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close this bookEssays on Food, Hunger, Nutrition, Primary Health Care and Development (AVIVA, 480 p.)
View the document(introduction...)
View the documentAbout the Author
Open this folder and view contents1. The Causes of Hunger and Malnutrition: Macro and Micro Determinants
Open this folder and view contents2. Technical, Ethical and Ideological Responsibilities in Nutrition
Open this folder and view contents3. De-Westernizing Health Planning and Health Care Delivery: A Political Perspective1
View the document4. Book Review: Susan George. A Fate Worse Than Debt: A radical new analysis of the Third World debt crisis (Or, the world financial crisis and the poor)
Open this folder and view contents5. Viewpoint - Ethics, Ideology and Nutrition
Open this folder and view contents6. Ethics And Ideology in the Battle Against Malnutrition
Open this folder and view contents7. The Challenge of Feeding the People: Chile under Allende and Tanzania under Nyerere
Open this folder and view contents8. The Role of Health and Nutrition in Development (Le Rôle de la Santé et de la Nutrition dans le Développement - El Papel de la Salud Y la Nutrición en El Desarrollo)
Open this folder and view contents9. Multidisciplinarity, Paradigms and Ideology in Development Work
View the document10. Survey on Attitudes to Nutrition Planning
Open this folder and view contents11. “Household Purchasing-Power Deficit” - A More Operational Indicator to Express Malnutrition
Open this folder and view contents12. Foreign Aid and its Role in Maintaining the Exploitation of the Agricultural Sector: Evidence from a Case Study in Africa
View the document13. Low School Performance: Malnutrition or Cultural Deprivation?
View the document14. Hunger and Malnutrition: Outlook for Changes in the Third World*
Open this folder and view contents15. Viewpoint: Nutrition Planning - What Relevance to Hunger?
View the document16. Rosalia
Open this folder and view contents17. The Political Economy of Ill Health and Malnutrition
Open this folder and view contents18. Commentary - The Markets of Hunger: Questioning Food Aid (Non-Emergency/Long-Term)
Open this folder and view contents19. Activism to Face World Hunger: Exploring New Needed Commitments
Open this folder and view contents20. The Child Survival Revolution: A Critique - or Health Still Only for Some by the Year 2000?
Open this folder and view contents21. Development Nemesis
View the document22. Looking Beyond the Doable: Resolutions for a New Development Decade
Open this folder and view contents23. Egos/ Alter Egos of the Main Actors in Development Projects:
Open this folder and view contents24. Positive Deviance in Child Nutrition: a Discussion
View the document25. The Project Approach in Development Assistance
View the document26. Triage Management in Third World Health Ministries
Open this folder and view contents27. On Behalf of the African Child: Challenges and Windows of Opportunity for the Donor Community.*
View the document28. The Household Entitlements Revolution or a Women-Centered Approach to Family Security
View the document29. Brave New World: A Political Pendulum in Search of its Balance
Open this folder and view contents30. Malnutrition and Income: Are We Being Misled? (A Dissenting View with a Confusing Literature)
View the document31. A Path for the 1990s?: Government-Donor Partnership to Finance PHC in the Third World
Open this folder and view contents32. Downsizing the Civil Service in Developing Countries: The Golden Handshake Option Revisited.
Open this folder and view contents33. The World Declaration on Nutrition and the 1992 International Conference on Nutrition (ICN) Plan of Action: The Cutting Edge of Conventional Thinking.*
View the document34. Income Generation Activities for Women, the Ninth Essential Element of Primary Health Care? An Idea Whose Time has Come!
View the document35. Some Reflections on ACC/SCN's 'How Nutrition Improves'
View the document36. Nutritional Goals for the Mid-Nineties: A Call for Advocacy and Action
Open this folder and view contents37. A. The Emerging Sustainable Development Paradigm: A Global Forum on the Cutting Edge of Progressive Thinking
Open this folder and view contents37. B. Sustainable Development beyond Ethical Pronouncements: the Role of Civil Society and Networking
View the document38. Foreign Aid: Giving Conditionalities a Good Name or Conditionalities: the Launching of a South-South Counter-Offensive
Open this folder and view contents39. The Community Development Dilemma: when are Service Delivery, Capacity Building, Advocacy and Social Mobilisation really Empowering?
View the document40. Development in the Mid 1990s: Reflections of an Old Socialist
View the document41. Book Review: Questioning the solution -The politics of primary health care and child survival with an in-depth critique of oral rehydration therapy
View the document42. Equity In Health and Nutrition and the Globalization of the World's Economy
View the document43. A. Different Challenges in Combating Micronutrient Deficiencies and Combating Protein Energy Malnutrition, or the Gap Between Nutrition Engineers and Nutrition Activists
View the document43. B. Micronutrient Deficiencies and Protein-Energy Malnutrition
Open this folder and view contents44. Northern-Led Development: is it Selling Technical Fixes to Solve the Problems of Ill-Health and Malnutrition?
View the document45. Actions and Activism in Fostering Genuine Grassroots Participation in Health and Nutrition
Open this folder and view contents46. Health, Nutrition and Sustainable Development.
View the document47. New Perspectives, Old Risks: our Need to Change and to Reconceptualize or Reemphasizing the Need to Tackle the Causes of Poverty in the Battle against Ill-Health and Malnutrition
View the document48. Health Sector Reform Measures: Are they Working?... And where do we go from here?
View the document49. On Development, the Real World, Power Games and the Ugly Faces of Greed (Food for thought about a state of mind).
View the document50. So What... in Search of the 'Big Picture' in Development (Food for a depressive thought)
Open this folder and view contents51. Can Significantly Greater Equity be Achieved through Targeting?: An Essay on Poverty, Equity and Targeting in Health and Nutrition. (*) (Food for a targetter's thought)
Open this folder and view contents52. Globalization, or the Fable of the Mongoose and the Snake (Fableous food for thought)
View the document53. Elements for a Nutrition Activism Course and Curriculum*
View the document54. The Role of Human Rights in Politicizing Development Ethics, Development Assistance and Development Praxis
View the document55. A Letter to the Student Erica who is Planning to Specialize in International Nutrition
View the document56. Food for a Capitalist thought - Book Review - The Lugano Report: On Preserving Capitalism in the Twenty-First Century
View the document57. Food for Finding where Your Thoughts Are - Variations on a Theme by the Chilean Writer Isabel Allende
View the document58. Remembering
View the document59. Letter to The Lancet - Draft 2 IMCI: An Initiative in Need of a New Name, a Greater Community-Centered Focus, and a Grassroots Mandate
View the document60. Food for Planning the Right Human Thoughts - Human Rights Based Planning: The New Approach
View the document61. Food for an Ombudsman's Thought - On Health Sector Reform, Health and Poverty and Other Herbs
Open this folder and view contents62. What does the New UN Human Rights Approach Bring to the Struggle of the Poor?
View the document63. Food for a Poor Thought on Health and Poverty - Health a Precious Asset, But Not ‘A New and Potentially Powerful Exit Route from Poverty’
View the document64. Food for a Poor Thought on Attacking Poverty - The WB’s World Development Report 2000/2001 or the Trivialization of the Concept of “Empowerment”
View the document65. Human Rights or the Importance of Being Earnest: A Personal Account
View the document66. AID and Reform in Africa: Lessons from Ten Case Studies, Final Report
View the document67. Food for Thought About a State of Mind (2) - On Morality, Freedom, Choices, Justice and the Need for People’s Power
View the document68. Thinking Loud - On Statistics*
Open this folder and view contents69. A Reader in Human Rights (1) - The Short Papers Here Collected are Part of an Ongoing Series the Author Irregularly Submits to About a Half Dozen E-Mail List Servers
Open this folder and view contents70. Aiming at the Target: What’s Left for the Devil to Advocate?

28. The Household Entitlements Revolution or a Women-Centered Approach to Family Security

Not as a surprise, this 5th Report shows a mixed picture of what we have achieved (or not achieved) in the world in terms of nutrition outcomes.

- Should we --the nutrition community-- blame ourselves in part for not having achieved more? The response to this question passes through asking ourselves another:

- Have we really tackled all major obstacles and opportunities to improve these nutrition outcomes? Here, we can probably say with confidence that we have not.

- Have we overlooked, neglected or consciously avoided tackling some of the non-nutrition obstacles and opportunities that could have maximized nutrition outcomes? Even if this is the most value-loaded question of the three, it is crucial we take it face-on when, from now to 2015, we engage new, more effective mechanisms to reach the goal of halving the <5 malnutrition rate worldwide.

It is to expand on these matters that this article now turns.

The Household Entitlements Revolution here proposed looks at the challenges we face in nutrition work from a more comprehensive perspective; it focuses not only on nutrition per-se, but on how to simultaneously address a host of related (non-upheld) household members’ rights.

Making this Revolution women-centered and focusing it on indicators of family security departs, on the one hand, from the principle that there is an array of household (HH) securities that are indispensable for the well-being of HH members in general and for the women in it in particular. On the other, the issue of providing such securities has remained unresolved in most past and current nutrition and development work --i.e. we have failed to secure poor women's actual access to and utilization of the resources and services they need to fulfill their basic entitlements (of which nutrition is only one).

The main rights HHs in general and women in particular are entitled to are those related to attaining minimum levels of security in:

- Food and nutrition (macro- and micro-nutrients).
- The care of children and the support of women to do so.
- Women’s own gender-related needs and entitlements.
- Health.
- Clean water supply and sanitation facilities/services.
- Housing (shelter).
- Income (in kind/in cash, including employment opportunities and access to credit/subsidies, especially for women).
- Education (pre-primary/primary with a focus on girls, female literacy/numeracy).
- Fuel (energy).
- Legal protection (mainly, but not only of children and women's rights).
- Physical environmental safety.
- Physical personal safety during armed conflicts.
- Women's personal safety from domestic violence.

For monitoring and accountability purposes, the minimum standards and the best indicators for each of these entitlements need to be set by community representatives themselves, together with experts, in each (of the many) different local context(s).

There is nothing terribly new in this HH and women-centered approach to overall family security. It just (re)packages well known basic children's and women's rights in a way that more explicitly emphasizes the need for a new set of priorities that transcends current development orthodoxy. The most important aspect of this approach is, perhaps, that it has the potential to bring us closer to (and to focus our work more on) the underlying and basic causes of neglect, abuse, ill-health, malnutrition and unnecessary mortality of women and children.

Under this approach, the major focus of attention in the search for solutions to the above causes, therefore, shifts: it now starts with a major and explicit effort to identify insecure HHs and women living insecure lives. Only then, does attention turn to devising a more comprehensive set of interventions that, as much as possible, simultaneously addresses several of the insecurities identified. [It is important to notice that some of the above insecurities are always 'limiting', in the same sense that a limiting amino-acid restricts the biological value of a protein: regardless of the ample supply of all other amino-acids needed to synthesize the protein, the absence of even one limiting amino-acid stops the synthesis of the protein altogether. This metaphor illustrates well what ‘orthodox’ development work in nutrition has quite consistently neglected so far].

Locality by locality, the identification of vulnerable, insecure HHs and women is also to simultaneously be accompanied by the identification of the coping mechanisms proven successful as utilized by both HHs and women to get access to the different resources and services that help them fulfill their entitlements under given difficult local conditions and circumstances. These coping mechanisms will be very different in urban as opposed to rural settings and will have to be surveyed with different instruments.

The ensuing challenge is then twofold: On the one hand, one has to foster the needed community organization and consciousness raising to forcefully and persistently place women’s claims and demands on selected duty bearers; this is necessary to create yet new conditions that will further expand the opportunities and remove the existing barriers for insecure HHs and women to attain the securities so far not available to them. On the other hand, together with the community, one has to find the interventions that support the adoption of the proven and successful coping mechanisms by a larger proportion of at-risk women and HHs in that particular environment.

This two-pronged approach then becomes the basis for directing interventions to the more vulnerable. The widespread organization of women for active lobbying and the communication and adoption of the positive coping mechanisms used by each local community become the key challenges for all of us; the use of participatory, consciousness-raising Education Information and Communication (IEC) techniques is key here.

All this, calls for a much heavier emphasis on local and national social mobilization programs and a better coordination among them. If and when the approach here proposed starts to be accepted by a growing number of development organizations, coordination among UN and bilateral donor agencies in the field --as well as among NGOs and grassroots organizations at local and national level-- will have to get more prominence and a greater sense of urgency so as to maximize their combined social mobilization capabilities.

In practical terms, what this revolution also means is that sectoral approaches --nutrition, health, water and sanitation, basic education, income generation, women's affairs, etc.-- need more integration. Such a drive for integration actually has to come from the HH and local women's organizations level up. This is helped by all technical sectors and programs, together with the local organizations, jointly embarking in the upfront identification of insecure HHs with women living insecure lives. Ideally, local organized groups should actually actively participate from the planning of the identification of vulnerable HH surveys on. If such community groups do not yet exist, preliminary efforts will have to be made to organize them.

If all sectors jointly start identifying these insecure HHs, as well as the successful coping mechanisms used by some of them, and then contribute their findings to a community participatory forum, a great contribution will be made to a more appropriate search for more workable and sustainable solutions to the problems at hand --and not only for those of malnutrition alone.

Interventions chosen do not need to (and probably will not) be new, but will be combined and focused in a way that different relevant causal levels are tackled, using some tried and perhaps some new approaches to solve old problems expressed as felt needs by community representatives, especially women. Some interventions will be manageable with the exclusive inputs (resources) and organization (mobilization) of community members and existing women's organizations, others will require some form of public pressure and lobbying that can translate women’s felt needs into effective claims and demands. It is both of these, the internal and the external dynamization processes together that will ultimately lead to the indispensable empowerment of the organized community.

The approach here proposed does not lend itself for a grandiose national-scale scheme. Its focus has to be intensive rather than extensive. It calls for a gradually growing set of mostly local interventions that should perhaps start in the geographically most vulnerable region(s) or district(s) of the country.

The pilot implementation of this HH and women-centered approach could best be achieved through operations research activities: trying out different approaches and documenting their impact. The surveying of HHs and women for vulnerabilities and coping mechanisms will require working on some simple data collection tools that can be analyzed simply. The engagement of local organized groups and the sharing of the results of these surveys with them will then lead to local collective decision-making. NGOs and other organizations can help finding funds for some of these community-based interventions and can support women’s lobbying since they often have the advantage of having a more national presence.

In conclusion, if towards 2015, we are to more significantly improve nutrition outcomes of women and children worldwide, we have to address a number of their more crucial unfulfilled entitlements at the same time. It is at this point, really, that the question raised at the beginning of this article comes up again: How effective is it to continue trying (sometimes so hard) to tackle one (or two) entitlement at a time..? Nutrition alone cannot be significantly improved without resolving the access questions related to other entitlements when these are limiting as well. So, if we want to engage more effective mechanisms to improve nutrition outcomes worldwide, this is the major challenge we simply have to confront: Jointly assess all the major HH level shortcomings with a geographical rather than a sectoral program focus and let communities have the final word on the better interventions.

Claudio Schuftan MD
IPO Box 369, Hanoi, Vietnam
Fax: 84 4 971 0802