirect benefits.

Self-targeting. Recent evidence on the scheme's performance in reaching the rural poor is available from the National Sample Survey for 1987-88 The survey asked whether or not anyone in the household had participated in a rural public works project (mainly, but not restricted to, the EGS) for sixty days or more in the last year, and asked a similar question about participation during the previous five years in the Integrated Rural Development Programme, a scheme of subsidized credit targeted to the poor on the basis of an income means test Figure 4 plots participation in public works and the credit program against consumption per person Consistent with previous information about the EGS, it shows that participation in rural public works in Maharashtra tends to be greatest for the poor. Self-targeting seems to work for the EGS (while the means-tested credit program is strikingly untargeted).

Net income gains to participating households. Net income gains to participating households are more difficult to measure than the scheme's targeting performance Foregone income is the main cost involved, which may be significant even in situations of relatively high unemployment. It depends on how participation in the EGS displaces other more or less productive household activities. Evidence from a detailed study of two villages in the Sholapur and Akola districts of Maharashtra found that foregone incomes are positive, although quite low. The bulk of the displacement in time allocation is in unemployment for men and leisure or domestic work for women. The net gains to participants represented about the-quarters of their gross wage receipts. Factoring in other costs, notably materials and supervision, the study found that about half of the gross budget disbursement directly reaches the participants, most of whom would be deemed poor by any reasonable standard. However, the impact on poverty is no greater than what could be expected from the same gross budget disbursed as uniform (untargeted) cash handouts to all households .

Indirect benefits. The evidence cited above suggests that in the case of the ESG poverty alleviation depends on the indirect benefits The same study cited above estimates that indirect benefits equal to about 40 percent of cost, if uniformly distributed across all households, would be enough to tilt the scale in favor of the public works scheme over untargeted uniform transfers Thus, conventional benefit-to-cost ratios well below unity would still ensure that the EGS was relatively cost-effective in alleviating poverty.

The two most important sources of indirect benefits from the EGS are through asset creation and induced effects on agricultural wages Since its inception until March 1991, a staggering total of 195,000 EGS works had been completed To date their benefits have not been systematically quantified. A 1980 study by the Programme Evaluation Organization of the Planning Commission, Government of India, and the Directorate of Economics and Statistics, Government of Maharashtra, did provide some information about a range of benefits from the assets created by sixty-six completed works spread over four districts of Maharashtra It listed a total of 2,051 households, or 31 households per completed work, who benefited in different ways from EGS assets, including 1,427 households who reported an increase in their farm production, 335 who repaid outstanding loans, and 558 who were able to create new assets from increased earnings. The study also reported an enhancement of the employment potential of the area around the completed works, with farming households reporting greater use of both family and hired labor. It is, however, difficult to say how far these findings can be generalized (see box 3).

Figure 4. Participation in public works versus subsidized credit programs, Maharashtra, 1987-88.

During the mid-1970s to the mid-1980s, the real wages of agricultural laborers in Maharashtra increased substantially, with increases ranging from 50 to more than 100 percent depending; on the region Again, how much of this can be attributed to the EGS is not known However, even if the EGS's contribution was relatively small, the overall benefits could be enormous, because a wage increase benefits not just the 500,000 EGS participants, but the entire work force of 8 million agricultural laborers. Note that maintaining the scheme's guarantee aspect is an important factor in the realization of these benefits: assured employment allows workers to make credible threats during wage bargaining in local labor markets.

Stabilization benefits. The EGS can claim a certain measure of success in stabilizing the incomes and consumption of the poor, both within a year and across good and bad years. The evidence here is indirect, and is based mainly on the pattern of labor attendance at EGS projects (figure 5) First, EGS attendance seems to be responsive to the seasonally of labor demand in agriculture. Monthly labor attendance typically peaks during March to May and is at its lowest during September to November. This is consistent with Maharashtra's crop calendar The major food crops (jowar, rice, bajra) are grown in the kharif (monsoon) season, with sowing in June to August and harvesting in October to December. Even the rabi (post-rainy season) food crops (sown in September through November and cotton, the principal nonfood crop (sown in June. through September), are harvested by about March.

Similarly, some evidence indicates that EGS attendance responds positively to shocks in the agricultural sector. For example, during 1979 80, when Maharashtra was hit with a drought in the central and western (Madhya Maharashtra and Marathwada) region end later a flood in the eastern (Vidharbha) region, labor attendance increased sharply. The same happened during 1985 87, when drought conditions led to a roughly 30 percent drop in food grain output.

Lessons Learned

Despite its popularity, the EGS remains controvelal in some respects. The scheme has often been criticized, with some justification, for creating low-productivity assets with poor subsequent maintenance and little complementary investment Some people also argue that while the EGS provides short-term income supplements to the rural poor, it has not unproved their long-term income earning capacity to the extent at they no longer need the EGS. According to this view, a truly successful EGS should have been self-liquidating. Several considerations are relevant when assessing the merits of this argument First, there is scattered evidence of long-term income gains in some areas. Also, the success of the EGS needs to be judged against alternative antipoverty programs or policies. In general, targeted poverty alleviation programs cannot substitute for a sustained broadly based growth process, but they can often be a useful component of an overall development strategy to help the poor. In that context, there will arguably he scope for public works employment programs such as the EGS, particularly in a settings of surplus labor, unstable incomes, and poor infrastructure.

Box 3. Induced income effects of EGS assets: Ralegaon Shindi.

One of the best known examples of induced income gains from the EGS is that of Ralegaon Shindi, a village in the drought prone district of Ahmandagar in central Maharashtra. In this village, EGS funds (supplemented with other public funds) have been successfully used to harness scarce water and to develop social forestry. As a result, the village harvests two or three crops a year and has enough wood or biomass fuel. Ralegaon Shindi claims to have eradicated unemployment, and the EGS is no longer needed in this village.

Source Sarthi Acharya, The Maharashtra Employment Guarantee Scheme: A Case Study of Labor Market Intervention (New Delhi: International Labour Office, Asian Regional Team for Employment Promotion, 1990).

Figure 5. Average monthly attendance at EGS projects, 1975-89 .

Tunisia: From Universal Food Subsidies to a Self-Targeted Program

Through the Caisse Grale de Compensation (CGC), the Tunisian government has subsidized the consumption of basic foodstuffs and a variety of other items since 1970 The benefits have been available to anyone who chooses to purchase subsidized commodities in whatever quantity they desire.


While CGC subsidies made a substantial contribution to the level of consumption by the poor, by the 1980s it was apparent that the universal subsidy program had become too costly for the government. The government was faced with a common policy dilemma in reforming its universal subsidy program how to reduce budgetary costs in a politically acceptable way while protecting the poor. A central theme of the Tunisian reform program, which was introduced into the Eighth Development Plan (1991-96), has been its reliance on existing institutions. Rather than switching to an entirely different method of transferring income to the poor, the government has sought to fine-tune the existing framework of price subsidies by shifting subsidies to those food products that are primarily consumed by lower income groups. With this approach, a type of self-targeting, subsidized products are still available to all, but the subsidized commodities selected are of the kind that the rich choose not to consume For a summary of the program and selected indicators, see table 3.

Impact of the Universal Subsidy Program

Since its inception, the central objectives of the CGC subsidy program have been to redistribute income in favor of the poor and to purchasing power and nutritional status of low-income groups. To some extent, the universal subsidy program succeeded in meeting these goals. It was progressive in relative terms, contributing some five times more to the purchasing, power of the poor than of the rich as a share of total expenditures. This is not surprising because the bulk of CGC subsidies were on food products that generally constitute a larger share of total spending by lower-income groups than by the more well-to-do. Indeed, subsidies on food items covered by the program have been very important to the poor. In 1990 they contributed more than 11 percent to the total expenditures of the lowest income group. More than 74 percent of total caloric intake by the poor and close to 44 percent of their protein consumption were derived from subsidized products.

Despite these benefits, by the mid-1980s it was clear that the universal subsidy program was inefficient and costly. It was inefficient because it subsidized a broad range of products available to all Tunisians regardless of need. The wealthiest income group actually benefited twice as much from the program as the poorest income group in absolute (per capita) terms. The program was costly because it claimed a large share of government resources: by 1984 outlays on subsidies hovered at around 4 percent of GDP and 10 percent of total government expenditures.

Alternative of Reform

The program's high and rising costs combined with inefficiencies and substantial leakages to the nonpoor made an overhaul of the universal subsidy system an urgent priority. In the early 1980s Tunisian policymakers began exploring ways to reform the program. An initial attempt to reduce the CGC's budgetary costs was made at that time, and subsidies on several food items were eliminated, effectively doubling their prices. However, the violent riots that erupted in response to these efforts forced officials to rescind the measures and delayed the adoption of significant reforms until the end of the decade.

Rather than eliminating the transfers, which was no longer politically feasible, or continuing with the costly existing program of universal pro vision, Tunisian policymakers examined several alternatives for better targeting of transfers to the poor. In practice, correctly identifying eligible people can be difficult because of incomplete information about individuals' economic status This problem has plagued assistance programs begun in Tunisia in 1986 to ease the pressures of structural adjustment on the poor. These programs rely on individual assessment (means testing) to screen potential beneficiaries. However, administration of these programs has proved to be difficult and eligibility Lists are rarely updated. As a result, the direct assistance programs have suffered from substantial leakages to the nonpoor and have excluded eligible beneficiaries. For these reasons the Tunisian government has not considered individual assessment schemes, such as food stamps, to be feasible replacements for the food subsidy program.

The government has also explored other targeting approaches, but these have not proved to be suitable for reforming the food subsidy program either. For example, the authorities rejected geographic targeting, because in many areas distinctions between neighborhoods are too obscure to make it effective.

Reform Program: From Universal Subsidies to Self-Targeting

Given political, economic, and administrative constraints, reforms that reduce costs and improve the equity of subsidies are obviously preferable to those requiring an entirely new institutional structure. In this context, a reform program was incorporated into the Eighth Development Plan (1991-96) with the primary goal of reducing CGC expenditures while protecting lower-income groups The primary components of the reform program include (a) improving the targeting of the CGC intervention, (b) adjusting prices gradually to reduce and eliminate subsidies on certain product and (c) reducing unnecessary production and distribution costs for subsidized products.

Table 3. consumer subsidy reform and selected indicators, selected years.

A particularly innovative aspect of the Tunisian reform program is its reliance on self-selection mechanisms to improve the targeting of subsidies. Self-targeting occurs when benefits are available to all, but the program is specifically designed so that the nonpoor elect not to participate. While other targeted programs require some sort of explicit screening mechanism (such as individual or group assessment) to determine eligibility, with self-targeting the decision to participate is made by individuals themselves rather than by social workers or other government agents.

The principal device used to promote self-targeting in Tunisia is quality differentiation Designing a self-targeted food subsidy program using quality grading involves examining household expenditure data to determine whether significant differences exist in consumption across income groups. If the poor consume a different basket of goods than higher-income groups, this basket can be targeted for subsidies. Using existing survey data to identify goods for subsidies allows self-targeted programs to economize on information costs by avoiding the cumbersome task of assessing individuals' income levels to determine eligibility. In practice, however, consumption patterns may not differ significantly across income groups. This does not mean that self-targeting is not feasible, but that it may require some creativity to invent "inferior" subsidized goods that are unattractive to higher-income groups and to encourage unsubsidized high quality alternatives to siphon off demand by the rich.

As a first step in improving the targeting accuracy of the Tunisian program, the government eliminated subsidies on goods clearly consumed disproportionately by the rich Efforts were then extended further to include two additional methods of self-targeting in the cereals, milk, cooking oil, and sugar subsectors.

The first method, the superior goods approach, involves easing government controls to allow the private sector to market high quality, unsubsidized products that appeal to high-income consumers as alternatives to their subsidized counterparts In general, the quality of the subsidized products is reasonable, but not exceptional. Because markets have been tightly controlled by state marketing boards in the past, the subsidized product has often been the only quality available on the market. To reduce subsidy costs while maintaining benefits to the poor, the authorities have liberalized the sale of higher quality versions of these goods, which are sold at cost-and are bought by wealthier consumers, who then consume less of the subsidized products.

The second method for extending self-targeting, a variation of the inferior goods approach, involves differentiating goods within a particular product line through different types of packaging and the use of generic ingredients. The products packaged in the lowest quality cartons or containing generic ingredients are subsidized. These perceived inferior features discourage consumption by upper-income groups, although the intrinsic quality of the subsidized products remains good.

Impact of the Reform

The two mutually reinforcing techniques for self-targeting described above have been successfully implemented in Tunisia. Data on CGC spending indicate that the reforms have reduced costs significantly outlays on the subsidy program were cut from over 4 percept of GDP and close to 10 percent of government expenditures in 1990 to 2 and 6 percent, respectively, in 1993 While data for an extensive quantitative assessment are not yet available, anecdotal evidence suggests that the rich are indeed shifting consumption toward superior goods in each subsector, whereas the inferior goods created under the reform program appear to be well targeted toward the poor (To analyze the results of self-targeting efforts more rigorously, data are being collected in a small scale survey currently under way in Tunisia and the results will be available in an upcoming study.) Despite these evident successes, analyzing the impact of price increases on lower-income groups reveals mixed results: simulations show that any increase in the real prices of subsidized goods has an adverse effect on the welfare and nutritional intake of the poor Targeted price adjustments, which reduce or eliminate subsidies on products consigned disproportionated) by the rich, dampen these effects. However, price increases on such products still hurt the poor because even these goods are consumed to some extent by low-income groups. This dilemma reflects a genuine tension between the goal of reducing the CGC program's budgetary costs and that of protecting the poor.

Lessons Learned

Political considerations, imperfect information, and the importance of food subsidies to poor limit the tools available to Tunisian policymakers in reforming the universal subsidy program. The three pronged reform program adopted by the Tunisian authorities makes use of available information and existing institutions developed by the universal subsidy system This approach has also proved to be a politically acceptable way to cut budgetary expenditures while protecting the consumption of the poor. While the results of the reform efforts since 1991 are impressive, particularly their successful reduction of budgetary costs, there is still scope to improve the effectiveness of the reform program.

Self-targeting. Self-targeting efforts in Tunisia should be reinforced Liberalizing government controls on superior goods and allowing unsubsidized goods to enter the market through private channels to siphon off the demand of wealthier consumers should tee intensified in all subsectors The inferior goods approach should also be strengthened by further tailoring the selection of subsidized goods to the consumption patterns of the poor.

Price increases. In general, price increases should be gradual, but should at least keep pace with inflation to control budgetary costs. These increases should be focused on goods consumed disproportionately by higher-income groups. While targeted price increases are not as detrimental as indiscriminate subsidy cuts, the government needs to pay close attention to their impact on the poor. It should simultaneously introduce compensating measures where feasible.

Data requirements and monitoring. The information necessary to design a self-targeted subsidy program includes household expenditure data. The government should seek to collect this information regularly to monitor the progress of the ongoing reform program. This could be done using frequent small-scale surveys as opposed to the larger, five-year surveys currently being used. In addition, marketing studies that consumer acceptance of self-targeted products should be conducted prior to widespread introduction of new targeted goods Moreover, policymakers should seek to establish an explicit, consistent definition of the target group, and then coordinate monitoring of the standard of living of this group.

The Tunisian case provides a useful example for other countries that are contemplating similar reforms, but that are concerned about the practicalities of implementing self-targeting reforms Note that Tunisia's self-targeting efforts are part of a reform program. Self-targeting via quality differentiation is appropriate in Tunisia precisely because a system of food price subsidies was already in place. The aims of the self-targeting component are to modify existing institutions to reduce leakages to the nonpoor, to cut the scope of the program, and to protect the welfare and consumption of the poor. Self-targeting may not be suitable in cases where the institutional framework of food subsidies did not previously exist In cases where self-targeting does seem appropriate, the technicalities of the program, such as the particular quality features of the targeted products, are likely to be specific to the region or country in question The Tunisian experience offers an example of one way in which such reforms were implemented, and provides the information necessary to design an effective self-targeting reform program.

Honduras: Food Coupons

Widespread poverty in Honduras was aggravated during the economic crisis of the late 1980s, resulting in a significant increase in the incidence of undernutrition, particularly among young children The proportion of children under five years of age exhibiting symptoms of severe and moderate malnutrition increased from 38 percent in 1987 to 46 percent in 1990 according to the Ministry of Health's national health survey Chronic malnutrition (stunting or low height-forage) among school-age children averaged 40 percent in 1986 Nutrition deficiencies among poor pregnant women was a factor behind the hi&in incidence of infant mortality (50 per 1,000), low birth weights, and high rates of maternal mortality that reached 221 per 100,000 in 1991.

The traditional nutrition assistance programs that existed in Honduras prior to the creation of the Family Assistance Program (PRAF) involved distributing food though various channels. All these traditional programs carried high overhead costs and suffered from serious logistical problems. Limited coverage and faulty targeting contributed to their failure to reach those most in need. Weaknesses in their education efforts included failing to communicate adequately information about breastfeeding, weaning practices, or adequate diets for children and women. Neither did they provide incentives for the poor to use existing health care and education facilities Reliable evaluations of program outcomes were not conducted, and a policy framework for integrating and consolidating nutrition assistance efforts was missing.

To address these issues, the government decided to test a new strategy of income transfers in the form of food coupons targeted to the most vulnerable groups. It created the Family Assistance Program in July 1990 to expand the coverage of nutrition assistance while improving targeting and reducing the administrative costs of program implementation Operated initially through the primary school system in the poorest departments, the authorities introduced a pilot program in 1991 to test delivery of food coupons through the basic health network The pilot program proved effective, and implementation of an expanded PRAF program with improved targeting and parallel strengthening of preventive health care and primary education services began in early 1993.


Under the first PRAF food coupon program (Women Head of Household Coupon Program) coupons are distributed through the schools to poor mothers and their children attending grades one through three in primary school and shown to be at risk of malnutrition. Expansion of this program covers children entering the first grade of primary school at risk of malnutrition as identified by the annual nutrition census (height/age). In addition, at participating schools where the results of the annual nutrition census show an incidence of malnutrition equal to or higher than 60 percent, all first graders become beneficiaries of the program The food coupon, distributed three times a year, is equivalent to US$37 per year, and is estimated to cover 20 percent of the value of the individual food basket of the beneficiaries. As of October 1993, approximately 205,000 mothers and children were benefiting from this program in eight departments. To maintain eligibility, children have to attend school.

The coupons for the Maternal Child Coupon Program are administered through health centers targeted to low-income children under five and pregnant and lactating mothers. This program currently benefits approximately 104,000 poor mothers and children in ten departments. The program provides coupons every month equivalent to US$45 per year for each eligible child and mother. The intervention is concentrated on the earliest stages of infancy and childhood, and includes assistance to pregnant women to improve the chances of reaching children before malnutrition causes permanent damage To maintain eligibility, beneficiaries must meet health surveillance requirements Together with the coupon, beneficiaries receive information on breastfeeding, weaning practices, and adequate diets for women and children Intensive supervision at both coupon delivery sites ensures against leakage to noneligible individuals.

The private sector is involved in all stages of the program with the commercial banking network participating directly by distributing coupons and redemining them from local merchants Local merchants participate by accepting the coupons in payment for food and other basic goods. Successful communication about the program has resulted in dose to 100 percent acceptance of coupons by merchants. Potential problems of corruption on the part of shopkeepers have been avoided by the willingness of local commercial banks to redeem coupons directly, leaving no room for merchants to demand "servicing fees" for redemption of the coupons against goods.

Beneficiaries can redeem the food coupons through commercial establishments (including private banks) within four months of their issue, with redemption not contingent upon the purchase of food In practice, beneficiaries use the bulk of the coupons (88 percent) at local stores to purchase food, and spend the remainder on essential items such as school supplies, shoes for their children, and medicine Commercial banks redeem the coupons at the Central Bank of Honduras. Used coupons are canceled at the Controller's Office The authorities have not adjusted the coupons' face value because inflation rates have declined, but they reviewed this issue in early 1994, and plan to make an adjustment in 1995 The costs of using health care staff and primary school teachers for distributing coupons to the beneficiaries has not been systematically measured, but the PRAF intends to do this as part of its monitoring and evaluation activities.

PRAF's food coupon expenditures amounted to US$7.2 million equivalent in 1992, including 3.4 percent administrative costs. These costs are lower than those programs that distribute food in-kind generally incur. PRAF's success in reaching target groups has convinced the government that the food coupon program should be continued over the medium term.

Program Impact

An evaluation of the pilot experiments indicated that the program was cost-effective in alleviating poverty and was more efficient than other nutrition assistance programs There is widespread acceptance and support of the program by beneficiaries, implementing agencies, participating retailers, and banks, leading other donor agencies to consider monetizing existing in-kind food aid programs as they reach their completion, particularly as the food coupon programs have not had inflationary effects.

In addition, the PRAF program provides its beneficiaries with incentives to use preventive health services and primary schools Enrollment in participating primary schools rose by 12 percent, while the number of consultations at participating health centers increased by 131 percent during 199091.

Lessons Learned

The key elements contributing to the PRAF's success are (a) the use of coupons as opposed to in kind nutrition assistance; (b) the simple and standardized eligibility criteria for beneficiary selection, (c) the high frequency of coupon distribution (in the case of the Bono Materno Infantil Program), which increases the probability of coupon use to purchase food; (d) the simple coordinating mechanisms between PRAF the Central Bank, private banks, the Ministry of Health, the Ministry of Education, and merchants; (e) the annual recertification of beneficiaries, that is, the existence of clear exit criteria; and (f) the direct linkage with primary health and primary education services.

Chile: Targeting and Decentralizing Health and Nutrition Programs

Ensuring that subsidies and services meant for the poor actually reach them and are not diverted to the less needy requires a constant effort Targeting and decentralizing programs to alleviate poverty is essential to make the most of scarce resources, butts an extraordinarily complex institutional, administrative, and political task Existing programs and institutions often have to be restructured, complex legal issues have to be addressed, and targeting and decentralization faces considerable resistance from powerful groups that in the past have captured much of the subsidies.

Chile's innovative reforms in the social sector during the 1980s and early 1990s in education, health and nutrition, housing, and social security—represent a success story of effective, well-targeted reforms that have broad and relevant lessons for other countries These reforms have produced record gains in social indicators such as life expectancy, nutrition, infant and child mortality rates, and birth weights.


From 1960 to 1991, Chile's infant mortality rate fell from 1195 to 146 per 1,000 live births; the child mortality rate dropped from 9 1 per 1,000 to only 0 8; the percentage of low birth weight new barns declined to 5.7 percent, a decease of around 45 percent since 1976; and life expectancy at birth increased by more than 13 years, a world record gain. The greatest reduction in infant and maternal mortality has taken place in poorer rural areas, where mortality rates were the highest The decline was achieved by improving access to health services, potable water, and sewage disposal systems.

This remarkable improvement in social indicators in Chile during the last three decades occurred in a highly unstable and difficult economic situation for the country as a whole. As shown in table 4, GDP growth was highly unstable, even negative, in some years, unemployment was high during the early 1980s; inflation was extraordinarily high during the early 1970s; and government real expenditures on health programs declined. Given these circumstances, why did the social indicators continue to improve at rates even faster than in the past?

Chile a long history of combined health and food distribution programs, the most important of which are the Complementary Feeding Program (CFP), the School E ceding Program, and the Day Care Food and Education Program The food distribution programs that gave birth to the CFP started as early as 1936 with the distribution of milk to children from birth to age two . Since then, the CFP has constituted an important part of Chile's welfare system, lasting through many different political regimes The reason why these programs have survived numerous and radically different political regimes is that they were initiated to ameliorate malnutrition from a technical perspective, and were not perceived as part of the political platform of a specific party. Since their initiation both government analysts and university academics have participated in the debate about the design and implementation of the health and nutrition programs.

Table 4. Growth rates in GDP and government spending, 1970-90.

Government expenditure

Growth in GDP per capital

Unemployment rate


Health Social of 1988





(millions expenditures dollars)

(as percentage of GDP)(b).















1 5.8


















1 5.0














































































— Not available

a. October through December each year.

b. Social expenditures include health social welfare social security education, regional development and housing

Source Central Bank of Chile.

With the creation of Chile's National Health System in 1952, the authorities redefined the food distribution programs, integrated them with the provision of health services, and expanded the CFP to coyer children under six and pregnant and lactating women. As a result, the entry point into the integrated health and nutrition programs was during pregnancy, and continued until the child was six years old. In primary school, the school lunch program provides on-site food rations for lowincome school children linked to school attendance.

The main objectives of the redefined CFP were to prevent malnutrition among the most vulnerable groups and to promote health through regular visits to health clinics, immunization, and education on the use of health services among low-income families. Food distribution involved not lust providing tree food, but was used as a device to attract beneficiaries to health and nutrition services This was accomplished by channeling the distribution of milk through health clinics and rural health posts.

Because the food distribution program was conditional on the beneficiaries having regular health check-ups, this required a nationwide infrastructure of health clinics to meet the increased demand for preventative and curative services. Consequently, during the 1960s the government expanded its investments in physical as well as human resources.

Reform of the Social Services' Delivery System

During the 1970s the government reoriented its efforts to improve the targeting of health services and food distribution to the needy To increase efficiency in the provision of services, service delivery was decentralized to the local level (municipalities), and the responsibility for manufacturing milk products was transferred to the private sector. In this way, the government was able to expand and improve primary health services, giving priority to mothers and children of low-income households, and to expand coverage in rural areas. Better food presentation was emphasized, and industries that produced the milk for the program were required to sell the same product they sold m the supermarkets, thereby eliminating the image of "a product for the poor" For the preschool population (children age two to six), the authorities. introduced milk-cereal mixtures instead of powdered milk to increase the children's intake of vitamins and minerals, diminish food leakages within the family, and use cheaper raw materials (for example, soybeans). Finally, as a preventive measure, in 1983 the government initiated a reinforced program that provides additional food and more frequent health care for low-weight pregnant women, undernourished children, and those nutritionally at risk. A scale that measures weight increments is used to identify the children nutritionally at risk.

Tables 5, 6, and 7 present various quantitative indicators on coverage and government expenditures on health and nutrition programs. Table 5 shows coverage and the implicit income transfer from the three principal programs, table 6 presents the annual cost per beneficiary of the same programs, and table 7 shows the coverage of potable water and sewerage services.

In October 1993, based on the results of a recent evaluation of the criteria for targeting the reinforced program (see table 6 for an explanation), the program directors decided to use weight-forage and weight-for-height as key indicators in defining the target population. These changes are expected to reduce the population participating in the reinforced program by some 30 to 40 percent This result shows the need for constant review of the targeting criteria and the operation of the health and nutrition programs, so that adjustments can be made in accordance with the current situation and are not historically based.

Some Features Underlying the Social Reforms

A common principle underlying the orientation of social reforms in Chile during the 1980s was that government spending should subsidize the demand for and not the supply of social services. That is, subsidies should be given directly to beneficiaries rather than to providers, and should be given in the form of direct subsidies (vouchers) rather than indirect subsidies (such as subsidizing the price of commodities).

Decentralizing service provision was another Important component of the reforms based on the view that municipalities and the private sector rather than the central government should provide social services Local governments or institutions are closer to the beneficiaries, resulting in improved quality of services, better targeted programs, increased enrollment of low-income households, and more effective administration.

The authorities gave high priority to the development of an effective information system, which was seen as key for planning the reforms and introducing targeting One of the main instruments for targeting social programs was the poverty map, prepared in 1974, and later complemented by a living standards measurement instrument called the Committee for Social Action Index System The latter has become a useful tool to help the local authorities (municipalities) identify the target population for a wide variety of social assistance programs, such as subsidies for housing and pension assistance.

The CFP uses health and nutrition information gathered monthly at the health clinics to make decisions at the local, regional, and central levels. The regularity of the information permits the local staff to assess health and nutrition trends, thereby permitting timely modifications of ongoing programs and assessments of the short-term needs for a new intervention.

Table 5. Coverage and implicit income transfer from the principal food distribution programs Implicit income transfers.



Implicit income transfer as a percentage of household income

Complementary Feeding Program

71% of total population under 6'

16% for the poorest decile
6.7% for the second poorest decile

School Feeding Program

80% of the expenditure allocate to poorest quintiles the program covers
52% of the children in quintile 1 and
26% In quintile 2(b)

32.0% for the poorest decile
13.3% for the second poorest decile.

Day Care Food and Education Program

40.000 children in the two poorest quintiles in 1978 and 72.000 in 1991.

—Not available

a. Actual coverage by the public health system is 78 percent of the population between one and less than two years old and 70 percept of the population between two and five.

b. Of children attending primary school in urban and rural areas.

Source: Isabel Vial, Rosa Cahmi and Carlos Castilo and Isabel Vial and Antonio Infante, From Platitudes co Practice: Targeting Social Programs In Latin America, ed. M. Grosh (Washington, D.C: World Bank, 1992);.

Table 6. Annual cost per beneficiary for the basic and reinforced CFP and the school feeding program, 1990 (U.S. dollars).


Bask CFP

Reinforced CFP

Children age 0-< 1



Children age 1-<2



Children age 2-5



Pregnant women











Table 7. Coverage d urban and rural potable water and sewage services, selected years (percentage of all household).


Urban Potable water


Rural potable water






1 2





















— Not available

Source: Secretario de Desamollo y Asistencia Social. .

Another information system designed to measure the redistributive impact of social spending is the Living Standards Measurement Survey, a comprehensive national household survey, that contains information on all the subsidies programs the government currently runs. It covers a representative sample or approximately 20,000 households at was first obtained in 1985 and subsequently studied in 1987, 1990, and 1992. These surveys have provided reliable information on the efficiency of the targeting in the various programs, presenting information an the subsidies the different income groups have received, and allowing planners to make corrections where needed.

Developing the informations systems has been costly, and at the beginning they represented an additional burden for the municipalities, particularly during the first stages of the decentralization process However, because of technical advances and strengthened institutional capacity, the local governments have been able to improve the systems while decreasing their costs.

Aside from the issue of targeting, an important current issue concerning social programs in Chile is how to reorient the subsidies from the supply side to the demand side and the extent to which this should be done. This is particularly complex in the provision of health, where a large percentage of the target population depends on a centralized national health system Discussions are currently oriented to the design of mixed service provision, whereby the beneficiary will be allowed to select where to seek service, which will be paid (totally or partly depending on the beneficiary's income level) directly to the institution providing the service.

A major reason for the effectiveness of the government's social programs is the presence of a leading institution for policy change Chile's National Planning Office, which took the leadership role in designing the implementation of the economic and social principles and policies applied by the new government Such leadership included developing methodologies for cost effectiveness analysis to be followed by all public agencies and designing and implementing an information system for targeting social assistance programs Targeting to the poor and improving the coordination of social projects implies the use of two types of information systems: one to identity beneficiaries and the other to evaluate the social programs. The latter is a key instrument for designing policy and for establishing priority needs and programs.

Another important feature of the reforms has been the training of senior and mid-level officials. The authorities achieved this by creating a scholarship program to send students abroad to study in several disciplines and by developing well designed training programs in Chile. They also provinced training to municipal officials of the twelve regions. the result was a core of well professionals, distributed nationwide, that facilitated the governments preparation, planning and implementation of the reforms.

Lesson Learned

In summary the main lessons that have emerged from Chile's experience are as follows:

· Strong leadership is needed that can articulate a clear set of objectives and a strategy. To achieve the objectives requires a solid blend of economics and technical skills so as to be able to communicate effectively with the government's economic team. For effective targeting the government must be able to identify and capitalize on the complementarities among the various programs

· The design and implementation of targeting takes time. Decentralization and "municipalization" requires legal changes and budgetary adjustments. Efficiency and equity problems cannot be resolved with quick, superficial fixes. Instead they often require large institutional changes that result in new roles for central government bureaucracies and changes in the way social services are financed and operated

· In primary health care, the authorities should emphasize linking maternal and child health programs with growth monitoring and food supplementation measures, paying special attention to the group at risk. These interventions, coupled with a significant increase in the coverage of potable water and sewage handling facilities, were key factors behind Chile's record declines in infant mortality and morbidity, undernutrition, and maternal mortality.

· Continuity in the reform process is important. Chile's success is a result of strong government commitment to overcome setbacks and pressure exerted by interest groups Reforms are difficult and in Chile's case required considerable negotiation, trial and error, and corrections.

· Targeting of social programs and decentralizing their implementation is bound to raise strong resistance among those currently employed by the system and will probably involve higher fiscal costs in the short term Some employees will be made redundant; others will be asked to relocate; and many will become employees of a municipality, facing an uncertain future with a totally new set of employers at the local level. The government might have to pay for early retirement by many employees and for the relocation costs of others

· Local institutions like municipalities and the private sector can play a significant role in poverty alleviation strategies by providing health and nutrition services in coordination with other programs. This will avoid the duplication of programs and benefits.

· Two types of information systems are needed for targeting and for improving the coordination of social projects, one to identify beneficiaries and another to monitor the impact of social programs. The latter is key for designing policy and for establishing priority groups and programs.

Zimbabwe From Relief Feeding to Food Production

Zimbabwe, while able to show improvements in children's nutritional status since the 1980s despite economic setbacks and drought, remains a country with unacceptably high levels of stunting (low height-for-age) This is particularly disappointing given its earlier status as a food exporter in normal agricultural years Factors contributing to the continued levels of malnutrition include individual household poverty, seasonal food shortages and concomitant preharvest increases in infectious disease, a decline in per capita maize production, heavy work loads for women, lack of exclusive breast-feeding among infants six months and younger, and lack of knowledge about optimal feeding patterns for young children.

In response, two of Zimbabwe's most important nutrition initiatives have been the national Children's Supplementary Feeding Program (CSFP) and the Community Food and Nutrition Program (CFNP) The government started the Children's Supplementary Feeding Program in 1981 to provide emergency relief to children in drought prone areas. The CSFP attempted to avoid some of the dependency-creating aspects of most supplementary feeding programs by using locally grown food and including nutrition education. In an even larger step in this direction, the phasing out of the CSFP and its replacement by a program designed to enhance local growing of the supplementary foods, the CFNP (originally called the Supplementary Food Production Program), was started by 1982. However, during the 1992 drought the authorities reinstated the CSFP on a much larger scale than before.

Children's Supplementary Feeding Program

The CSFP was a cooperative effort between governmental and nongovernmental agencies operating under the umbrella and direction of the Ministry of Health A national working group was set up with representatives from relevant ministries and voluntary organizations. In the provinces the provincial medical officers of health set up committees with intersectoral representation from within the Ministry of Health (for example, environmental health, health education, maternal and child health, nursing, and nutrition) and other relevant sectors, such as lands, agriculture, and water development, and NGOs operating in the area. At the district and village levels, the CSFP relies heavily on community participation, with local committees composed of health workers, school teachers, community development workers, and women's advisors. Parents in the villages where feeding points are established select a feeding point communittee to run the program, with the committee responsible for developing a duty roster to ensure that feeding occurs on a daily basis an that the work load is shared During the 1992 drought the authorities developed a manual to enable extension workers (particularly village health workers) to help the community implement the program.

Implementation. Following the selection of high-need areas based on a variety of nutrition surveillance data, one- to five-year-olds are chosen for supplementary feeding using mid-upper arm circumference measurements (circumference of less than 13 centimeters). Meals are based on local foods—maize meal, beans, groundnuts, and oil—and are planned so as to provide approximately one-half of the daily energy requirements of the one to two-year-olds and one-third of the daily energy needs of the three to five-year-olds. The cost per beneficiary per month is approximately US$1.45.

During the 1992 drought, the country was divided into three zones based on clinical malnutrition and crop forecast data. This categorization facilitated the early targeting of assistance resources to the most needy areas. The program rapidly reached more than 1 million beneficiaries because of the existence of CSFP intersectoral committees at the national, provincial, and district levels. The authorities further streamlined the work of these committees by establishing a task force of relevant ministers under the chairmanship of the vice president and creating a full time secretariat to oversee the day-to-day running of the program. Six working groups were established to facilitate program planning and implementation that were responsible for the following activities: (a) nutrition program monitoring and evaluation; (b) training; (c) community mobilization; (d) information, education, and communication; (e) procurement and resource mobilization; and (f) transport and logistics.

Impact. Evaluation of the feeding program in 1981 documented a weight gain by children in the program twice that of children in a control group, and with children that obtained thirty or more supplementary meals having a threefold weight increase when compared to their contemporaries. Perhaps more important, the number of [amities who stated their desire to grow groundnuts for home consumption in the following agricultural season almost doubled, from 45 to 80 percent of families In addition, the establishment of the Community Food and Nutrition Program minimized growth faltering after the feeding program was terminated.

More recent evaluation of the program's impact during the 1992 drought indicated that while the incidence of malnutrition in children under five increased in 1992, six months after the feeding program began the levels of malnutrition had decreased in all the provinces. In October 1992, 2 percent of children had severe malnutrition and 5 to 7 percent had moderate malnutrition based upon mid upper arm circumference measurements. When the survey was repeated in April 1993, a non drought year, the levels remained the same. More than 70 percent of children under five were receiving supplementary meals at the time of the second survey.

Among the strengths of the program is its progression from a focus on relief efforts to an emphasis on education, along with its capacity to reach even the most remote areas and feed children at, or dose to, their homes Structurally, (he flexibility of building upon grassroots organizations at the district level provided the greatest degree of personal commitment and management responsiveness.

Lessons Learned

Experience with the CSFP demonstrated that the following program elements are required to Implement emergency relief activities successfully:

· Ensuring political commitment and being willing to mobilize resources
· Implementing intersectoral collaboration and coordination using existing structures.

Encouraging community participation in and ownership of the program.

Providing clearly defined program implementation guidelines and training and orientation for all key implementors at all levels.

· Instituting appropriate collection and use of food security and nutrition status data for targeting purposes

· Incorporating community coping strategies into future preparedness plans

· Recognizing the crucial role of village community workers in mobilization, program implementation, community training and program monitoring

· Communicating the basic message about local availability of food commodities for providing children with adequate nutrition.

Community Food and Nutrition Program

The authorities implemented the CFNP to address chronic malnutrition by mobilizing villagers to grow nutritious foods (groundnuts, beans, and vegetables) in community gardens and rain fed plots or by raising poultry or rabbits in areas where water is a constraint In many cases, projects are linked to day care, growth monitoring, and special feeding sessions for children identified as malnourished The authorities have initiaded more than 3,000 CFNP projects, with 10 to 200 participants per project.

The CFNP effectively makes more land available to the poorest farmers and places them in working contact with more successful farmers for the transfer of fanning techniques The government extension service is attracted to the community plots because working with existing cohesive groups is efficient Community decision making and collective self-reliance are two primary foci of the program, with the long-term objective being to develop a village - level capacity to identify and correct the causes of malnutrition, particularly among children age five and younger.

Program Management

A major emphasis of the program has been close attention to project management. Chaired by the Ministry of Agriculture Extension Service, the intersectoral National Steering Committee for Food and Nutrition provides leadership for the program At provincial, district, and ward levels, similarly composed food and nutrition management committees are responsible for managing the program At all but the national level, these committees have been institutionalized as development subcommittees, and serve as an entry point for placing nutrition on the development agenda, at least in the provinces.

These committees have run well because of an early definition of the roles of each sector in the program A management handbook describes these agreed roles, and is used as the basic tool for intersectoral training of the committees As it is now viewed as an integral part of each sector's work plans, the CFNP does not disrupt other duties At the ward level, contact with villages is maintained through a nutrition coordinator.

No development committee exists at the national level, although the State Planning Agency may eventually fulfill this role In the meantime, the National Steering Committee for Food and Nutrition lacks executive powers and must depend upon the good will of each sectoral ministry and the personal commitment of the committee members.

Project Implementation

The authorities use data from clinic-based nutrition surveillance (weight-for-age) and other nutrition surveys and reports and information from other sectors to identity communities with high levels of malnutrition and poor household food security. Extension workers discuss the situation with the leadership of each community and explain the program's objectives and how the villagers can actively participate in addressing malnutrition. The community, with the technical advice of the agricultural extension worker, decides on the project it wishes to undertake. The request for inputs is transmitted through the district to the province.

Families in the village work together to produce food communally, primarily to be fed to children under five. The production package consists of groundnuts and beans for rainfed plot and gardens and small stock The families appoint a committee that plans the work roster and manages the group's activities. Parents organize the group feeding of children under five in the project and those referred by the clinic or outreach sites five times a week.

The key messages communicated to project participants are as follows:

· The importance of food preparation, hygiene, and storage.

· The importance of using energy dense food m each meal.

· The group feeding meal is a supplement to, not a substitute for, other meals provided at home.

· The child needs to be fed at least four times a day with cereals, beans, groundnuts, oil, and vegetables.

· The mother should continue breast-feeding until the child is at least eighteen months old.

· The child should be fed during illness.

· The child with diarrhea should be given salt and sugar solution and continue to be fed

· The child should eat from his or her own separate plate.

The child should be weighed regularly to assess growth The nutrition education messages are integrated into the training of all extension workers at the village level, and they are expected to relay this message to project members within the context of their sectoral activities Practical demonstrations have been encouraged as the best method of education.

An ongoing monitoring system is in place, with standardized assessment forms completed for each project that contain detailed information, including the number of recipients, the types of projects, and so on Each province submits quarterly and annual progress reports that are the basis for the disbursement of funds.


A 1989 evaluation of the previous four-year period found significant progress in developing a management system, in raising awareness of nutrition issues at all levels, and in securing community support for and participation in projects.

Further achievements of the program include the following:

· Increased awareness of the potential role of sectors other than health in alleviating malnutrition.

· Greater involvement by staff in key development sectors such as agriculture in Zimbabwe's nutrition programs.

· Enhanced integration of nutrition issues in other development activities. For example, the Water Development Program systematically promotes small-scale gardens at primary water points in rural areas, and the Agricultural Department is incorporating basic food requirements for a family of six in its land use planning exercise

· Heightened appreciation by key policy makers of the need for a national food and nutrition policy to institutionalize intersectoral coordination and collaboration.

· Increased promotion of community awardness of food and nutrition problems and the potential for addressing them using local resources and limited external assistance.

· Strengthened community self-reliance and reduced dependence on direct food aid.

India: Tamil Nadu Integrated Nutrition Project

If hunger is the worst consequence of poverty and malnutrition is the worst consequence of hunger, then according to Lipton the fight against poverty is "first and foremost a fight against nutritional risk." Projects that address hunger therefore have to steer resources to the very poor, avoiding trickle up, and ensure that their extra income is converted into calories for those at risk of malnutrition. The Maharashtra Employment Guarantee Scheme described earlier is one of the best examples of a project designed to do both However, income gains reaching the poorest families may still fail to raise the calorie intake of the two groups most vulnerable to nutritional stress: children under two and pregnant and breast feeding women The Tamil Nadu Integrated Nutrition Project (TINP) typifies a highly targeted effort to reach those in the vulnerable groups at demonstrable risk of malnutrition.

Tamil Nadu's poor nutritional profile is not commensurate with its relatively better position among Indian states in respect of many other indicators of development. Although the state has comparatively lower birth and infant mortality rates and a higher literacy rate, it is among the worst off states in terms of average calorie consumption (table 8).

In the late 1970s about twenty-five different nutrition programs were operating in Tamil Nadu at an annual cost of Rs 162 million (approximately US$15 million). However, fewer than 10 percent of the groups identified as the most vulnerable were actually receiving benefits from these programs. The reasons for the programs' limited success are as follows:

They did not reach the intended beneficiaries because feeding was done on a drop-m basis rather than aimed at those who were identified as being at risk.

Most programs did not cater adequately to the nutritionally most needy group, those under three years of age.

· The food distributed tended to substitute for rather than supplement food normally consumed at home.

· Family members usually shared take-home rations, thereby diluting the impact on the intended beneficiary.

· Most programs placed little emphasis on nutrition education even though food habits were a major determinant of nutrition status in Tamil Nadu, particularly of children being weaned, whose growth faltered dramatically across all income groups.

· Existing maternal and child health services were inadequate.

Thus the government's main concern was to design a program that would avoid these common pitfalls of nutrition programs. The large numbers to be covered and the potential difficulties of broad intersectoral collaboration necessary for a large project were daunting Project activities were confined finally to those components the government thought were likely to have the greatest impact on nutrition status: health services and nutrition education with a core of nutrition services, including growth monitoring and selective nutrition supplementation.

Project Goals

The TINP’s overall goal was to improve the nutrition and health status of preschool children, especially those under three, and of pregnant and nursing women Its objective was a 50 percent reduction in the prevalence of severe and moderate protein-energy malnutrition, estimated at about 60 percent among preschool children. In addition, the project aimed to reduce the infant mortality rate (then 125 per 1,000 live births) by 25 percent, reduce the proportion of children under five showing signs of vitamin A deficiency from about 27 to 5 percent, reduce the prevalence of nutritional anaemia among pregnant and nursing women from about 55 to 20 percent, and increase the provision of antenatal services and trained attendance at deliveries from about 50 to 80 percent.

Project Coverage

The TINP covered about 40 percent of the state's rural population, 17 million people living in 10 of the state's 22 districts. After an initial year-long trial in one block (an administrative unit with a population of about 100,000 people), the project expanded at the rate of 35 blocks per year to cover a total of 173 blocks at the end of five years. A community nutrition center housed in a rented dwelling was opened in every village of approximately 1,500 persons. A total of 9,000 such centers were opened, each staffed by a community nutrition worker and a helper. They were responsible for monitoring growth; selecting children for feeding; distributing the nutrition supplements; organizing people to participate in health activities; and providing nutrition education through demonstrations, house visits, and the organization of women's groups.

Table 8. indicators for selected states, venous years


Birth rate, 1989 (births per 1,000 people)

Infant mortality rate, 1990
(deaths per 1,000 live birth)

Female literacy rate, 1991

Annual per capita income 1987 (Rs)

Daily pen capita calorie intake 1988 (kcal)

Andhra Pradesh






















2, 71






1 .983


Tamil Nadu





1,910 .

Nutrition Services.

Nutrition services, the core of the project, centered around monthly growth monitoring of children. Short-term supplementary feeding was provided for those found to be malnourished, those showing signs of growth faltering, and selected pregnant and nursing women. All children under three received deworming medicines and a mega dose (200,000 international units) of vitamin A twice a year Daily iron folate tablets were provided to pregnant women for three months. Intensive counseling was given to mothers to improve the home care and feeding of children. Education on the home-based management of diarrhea with fluids and feeding was an important component of the nutrition strategy.

Children were enrolled in the supplementary feeding program only if they were at risk, that is, if they were identified as severely malnourished or if their growth pattern faltered, indicating incipient malnutrition. While children in Grades III and IV of malnourishment were admitted to feeding immediately when their malnutrition was detected, those losing weight or failing to gain weight (in Grades II, I, and normal) were admitted to feeding only after two successive weighings (thirty days) in the six- to twelve month age group, and four successive weighings (ninety days) in the twelve- to thirty-five-month age group Enrollment in feeding was accompanied by intensive education about nutrition for the mothers of these children The project provided feeding for a limited time (ninety days) only. Those who had gained at least 500 grams over three months exited from the feeding program Children who did not gain adequate weight during this period were referred for medical evaluation and treated for any illness detected.

Pregnant and nursing women were also selected for feeding on the basis of any of the following objective criteria:

· Having a child enrolled for supplementary feeding

· Lactating simultaneously with pregnancy

· Being of fourth or higher parity

· Having edema

· Being a single mother

· Carrying twins.

These women received food supplements daily during the last trimester of pregnancy and the first four months after childbirth.

Health Care

Health care was intended to back up the nutrition effort It included antenatal registration and care, tetanus toxoid immunization, deliveries by trained personnel, child immunization, and examination and medical care of children found sick or not gaining adequate weight. Coordination between health and nutrition workers was considered particularly important for malnourished children who failed to respond to therapeutic feeding.

Under the project the authorities strengthened the existing rural health system to provide improved maternal and child health services and preventive care. The supply of drugs and medicines to the block-level primary health centers was also augmented The project constructed some 1,300 sub-health centers in the villages, each with an outpatient clinic and a place for the multipurpose health worker to live Training facilities for multipurpose health workers were created or improved. As the government of Tamil Nadu had rejected the central government's community health guides' scheme, there was great potential for using community nutrition workers to improve the spread of primary care services, which were estimated to be reaching only 30 percent of villagers.


Communications were designed to familiarize families with and involve them in the project's goals, encourage them to accept services, and influence them to perform activities at home to improve the health and nutrition of mothers and young children. The interpersonal communication skills of nutrition and health staff were strengthened by training. They were provided communication materials for use in the field and encouraged to produce materials of their own A staff newsletter informed and motivated them. Mass media campaigns reinforced interpersonal communications. Films, radio spots, wall posters, advertisements, and folk theater were used.

Villages prepared to receive the project by having its objectives and design explained to village elders and opinion leaders. Communications materials were used to describe the activities. In the last week of the community nutrition workers training, joint training with the multipurpose health worker was aimed at informing the community of and involving it in initiating the community nutrition center.

A key to winning community support were the women's working groups These were groups of fifteen to twenty women identified by the community nutrition worker as progressive, capable of working together, and interested in the activities of the community nutrition center The groups met once a month at a cooking demonstration where the community nutrition workers demonstrated nutritious and easy to make weaning food recipes. The community nutrition workers gave the women health and nutrition training and some of the women became quite proficient in using flip books and flannel graphs to spread the health and nutrition messages to their neighbors. To sustain the interest of women's working group members, the project recently experimented with a community self survey and with the "adoption" of several families by each group member.

Another recent innovation in the communications effort was the formation of children's working groups The facility with which children communicate and the enthusiasm with which they learn and relay project messages through poems, songs, and skits has made this a highly successful activity.

A crucial communication strategy was the monthly growth monitoring session. Children's growth patterns were discussed and mothers were complimented for good growth In the case of faltering, the community nutrition worker would suggest the causes of and remedial actions for faltering, and would follow up with home visits to continue the mother's education. Graduation from feeding provided ample demonstration of the effect of extra feeding on growth that could actually be seen on the growth card. Selective feeding was, therefore, a key communication strategy.


The project design included a monitoring system, planned evaluation, and the conduct of special studies. The management information system was designed to measure project benefits in terms of improved maternal and child health and nutrition and to document the process by which these gains occurred (or did not occur).

The monitoring system was based on three important principles:

· Collect only what information is needed, not what is possible.
· Devolve responsibility for data interpretation and remedial action to the lowest possible level
· Manage by exception.

TINP's Achievements

Independent mid-term and final evaluations of the project found an impressive improvement in children's nutrition status Severe malnutrition had been reduced by 25 to 55 percent in different blocks depending upon the duration of the project There had been a corresponding shift in the proportion of children in the better nutrition grades, indicating an improvement in the entire population of children from newborns to age three. The proportion of children in feeding at any tune (children fed/children registered) declined from 40 percent to 25 percent On average, 80 to 85 percent of children entered feeding for at least one ninety-day period. Fully one-half of these required only a single period of intervention to maintain healthy growth Some 40 percent required two or more periods of supplementary feeding and a group of from 5 to 10 percent required almost constant feeding, never emerging from the lower grades of undernutrition.

Thus, each child in the community received personalized attention and supplementary feeding when required, at a cost equivalent to feeding only 25 percent of children at any one time. Some 2.4 million children participated in the TINP project. The total cost of the project, including food, salaries, construction, and administration, was US$26 per beneficiary, or roughly US$9 per child per year. Of course, this notional calculation does not consider the extensive benefits the program provided to other children in the community.

Evaluation also found the nutrition benefits of the project were long lasting. Children in the thirty seven- to sixty-month age group who had been in the project enjoyed better nutrition status than their counterparts in other communities who had not. The final evaluation estimated that the project had reached 77 percent of children. The shortfall in coverage was caused by the community nutrition workers not covering outlying hamlets in less accessible areas of their villages adequately. This error is being addressed in the follow-on project (TINP-II).

The monthly weighings had been carried out regularly with a high degree of participation. More than 90 percent of enrolled children were weighed each month, and participation in feeding was almost 97 percent of those eligible. The proportion of children participating in feeding who were actually ineligible was 2 percent. Almost all mothers interviewed stated that the food supplement was palatable and readily acceptable to their child. Most reported little sharing of the supplement or substitution of home feeding. This was probably because of the close attention paid by the community nutrition workers; the on-site feeding; and the provision of the food supplement in the form of ladoos, a traditional snack.

Among the project's disappointments was the poor enrollment of pregnant and lactating women in supplementary feeding, only 50 percent of those eligible This low enrollment has been attributed to the inconvenience of daily feeding and to the fact that the health worker was made responsible for selecting pregnant women for supplementation. Cultural factors undoubtedly also played a part. The follow-on project allows selection by the community nutrition worker and take-home feeding for eligible mothers.

Evaluation also showed that while infant mortality fell throughout the project period, this was no more significant in the TINP areas than in the rest of Tamil Nadu. There was a clear decline in hospitalization for diarrhea! illness, which seems to have been associated with earlier and better use of home sugar salt solution. Immunization levels climbed to more than 80 percent throughout the state, associated with the national Universal Immunization Program. Other health services were found to have had rather low coverage. Coverage of children with biannual deworming was estimated to have been nearly 50 percent, while vitamin A supplements reached only one-quarter of children. This too was initially the responsibility of the health worker and was plagued by an uncertain supply of the liquid vitamin. It will now be given on a regular basis by the community nutrition worker. The referral of children to the primary health care system if they failed to gain weight during supplementation was poorly implemented and remedial actions were rarely, if ever, taken.

The communications component was evaluated largely through qualitative techniques. Substantial improvements were noted in mothers' knowledge and home treatment of diarrhea as well as in their appreciation and acceptance of immunization Unfortunately, little information was collected on the frequency and timing of breast-feeding or on weaning, although child feeding practices appear to have improved throughout the project area. Workers acknowledged the usefulness of the wide range of attractive and appropriately targeted communication materials. The training of project functionaries in communication skills was particularly noteworthy.

Lessons Learned

The project demonstrated that it was possible to have a substantial impact on malnutrition within a context of low economic levels and with the assistance of community-based nutrition workers. At a cost of US$9 per child per year (and an effective transfer to the household of about US$3 on average per child per year), the relative cost-effectiveness of the project's approach as compared to direct transfers to the household may be called in question However, a number of studies have confirmed that the income elasticity of demand for calories is less than one even in the lowest income groups. Furthermore, the evaluations not find that calorie adequacy at the household level was an acceptable proxy for calorie adequacy of individual preschoolers, although it might capture major calorie deficits in pregnant and breast-feeding women. Thus programs that improve income alone may or may not adequately reduce the risk of malnutrition in vulnerable groups. The TINP approach is successful in capturing this target group, although it reaches them in households both with and without energy deficits.

Niger Komadougou Small-Scale Irrigation Project

The objective of the Komadougou small-scale irrigation project, funded by the International Fund for Agricultural Development as part of its Special Country Program in Niger, is to reduce the vulnerability of agriculture to drought and desertification. The project has been successful in alleviating hunger This is all the more remarkable given the difficult implementation conditions of rural development projects in Sahelian countries in recent years .


The Komadougou Valley Program owes its success in large part to the rapid expansion or a profitable cash crop: the Diffa green pepper. Like many other success stories in African rural development, the project builds on locally initiated development processes that have been further supported and enlarged through people's participation.

The Komadougou River, which flows from July to December and feeds a complex system of sixty ponds and secondary branches along its valley marks the border between Niger and Nigeria 150 kilometers upstream of Lake Chad. Approximately 30,000 inhabitants of the district of Diffa live along the northern bank of the Komadougou River and around the ponds, where they practice a mixed rainfed (millet and cowpeas on 1 0 to 4 0 hectares per household) and irrigated (green peppers, wheat, corn, and cowpeas on 0 2 to 1 0 hectares) agriculture.

The area has suffered from a drastic reduction in the level of rainfall, from an average of 350 millimeters per year in the 1950s to 225 millimeters per year in the 1980s. The rainfed millet, which was once the main food source of the local Manga and Mober populations, is now a highly uncertain crop. During the last twenty years the district has suffered from intermittent drought that has sometimes wiped out the millet harvest. Depending on the amount of rainfall, this crop now provides no more than 20 to 40 percent of the annual cereal requirements of farm households in the Komadougou valley A number of farmers living by the river have even gone so far as to abandon dune millet cultivation altogether. Simultaneously, a reduction in the level and duration of the river flow has also affected the traditional cultivation of floating rice Consequently the 3,000 to 4,000 hectares of small-scale irrigation is now the most important and secure {arming activity in the valley.

Irrigation permitted a major evolutionary step in the local farming system with the introduction of green pepper (Capsicum anuum) cultivation in the 1950s and its subsequent expansion in the 1980s By 1990 the area given over to green pepper production covered some two thirds of the total irrigated area. This cash crop has a large demand in the urban centers of Nigeria and Niger, and thus enjoys a good market price. As the cultivation of green peppers has spread, so farm households in the Komadougou valley have increasingly met the structural cereal deficit by purchases from Nigeria financed by the sale of the cash crop.

In this context, poverty and hunger are directly dependent on access to irrigation facilities Farmers encounter three main constraints to the development of irrigated agriculture: first, the recurrent drying up of ponds before the cud of the vegetative cycle (the river frequently dries up in December and most of the ponds dry up in January, whereas the green pepper fructification lasts until the end of February), second, the lack of credit facilities to purchase motorpumps, and third, the intermittent infestation by pests and diseases.

Project Design

Formulated in the mid-1980s, the project has aimed at countering some of the most deleterious effects of drought conditions through a twofold physical target.

· To improve forty-one natural reservoirs fed by the Komadougou River, including constructing one or more retention dikes, deepening natural feeder canals, and building inlet structures. Irrigation infrastructure around these reservoirs would include individual small pumps, shadouf (person-operated traditional water-lifting system) irrigation, and collective schemes that would irrigate a total of 870 hectares, including an incremental area of 100 hectares.

· To rehabilitate twenty irrigation schemes pumping directly from the Komadougou River and providing a complementary supply of groundwater through boreholes. These schemes would serve principally as a test to determine the feasibility of groundwater irrigation.

The total of improved or incremental irrigated areas would amount to 950 hectares. These works would be complemented by extension services and credit delivery for irrigation equipment and agriculture inputs. Altogether, estimates indicated that some 2,400 farming families (11,760 individuals) would benefit from the project.

Project Implementation

Five years after start-up and one year before completion the 35 villages where some 2,300 farmers live have directly benefited The number of indirect beneficiaries, such as traders and herders, is unknown, but is probably significant. Twenty-seven pond systems have been developed. The average unit price of the reservoir developments has been less than expected, largely because of participation by the beneficiaries in the earth moving works on a volunteer basis. The irrigated area originally covered by the reservoirs was estimated at 520 hectares of individual plots, but has increased by more than 50 percent in the last five years. The average investment cost per hectare for this increment private irrigated area (water retention concrete infrastructure provided on a grant basis small motorpumps and mobile pipes on credit) is less than US$1,800, among the lowest in Niger.

The project has delivered 350 small gasoline motorpumps and 1,960 mobile pipe elements to individuals or small groups (of between two to five members) on a three-year credit basis This credit program has allowed access to motorpump ownership by about 1,000 farmers in 26 villages. Until now, the reimbursement rate has been 100 percent, a remarkable result in the context of Sahelian Africa, and the demand for new motorpumps is still increasing.

Fourteen collective irrigation schemes with concrete covered canals, most of them pumping in the improved reservoirs, have been developed on a total of 165 hectares (average size of schemes is 12 hectares) benefiting 640 farmers with an average plot size of 0 25 hectares. These self-managed schemes are cultivated with green peppers, paddy, or wheat, depending on the soils. The management performance contrasts with that of the state-owned and cooperative schemes The average investment cost for the eleven schemes exploiting surface water in the ponds is US$3,500 per hectare, a reasonable cost for these kind of works. The cost of the pumping devices has been reduced considerably in the last two years by replacing large diesel motorpumps, which were difficult to maintain because of the lack of spare parts on the local market and which cost US$1,800 per hectare, with small gasoline pumps, which the farmers prefer and which are easy to maintain and replace, at a cost of US$300 per hectare. Given the lack of banking institutions in the area, the financial amortization of big collective pumping devices is difficult and farmers' groups have begun to buy small pumps to replace such equipment progressively.

The idea of providing a complementary supply of groundwater through the experimental boreholes has been abandoned after the building of six boreholes on three schemes because of the prohibitive investment (US$14,000 per hectare) and operating costs of this technique.

Although the potential of the reservoirs' development has not yet been fully realized, the overall effect on irrigated area expansion is, nevertheless, greater than expected. The net increase in irrigated area is estimated at 300 hectares of individual plots and 100 hectares of collective schemes This total of about 400 hectares of irrigated land expansion exceeds by far the initial objective of 180 hectares The individually irrigated area is rapidly increasing because of the net increase in water availability in the reservoirs after the fall of the water level in the river and the supply of motorpumps and pipes to individual farmers on credit.

Project Impact

A visible effect of the rapid expansion motorpump adoption is the complete disappearance of the shadouf in participating villages. The credit program for providing the small motorpumps not only permits an increase in the irrigated area, but also reduces the percentage of farmers renting pumps, the poorest category of farmers in the valley. The cash incomes of motorpump owners are actually three to four times higher than those of farmers renting their equipment (the rental charge is a third of the harvest). A survey conducted in 1990 showed that the average net cash incomes from green pepper production varied from US$911 per year for farmers that owned their pump to US$293 per year for farmers that rented their pump. As the project provided most pumps to small groups averaging three farmers, and assuming that most of the 1,000 buyers were previously renting their pumps or using a shadouf, an average cash income increase of 100 percent after credit repayment appears to be a reasonable estimate of the effect on this poorest category of beneficiaries.

In most reservoirs the duration of water availability has been increased by one to two months, irrigating some 940 hectares and allowing completion of the green pepper vegetative cycle, resulting in an in crease in yields Progress in yield terms is, however, difficult to evaluate, and is probably inferior to expectations because of the poor quality of the extension services in the area and the lack of a pest control program However, on the collective schemes rice yields are good at 4.7 tons per hectare.

In terms of food security' end given the availability of cereals on the nearby Nigerian market, green pepper production appears to be the best option for the farmers of the Komadougou valley. For example, on a single hectare of irrigated land, and given average yields and production costs, the net return for cereal production is estimated at 10 tons for wheat and 2.8 tons for paddy (1.8 tons of rice). The net cash income on the same area cultivated with green peppers amounts to US$ 1,000, corresponding to more than 4.1 tons of millet at the average Nigerian market price Estimates indicate that local households purchase at least 50 percent of their cereal requirements.

Although this small irrigation development subprogram is not yet complete, it shows the following clear signs of success:

· The beneficiaries have participated actively in the development works.

· The collective schemes are self-managed and functioning relatively well.

· The farmers are supporting full operating costs with the exception of heavy infrastructure amortization.

· The incremental irrigated area has surpassed initial objectives and has proved to be cost-effective.

· The farmers continue to demand new reservoir developments, credit facilities, and collective schemes.

· The credit provided is being fully repaid

· The farmers' cash incomes have increased significantly and could be higher still.

Lessons Learned

The project's achievements are partly due to a particularly favorable context for the development of irrigated agriculture: the quality of the water and soils, the access to a large market in Nigeria for the sale of outputs and for input purchases, the favorable relative prices, and the widespread knowledge and tradition of small irrigation in the area In this context, the willingness of local farmers, the appropriateness of the subprogram's design, the quality of the local staff, and the overall participatory and flexible approach adopted have resulted in remarkable progress toward food security and a better standard of living in the Komadougou valley.

The irrigated production systems still have plenty of potential for improvement, especially in terms of improving green pepper yields through controlling pests, improving cultivation techniques, applying fertilizer, and so on; improving marketing practices through better exploitation of the seasonal price variations by providing credit for storage and marketing,- diversifying irrigated crop production; and developing transport facilities, for example, through providing credit for ox carts and upgrading secondary rural roads.

The interim evaluation underlines three substantial issues that must be considered if a second program is to be undertaken to consolidate and build upon what has been achieved to date, namely:

The credit delivery service is still dependent on the program staff A local credit and savings institution should be developed.

· Pests and diseases, including nematodes, may continue to breed if nothing is done in terms of diversifying crops and facilitating access to pest control inputs.

· The sheer profitability of green pepper cultivation might lead to overexploitation of the water resources in existing reservoirs as the number of private motorpumps increases. Villagers should be clearly informed about the total irrigation capacity of each pond and adopt rules to avoid excess pumping.

Provided that these issues are adequately addressed in the years to come, one can conclude that this subprogram has ameliorated the food security of the poorest households and lessened the risk of hunger in the project area The project's overall rate of return and the replicabilility of such a program need to be carefully assessed before any final conclusions can be reached Furthermore, the effects of pond development on the river discharge should be monitored to avoid a negative impact on flood recession crops downstream.


1. Siddharth Dube wrote this section based on Soekirman and others, "Economic Growth, Equity and Nutritional Improvement in Indonesia" (A United Nations Administrative Committee on Coordination l Subcommittee on Nutrition (ACC/SCN) country case study for the XV Congress of the International Union of Nutritional Sciences, Adelaide, Australia, September 26 - October 1, 1993); United Nations ACC/SCN, Second Report on the World Nutrition Situation, vols. I and II (New York, 1993).

2. This section was provided by FINCA International, Inc., 901 King Street, Suite 400, Alexandria, Va 22314, U.S.A. .

3. This section was provided by Freedom from Hunger, 1644 DaVinci Court, PO. Box 2000, Davis, Cal. 95617, U.S.A.

4. Barbara Kennelly. Literature Review of the Impact of Income-Generating Activities an Household Nutrition (Davis, Cal.: Freedom from Hunger, 1988).

5. Cheryl Lassen and Barbara MkNelly, Freedom from Hunger's New Credit-Led Approach to Alleviating Hunger. Is It Working? Mid-term evaluation by the US Agency for International Development Partnership Grant, Cooperation Agreement no. OTR-0158-A-00-8147-00 (Davis, Cal: Freedom from Hunger, 1991).

6. Barbara McNelly and Chatree Watetip, Impact Evaluation of Freedom from Hunger's Credit with Education Program in Thailand (Davis, Cal Freedom from Hunger, 1993).

7. This section was provided by The Aga Khan Foundation, 8-Aga Khan Road, F-614, Islamabad, Pakistan.

8. The International Fund for Agricultural Development provided this section.

9. Gaurav Datt prepared this section.

10. Martin Ravallion and Gaurav Datt, "Is Targeting through a Work Requirement Efficient? Some Evidence for Rural India," Public Spending and the Poor; incidence and Targeting, ads. D. van de Walle and K. Nead (Washington, D.C.: World Bank, forthcoming).

11. Laura Tuck and Kathy Lindert wrote this section.

12. Population is ranked by expenditure per capita per year, which is used as a proxy for income throughout the analysis. In 1990, the poorest income group, with annual per capita expenditures of less than D 250, represented 13 percent of the population, while the richest included those 13 percent with an annual per capita expenditure greater than D 1,200.

13. Institut National de la Statistique, Household Expenditure Survey (Tunis: Institute National de la Statistique, 1985). Intake is derived from purchased subsidized products only and excludes on-farm consumption.

14. Direct assistance schemes include the Needy Families Program and the Union Tunisienne de Solidaritociale, which is responsible for low-income food ration programs and cash transfers to the elderly and handicapped These programs are small compared to the CGC program and could not compensate the poor for an elimination of food subsidies.

15. Anna Sant'Anna and Jean Jacques De St. Antoine wrote this section.

16. Isabel Vial and Alberto Valdes wrote this section.

17. For information about these programs see T. Castaneda, Combating Poverty: Innovative Social Reforms in Chile during the 1980s (San Francisco: ICS Press, 1992).

18. Julia Tagwireyi wrote this section.

19. Michael Lipton, Poverty, Undernutrition and Hunger, World Bank Staff Working Paper no 597 (Washington, D.C: World Bank, 1985).

20. Jayshree Balachander wrote this section, which is reproduced in part from Jayshree Balachander, "Tamil Nadu's Successful Nutrition Effort," Reaching Health for All, eds. Jon Rohde, Meera Chatterjee, and David Morley (Delhi: Oxford University Press, 1993).

21. Severe malnourishment corresponds to Grades III and IV in the classification of the Indian Academy of Pediatrics, which uses the Harvard weight-for-age standard, that is, 81 percent and above is median to normal 71 to 80 percent is Grade 1, 61 to 70 percent is Grade II, 51 to 60 percent is Grade III, and under 50 percent is Grade IV.

22. Children younger than 24 months received a food ration containing approximately 140 calories and 6 grams of protein a day. Those between 24 and 36 months, severely malnourished children, and mothers received double this amount daily.

23. This section was provided by the International Fund for Agricultural Development.

24. It is worth mentioning in this respect the recent decision by the U.S. Agency for International Development to help the Government of Niger meet its counterpart funding obligations.

Appendix 4 - ending hunger soon: concepts and priorities

At least 700 million people do not have access to sufficient food for a healthy and productive life. This is despite the existence of sufficient global food supplies to cover their minimum deeds. The world now produces more food per capita than it did a decade ago. Of course, even if current supplies can, in theory, match current minimum needs the adequacy of future supplies is not assured. Seeking to match the food supply with the demands of a fast growing world population is a huge task. However, the problem is that hunger is not just about the food supply. Trying to guarantee a minimum diet for today's hungry even when the food is available is just as great challenge.

Hunger exists because poor people cannot gain access to available food. This occurs at all levels: food may be available at a global level, but individual countries can go short; sufficient food may be available on the market at national or regional levels, but some households go hungry because they cannot purchase it; sufficient food may be available at a household level, but some individuals go hungry because they do not have access to it. Hunger is therefore as much about access as it is about supply. Undernutrition and starvation can occur in the midst of plenty.

While hunger is thus first and foremost a humanitarian concern, it is also a development issue. Low Labor productivity and limited purchasing power impair the ability of hungry individuals to capitalize on the benefits of many development investments. This, in turn, compromises the success of such investments. If constraints to the production of and access to food are different for different groups of people, then policy and project interventions should be tailored to the location- and income-specific needs of such groups. It is therefore useful to separate out and address the issue of hunger as a major element (both a symptom and a cause) of broader problems of poverty and food insecurity.

This paper begins by presenting a conceptual framework for understanding the linkages between hunger, poverty, and food insecurity at both macro and micro levels. This is followed by a review of the characteristics and causes of hunger. Finally, the paper considers priority policies and programs for reducing hunger and for bolstering household efforts at coping with hunger and food insecurity.

Conceptual Framework

A clear distinction must be made between hunger and food security. Hunger-largely an advocacy rather than a scientific ferm is defined here as an individual's inability to eat sufficient food in terms of calories and nutrients to lead a healthy and active life. Hunger is a recurring feature of absolute poverty that has long-term (chronic), short-term (acute), and seasonal (transitory) dimensions. Food insecurity leads to, and is often characterized by, hunger, but food security is not just the absence of hunger. It is about the absence of risk relating to adequate food consumption. Food security can be defined as secure access by all people at all times to the food required for them to lead 2 healthy life. While food is the defining focus of the concept, the risk of individuals and households not being able to secure needed food is key. The risk of constrained access to food can arise from many causes, such as absolute shortages in the supply of food, which are often the result of climatic vagaries or natural disasters; inaccessibility of available food because of political (war) or economic disruptions; or massive income collapse associated with disruptions in labor or food markets.

Hunger is perhaps the most obvious manifestation of food insecurity resulting from a complex combination of these factors, compounded by institutional and policy failure. In other words, it is a combination of the degree of poverty, the degree of risk of failing to secure local food and income, and the chance of receiving external assistance that defines food insecurity.

Institutional capabilities and the capacity of policy to respond in a timely manner to crises are essential to prevent hunger from materializing on a large scale It is a failure of policy to deal appropriately with demographic, environmental, productivity, and political pressures that makes some segments of society and some regions more vulnerable to hunger than others. Wars and civil unrest may become partially endogenous to these determinants of vulnerability over time. Strategies for ending and preventing hunger must, therefore, build on a recognition that institutions and their policies (and their constraints) play a key role, and that long-term forces are as relevant as short-term forces.

The most important institution at the micro level—the household, with its complex internal organization and diverse macro-level linkage must figure prominently in the analysis of hunger, especially where state institutional capabilities remain weak. However, the failure of public action must not lead to advocacy for reliance on household "coping," the cost of which usually includes suffering". Limitations to effective market based actions against hunger in many famine prone countries and/or those undergoing policy reforms suggest a continued need for improving the role of public action.

Poverty, Policy, and Hunger

Figure 1 portrays some of the long-term relationships between causes and symptoms of hunger. Poverty, including the associated vulnerability to natural or man-made shocks, is a root cause of hunger. Yet poverty and its dynamics may be seen as an endogenous outcome of limited resources and flawed policies. Endogenous and exogenous relationships are conceptualized at different levels of analysis. The figure traces broad interactions between root causes such as policy failures (including war), resource poverty and climatic disruptions, and population growth and outcomes in the realm of macroeconomic activity and household strategies. For example, the top row of causal factors rep resents economic strategies and policy interacting with social discrimination, conflicts, and military conflict; resource endowments and their relationship to climate or disasters influencing levels of poverty and food availability; and population growth. These elements directly affect both the design and the success of policy and project interventions, such as subsidies and distributional policies, that influence input/output relationships, and thereby influence domestic food production levels and stability.

Other policies, such as wage policy, and project interventions, such as paid labor-intensive public works, interact at the level of capital, labor, and output markets. These relationships determine prices, and hence the real purchasing power and terms of trade of the poor. Severe deterioration in, or rapid fluctuations of, purchasing power and terms of trade among the poor can have a strong impact on nutrition. It is in such instances that income and consumption failure become most severe and result in extreme hunger, and that the failure of household "entitlements" becomes evident.

Analytical discussion on any one of these interactions should be pursued with a recognition of the upstream/downstream and short term / long-term linkages between individual elements. Recognition of the complicity of these relationships is crucial for effective action aimed at curbing and eliminating hunger.

Sources of Risk

Food-insecure households can be found in different socioeconomic and demographic groups depending on factors such as agroecological characteristics, access to land, diversity of income sources, and the state of development of the economy. Different types of risks affect various groups of food-insecure households and their members in different ways (table 1).

The most severe hunger problems affect particularly high risk demographic groups in rural and urban households characterized by low and variable household incomes, limited asset wealth, low human capital, and a high risk of income and consumption instability or collapse. For example, children in poor small-holder households that have limited income diversification may be severely affected if their household experiences a bad crop or loss of employment, and they are located in an area of civil unrest.

To improve household food security, location specific risks need to be identified so that effective risk reducing actions can be implemented. The risks associated with hunger have short- and long-term dimensions. Some of the more common risks are briefly discussed below.

War and oppression. The impact of civil unrest and armed conflict is not limited to the area directly affected. When wars erupt, often because of perceptions, real or otherwise, that the policies of the central authorities discriminate against peripheral groups, the poor in deficit areas away from the front line are affected through rapidly declining food supplies and rising prices. As conflicts continue crops are not sown, farmers abandon their lands, and longer-term production declines. This adds to the strain on the food supply chain in areas that may already be at risk.

Figure 1. Relationships among variables responsible for hunger in developing countries.

Unable to secure a living or feed their families, vast numbers of the poor migrate to neighboring countries or to more peaceful areas of their own country. In the early 1990s more than 5 million Africans were classified as refugees or asylum seekers, with another 35 million living outside their own countries in search of employment 7 Another 10 million or so were to be found in other parts of the developing world. Such dislocations create problems of increased food insecurity among the displaced poor, a concentration of job seekers in urban areas of already high unemployment, and resistance to the assimilation of newcomers among many host populations.

Even when peace returns to an area people continue to feel the impact of years of war. Food production in Mozambique has yet to recover from the displacement of more than 1.5 million people (about 10 percent of the population) during fifteen years of civil war The result in 1992-93 was that the total food crop area planted was far below the long-term average. What is more, 1 million refugees may soon return. The lack of productive assets owned by, and poor nutritional condition of, many resuming refugees means that production gains from a larger cultivated area and potentially higher yields will not materialize in the near future without considerable assistance. Investment will therefore be required in seed distribution and cultivation technology, as well as in defusing land mines, to return formerly cultivated lands to previous levels of productivity.

Natural resources and human resources. Estimates indicate that half of Africa's poor farmers already live in environments characterized by a natural resource base highly vulnerable to degradation, while in Latin America the figure is closer to 80 percent. The resource environment affects the nutrition and food security of hungry people mainly through impacts on crop choice and crop yields . Food insecure and poor households do not deliberately degrade their resource base without thought for the consequences. They are often confronted with a choice: short-term satisfaction of food needs with consequences for long-term environmental degradation, versus short-term hunger with fewer environmental demands. Much environmental destruction, such as deforestation and soil erosion, can therefore be ascribed to the struggle of the poor to feed themselves .

Growing family size and deepening poverty forces farmers to cultivate marginal lands and reduce fallow periods. It also forces the landless and the unemployed (as well as farmers and pastoralists) to cut trees for fuel and fodder, but environmental damage, such as tree loss through charcoal production, becomes a direct constraint on future expansion of food harvests. Failure to address hunger issues leads to productivity losses today, directly through reduced work time because of illness, and indirectly through time spent caring for the sick.

Table 1. Sources of risk of hunger and affected populations


Households and people at risk of hunger .

Politics and policy failure

· Households in war zones and areas of civil unrest

· Households in areas of low potential that are not connected le. growth centers via roads or other means of communications

Crop production risks
(pests, drought ,etc.)

· Smallholders with little income diversification and limited access to improved technology (for example, improved seeds, fertilizer irrigation, pest control

· Landless farm laborers

Agriculture trade risks
(disruption of exports or imports)

· Smallholders who are highly specialized in an expert crop

· Small-scale pastoralists

· Poor households who are highly dependent on imported food

· Urban poor

Food price risks (large sudden price rises)

· Poor, net food purchasing households

Employment risks

· Wage earning households and informal sector employees in pen urban areas and, when there is a sudden crop production failure, in rural areas

Health risks (infectious diseases, for example, resulting in labor productivity decline)

· Entire communities. but especially those households that cannot afford preventive or curative care as well as vulnerable membres of these households

Demographic risks (individual risks affecting large groups)

· Women, especially when they have no access to education

· Female-headed households, widows, abandoned women

· Children at weaning age

· The aged.

Source Adapted from von Braun and others, Improving Food Security of the Poor .

Failure to address hunger issues can also lead to further environmental degradation and depending problems in the future. Children's cognitive development and school performance are impaired by poor nutrition and health, with consequent losses in productivity during adulthood. Nutritional deficiencies play a large part in poor school enrollment, absenteeism, early dropping out, and poor classroom performance in developing countries. The education factor is particularly important for girls given its role in lowering later fertility, and thus the population growth rate.

Eradicating hunger would therefore have a beneficial impact not only on human productivity and well-being, but also on the environment. Improved adult nutrition leads to higher farm productivity, improved productivity in the Labor market, a likely reduction in population growth, and reduced depletion of natural resources for short-term gain.

Governance, participation and democracy. A key factor in eliminating persistent hunger and recurrent famines is public action. This involves not just governmental initiatives in the delivery of resources to target populations, but active participation by the public, both as individuals and through grassroots nongovernmental organizations. Public participation can have positive and powerful roles both in collaborative and in adversarial ways with regard to government policies. Collaboration is essential in public health campaigns, such as nutrition education, and in famine relief operations, which require cooperative efforts to ensure their success. However, the public's adversarial role often brings problems to the government's attention and demands resolution.

The demand for action through political activism, journalistic pressures, and informed criticism can help to identify both persistent hunger and famine risk. It is no accident that those countries most successful m famine prevention have been those with more pluralistic politics and open channels of communication and criticism. While China made great post revolutionary strides in terms of eliminating endemic hunger, the population was still vulnerable to famine in the late 1950s. By contrast India, with its open journalism and adversarial politics, was relatively less successful in reducing endemic undernutrition, but has avoided famine. Starvation deaths and extreme deprivation are newsworthy, whereas increased morbidity and mortality rates from endemic undernutrition are not.

The absence of political opposition and free speech have contributed greatly to famine vulnerability in Africa today. Many autocratic African governments have recently been challenged by mounting social anger at the increasing poverty of large segments of society. However, if fledgling, transitional democracies are to survive, they must quickly satisfy the needs and demands of those who brought them to power. This requires positive support by the international community. Democracy is vulnerable where external debt, disease, hunger, and poverty are commonplace. Opportunities for investment aimed at stabilizing fragile economies, even where democratic institutions may yet be imperfect, should be seized whenever they appear.

Setting Priorities for Ending Hunger

While the dimensions, causes, and consequences of hunger differ widely from country to country, and even within the same country, substantial numbers of hungry households and individuals inhabit practically all low-income and many middle income countries.

Incidence of Hunger

Hunger is concentrated among certain demographic and socioeconomic groups, as well as geographically. For example, hunger in most countries is concentrated among the very poor in both rural and urban areas, households headed by women, the displaced and dispossessed, the elderly and disabled, and among certain categories of infants and children. At the same time, more of the poor and hungry are located in regions of the developing world that are poor in natural, infrastructural and institutional resources. In Sub-Saharan Africa, for example, almost 40 percent of the population can be classified share that is coincided with the proportion that does not eat a minimum diet." Approximately 50 percent of Africa's poor inhabit semi-arid tropical regions that have poor physic infrastructure and services, and depend on low and variable rainfall for food production. As a result, local diets are dominated by low-yielding coarse grains (millet and sorghum) that have shown limited potential for large productivity increases.

The proportion of the total population not eating a minimum diet is 25 percent in south Asia and 16 percent in southeast Asia (ACC/SCN 1993) . In south Asia one again finds more than two-thirds of the absolute poor (who are associated closely with hunger) in the driest agroecological logical zones of warm tropics. In this instance their diet is dominated by cereals such as rice and wheat, with coarse grains and cassava an important complement. While rice and wheat were the star performers of the green revolution the chest areas of the subregion benefited relatively less from the new technologies than did the moister tropics and subtropics.

The proportion of South America's population not consuming a minimum dirt is 25 percent with the largest number of poor again located in the driest agroecological regions, as well as in urban conurbations.

Hidden Hunger

While the total number of hungry people in all regions may e. exceed 700 million, millions more people world wide are subject to chronic micronutrient deficiencies. Acute hunger may relate not only to catastrophic calorie consumption deficiencies, but also to transitory fluctuations in calorie supply, micronutrient deficiencies, diet diversity problems, and also to maldistribution of resource within household units. For example, estimates indicate that 40 million preschool children a e suffering from chronic vitamin A deficiency, and that between 200 and 300 million people worldwide are experiencing endemic iodine deficiency goite.

Addressing these forms of hidden hunger requires a multifaceted approach, including pro viding nutrition education; ensuring that food supplies have the appropriate micronutrient content, that is, that they include fruits and leafy green vegetables; supplementing people's diets through feeding programs; organizing food fortification, such as iodine modules in water supply projects or the provision of iodized salt; and disease.

It also calls for reducing the constrains disadvantaged groups within certain households face in gaining access to the benefits of development initiatives. Communitities and households are not neutral media through which development resources flow evenly. While hunger is not solely a function of adequate global food supplies, the issue of individual access to resources has implications beyond income and purchasing power Addressing hidden hunger therefore requires attention not just to health care, water supply, and education, but also to the distribution of these and other resource within the household. Hunger can exist in households that are not poor by local standards.

Hunger is therefore a problem of great complexity as well as of scale. But in a world of limited resources for development in poor countries, this raises the question of which hungry people should be taken care of first. Given wide variability in the causes and manifestation of hunger, no general blueprint for setting priorities can be sought. Each country will always address its problems according to the prevailing demands of political economy and to the perceived costs and benefits of alternative investments.

Nevertheless, the issue of setting priorities for investment initiatives has received insufficient attention Just as the sequencing of policy reforms may be crucial to the success of the overall package of reforms, the sequencing of polices and programs to address hunger can be important. Long-term initiatives independent of short-term actions may be unsustainable, while the converse is also true. Priorities need to be set for coordinated action among donors, governments, and communities to be possible.

We argue here that coordinated action should focus on the worst symptoms of hunger first, in the context of a strategy for long-term interventions aimed at removing the root causes of hunger flus suggests a primary focus on problem areas of Africa and Asia with priority attention to the acute problem of famines, which are the worst case of entitlement failure associated with all there root causes of hunger laid out in figure 1. The second focus is the much larger problem of chronic and transitory dietary deficiencies-of macronutrients and micronutrients in rural areas of Africa and Asia, particularly those areas that are resource poor and ecologically fragile. A third focus would be chronic dietary deficiencies among the urban poor, with an increasing emphasis on Latin American problems alongside those of other developing countries. .

Famine Prevention and Mitigation

Governments and donors should give the highest priority to addressing famine. The world cannot afford to let the worst cases of hunger go untreated. With high population growth the absolute number of people becoming vulnerable to famine continues to grow. In the early 1990s the number stood at roughly 30 million people in Africa. This catastrophic hunger has profound implications for economic growth in affected countries, let alone for their longer-term human capital development, as well as for demands made on more developed nations for food and other assistance. The longer the social and economic malaise associated with famine persists, the harder and more costly it becomes to eradicate.

This calls for a swift and effective response to famine set within a framework of actions to remove the underlying causes Free food aid to severely malnourished individuals will not alone solve the problem While temporary solutions to acute hunger are often achievable in a short time at relatively low cost, this does not make them sustainable in the longer run.

Famines are extreme, regionally concentrated shortfalls in food consumption that result in rising undernutrition and death rates They do not happen suddenly. Famines result from an accumulation of events that progressively erode the capacity of poor households to deal with short-term shocks to the local economy Shocks often take the form of environmental extremes, but the conditions that promote household vulnerability to extremes develop over long periods, typically in the context of inappropriate economic policies.

Famines should therefore be recognized as national and international policy failures They signal a lack of preparedness and political commitment to prepare for and implement public initiatives against acute hunger. While a reduction in long-term poverty and stimulation of private sector economic activity—two of the key aims of structural adjustment policies—serve to reduce the risk of famine, action by public agencies remains necessary, at least in the medium run, to protect vulnerable households that lack the resources to protect themselves.

Successful preparedness and mitigation depends on a public commitment to intervene effectively and on time. This has the advantage of offering high returns in reduced hunger relative to the resources invested. Also needed are the conditions that prevent hunger from recurring on the same scale and at the same intensity as before. Such conditions include building institutional capacity at regional and local levels, detecting and diagnosing indicators of distress in close collaboration with affected communities, preparing programs and projects for vulnerable regions ahead of time, and executing appropriate interventions in times of need.

The successful eradication of famine, as well as the removal of nutrient deficiencies, depends on successful economic growth. Unless growth underpins appropriate targeted interventions, short-term mitigation of acute hunger cannot be sustained. Thus, in countries with a large agricultural sector, a key contribution to famine prevention must come from an employment creating agricultural growth strategy from which hungry populations reap a direct benefit, an issue taken up in more detail below.

Agricultural Growth for Sustained Hunger Reduction

In most developing countries, there is little question that policies for enhancing economic growth' particularly in agricultural productivity, must provide the bedrock for future development, including the elimination of hunger Agricultural growth can address hunger not only by increasing production, but also by generating rural employment, and therefore income. Yet with population growth rates in excess of 3 percent per year in much of Africa, and growth in agricultural output during the 1980s rarely surpassing 2 percent per year in many countries, even outside Africa, the challenge to agriculture is daunting.

While opportunities for bringing new land under cultivation have compensated for slow yield growth in the past, continued attempts to expand agricultural land will entail ever Larger investments, accelerated deforestation and land degradation, and ultimately, falling yields. Productivity increases must be sustainable The issue is one of finding a way to meet growing food demands without compromising the ability of the total stock of resources, both natural and human, to meet even larger demands in the future .

To facilitate yield increases in developing countries higher investment in agricultural research and technology is urgently needed, particulary for those crops most important to the poor. As population and food demand continue to grow, failure to develop and implement appropriate production and marketing technologies will lead to either more food insecurity and hunger, for which the current generation of poor people will pay, or to further degradation of our natural resources, for which future generations will pay.

The tradeoff between meeting future food demands and maintaining production capacity can be avoided and sustainability in food production can be assured only if (a) investment in appropriate research and technology is accelerated; (b) relevant externalities, including those related to resource ownership and user rights and the needs of future generations, are either taken into account in production and consumption decisions or effectively dealt with by government policy; and (c) poverty is significantly reduced or alleviated .

Because of the risk of irreversible degradation of natural resources and the urgent need to assure sustainable production to meet future food demands, understanding why investment in the most promising solution, agricultural research and technology, appears to be decreasing is difficult. For example, US. assistance to agriculture in developing countries in 1990 was less than one-half (in real terms) what it had been in 1988. The World Bank showed a similar, though less dramatic, decline of 25 percent in assistance to agriculture during the same period In 1994 funding for the Consultative Group on International Agricultural Research—the driving force behind the green revolution is likely to be 27 percent below its level of funding for 1990 in real terms.

This decline is unfortunate on several counts. First investigators documented high rates of return for investments In agricultural research during the 1980s and early 1990, even in Africa. Second, there is a time lag between agricultural research and increased production. The adequacy of current food supplies is a testimony to past investments in agricultural research For the impact of new technologies or support services to be realized in the agricultural sector could take ten years or longer.

Improved crop technology need not be restricted to the production of staple food crops Growth in the staple food sector and growth in the cash crop sector are not mutually exclusive The complementarily between the production of traditional food crops and of cash crops is often overlooked Longitudinal studies in many parts of Africa show that the real income poor small-holders earn from cultivating cash crops is generally converted into food calories for consumption in a similar manner to income earned from subsistence food production . Appropriate policies for technological change, input supply, pricing, marketing, and infrastructural growth benefit both sectors and are crucial for growth in both In other words, the attainment of optimal food security should not rely on growth in the food sector alone, but on the development of the most productive agricultural resource, which may be an export crop.

Appropriate policies not directly related to agriculture are also required The use of new technology alone is not sufficient Investment in rural roads, institutional change, and appropriate policies are needed to facilitate farmers' access to modern inputs, improve farm management, develop a marketing system capable of assuring sufficient food for rapidly growing urban populations,, provide the necessary production incentives, promote economic growth in rural areas, and enhance the exchange of commodities (including labor) and services between urban and rural areas. Attention to the removal of institutional and policy barriers to dynamic factor markets continues to be needed.

Without effective markets, more food will not be within the reach of rural and urban net consumers of food, including the landless and the unemployed Agricultural production increases alone are insufficient to achieve food security if hungry individuals cannot secure that food. Thus a precondition for sustainable agricultural development is economic viability, both at microeconomic and macroeconomic levels. Increases in agricultural production must be combined with employment creation, higher incomes, and price stability if growing populations are to have access to enough food in the future.

Policy and Program Options

A range of policy instruments is available to improve access by the poor to the income and food required to alleviate hunger A combination of instruments is required so that short-term goals are achieved in tandem with long-term development The portfolio of actions taken should focus narrowly on the achievable and on the cost-efficient, both measured in terms of the effectiveness of resource transfers—be they calories, income, or technology—to target populations Key instruments to be considered include the following:

· Targeted food distribution and subsidies
· Employment creation (resulting in rural roads and resource improvements).

Institutional strengthening, such as providing credit for the poor.

· Price and trade policies for stabilizing consumption
· Human capital investments.

Targeted Distribution and Food Subsidies.

Food transfers, which are income transfers in kind, are widely used as a means of alleviating food insecurity, but they have come under attack for their potential adverse effects on markets, for their high fiscal costs, and for their perceived inconsistency with structural adjustment policies. In the current climate of structural adjustment there is additional pressure to eliminate such transfers except where justified on strong humanitarian and/or developmental grounds. This section considers three types of programs: targeted feeding programs, food stamps and other income transfers, and food price subsidies. Targeted feeding programs. Except in the context of emergency relief, feeding programs are generally aimed at those people most vulnerable to malnutrition, usually children and poor women of child bearing age. The targeting of feeding programs is achieved through various means depending on nutritional need and the programs' objectives. Geographical targeting works well when a high prevalence of hunger is identified in selected areas. School feeding programs can be used to target school-age children. Means tests and vulnerability tests are also used. General food distribution is rarely cost-effective because of leakages, but the administrative costs of targeting can overwhelm certain feeding programs.

Feeding programs rarely increase the food intake of those targeted by 100 percent of the food given because of sharing of food with household members or substitution with home produced and purchased food. The income elasticity of food expenditures tends to be less than unity, and not all the increased expenditure goes to increasing calorie intake, but also goes to improving the quality of the diet in terms of the taste and convenience of the food. However, such programs are often politically and socially acceptable as a means of transferring income.

Food stamps and other income transfers. Interest in food stamp programs as a means of providing a food-mediated income transfer to low-income households and as an alternative to food subsidies has picked up in recent years Food stamp programs are expected to display the higher consumption effects of food-based income, as well as to reduce the administrative burden and costs imposed by food handling and transport.

Yet experience with rood stamps is mixed For example, in Zambia large-scale counterfeiting compromised such programs In Sri Lanka the income verification procedure excluded wage earring workers on tea plantations even though they appeared to be a nutritionally needy group. These problems are not unique to food stamps; they are also encountered with in-kind transfers The questions which approach is more efficient in transferring its resource to a target population within the confines of accepted leakages.

Fixed, nominal value stamps do not protect consumers from price fluctuations, even when periodically adjusted for inflation. To be cost effective, the targeting of food stamp programs has to be based on narrow criteria associated with need. I his is not perfect even in the United States, which uses means testing, and is especially problematic in poor countries If food stamps programs employed the methods used for targeting feeding programs they could probably be more effective.

Food price subsidies and rationing. Consumer food price subsidies are widespread and have been introduced in most low-income countries. They can take the form of generalized price subsidies or rationed access to a commodity at a price below market value Generalized price subsidies are more costly in terms of fiscal and economic costs than limited access subsidies, and are also more regressive in the distribution of economic benefits.

Household food security is a goal of certain subsidy programs Food subsidies increase the real incomes of households with access to the subsidies. In a number of programs surveyed, food subsidies accounted for 15 to 25 percent of the real income of poor households receiving subsidies. Food price subsidies also generally increase household food consumption. Furthermore, subsidy programs have a positive and significant effect on food consumption by preschool children, although they may result in decreased consumption of other foods and leakage to other household members may occur 38.

Programs that provide rations in fixed quantities have, in general, succeeded in leaching the people to which they were directed However, experiences in Egypt the Philippines, and Sri Lanka underline the difficulty of achieving universal household food security through rationed distributions and targeted income transfer goods in a single program in a cost-effective manner 39 Self-targeting can be achieved through commodities that better off consumers consider inferior, and that are therefore used more by the poor.

Traditionally, food aid has been used to support food subsidies, an action often viewed as a mixed blessing By promoting food subsidies, food aid has been perceived as inhibiting growth in domestic food production in the short run, and as misallocating resources, both public and private, in the long run so as to create a dependency on externally subsidized food Yet the empirical evidence does not support such a generalization, at least for Asia. The so called disincentive effects of food aid on domestic agriculture have been exaggerated, and many countries that received high levels of food aid subsequently achieved above average agricultural growth For example, India, the Republic of Korea, and Taiwan (China), which used to be major ford aid recipients, no longer depend on such aid. Evidence of disincentives for agriculture at the microeconomic level in countries such as Ethiopia and Niger is also slim. In other words, the actual effects of food aid are very much a function of recipient countries' food and agricultural policies.

Employment and Income Generation Programs

Besides programs and polices oriented toward agricultural production, other programs intended to diversify employment and income can reduce risks for hungry households These other income generation programs, which can be complemented by other non-labor-based interventions, differ from programs oriented toward food production in that they stimulate or stabilize the demand for food, but may not directly expand the supply of food.

Labor intensive public works programs. Labor intensive public works programs can address four key problems facing many low-income countries today food insecurity, growing unemployment, natural resource degradation, and deficient physical infrastructure. Public works are, in general, public programs that provide employment and generate public goods, such as physical and social infrastructure Food aid can be, directly or indirectly (monetized), a component of the wage payments.

The food security effects of employment programs are a function of program design . For instance, a short-term project may result in expenditure patterns by the poor that treat project income as "windfall profits" A small food consumption benefit from the Bangladesh food-for-work program hints at that behavior. In contrast, long-term benefits from improved rural roads produce more secure income flows and substantial consumption improvements for the lowest-income households.

Good public investment through public works programs, and thus the creation of productive and sustainable assets, needs to be emphasized in policy Note, however' that income effects derived from works programs can also have favorable private savings and investment effects that improve household food security, as observed from experiences in Bangladesh and Guatemala . In countries such as Niger and Ethiopia, income from public works has contributed more than 20 percent of total income to the poorest households, who have reinvested some of this income in agriculture. Strengthening financial institutions for the poor in tandem with public works programs is suggested in order to foster these positive effects.

Public works programs can be a viable instrument for famine prevention as demonstrated by the Employment Guarantee Scheme in Maharashtra, India. The employment guarantee feature of the scheme, which generates unlimited employment to adults at a fixed wage, also triggers "relief works" automatically at local levels . This enables small crises to be addressed through local action, an important lesson for dealing with the problem of localized famines in Africa Note, however, that public works programs cannot address the immediate needs of hungry individuals who are unable to participate in the schemes. Other complementary programs are required for households that are poor in labor as well as in income terms.

Properly designed public works programs have a unique feature in favor of poverty and hunger alleviation with low administrative costs and effects: self-targeting At appropriate wage rates, the working poor identify themselves by offering their labor. However, the self-targeting feature only operates effectively with an appropriate (low) wage rate policy and a flexible absorption of applicants without rationing work places. The issue of whether to pay in cash, in kind, or a combination of the two is related to the wider problem of wage rate determination and to the risk of market failure.

Providing credit to the poor for stabilizing consumption and for self-employment through private investment is an important mechanism for improving food security in the growing and diversifying rural economies of many low-income countries Many innovations occurred in the 1980s and early 1990s. These programs are most likely to succeed in areas where agricultural growth is proceeding well and that have good roads and market activity.

The most successful programs in generating self employment for the poor and stabilizing consumption are those that combine small-scale credit with group motivation, technical advice, and other forms of assistance such as nutrition and health programs, for example, Bangladesh's.

Grameen Bank Group loans for poor households without collateral can be an effective mechanism that ensures repayment as long as the group remains small and peer pressure can operate.

Access to credit is an important food security mechanism, both in the short run and in the long run. In the short run it enables the poor to weather shocks without selling productive assets, which would render them even more vulnerable to future shocks. In the long run it enables them to adopt new technologies and farming methods that increase yields and production without causing environmental degradation and natural resource depletion.

Development practitioners increasingly understand that production fluctuations, market infrastructure, government policy, location, and sectoral diversification are important determinants of a country's demand for stabilization of food availability and prices. Stabilization must tee attuned to a country's specific production risks (for example, whether it is prone to droughts or floods and trade risks (for example, whether it is landlocked). The response of local- and farm-level storage to public policies is an important consideration, especially in circumstances where post-harvest losses are significant and where local market disruptions occur frequently.

Price stabilization has both benefits (including in terms of food security) and costs. It is expensive. Frequently, low-income countries cannot afford it financially or administratively Recent research into domestic price stabilization schemes in developing countries suggests that governments can minimize the costs of stabilization by relying on market mechanisms when possible, avoiding schemes that require physical handling of the commodity, not trying to stabilize prices too much, and attempting to mimic prices that would be established in a freely functioning market.

Food market end trade interventions are wide spread not only in low-income countries, but to an even greater extent in high-income countries The stabilization policies of high-income countries can destabilize world markets. The extent and level of intervention in low-income countries vary and the late 1980s saw considerable steps toward the liberalization of the agriculture and food sectors in these countries. This does not indicate a reduced concern for food security on their part.

Human capital investment. Longer-run enhancement of the labor productivity of the poor requires that both chronic energy deficiencies and hidden hunger be addressed directly through investments in improved health and human resources Improved investment in primary health care facilities and services could significantly reduce undernutrition and malnutrition in many regions. The improvement of potable water supplies also remains a long-term priority.

At the same time, improved education is needed The upgrading of human capital, with a positive emphasis on female education, has strong multiplier effects in income growth, technology adoption, and the control of population expansion All are crucial to the enhancement of long-term food security.

Combining the Options: Targeting Risks of Food Insecurity

The policies and programs briefly reviewed above address the risk of a household becoming food insecure, and therefore hungry. These risks can originate from different sources and the effectiveness of policies and programs can vary For example, a program that raises crop yields may not have an impact on household food security in the short run, whereas a short-term feeding scheme on its own may not have a measurable impact in the long run Table 2 links the risks of hunger with the policies and programs discussed above The following points from the table deserve highlighting:

· Crop production risks are best addressed directly through technological change and improved commercialization of agriculture in the long run. In countries with high risks of food unavailability and price fluctuations, join/promotion of technological change in staple foods and an appropriate incentive environment for agricultural commercialization is called for. Hunger is often best addressed not by self-sufficiency goals (be it at household or at national levels), but by food security goals that seek an efficient balance between higher domestic production and trade

· Short-term food availability and related food price risks can be addressed by means of a large array of options, including policies at the macroeconomic level; stockholding; trade and aid policies; and programs such as public works, provision of consumption credit, food subsidies, feeding programs, and income transfers that strengthen the entitlements of food-insecure households. Agricultural production policies address these risks in the long run

· Employment and income risks can be tackled in the long run through agricultural production policies, and in the short run through entitlement strengthening as indicated Labor-intensive public works would have both short- and long-run risk reduction effects, the latter by cre.

· Food security policies alone—with the exception of those feeding programs that have strong ties to health care—have only a limited impact on the mitigation or prevention of health risks, which together with food security risks establish nutritional risks Other policies and programs are needed in conjunction with food security policies. Promoting behavioral change through nutrition education can have favorable effects for dealing with most of the risks. Long-run benefits result from the human capital enhancement effects of short-term subsidies and transfer policies.

Table 2. Hunger risks and policy choices.

The typical problem of combined chronic and transitory food security problems of poor house holds requires a well-designed portfolio of food security policy actions. Such a portfolio builds on assessments of the nature of risks and of the instruments available, which are influenced by institutional capacities. Throughout this review, a number of complementary actions that need to be undertaken in conjunction with food security policies and programs have been identified. These complementary actions include the development of an adequate market infrastructure and policies that do not impair trade The rapid development of rural financial markets open to all individuals, which permits the smoothing of consumption, is another complementary action.

From Hunger Response to Social Security

A long-term view of hunger alleviation needs to be established and institutionalized Polices aimed at household food security must be seen as basic to social security policy, achievable by an appropriate division of labor between the private and public sectors Such a division of labor depends on country and community-specific capabilities It also depends on more than ensuring an adequate supply of food to countries with a severe hunger problem.

A key component in the pressure on the world to feed itself is that many regions still exhibit high and rising population growth rates. Large families are a means of social security for the poor. In the next two decades 2 billion people will be added to the world's population the largest population increase ever in a twenty year period. Efforts that provide social security will contribute to lowering fertility rates by (a) reducing mortality rates, (b) reducing the number of births required in a family to ensure a given number of surviving children, and (c) reducing the demand for surviving children. This will reduce the pressure on the food supply chain. Many of these goals, however, can only be achieved in the long run.

Given the close relationship between agricultural production and the livelihood of the poor in rural-based economies partly mediated via price, wage, and employment effects—it is in the agricultural policy area that a number of countries can most rapidly contribute to social security with growth. Improved agricultural technology and roads, combined with an effective foreign trade policy, contribute to basic social security by reducing the impacts of production fluctuations.


The absolute number of hungry people is likely to continue to grow well into the twenty-first century. Successes in reducing hunger in parts of Asia, and even in parts of Africa, should not be overlooked; they are signals that certain policies, projects, and practices can work However, the donor community and the governments of poor countries have finite resources for investment against hunger, and the problem has no easy or inexpensive solution.

This requires developing country policymakers and international donors to focus on key policies and programs that will not only raise the food supply, but will also improve food access by the poor This calls for three major priorities with back ward and forward linkages as illustrated in the conceptual framework presented at the outset, namely.

· First, the focus must be on tackling the worst hunger where it exists today. This requires effective famine mitigation and preparedness activities in Africa's most vulnerable countries.

· Second, well-targeted investments are required in rural areas to tackle chronic and hidden hunger. Potential actions include employment creation programs aimed at raising and stabilizing the incomes of the poor, improved institutional credit programs, targeted food distributions, and effective price and trade policies, coupled with appropriate education, nutrition and health investments.

· Third, the first two priorities should be under written by longer-term investment in agricultural growth, which benefits the poor directly, supported by agricultural research, trade, and well-functioning factor markets.

Success in the third priority should, over time, reduce the need for investments of the first and second kinds. Investment in agriculture over and above investment in emergency interventions yields three important gains: (a) a net increase in the aggregate food supply, (b) a net saving in the Volume of relief activities required, and (c) a net saving in relief costs because of improved efficiency of delivery. Quantifying these savings in absolute terms is a complex task, but one that would better guide the process of setting investment priorities. The longer decisions are made on an uninformed ad hoc basis, the longer hunger will persist.

For success in the fight against hunger, international cooperation toward food security for ale must be institutionalized by means of appropriate incentives. Given the nature of political and administrative processes, the recognized need for cooperation and coordination among agencies and ministries, for example, those concerned with agriculture and health, must be continuously reinforced. The related United Nations' agencies, such as the Food and Agriculture Organization of the United Nations, the World Health Organization, the United Nations Children's Fund, the World Food Programme, the International Fund for Agricultural Development, and other development agencies, as well as the Consultative Group on International Agricultural Research, the World Bank, and the International Monetary Fund, have a key role to play in setting good examples and in fostering such cooperation at country and international levels.

There is no excuse for the continued occurrence of hunger in today's world Public policy actions based on partnerships between communities and public agencies can tackle hunger effectively This calls for an improved understanding of local constraints and needs. With its complex origins, hunger requires appropriate multisectoral solutions that focus on a narrow set of achievable priorities. Local conditions will dictate these priorities, which must be welt coordinated, not just among international players, but also among local communities and their governments.


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2 Food and Agriculture Organization of the United Nations (FAO), Food Outlook 8/9 (Rome: FAO, 1993).

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5. Jean Dr and Amartya Sen, Hunger and Public Action (Oxford: Clarendon Press, 1989); J. von Braun, T. Teklu, and Patrick Webb, "Famine as the Outcome of Political, Production, and Market Failures," IDS Bulletin 24 (4) (1993): 73-78.

6. Patrick Webb, J. von Braun, and Y. Yohannes, Famine in Ethiopia’s Policy implications of Coping Failure at National and Household Levels, Research Report 92 (Washington, D.C: International Food Policy Research Institute, 1992).

7. R S. Chen, "Hunger among Refugees and Other People Displaced across Borders," Hunger 1993: Uprooted People, ed. Bread for the World Institute on Hunger and Development (Washington, D.C.: Bread for the World Institute on Hunger and Development, 1992); S. S. Russell, K. Jacobsen, and W. D. Stanley, International Migration and Development in sub-Saharan Africa, vol. 2, Country Analyses, World Bank Discussion Paper 102 (Washington, D.C.: World Bank, 1990).

8. Bread for the World Institute on Hunger and Development, ea., Hunger 1993: Uprooted People (Washington, D.C.: Bread for the World Institute on Hunger and Development, 1992).

9. H. J. Leonard and contributors, Environment and the Poor: Development Strategies for a Common Agenda U.S. Third World Policy Perspectives 11 (New Brunswick, N.J.: Transaction Books, 1989).

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11. S. A. Vosti, "Reprise of Rio: Survival's Sharp Edge," Diversity 8 (4) (1992): 380-96.

12. Dr and Sen, Hunger and Public Action.

13. Von Braun, Teklu, and Webb, "Famine as the Outcome of Political, Production, and Market Failures," 73 78.

14. United Nations Administrative Committee on Coordination /Subcommittee on Nutrition (ACC /SCN), Second Report on the World Nutrition Situation (Geneva: ACC/SCN, 1993); S. Broca and P. Oram, "Study on the Location of the Poor," Report prepared for the Technical Advisory Committee of the Consultative Group on International Agricultural Research (Washington, D.C.: International Food Policy Research Institute, 1991).

15. J. S. Davis, P. A. Oram, and J. C;. Ryan, Assessment of Agricultural Research An International Perspective (Canberra: Australian Centre for International Agricultural Research in collaboration with the International Food Policy Research Institute, 1987).

16. ACC/SCN, Second Report on the World Nutrition Situation.

17. Broca and Oram, "Study on the Location of the Poor".

18. Broca and Oram, "Study on the Location of the Poor.”

19. ACC/SCN, Second Report on the World Nutrition Situation; Per Pinstrup Andersen, "Global Perspectives for Food Production and Consumption," Tidsskrift for Landakanimi 4 (December 1992): 145 69.

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21. J. von Braun and others, Urban Food insecurity and Malnutrition in Developing Countries: Trends Policies, and Research Implications (Washington, D.C: International Food Policy Research Institute, 1993).

22. "Slow Famine Relief Imperils Millions" Africa Recovery, June 3. 1993.

23. Patrick Webb and J. von Braun, Food Security and Famine in Ethiopia: Lessons for for (London: (London: John Wiley and Sons, 1994).

24 T. Teklu, J von Braun, and E Zaki, Drought and Famine Relationship in Sudan: Policy Implications, Research Report 88 (Washington, D C: International Food Policy Research Institute, 1991); Webb, von Braun, and Yohannes, Famine in Ethiopia: Policy Implications of Coping Failure at National and Household Levels.

25 Per Pinstrup-Andersen, "Socio-economic and Policy Considerations for Sustainable Agricultural Development" (Paper presented at the Thirteenth World Bank Agricultural Symposium on Agriculture and Environmental Challenges, Washington, D C, January 6-7, 1993.

26. Pinstrup-Andersen "World Food Trends and How They May Be Modified."

27. Pinstrup-Andersen. "World Food Trends and How They May Be Modified ".

28. Von Braun and others, Urban Food Insecurity and Malnutrition in Developing Countries.

29. This decline relates to the thirteen international research centers that existed prior to the expansion in 1992. The CGIAR currency comprises eighteen centers.

30. Pinstrup-Andersen, "World Food Trends and How They May Be Modified ".

31. J. von Braun and E Kennedy, eds., Agricultural Commercialization, Economic Development, and Nutrition (Baltimore, Maryland; The Johns Hopkins University Press for the International Food Policy Research institute, forthcoming).

32 Per Pinstrup-Andersen, "The Social and Economic Effects of Consumer-Oriented Food Subsidies: A Summary of Current Evidence," Food Subsidies in Developing Countries. Costs, Benefits, and Policy Options, ed P. Pinstrup-Andersen (Baltimore and London: The Johns Hopkins University Press for the International Food Policy Research Institute, 1988).

33. E. T. Kennedy and H. H. Alderman, Comparative Analyses of Nutritional Effectiveness of Food Subsidies and Other Food-Related Interventions (Washington, D.C.: International Food Policy Research Institute, 1987).

34. Kennedy and Alderman, Comparative Analyses of Nutritional Effectiveness of Food Subsidies and Other Food-Related Interventions.

35. Kennedy and Alderman, Comparative Analyses of Nutritional Effectiveness of Food Subsidies and Other Food-Related Interventions.

36. H. Alderman, M. G. Chaudhry, and M. Garcia, Household Food Security in Pakistan: The Ration Shop System, Working Papers on Food Subsidies 4 (Washington, D.C: International Food Policy Research Institute, 1988).

37. Per Pinstrup-Andersen and H. Alderman, "The Effectiveness of Consumer-Oriented Food Subsidies in Reaching Rationing and Income Transfer Goals," Food Subsidies in Developing Countries.

38 M. Garcia and Per Pinstrup-Andersen, The Pilot Food Price Subsidy Scheme in the Philippines: Its Impact on Income, Food Consumption, and Nutritional Status, Research Report 61 (Washington, D C: International Food Policy Research Institute, 1987); N. Lustig, "Fiscal Cost and Welfare Effects of the Maize Subsidy in Mexico," Food Subsidies in Developing Countries.

39 H. Alderman and J. von Braun, The Effects of the Egyptian Food Ration and Subsidy System on Income Distribution and Consumption, Research Report 45 (Washington, D.C.: International Food Policy Research Institute, 1984); N. Edirisinghe, "Food Subsidy Changes in Sri Lanka: The Short-Run Effect on the Poor," and M Garcia, "Food Subsidies in the Philippines: Preliminary Results," Food Subsidies in Developing Countries.

40. H. Singer and S. Maxwell, "Food Aid to the Developing Countries A Survey," World Development 7 (3) (1979) : 225 46; J. von Braun and B. Huddles ton, "Implications of Food Aid for Price Policy in Recipient Countries," Agricultural Price Policy for Developing Countries, eds. J W. Mellor and R Ahmed (Baltimore and London The Johns Hopkins University Press for the International Food Policy Research Institute, 1988).

41. Patrick Webb, "Food Security through Employment Creation in the Sahel: Labor-Intensive Programs in Niger," Report to the Deutsche Gesellschaft fur Technische Zusammenarbeit (Washington, D C: International Food Policy Research Institute, 1993); Webb, von Braun, and Yohannes, Famine in Ethiopia.

42. International Food Policy Research Institute! Bangladesh Institute of Development Studies (IFPRI/ BIDS), "Development Impact of the Food-for-Work Program in Bangladesh," Final report submitted to the World Food Programme (Washington, D.C.: International Food Policy Research Institute, 1989); l- von Braun, T. Teklu, and P. Webb, Labor Intensive Public Works for Food Security: Experience in Africa, Working Papers on Food Subsidies 6 (Washington, D.C: International Food Policy Research Institute, 1991).

43. M. Hossain and M. Mokaddem Akkash, Public Rural Works for Relief and Development A Review of the Bangladesh Experience, Working Papers on Food Subsidies 7 (Washington, D.C.: International Food Policy Research Institute, 1993).

44. S. K. Kumar and O. H. Chowdhury, '´The Effects on Nutritional Status, Development Impact of the Food for-Work Program in Bangladesh," eds. International Food Policy Research Institute
(IFPRI)/Bangladesh Institute of Development Studies, final report submitted to the World Food Programme (Washington, D.C.: IFPRI, 1989); S. R. Osmani and O. H. Chowdhury, "Short-Run Impacts of Food-for-Work Programs in Bangladesh," Bangladesh Development Studies 11 (1 and 2) (1983):135-90.

45. S. Kurnar, S. 1988. "Rural Infrastructure in Bangladesh: Effects on Food Consumption and Nutrition of the Population" (Washington, D.C.: International Food Policy Research Institute, 1988); K L. Bell, R W. Hay, and T. Martinez, "Consumers and Savers: Can Food-for-Work Stimulate Economic Growth at the Household Level?" (Oxford. University of Oxford, International Development Centre, Food Studies Group, 1989).

46. Webb, "Food Security through Employment Creation in the Sahel: Labor-Intensive Programs in Niger"; P. Webb and S. Kumar, "Ethiopia's Food/Cash for Work Programs: Experiences under Joint Stress from Famine, Drought, and Economic Policy Reform" (Paper presented at the International Policy Workshop on Employment for Poverty Alleviation and Food Security, Virginia, October 11-14,1993).

47 H. Ezekiel and J. C. Stuyt, "The Maharashtra Employment Guarantee Scheme Its Response to Differences in Employment Patterns between Districts," The Economic Times (Bombay), May 31-June 2,1989.

48. M. Ravallion, G. Datt, and S. Chaudhuri, "Higher Wages for Relief Work Can Make Many of the Poor Worse Off: Recent Evidence from Maharashtra's Employment Guarantee Scheme" (Washington, D.C.: World Bank, 1990).

49. Osmani and Chowdhury, "Short-Run Impacts of Food-for-Work Programs in Bangladesh"; Webb and Kumar, "Ethiopia's Food/Cash for Work Programs.”

50. M. Zeller, G. Schreider, J. von Braun, and F. Heidhues, "Credit for the Rural Poor in Sub-Saharan Africa," Report to the Deutsche Gesellschaft fur Technische Zusammenarbeit (Washington, D.C: International Food Policy Research Institute, 1993).

51. M. Hossain, Credit for Alleviation of Rural Poverty The Grammeen Bank in Bangladesh, Research Report 65 (Washington, D C: International Food Policy Research Institute, 1988).

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53. Von Braun and others, Improving Food Security of the Poor.

54. O. Knudsen and J Nash, "Domestic Price Stabilization Schemes in Developing Countries," Economic Development and Cultural Change 38 (3) (1990): 539-58.

55. J. Mellor, C. Delgado, and M. Blackie, Accelerating Food Production in Sub-Saharan Africa (Baltimore: The Johns Hopkins University Press, 1987).

Appendix 5 - hunger and the world bank: an NGO perspective

An NGO Statement Presented to the World Bunk Hunger Conference, November 30, 1993

Hunger is, in most instances, a consequence of economic impoverishment and marginalization It is thus imperative that economic empowerment form the core of strategies to eliminate the underlying causes of hunger These efforts must also include adoption of policies that build self-reliant food security.

Strategies aimed at economic empowerment and self-reliant food security cannot be imposed from the top Rather, they must be identified, formulated, implemented, and evaluated with the full participation of those whom these strategies are intended to serve. Such participatory strategies preclude a business-as-usual approach to project and policy development and implementation, and will produce substantially superior results than conventional practice.

Given that structural adjustment policies frequently have increased hunger in countries in which they have been implemented, NGOs are pleased to see this issue on the agenda for the conference. However, for meaningful follow through to the conference we believe that the Bank must initiate an open review of its role in designing and supporting macroeconomic policies that worsen the problem of hunger It must then engage in a participatory process of rethinking and reformulating its projects and policies such that they address short-term poverty alleviation, as welt as long-term economic empowerment of the poor.

We therefore call upon the World Bank to commit itself to implementing the recommendations presented below by the end of 1996 as its contribution to the general effort to end hunger.


True participation is assured only through economic and political empowerment based on increased control of productive resources. There fore, the World Bank should make this empowerment a cornerstone of its work with governments on programs, policy, and institutional reform. This means making a significant commitment to programs and policies that will increase access for the poor, especially women food producers, to all productive resources (such as land, capital, technology, and markets) and skills such as literacy.

Due participation also requires full recognition, respect, and support for community rights and social processes These include the cultural rights embodied in the substantial contribution of food preferences and practices to the cultural identity of most peoples. Those who presume to help a people strengthen their food security have an obligation to avoid the arbitrary infringement of their right to choose their own cultural food and other practices.

The World Bank must revamp and democratize the process by which it identifies and supports all development projects and policies, including structural adjustment policies In this regard, we applaud Mr. Preston's statement of April 28 about the importance of "ensuring broad participation of the poor m the design as well as the implementation of projects. We want this to become the norm of our operations in the years to come." We affirm not only his recognition of the importance of involving the poor early on, but also his commitment that this become the norm for all operation programs as well as projects.

At the same time, we are aware from our own field experience that the participation elicited from the poor by multilateral agencies is often superficial, may not be broadly representative, and the results of consultations are often ignored. Many of these problems can be overcome by seeking participation by those most vulnerable to hunger, particularly women We recommend that the Bank actively reach out to and incorporate the perspectives and recommendations of women's groups, community groups including NGOs and other actors in civil society in all Bank programs and policies. We also call upon the Bank to strengthen and encourage NGO and community involvement in obtaining reviewing, and responding to information on all prospective World Bank projects and policy recommendations.

Full and meaningful participation is not possible without access to relevant information The World Bank is a public institution engaged in providing public financing to public agencies for public purposes. The public in whose name such financing is provided and which ultimately must repay the resultant financial obligations has a right to full information regarding those obligation The World Bank's willingness to respect this right of the sovereign people and to require borrowing governments to do likewise will be a basic measure of its commitment to participation.

In order to monitor the results of its commitment to participation, we recommend that all project and adjustment operations considered by the board be accompanied by a full and gender disaggregated description of how poor and hungry people have been consulted, how they will directly benefit, and how actual consequences for them will be monitored using gender disaggregated indicators of equity (for example, distribution of income, distribution of land ownership, access to credit, and other similar indicators).

Finally, we recommend that the management incentive system of the Bank be revamped to ensure that advancement within the institution is linked to demonstrated commitments to and skills in fostering popular participation in Bank operations. This recommendation was embraced by Mr. Preston in his 1992 meeting with the World Bank NGO Committee. The Wapenhans Report amply demonstrated how giving priority to getting project approvals and moving money has impaired the quality of Bank operations. Our recommendation for revamping incentives should be at the heart of portfolio management reforms.

People-Centered Macroeconomic Policies

While we support efforts to fight hunger at the grassroots, the Bank has long been an advocate of the proposition that polices are key to development outcomes. We agree. If the policies are wrong, hunger will persist in spite of the most effective and committed grassroots NGO antihunger activity We therefore urge the Bank to make the economic empowerment of the poor a fundamental priority not only in projects, but also in its policy reform efforts.

In particular, the Bank should give priority in policy and sectoral adjustment programs to policies that will raise real incomes and reduce risks for poor and hungry people on a direct and immediate basis’s well as in the medium and long term. This includes policies that enhance food security, employment, and incomes in both urban and rural settings; and lead to permanent reduction in foreign indebtedness and increase self-reliance in meeting basic needs.

Furthermore, the World Bank must relinquish its insistence that free and open markets are an adequate vehicle for allocating available food The market is frequently not effective in equitably or efficiently distributing food, as starkly revealed in numerous historical instances of famine amidst plenty. All policy initiatives must take this into account through measures that assure the poor have the means to meet their basic food needs.

For the Bank to continue to rely on trickle down economic policies and top down program planning is not consistent with a commitment to ending hunger These policies are not only failing to improve the quality of life of the poor-especially the ultra poor—they are increasing the social security and vulnerability to hunger of these groups.

Each adjustment operation or other policy initiative presented to the World Bank's board should be accompanied by a description of how that operation or initiative will benefit the poor as a primary focus—not simply as the objects of the safety net programs that often supplement World Bank/IMF structural adjustment operations.

Project Quality

Now that the Bank is attempting to become a more client government-centered institution, it is essential that it do more to ensure accountability to the poor, who are the people most affected by the Bank's policies and programs. As the Bank reorganizes centrally and in the field to upgrade its portfolio management, the modalities and locus for enhancing popular participation should be unambiguous, and above all country specific. We recommend that this be done directly with NGOs, community-based organizations, cooperatives, and other actors in civil society. We recommend that the Bank work with governments and NGOs to develop specific guidelines to ensure that operations are viable at all stages from a sustainable development point of view. The portfolio management reform process is giving more emphasis to ensuring development impact as well as economic performance. Unfortunately, for the Bank, the meaning of "development impact" remains cloudy

We recommend that the Bank's definitions of development impact and project quality give substantial weight to an operation's anticipated and actual contribution to equity, environmental sustainability, and participation goals. Such guidelines should ensure, for instance, that the Bank commits to funding only projects and programs that actively and directly increase sustainable on-site livelihood opportunities for disadvantaged people in the localities in which they presently live.

Personnel evaluations should include assessments of contributions to development impact and project quality so defined.

Poorest of the Poor

The Program of Targeted Interventions (PTI) would target investments toward the poor, broadly speaking. We recommend that in the next two years, the percentage of IDA PTI lending— especially lending focused on the social sectors— be increased from 40 percent to a minimum of 50 percent, and that combined IBRD/IDA PTI lending be increased from 26 percent to a minimum of 45 percent.

We also recommend that the Bank include in all poverty studies, social impact assessments, and project appraisals a gender disaggregated assessment of the specific and distinctive needs of the ultra poor (the poorest 10 to 20 percent) and make specific provision to invest in members of this group and to expand the livelihood opportunities available to them.

This statement is enclosed by the following organizations:

Chuck Woolery
Alliance for Child Survival.

George Porter
Aotearoal Zealand Council for international Development.

Antonio B. Quizon
Asian NGO Coalition for Agrarian Reform and Rural Development (ANGOC), The Philippines.

Edwin Zablah
Association Latinoamericano des Organizaciones de Promocion (ALOP).

Sekai Holland
Association of Women's Clubs, Zimbabwe.

Binta Sarr
Association pour la Promotion de la Femme Senegalaise—APROFES, Senegal.

David Beckmann
Nancy Alexander
Bread for the World.

Dr. Philip Johnston

Cathy Shepherd
Caribbean Association for Feminist Research and Action /Women Working for Social Progress.

James E Hug, S. J
Center of Concern.

Georgina Ashworth

Safieton Diop
Collectif des Femmes pour la Defense de la Famille, Senegal.

Jeremy Hobbs
Community Aid Abroad, Australia.

Rodney E. Leonard
Community Nutrition Institute.

Michael Hansen
Consumer Policy Institute
Consumers Union of Japan Development Action Group, South Africa.

Douglas Hellinger
The Development GAP.

Lori Udall
Environmental Defense Fund.

Carlos Heredia
Equipo Pueblo, Mexico.

Anano Mwenegoha
Evangelical Lutheran Church, Tanzania Food Irradiation Network, Japan.

Mazide N'Diaye
Forum for African Voluntary Development Organizations (FAVDO), Senegal .

Foundation EL TALLER, Tunisia.

Rupert Scofield
Foundation for International Community Assistance.

Edwin Zablah
Fundacion Augusto C. Sandino, Nicaragua.

Richard Burmgarner
Global Food and Nutrition Alliance.

Bev Greach
Group for Environmental Monitoring.

Joan Holmes
The Hunger Project.

Ben Turok
Institute for African Alternatives, South Africa.

Mark Ritchie
Institute for Agriculture and Trade Policy.

Gonzalo Tapia
Interamerican Network of Agriculture and Democracy.

John Miheve
Inter-Church Coalition on Africa.

Jim Bell
Interfaith Impact for Justice and Peace.

Mensah Todzro
Les Amis de la Terre, Togo.

Maryknoll Fathers and Brothers Justice and Peace Office.

Wendy Gordon
Mothers & Others for a Livable Planet.

Akin Mabogunje
National Board for Community Banks, Nigeria.

Rev. Mutava Musyimi
National Council of Churches of Kenya.

Lynn A. Greenwalt
National Wildlife Federation.

Network for Safe and Secure Food and Environment, Japan.

Chuck Kaufman
Nicaragua Network Education Fund.

Rita Clark
Nicaragua United States Friendship Office.

Kathy Lawrence
NGO Working Group on Sustainable Agriculture.

Not to the Harmonization Action Committee, Japan.

George Porter
Pacific Institute of Resource Management, New Zealand.

David Korten
People Centered Development Forum.

Monica Moore
Pesticide Action Network North America.

Graeme A. Reid
PLANACT, South Africa.

Alison Clarke
Politics of Food Program.

Caleb Rossiter
Project on Demilitarization and Democracy.

Luis Lopezllera M.
Promociel Desarrollo Popular, Mco.

Public Interest Research Group, India.

Allen M. Armstrong
Rangpur Dinajpur Rural Service, Bangladesh.

Karin Nansen
REDES-FOE, Uruguay.

Joanne Carter

Rudolf Buntzel
Rural Development Education of the Evangelical Church in Germany.

Susan Shure
Shure Communications.

Horace Levy
Jennifer Jones
Social Action Centre, Jamaica.

Mildred Robbins-Leet
Trickle Up Program.

Susan C. Peacock
United Church Board for World Ministries.

Bella Abzug
Susan Davis
Women's Environment and Development Organization.

Merle Hodge
Women Working for Social Progress.

Peter Mann
World Hunger Year.

Philip J. Hunt
World Vision Australia.

Joe Muwonge
World Vision International.

J. Patrick Madden
World Sustainable Agriculture Association.

This statement is endorsed by the following individuals (organizations listed for identification purposes only):

Tariq Banuri
Sustainable Development Policy Institute.

Omega Bula
All Africa Conference of Churches.

Christopher Dunford
Freedom From Hunger.

Karen Fennell
American College of Nurse Midwives.

Thomas Forster
NGO Working Group on Sustainable Development.

Leanne Grossman

John Gershman
Institute for Food and Development Policy / Food First.

Mark W. Harrison
General Board of Church and Society, The United Methodist Church.

Rev Dan C. Hoffman
Joint Ministry in Africa Office of the Disciples of Christ and the United Church of Christ.

Rev. Douglas B. Hunt
Church Center for Sustainable Community United Church of Christ, Office for Church in Society

Timmie Jensen
Chol Chol International.

Kathy Lawrence
Cites Network for Sustainable Development.

Carolyn M. Long

Erich O. Manias
Joint Ministry in Africa Office of the Disciples of Christ and the United Church of Christ.

Paul Nelson
Church World Service / Lutheran World Relief.

Carla Roppel
OXFAM, Global Agriculture Project.

Pablo Stone
Disciples Peace Fellowship.

Susan Drake Smith
Appropriate Technology International.