NUTRITION AND

FOOD SECURITY
July 2021

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What is Nutrition
insecurity?

2
 What is Nutrition insecurity
Nutrition Security: is a broader concept that
refers to access to individuals to nutrients and their
utilization for optimal health.

• The current approach in addressing nutrition security

focuses on 3-pronged factors food, care and
health, which we argue are the pillars of nutrition
security, comprising a framework called the “food-
care–health framework”.

• Household food security, care of the vulnerable

segments of the population and adequate health
services and environmental hygiene are the
underlying determinants of Nutrition security that
have a very close interrelationship. 3
 Nutrition insecurity….
• Availability and accessibility of food and
health services alone cannot be a guarantee
for nutrition security.

• Vulnerable segments of the population need

someone to cater for them, to feed them, to
take them to the nearby health institution for
preventive and therapeutic care and to give
them psychosocial support.
4
 Conceptual framework for causes of
famine

Functional Consequences: Mortality, Consequences

Morbidity, Lost Productivity, etc.

Manifestations
Nutritional Status

Immediate
Diet Health Causes

Household Environ. Health, Underlying

Care of Mother
Food Security Hygiene & Sanitation Causes
and Child

Human, Economic, and

Institutional Resources

Political and Ideological Structure Root

Ecological Conditions Causes
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Adapted from Potential Resources
UNICEF
Relationship between Nutrition
security and food security

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 What is food security ?
• Food security exists when all people, at all times, have
physical, social and economic access to sufficient, safe and
nutritious food that meets their dietary needs and food
preferences for an active and healthy life (World Food
Summit Declaration, 1996).
• This definition is based on three core concepts of food
security:
– availability (physical supply),
– access (the ability to acquire food) and
– utilization (the capacity to transform food into the desired
nutritional outcome).
• If these conditions are not fulfilled a person is said
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to be in the state of food insecurity
 Measuring food insecurity
Food balance sheets

Household economic approaches

Anthropometrics

Coping strategies

Experiential methods

FOOD INSECURITY

8
 In the last three months did
“ you… ”
70

60
Proportion agreeing

50

40

30

20

10

0
Worry about Run out of Reduced Children did Feel hungry You or other
running out of food? variety of not have but didn't adult not eat
food? food for enough to eat? enough?
children? eat?

9
 DIMENSIONS OF FOOD
INSECURITY
• Chronic food insecurity: - Is Food
insecurity which is the result of
overwhelming poverty indicated by lack
of assets
• Acute food insecurity:- is a
transitory phenomenon related to man
made and natural shocks such as
drought.
• Both chronic and transitory problems of
food insecurity are widespread and
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severe in Ethiopia
HUNGER MAP

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12
 Category of food insecure household in
Ethiopia
Rural Urban Others
•Resource poor households •Low income HH •Refugees
Chronic •Landless or land scarce HH employed in informal •Displaced
•Poor pastoralists sector people
•Female headed households •Those outside the
labor market
•Elderly, disabled & sick
•elderly, disabled &
•Poor non-agricultural HHs sick
•Newly established settlers •Some female headed
HH
•Street Children
•Less resource poor HHs •Urban poor vulnerable •Groups
vulnerable to shocks to economic shocks affected by
Transitory especially drought especially those temporary
•Farmers & others in causing food price civil unrest
drought prone areas rises
•Pastoralists
•Others vulnerable to
economic shocks (e.g.. In
low potential areas) 13
 Different Stage of Food insecurity and
copping mechanisms
Stages of Food insecurity, coping mechanisms1

Stage of food insecurity process Coping mechanisms (household level)

Food insecurity Insurance strategies

 Reversible coping
 Preserving productive assets
 Reduced food intake, etc.

Food crisis Crisis strategies

 Irreversible coping
 Threatening future livelihood
 Sale of productive assets, etc.

Famine & death Distress strategies

 No coping
 Starvation and death
 No more coping mechanisms
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 What is Famine ? #1

• According to USAID background paper

on Famine, Famine is defined as
catastrophic food crisis that results in
widespread acute malnutrition and
Mass mortality…with beginning, a
middle and an end.

• This definition was critiqued for failing

short of capturing
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 What is Famine ? #2

• Accelerated deterioration of
conditions that precede famine
condition….the early warning sings
• Broader crisis that includes health &
physical security
• The range of livelihood crisis that
underpin famine vulnerability.

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 What is Famine ? #3

• Capturing the trajectory of famine

conditions and the broader crisis
beyond food availability is especially
crucial in the context of HIV/AIDS
pandemic

• A high prevalence of HIV/AIDS

pandemic creates famine conditions
and famine conditions facilitate the
spread of HIV/AIDS. 17
 What is Famine ? #4

• The ‘new variant famine’ where HIV/AIDS

is a central feature, a concept proposed
by Alex de Waal and Alan Whitehead has
three features which make the food crisis
wider, deeper and more intractable:
i. Vulnerability is wide spread
ii. Household impoverishment is more rapid
iii. Level of vulnerability continues beyond
the breaking of the famine
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 What is Famine ? #5
• Paul Howe and Stephen Devereux propose using a
famine intensity scale that:
– Disaggregate intensity( severity of the crisis in
given area at a specific point in time and
aggregate impact of the entire crisis)

– Move from arbitrary conception of famine/no-

famine to graduated understanding based on the
scales

– Assigns harmonized objective criteria in place of

individual subjective judgments 19
The famine intensity level

• Provides a clear-cut way of capturing

the localized conditions at a certain
point in time that can:
– Derive appropriate intervention
– Provide means of monitoring the
situation
– Allow stakeholders to prioritize resource
allocations based on need
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 A. The Famine intensity
scale
• Have 5 scales which are a continuum
of trajectory from early warning
signs to famine with a devastating
mass death

• There are objective indicators for

each category

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 Intensity scale 0
• Food security conditions
– CMR<0.2/10,000/day

– Wasting<2.3%

– Social system is cohesive;

– Prices are stable;

– Negligible use of coping strategies

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 Intensity scale 1
1 Food insecurity conditions
CMR>=0.2 but <0.5/10,000/day
AND/OR Wasting>=2.3%but <10%
 Social system remains cohesive;
Price instability and seasonal shortage of
key items;
‘Reversible ’ coping strategies start to fall
(e.g., mild food rationing) are Employed

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 Intensity scale 2
2 Food crisis conditions
• CMR>=.5 but <1/10,000/day
• AND/OR Wasting>=10% but <20%
• Social system is significantly stressed but
remains largely cohesive;
• Dramatic rise in price of food;
• ‘Reversible ’ coping strategies start to fail;
• Increased adoption of ‘irreversible ’ coping
strategies
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 Intensity scale 3
3 Famine conditions
 CMR>=1 but <5/10,000/day
 AND/OR Wasting=20%but <40%
 Clear signs of social breakdown appear;
 Markets begin to close or collapse;
 Coping strategies exhausted,
 ‘Survival strategies are more common;
 Affected populations identify food as the
dominant problem at the onset of the crisis
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 Intensity scale 4

4 Severe famine conditions

 CMR>=5 but <15/10,000/day
 AND/OR Wasting >=40%
 Widespread social breakdown;
 Markets are closed or
inaccessible to affected populations;‘
 Survival strategies ’ are
widespread 26
 Intensity scale 5
5 extreme famine conditions
 CMR>15/10,000/day
 Complete social breakdown;
 Widespread mortality

Source: Synthesis Report on the Famine Forum, USAID, May 2004

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 B. Magnitude scale

• Magnitude is determined ex-post by

measuring excess human mortality
based on the scale from minor famine
to catastrophic famine

• The intensity and magnitude scales

are not meant to replace the early
warning systems but to complement
them
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 The magnitude scale of famine

Type of Famine # of people affected

A Minor famine 0-999
B Moderate famine 1,000-9,999
C Major famine 10,000-99,999
D Great famine 100,000-999,999
E Catastrophic famine 1,000,000 and over

Source: Adapted from Synthesis Report on the Famine Forum, USAID, May 2004

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Famine in Ethiopia was catastrophic
as shown by figure 1

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14.3
Number of people affected (Million)

14
12
10
10
8 7.3

6 5.2
4 4
4 3 3 3

2 1

0
1977

1978

1979

1980

1981

1982

1983

1984

2000

2003
Year

Figure1. Number of people affected by shortage of food

in Ethiopia from 1977-2003.
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Why are African countries
prone to Famine ? #1

Conflict
Extreme production fluctuation
Limited employment other than farming
Lower level of saving
Regional break up of major markets
High rate of natural erosion
High rate of illiteracy and school
attendance
Poor health and sanitation 31
Why are African countries
prone to Famine ? #2

• Rapid population growth

• High national indebtedness
• HIV/AIDS
• Often poor governance which leads to
– poor distribution of resources
– Civil war
• High rates of chronic malnutrition
• **Not all African countries affected by the
above problems are prone to famine
32
 Cont..
• The famine experience in Ethiopia
and sudan in 1984/5 was averted in
Botswana. The strategy of averting
involved:
– Steady economic growth
– Supplementary poverty alleviation
– Drought relief programs

33
 Cont
The above strategies provided the
continuity and stabilization by:
• Channeling sufficient food through
market chains
• Providing price support to prevent
market collapse
• Supplementing consumer’s income

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Stages of food insecurity
and coping strategies

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 What is a coping strategy?
• People adopt a range of strategies (coping
mechanisms) to cope with reduced access
to food.

• In the latter stages of the process, coping

mechanisms become exhausted so that the
priorities of the individual and community
shift towards survival.

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Stage 1 - Food insecurity: 'insurance
strategies'
• During this first stage, the responses developed by
the population are reversible and in principle do not
damage future productive capacity.

• People anticipate problems and adopt insurance

strategies planned in advance to minimize the effects
of food shortages, enhance productive capacity and
preserve their productive assets.

• People's responses are characterized by

diversification of activities, longer work hours and
focusing on increasing income and limiting
expenditures.
37
 Stage 1. Food insecurity.Cont..
• The caring capacity for the non-productive
members of the community (elderly,
children, sick) will be reduced.

• For example when men migrate to the city

for temporary work, women become the
head of the household and have more work
and therefore less time to care for children.

• People also reduce their food intake,

without this immediately being a threat to
health. Therefore an increased level of
moderate malnutrition may be seen.
38
 Insurance strategies #1
Increase resources:
• Crop diversification for farmers
• Livestock diversification for pastoral
populations, sale of excess livestock, long
distance grazing
• Sale of non productive assets (utensils,
jewellery, charcoal, furniture)
• Labor migration (search for temporary
employment in towns)
• Diversification of informal economic activities
• Loans
• Prostitution 39
 STRATEGIES EXAMPLES
#2
Decrease expenditures:
• Reduction of food intake (reduced meal
frequencies and smaller quantities
eaten)
• Change in diet (consumption of wild
foods, cheaper foods etc.)
• Reduction of expenditures on health
care (and water purchase)
• Reduction of social support to the
community, (relatives and neighbors)
• Reduction of time available for care 40
 Stage 2: Food crisis: 'crisis
strategies'
• The responses in the next stage 'food crisis' are
less reversible as households are forced to use
strategies that reduce their productive assets and
threaten their future livelihoods.

• At this stage, the households or individuals are

obliged to develop new strategies to meet their
food needs.
• All surpluses have been sold and all potential for
increasing resources by diversification of activities
have been exhausted.

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 'crisis strategies‘ cont..
• People have to sell goods that are essential
for their future livelihoods.

• Additionally, economizing on health and

water resources results in a poor health

• environment which can be made worse by

gradual migration of the skilled and
educated of the community (nurses,
teachers etc.)
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 'crisis strategies‘ cont…
• In a food crisis, the prevalence of acute
global and severe malnutrition as well
as mortality rates associated with
them is elevated.
• An increased risk of mortality in
moderately malnourished individuals can
be attributed to a deterioration of the
health environment, which increases the
risk of infections.

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Example of crisis strategies for
a settled population
Increase resources:
• Sale of productive assets (tools,
seeds, livestock)
• Massive slaughtering of livestock
• Mortgaging of farmland or house
• Sale of farmland, house, sale of land
rights, harvest rights,
• Exchange of livestock for staple food

44
 Example of crisis strategies
cont…

Breakdown in social structures

• Prolonged migration, men do not return
from seasonal migration or are enrolled in
armies.
• Further cuts in use of water, firewood and
health services
• Community structures (mutual help
systems) collapse
• Skilled and educated people (health staff)
migrate

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 Example of crisis strategies
cont

• Decrease of community funds for funerals

and weddings

• Reduction of support to the non-productive

members of households (small children,
elderly, disabled)

• marginalization of non-productive
individuals, (orphans, beggars, etc.)
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Stage 3: Famine: distress
strategies
• Famine is the last stage of this process.
In nearly all cases, it is linked to war and
conflict.

• It is characterized by excess mortality and

high malnutrition in all the age groups of
the population, complete destitution, social
breakdown and distress migration as people
abandon their homes in search of food.

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distress strategies cont…
• All coping mechanisms have been
completely exhausted.
• The people are dependent on food aid for
immediate survival.

• Famine situations can result from

inadequate relief assistance during the
food crisis stage.

• Relief assistance has been too little, too

late, not well targeted, not well organized
or co-ordinated and often diverted. 48
 distress strategies
cont..
• This is frequently linked to serious
constraints such as high levels of
insecurity or lack of political
commitment (at international, national
or local level).

• The combined effects of insufficient

food intake and poor health
environment are important factors
leading to famine and death among
moderately and severely malnourished
49
people.
distress strategies cont..
• In fact, the majority of deaths (in absolute
number) occur amongst individuals who
are not severely malnourished.
• One of the main underlying causes of
famine mortality is deterioration in the
health environment.
• In addition to an adequate provision of
food, access to curative health care,
environmental sanitation and shelter can
avert many deaths.

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Summary of coping strategies

• An assessment should try to locate a deteriorating

food and nutrition situation on the continuum of
moving from food security to famine.

• Each stage will not necessarily show all

characteristics,

• The following table helps to illustrate which stage

a situation has reached and in what direction the
situation is likely to develop

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Specific characteristics of food insecurity, food crisis and famine

Food Food crisis Famine

insecurity

Mortality rate Normal Increased or high Extremely high

Population Seasonal Population Distress

movements migration displacement +/- migration

Global malnutrition could be Increased Extremely high

rate increased

Mortality related to Low Elevated High

moderate
malnutrition

Severe malnutrition Low Moderate or high High

rate

severe malnutrition in Low Low/moderate High

adults

Livelihood changes Temporary irreversible Complete

destitution

Selling of capital none or very Important Exhausted or

assets limited very limited

Activity Normal or Increased +++ Exhausted or

diversification slightly limited
increased

Reduction of Reduced Reduced +++ No more

expenditures possibility to
reduce.

Food availability Normal or Reduced Rare or none

slightly
decreased

Food accessibility Slightly reduced Reduced Severely

reduced or
none
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Dependence on food Low High or moderate Complete
aid
 ‘New Variant Famine’: AIDS and
Food Crisis in Southern African
countries
• Southern Africa is experiencing a food crisis which
is surprising in its scale and novel in its pattern.
• Proximate causes of food shortages include
familiar culprits such as drought and the
mismanagement of national food strategies.
• However, this crisis is distinct from conventional
drought-induced food shortages, in the profile of
those who are vulnerable to starvation, and the
trajectory of impoverishment and recovery.

54
 New Variant Famine’ cot…

• These new aspects to the food crisis can be

attributed largely to the role played by the
generalized epidemic of HIV/AIDS in the region.
• HIV/AIDS has such far-reaching adverse
implications that we are facing a ‘new variant
famine.
• There are four ways how HIV/AIDS is linked to
Famine:
– Changes in dependency patterns;
– losses of assets and skills associated with adult
mortality
– the burden of care for sick adults and orphaned
children; and
– the vicious interaction between malnutrition and
HIV infection. 55
Traditional livelihood systems have been
marked by considerable resilience,
defined as the ability to return to a former
livelihood, based upon diversity of income
and food sources, and accumulated skills
including knowledge of wild foods and
kinship networks.

 Only when these coping strategies collapse, are

African societies faced with ‘entitlement failure’
and outright starvation.
56
• It will be evident that HIV/AIDS renders
many of the more resilient strategies
impossible (laboring, relying on networks) or
dangerous (reducing food consumption), and
reduces the effectiveness of all.

• In a traditional drought, we might expect

affected households to take two years or
so to descend through the quadrants
into destitution and activities such as
commercial sex work. 57
• In new variant famine, this descent may
be much more rapid, and the possibilities
for recovery are much reduced.
• Aid agency surveys are finding rapid
increases in young women entering
commercial sex work in affected
areas.
• Widespread impoverishment and social
disruption, including increased resort to
transactional sex, threaten to increase HIV
transmission. 58
Rapid move of the resilience of coping
famine strategies in HIV/AIDS

Figure 1: Trajectory of livelihood coping strategies

 Reducing food  Agricultural wage labor

consumption  Gathering wild foods
 Reliance of  Producing crafts
High

family network
oo
o
Resilience

 Sale of essential  Agricultural wage labor

assists (planting, weeding)
 Crime  Selling of fire wood &
 Commercial sex charcoal
work  Begging
Low

Low High
Labor requirement 59
Assessments
in emergency
situation
60
 Nutrition in Emergency
What is an emergency?
• A number of different definitions of the term
‘emergency’ are used by international aid
organizations.
• Emergencies are characterized in these
definitions as 'extraordinary', 'urgent' and
'sudden' situations.
• The term 'complex emergency' has been
used in recent years to refer to a major
humanitarian crisis of a multicausal, essentially
political nature that requires a system-wide
response. 61
 Nutrition responses in
emergencies
• Responses include those that are
curative such as therapeutic care
and those that are preventative
such as improving the water supply
and sanitation to prevent epidemics
of disease.

63
 Who are most nutritionally vulnerable
in emergencies?

The population groups most nutritionally

vulnerable in emergencies can be
categorised according to their:
• Physiological vulnerability
• Geographical vulnerability
• Political vulnerability
• Internal displacement and refugee status

64
 Cont…
• Triggers for nutrition emergencies
• Where there is underlying vulnerability,
sudden events such as natural
disasters, conflict or economic shocks
can trigger a nutrition emergency.

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The impact of an emergency on nutrition
TRIGGERS

Natural disaster War Political/economic

(flood, drought, earthquake) shock

IMPACT ON POPULATION
Destruction of
Large-scale Breakdown of Loss of property Social
infrastructure
migration essential services and business disruption
(roads, markets
(health, water, (houses, land,
etc.)
sanitation etc.) animals, stock
etc.)

IMPACT ON HOUSEHOLDS
Reduced Residence in Lack of Loss of earnings Families
access to food overcrowded water, and access to split
settlements hygiene, health services
sanitation

IMPACT ON INDIVIDUALS
Malnutrition Disease

DEATH

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Advances in nutrition in emergencies
Rapid initial assessment
 Origin of the problem
– Harvest failure
– Civil unrest
– Increased food prices
– Population moment
– Logistic constraints
• Affected population
– How many people are affected
– Who is the most vulnerable group
– How the different socioeconomic groups are affected
67
 Rapid initial assessment
cont..
Logistical problems
– Security
– Roads
– Availability of lorries
– Skills available in the affected/refugee
population

68
 Rapid initial assessment
cont…

• Mortality
– IMR
– CMR
– Crude death rate
• Malnutrition in < 5 years
• Surveys of at least 200 households
– Wt, ht, MUAC, edema
– Questions about the previous months deaths and
causes of death
– Distance of water supply 69
• Mapping
– Rough number of people
– Structure of settlement
• Interviews
– Health professionals
– CHWs
– Local authorities

70
Types of emergency nutrition assessment
Type of Objectives
assessment
Rapid  To verify the existence
assessment or threat of an
nutritional emergency
 To estimate the number
of people affected
 To establish immediate
needs
 To identify local
resources available
 To identify the external
resources needed
Surveys  To establish the
prevalence of
malnutrition (including
micronutrient
deficiencies)
 To identify likely
causes of malnutrition
Nutrition  To identify trends in
surveillance nutritional status.
Data collection methods
 Direct observations of
population and environment
 Interviews with key
informants
 Focus group discussions
 Review of records from
available feeding centres
and/or health facilities
 Rapid surveys
 Cluster sample surveys of
under-fives (sometimes
women or older children)
 Repeated surveys
 Growth monitoring
 Sentinel site surveillance
71
 NUTRITION
INTERVENTION
IN
EMERGENCY
72
 Aims of Emergency intervention

Aims at reduction of excess mortality that results

during the first few weeks to months It involves
provision of :
– Food
– Shelter( if displaced)
– Program to control diarrheal diseases
– Epidemiological surveillance system
– Training of community health workers
– Curative care unit
– Coordination of operational partners
73
 Interventions
• Locating a situation on the food security/famine
continuum helps identify the most appropriate
type of intervention.

• In a food insecurity situation the focus of

interventions should be on preservation of
livelihoods to prevent people sliding into food
crisis and famine, e.g. food for work.

• Early warning systems are crucial at this stage.

74
 Interventions Cont..
• Support can be given to existing health
structures
– to enhance treatment of individual cases of
severe malnutrition.
• In a food crisis situation;
– it is crucial to prevent further movement along
the continuum by ensuring enough food. E.g.
general food distribution.
• As the social caring systems comes under
pressure provisions should be made to
support special vulnerable groups, e.g.
elderly, orphans, under five's in general.
75
Nutritional Interventions
The major focus is on:
• General food distributions(GFD)
• Selective feeding Programs
– Supplementary feeding program(SFP),

– Blanket supplementary feeding(BSFP), &

– Therapeutic feeding(TFP)
76
Emergency Nutritional
intervention
MUAC in all children
6-59 months

MUAC >= 13.5 Cm MUAC < 13.5 Cm

Not referred unless at Refer to the central

high risk WFH assessment

WFH > 80%

( >= -2 z score)

Not admitted to WFH 70-79% WFH < 70%

feeding programs (< - 2 Z score)
(< - 3 Z score

Not admitted to feeding

programs (if there is very Targeted Therapeutic
high rate of mal nutrition Supplementar feeding
blanket supplementary y feeding Program (TFC)
feeding Program
(SFP)
77
 GENERAL FOOD
DISTRIBUTION(GFD)
• The aim of GFD is to cover the immediate basic
food needs of a population in order to eliminate the
need for survival strategies which may result in
long-term negative consequences to human dignity,
household viability, livelihood security and the
environment
• Ideally a standard general ration is provided in order
to satisfy the full nutritional needs of the affected
population.
• In a population affected by an emergency, the
general ration should be calculated in such a
manner as to meet the population’s minimum
energy, protein, fat and micronutrient requirements
for light physical activity. 78
 THE MODES OF FOOD
DISTRIBUTION INCLUDE

 Employment Generation Schemes (EGS)

Gratuitous Relief (GR) /General [Free] Food
Distribution (GFD).
Due to the fact that food aid dependency is
a major concern in Ethiopia, 80% of the food
aid is distributed through EGS, especially in
areas that are chronically food insecure.

79
Nutrition Interventions
Cont..
• Selective feeding programs (SFP)like
therapeutic feeding centers(TFC)
and supplementary feeding
centers(SFC) and Blanket
supplementary feeding can be
installed.
• Health care systems and water
resources may also require support.
• In a famine situation, the primary
goal is to ensure survival, to reduce
80
mortality.
 Supplementary Feeding
Programs
• Targeted - where supplementary food is restricted
to only those individuals identified as the most
malnourished or most nutritionally vulnerable/at risk
during nutritional emergencies (includes pregnant
women, lactating mothers and young children under
5 years of age).
• The main objective of a Targeted SFP is
– to prevent the moderately malnourished from becoming
severely malnourished and consequently, reduce the
prevalence of severe acute malnutrition and associated
mortality.

81
 Cont…

• Blanket - where supplementary food is

distributed as a temporary measure to all
vulnerable members of a population at-risk of
becoming malnourished without identifying
the most malnourished.
• The general objective of a blanket SFP is;
– to prevent widespread malnutrition and mortality.

82
 Therapeutic Feeding
Program
 TFPs provide a rehabilitative diet together with medical
treatment for diseases and complications associated with
the presence of severe acute malnutrition.
 The specific aim of TFPs is to reduce mortality among
acutely severely malnourished individuals and to restore
health through rehabilitating them.
 TFPs may be administered through the following venues:
– Therapeutic Feeding Center (TFC)
– Nutrition Rehabilitation Unit (NRU) at a hospital or health
facility
– Community-Based Therapeutic Care (CTC/OTP) program

83
ADMISSION AND DISCHARGE CRITERIA FOR
THERAPEUTIC FEEDING PROGRAMS

84
Classification Tool for Implementation of Selective
Feeding Programs(Ethiopian Guideline )

85
 Cont..
• GAM: percentage of child population (6-59
months) with WFH z score < -2 and/or
manifesting bilateral oedema.
• SAM: percentage of child population (6-59
months) with WFH z score < -3 and/or
manifesting bilateral oedema.

86
 Aggravating Factors:
• Poor household food availability and accessibility, general food
ration below mean energy requirement
• Crude mortality rate >1 per 10,000 per day
• Epidemic of measles, whooping cough (pertussis), cholera,
shigella and other important communicable diseases
• High prevalence of respiratory or diarrheal diseases
• High prevalence of HIV/AIDS
• Outbreaks of diseases (malaria, etc.)
• Low levels of measles vaccination and vitamin A supplementation
• Inadequate safe water supplies and sanitation
• Inadequate shelter
• War and conflict, civil strife, migration and displacement

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 Shifting From
humanitarian to
Developmental
Approach
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 Shifting to Livelihoods Approach
• There is a critical need to shift from
project- driven approach to a systems
approach that addresses the root causes of
development failure.

• There was broad agreement that livelihoods

approach might best help use resources
during an emergency to move away from
a food-first approach toward a broad,
more complex definition of famine,
emphasizing a multi-sectoral approach to
drive an earlier and more appropriate 89
response.
 The six principles central to livelihood
strategies in crisis response
• 1) Rigorous assessment
• 2) Appropriate market support
• 3) Protecting essential assets
• 4) Easing vulnerable peoples ’ burdens
• 5) Timely interventions and
• 6) Increasing protection for populations at
risk of displacement.
These principles can guide the need for a shift
from a project-driven approach to a systems
response that addresses the underlying
causes of famine.
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 Long term strategies

Poverty Economic
Reduction Growth

Improved Social
Increased Child Sector
productivity Nutrition
Investments
Enhanced
Human
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Resource
 IMPLEMENTATION #1
Strategies to reduce malnutrition should
I. Be implemented at different levels
 households
 Community
 regional
 National
 International

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 IMPLEMENTATION #2
II. Combine different approaches
• Bottom up – Triple A Cycle
• Top-down
– Supplementation programs
– Fortification
– Food relief programs

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 IMPLEMENTATION #3

III. Involve those communities who

were directly affected in
Needs assessment
Planning
Implementation
Monitoring and evaluation
*This fosters
Self reliance
Mobilization of local resources 94
 IMPLEMENTATION #4

IV. Be fully integrated

Strategies that tackle only immediate
causes of malnutrition need to be:
Repeated often to have sustainable
effect
Enhanced by activities which address
the underlying or basic cause of
malnutrition
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Example of recommended ration

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 Ration composition should give
consideration to micronutrient
deficiencies

Commodity Risk Possible solution

Maize Pellagra(vitamin B3 Nuts, beans, whole grain

deficiency) cereals, meat, fish, eggs,
milk

Polished rice Beriberi (Vitamin B1 Parboiled rice, whole grains,

deficiency) ground nut, legumes, meat,
fish, egg, milk
No fresh fruit or Scurvy(vitamin C Onions, cabbage, canned
vegetables deficiency) tomato paste, vitamin c
tablets
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Thank you !

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