|From famine to food security (1997)|
|Household food security and nutrition in agricultural relief and rehabilitation programmes1|
1This article is based partially on unpublished reports by Carol Williams on her field visits to Ethiopia and Mozambique. Ms Williams' contribution is warmly acknowledged.
E. Muehlhoff and M. Herens
Ellen Muehlhoff and Marion Herens are Nutrition Officer and Associate Professional Officer, respectively, in FAO's Nutrition Programmes Service (Household Food Security Group).
In recent years the number of people affected by natural and human-caused emergencies has grown dramatically, from approximately 44 million in the mid-1980s to estimates of more than 175 million in 1993 (FAO, 1996a). Most crises in the 1990s have been brought about by civil conflict or war. Little is spared or protected in these situations; lives are lost, property is destroyed and hundreds of thousands of people are displaced. As a result of emergencies caused by conflicts and natural disasters, food security in a number of countries has deteriorated rapidly, especially in sub-Saharan Africa.
Severe disruption of food production and marketing systems is common during emergencies. Crop destruction and livestock deaths may result from natural events (drought, storms and floods as well as outbreaks of plant and animal pests and diseases), the devastation of war or a combination of events. Access to adequate food becomes difficult, and this hardship contributes to high rates of malnutrition. The provision of food, water, shelter, protection and medical care is essential for survival of refugees and internally displaced persons until the crisis is over and they can return to their homes or establish new ones. Actions are also needed to assist people who remain in their home communities during the crisis. Temporary food distribution and supplementary feeding for vulnerable groups and provision of agricultural inputs are common humanitarian interventions to help people cope when an emergency occurs.
This article focuses on the need for early efforts to foster recovery and promote sustainable development in rural areas. It stresses the importance of taking nutrition considerations into account in trying to ensure that households have secure access to food after a crisis occurs. It highlights the need to examine people's immediate food needs during an emergency and in the rehabilitation phase. As efforts are made to revitalize the local economy, the need to help rural populations meet their own nutritional needs in the long term is highlighted. Various strategies carried out by FAO and other international agencies, governments and communities are discussed.
EMERGENCY VERSUS DEVELOPMENT AID
In a number of countries, especially those that have been affected by prolonged crises, a shift in the type of development assistance is taking place, with external relief assistance often becoming the dominant form of aid (see Box).
TRENDS IN EMERGENCY AND DEVELOPMENT ASSISTANCE
The international community and donor agencies have expressed concern that frequent and recurring emergency situations are making increasing demands on international development aid and are absorbing large amounts of resources that might otherwise be available for development purposes. For example, World Food Programme (WFP) emergency food assistance and aid for protracted refugee and displaced person operations rose dramatically between 1989 and 1992. In contrast to emergency aid, WFP food aid designated for development of agricultural and human resources (e.g. food-for-work, food reserves, maternal and child health centre and primary and secondary school feeding programmes) has decreased in importance (see Figure).
WFP shipments for development projects, emergency and protracted refugee operations and displaced person operations, 1986-1995
Relief aid, however, is designed to alleviate the symptoms of food insecurity but not its causes. Such emergency assistance on its own cannot restore an area affected by famine or civil conflict to its previous situation, prevent future food insecurity or help communities in their path of development.
Prevention and preparedness measures and/or early mitigation strategies can alleviate the potentially devastating impact of natural or socio-political events if they are designed to establish mechanisms and build capacities to respond rapidly and effectively to such occurrences. Such efforts can help prevent natural disasters from turning into major emergencies (FAO, 1997). In countries that are prone to natural hazards, these strategies are part of development activities.
Even in regions with protracted conflicts there may be relatively peaceful periods which offer opportunities for development activities and conflict resolution. It must also be recognized that development activities that could help prevent food insecurity often face formidable obstacles, particularly in post-war situations, because in addition to human resources having been lost, infrastructure and institutions have been destroyed.
RELIEF - REHABILITATION - DEVELOPMENT
A gap has emerged between relief and development which has implications for the agencies that have traditionally been involved in either activity. The need for interventions that can bridge this gap and facilitate a faster transition from emergency response to sustainable development is compelling. Rehabilitation is gaining increasing recognition by FAO and other international agencies as an approach that can help distressed communities move away from emergency relief and re-enter the development process; communities would pass through phases of rehabilitation and reconstruction to eventual sustainable recovery (Brigaldino, 1995).
It is widely appreciated that the type of assistance provided both during and after an emergency can have a major influence on the ability of households to recover and re-establish their independence. Rehabilitation assistance is geared towards bringing the need for relief to an end, allowing communities, governments and aid agencies to concentrate on reconstruction (FAO, 1997). All three processes - relief, rehabilitation and development - may take place simultaneously. The exact combination of activities depends on the situation of the country.
If emergency assistance is linked to development assistance, poverty and food insecurity can be reduced and the improvements in a population's nutritional status can be sustained. This linkage can significantly lessen the need for future emergency assistance, as communities are encouraged to build up their capacity to prepare for and deal with future disasters. For identification and implementation of appropriate rehabilitation interventions that will ensure that relief and development are properly linked, the involvement and commitment of the recipient communities will be required.
The Rome Declaration on World Food Security and World Food Summit Plan of Action, adopted in November 1996, have underlined the urgent need to link relief operations and development programmes (FAO, 1996b). Creating conditions in which households can meet their own basic needs and sustain their nutritional well-being is a fundamental aspect of interventions carried out during the different phases of relief, rehabilitation and development programmes. Activities in the agriculture and food sector are key components in these programmes (see Box below).
ROLE OF FAO
FAO is the leading international agency for agricultural development. Raising the nutritional levels of all populations is a fundamental aspect of FAO's mandate. Although FAO is primarily a development agency, it is also an important provider of humanitarian assistance.
· To provide early warning of pending disasters and to minimize food insecurity and malnutrition following the outbreak of an emergency, FAO assesses the availability of crop and food supplies and the need for international food assistance through the Global Information and Early Warning System for Food and Agriculture.
· To assist countries in disaster prevention and preparedness programmes, FAO has created the Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases.
· After the onset of an emergency, FAO's Special Relief Operations Service can bring relief assistance such as agricultural inputs, e.g. seeds, tools, fertilizer, veterinary vaccines and animals for restocking.
· FAO also provides expertise in planning for agricultural rehabilitation following a disaster.
Ensuring that nutritional and household food security considerations are integrated into activities and interventions for relief and rehabilitation is an important duty. During and after emergencies, FAO interventions are aimed at ensuring that households receive appropriate support to prevent deterioration in their ability to obtain food and to enable them to recover if their food situation has worsened. In addition, FAO acts to lessen the potentially adverse impact of future crises.
NATURE OF EMERGENCIES
The precise nature and extent of an emergency determine the types of intervention to be carried out. An emergency may be sudden or gradual, short-lived or prolonged, natural or caused by human activities. Events may affect most of the population or may be limited to certain groups. The economic and social conditions of the country also determine the action to be taken.
Natural disasters may occur suddenly or may develop over a period of time, and relief and rehabilitation responses may vary accordingly. Be the onset slow (e.g. drought) or rapid (e.g. hurricane, earthquake), where resources and socio-economic conditions are fairly favourable, rehabilitation may be short-lived because households can quickly regain food security. If an emergency occurs in conditions of chronic food insecurity or a fragile environment, long-term assistance and a variety of interventions will be needed to support those people who are most affected, usually those who already lack resources and food-insecure groups.
Disasters caused by human activities are more complicated to respond to because they often involve a range of factors including climatic and environmental stress, destruction of infrastructure, loss of human resources, large-scale migration and political instability.
GENERAL CONSIDERATIONS IN PROVIDING ASSISTANCE
In many emergencies, intervention strategies must involve diverse sectors, such as agriculture, health, community development, education and planning, so that activities will pertain to both relief and development. Availability of resources and services, targeting of vulnerable segments of the population and appropriate timing are critical.
Resources and services
The condition of infrastructure such as road and rail networks, the institutional capacity of local and national governments to implement rehabilitation measures and the participation of affected communities determine whether relief and rehabilitation assistance have a positive impact. Particularly following war, the recovery of the local economy is influenced by factors such as the reconstruction of networks, the revitalization of local markets and increasing access to these outlets for selling produce and livestock and raising household assets and off-farm employment. Access to services such as water and irrigation, agricultural extension and input supply is essential for restoring the productive capacity of the land. In addition, health, nutrition, water, sanitation and education services are vital for restoring the health and productive capacity of the people.
Assistance must be appropriately targeted to ensure that the best use is made of scarce resources and that the most vulnerable individuals benefit. Food aid is usually targeted to those who are entirely destitute and to physiologically vulnerable groups such as the malnourished, infants, children, pregnant and lactating women, the elderly, orphans and the physically disabled.
Nutrition surveillance can serve as an important tool in targeting, since it not only identifies those individuals suffering from malnutrition, but may also provide relevant information about the effectiveness of the intervention by monitoring changes in the nutritional situation. In rehabilitation interventions where the aims are broad and the causes of household food insecurity are addressed, vulnerability is also defined according to socio-economic criteria. This distinction has important implications for designing interventions that are sensitive in meeting the particular needs of each group.
People who have sufficient assets such as animals, access to cash income and credit may be able to fend off hunger and starvation without compromising their future capacity for survival. Poor families often lack access to adequate food because they do not possess sufficient land, income or other resources to produce or purchase enough of the food needed for active and healthy lives. Agricultural interventions to improve household food security and nutrition, such as home gardening and crop diversification, should be designed for these vulnerable groups. A special focus on alleviating poverty and food insecurity can help speed and sustain their capacity to recover. People who have fled from conflict in rural areas and have temporarily settled in towns may also benefit from such programmes if suitable land and water are available and they are given the resources (e.g. seeds and tools) to grow food.
Whatever the intervention, correct timing is vital to prevent the loss of lives and the waste of scarce resources. It is essential that disaster preparedness and mitigation measures be implemented at the onset of an emergency (e.g. crop failure resulting from drought) so that households may be able to safeguard their productive assets and protect food security. For example, low-cost or subsidized cereals can be provided to farmers through the market, targeted food-for-work programmes or food distributions (including the distribution of supplementary foods to children and mothers) to alleviate the risks of hunger during the wait for the next harvest season. Some examples of interventions that can protect household resources from depletion are income support programmes, including labour-intensive employment schemes; direct cash support; exchange of livestock for cash or food; and fodder distribution in pastoral communities.
If preventive or mitigation measures are not possible or are insufficient, households will attempt to cope with an emergency by selling livestock, eating seed and migrating in search of employment, and their food situation will become more precarious. These activities may erode their ability to produce or procure food in the future and undermine their chances for early recovery and rehabilitation.
After an emergency, when farmers have lost their crops and productive assets, agricultural interventions need to be organized. For example, seeds for drought-tolerant staple crops and vegetables, tools, and veterinary care and fodder for livestock and draught animals may be distributed.
The timely provision of take-home food relief rations and of supplementary feeding for vulnerable groups is critical in preventing malnutrition and large-scale migration and enabling people to retain their seed and livestock.
NUTRITION AND HOUSEHOLD FOOD SECURITY CONCERNS
Both during and after an emergency, access to adequate food, health and care may be severely constrained. Households' nutritional status will be influenced not only by their access to an appropriate quantity and quality of food, but also by their access to wood or other fuel, clean water and food preparation equipment as well as time for feeding infants and young children. Nutritional knowledge and cultural practices may influence the amount and the type of food that each person in the household receives. Lack of access to health care and sanitation as well as food also affects appetite, nutrient needs and the ability to absorb nutrients.
When people are re-establishing their homes and farms, they may continue to be vulnerable to malnutrition. Displaced people or refugees returning to their home countries rarely have sufficient cooking equipment, storage vessels and water vessels to prepare their meals. There may be problems with milling of cereals because of lack of grinding mills. Scarcity of cooking fuel can be an additional problem affecting refugees and local populations alike, as large areas around relief camps have been denuded of trees in the search for lumber and fuelwood.
The nutritional knowledge of household members is one of the factors influencing how they allocate their scarce food resources among themselves and may determine whether labouring adults or nutritionally vulnerable infants and children have priority in receiving food. The ability to prepare suitable meals with the foods available is affected by households' understanding of their food and nutritional needs. Nutrition education may be needed to enable refugee and returnee populations to make use of unfamiliar foods. Whether farmers give priority to growing more nutritionally appropriate crops in the immediate post-emergency period may also depend on their nutritional knowledge, along with the availability of appropriate seeds and other inputs. Agricultural extension services and nutrition educators can have an important role in diversifying the local food supply and diet.
NUTRITIONAL ADEQUACY OF RATIONS
Whether households are in refugee camps or receiving relief at home, food assistance may be the main source of nourishment during an emergency. After a crisis, many people still need relief rations to meet their food requirements until the first harvest.
The nutritional composition of the food provided in assistance programmes is critical. However, food aid and food security intervention programmes do not always ensure that a balanced diet is available to the needy. Food rations typically consist of cereals, oil and beans; they often contain inadequate amounts of energy and protein and lack variety.
It is important that relief rations cover energy needs for agricultural work and reconstruction. The rations should be based on appropriate average requirements for individuals undertaking such physical activities (James and Schofield, 1990). Lack of adequate and appropriate food during peak agricultural periods contributes to under-nutrition because energy requirements are high at this time. Low body weight among adults, as measured by body mass index (BMI), is highly correlated with periods of illness, low physical activity and reduced capacity to work.
Diets among food relief recipients are frequently deficient in essential micronutrients such as vitamins A and C, niacin and iron. There is considerable evidence that the poor nutritional quality of food rations was a factor in several outbreaks of scurvy in Ethiopia, Somalia and the Sudan and in pellagra affecting Mozambican refugees in Malawi during the 1980s (Toole, 1992).
The micronutrient composition of the diet influences disease resistance, growth and development of children and capacity to work, learn and play. Severe and prolonged lack of micronutrients can lead to irreversible damage; for example, vitamin A deficiency causes night blindness and eventual blinding xerophthalmia, and iodine deficiency during pregnancy or infancy leads to brain damage and mental retardation in children.
Anaemia resulting from low iron intakes is known to weaken adults and to reduce their work capacity. Women of child-bearing age have greater iron requirements; thus ensuring sufficient iron intakes is especially crucial for this segment of the population.
Nutrition interventions are not limited to food provision and consumption matters; a wide range of activities can have an impact on food security and nutrition.
Data on levels of malnutrition, micronutrient deficiencies, mortality, outbreaks of disease and threats to health should be collected. These data can be compared with data from normal years (if they are available) to determine whether there has been a significant change in acute malnutrition. An increase in levels of malnutrition of more than 10 to 20 percent is likely to be a result of food insecurity, especially if the increase occurs in the absence of a major disease epidemic and the change affects the entire population (Young and Jaspars, 1995).
Anthropometry. Expertise in the area of nutritional or anthropometric assessment is needed. Data on levels of malnutrition [i.e. percentages of wasting or stunting or mid-upper-arm circumference (MUAC) for children; body mass index (BMI) for adults] can serve as good indicators of the nutrition situation of the community and can identify the population groups that are most at risk of malnutrition. By itself, anthropometric information is difficult to interpret meaningfully; it should be analysed in conjunction with qualitative information to identify the causes of food insecurity and malnutrition. Furthermore, there is a need to coordinate and standardize the collection of data on household food security, health and nutrition to ensure comparability and accurate interpretation of results with a view to planning appropriate interventions and monitoring their impact.
Local food patterns. Information about the basic food system and how food is obtained (e.g. wage labour, household agriculture, food aid, bartering) should be gathered. Knowledge of the seasonal cycle of activities and its effects on household food security and composition of the diet is important. It should be determined how and to what extent local food patterns are affected by the emergency situation. Persons familiar with the local conditions can provide valuable information about how households cope with food shortages (e.g. through changes in food acquisition behaviour such as gathering wild foods) and can identify the various sources of food available to people in different areas and agro-ecological environments. They can assess whether there are changes in meal patterns, types of food, frequency of feeding and patterns of breastfeeding. The constraints that women face in providing adequate care for their children can be identified.
Information about quality of the diet, food hygiene and safety and access to health services is essential for a comprehensive picture of the situation. Because adequate nutrition is of central importance to families and communities, especially in times of food scarcity, nutritionists are particularly well placed to assist the local planning authorities and to mobilize the local people in addressing their food, care and feeding problems. Nutritionists and others can obtain the views of community members regarding their immediate concerns and priorities and their own assessment of their current food situation. The views and priorities of different groups, including rich and poor farmers, nomads, casual labourers, artisans, fishermen and the urban poor as well as local or district authorities, should be considered. The comparative situation of male-and female-headed households should also be assessed. Based on these assessments, it can be determined whether various groups are at risk of food insecurity.
Planning and implementation
Nutrition considerations and objectives should be incorporated into relief and rehabilitation programmes from the start. Participatory assessment and planning approaches can be applied in planning interventions after emergencies. In planning agricultural interventions, household food security and nutritional needs should be addressed. For example, nutritionists can identify the need for food aid and food-for-work programmes in combination with agricultural rehabilitation. They can plan accompanying measures such as training and nutrition education for extension staff and affected populations, to include subjects such as food production, storage, processing and preparation of foods.
Agricultural relief interventions frequently include the distribution of seeds, tools, fertilizer, pesticides and draught animals. Nutritionists can recommend whether such distributions should include a general food ration as well. To make effective use of these agricultural inputs, households must have enough food to tide them over to the next harvest. As noted earlier, without the distribution of an adequate general ration, households may be forced to eat the seed, to sell the agricultural inputs to buy food or to labour on other people's farms or in food-for-work schemes at the expense of cultivating their own fields.
Crop choice. In seed distributions, priority is often given to the main staple crops, although pulses and vegetable seeds may be distributed as well. While the choice of crop is often determined by seed availability, the use of nutrition criteria can encourage a more diversified food supply that can meet the nutritional needs and consumption patterns of the population. Foods to be promoted should include energy-and protein-rich foods (i.e. staple, oil and legume crops) and micronutrient-rich foods (e.g. vegetables and fruits).
Provision of vegetable seeds can encourage even households with limited access to land to cultivate mixed gardens around their homestead. Home gardens can make valuable contributions to the family food supply and income as well as providing a welcome complement to relief rations. Home gardening is especially beneficial when attention is given to raising small animals as well.
Cassava and sweet potatoes, which are often less favoured and underutilized, are gaining importance as safeguards against food insecurity in conflict and post-conflict situations. They are substituted for rice and maize, which are usually considered to be higher status foods. Roots and tubers are easy to grow, mature quickly and provide energy. Since they are kept underground, they are less vulnerable to destruction and raiding. However, where these foods are not customarily consumed or are considered to be inferior, people may lack the knowledge and skills to store, process and prepare them properly. Educating people about appropriate storage methods and proper processing for these crops and about their use in the preparation of tasty meals and snacks will be important if their full nutritional benefits are to be derived. In the long term, education about nutrition and proper food utilization will also prove beneficial in helping to contribute to food diversity and to reduce dependency on one staple crop.
Obstacles. Interventions may not reach all households in need. Households with very limited access to farmland or water may not be helped by distribution of staple seeds or animals. In post-drought conditions these are some of the most vulnerable households since lack of land or water will prevent them from embarking on agricultural production.
Cultural conditions can present problems for women-headed households if women lack tenure to land and are excluded from participating in community decision-making processes. In some societies male-headed households may have a tradition of sharing farm equipment and animals and exchanging labour, while women may not benefit from such arrangements. Special support may be needed to enable women to prepare their land and to produce food. Where possible, women should be encouraged to work in groups to take advantage of inputs and to share responsibilities and labour for food production and income generation. This strategy works well, particularly among populations with strong traditions of labour sharing. Groups also provide a measure of protection during conflict situations when women may feel threatened in leaving the safety of their home compounds to work alone in fields in peripheral areas.
Monitoring and evaluation
Monitoring and information systems should be integral parts of relief and rehabilitation programmes from the beginning. Based on the initial assessments discussed above, indicators of the food security and nutrition situation are identified to measure the effects of interventions. It is particularly important to monitor the changes that people experience over a long period and how they try to cope with the changing situations. Such monitoring will allow a better understanding of the overall progress of the assistance programme in a given location and will also facilitate timely adjustment of activities, if necessary.
Local communities should be involved in the monitoring process, as such participation can encourage the development of a close relationship between the community, the local government and aid agencies. Encouraging community participation in programme implementation and creating opportunities for reviewing and discussing the results of monitoring (quantitative and qualitative data) will contribute to local capacity building and increase the chances of sustaining the activities.
It may be necessary to strengthen the capacity of government and non-governmental organization (NGO) staff to assess household food security and nutrition problems, plan and implement relief and rehabilitation programmes and monitor and evaluate interventions. Information, guidance and training on these activities can be provided at the national and local levels. Field staff should be trained in aspects of food production, storage, processing and preservation pertaining to food security and nutrition.
Coordination of assistance
Development of a strong national capacity and a clear focal point for nutrition within government agencies will facilitate collaboration and coordination among agencies with regard to information exchange, guidance and training on food and nutrition. The resources thus disseminated will raise awareness among policy-makers and planners about issues and activities related to the food and nutrition situation of refugee, displaced and local populations. Coordination will be enhanced among government ministries (especially health and agriculture), donors and NGOs in planning and practical development of food and nutrition interventions in relief and rehabilitation programmes. Increased cooperation could allow harmonization of strategies and approaches and improved resource allocation. Only if household food security and nutrition become part of national policy on relief and rehabilitation can decision-makers expect their actions to lead to an improvement of the nutritional condition of emergency victims.
There is a need for shared understanding of the aims and objectives of interventions among the various United Nations and government agencies and NGOs involved at the different stages of an emergency. Many emergencies, especially those identified as complex, require an international response that goes beyond the mandate or capacity of a single United Nations agency; this recognition has led to new policies to guide humanitarian assistance and to the establishment in 1992 of the Department of Humanitarian Affairs (DHA) at the United Nations Secretariat in New York to coordinate the UN system response to disasters (FAO, 1996c).
While emergencies often require an international response, it should be recognized that relief strategies that are based on a clear understanding of the needs and constraints of the local people who are affected by the emergency are more likely to evolve into appropriate long-term programmes and sustainable recovery. Through the rehabilitation and development of agriculture, livestock and fisheries as well as other employment- or income-generating programmes, nutrition situations and household food security can be enhanced and self-reliance can be restored.
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