FNS Landscape Review

TANGO InternationalApril 30, 2014

2

Countries With High Burden of Malnutrition

These 34 countries account for 90% of the global burden of malnutrition

3

Shifts in the Nutrition Landscape

2008• Stewardship of the nutrition system

dysfunctional and deeply fragmented

• New evidence base introduced in the 2008 Lancet Series, identified critical 1,000 day window

• Pinpointed a package of highly effective interventions for reducing undernutrition

• Proposed a group of “high burden” countries as priorities for increased investment

2013• Nutrition significantly elevated on

the global agenda• Launch of the Scaling Up Nutrition

(SUN) Movement in 2010: a major step toward improved stewardship of nutrition architecture

• Nearly every major development agency has published a policy document on undernutrition

• Donors have increased ODA to basic nutrition by more than 60 percent between 2008 and 2011, amidst a very difficult fiscal climate

• Nutrition is now more prominent on the agendas of the United Nations, the G8 and G20 and supporting civil society

Framework for Actions to Achieve Optimum Fetal and Child Nutrition and Development

4

5

Nutrition-sensitive Interventions and ProgramsInterventions or programs that address the underlying determinants of fetal and child nutrition and development— food security; adequate caregiving resources at the maternal, household and community levels; and access to health services and a safe and hygienic environment—and incorporate specific nutrition goals and actions

Nutrition-sensitive programs can serve as delivery platforms for nutrition-specific interventions, potentially increasing their scale, coverage and effectiveness

Examples:

Agriculture and food security Social safety nets

Early child development Maternal mental health

Women’s empowerment Child protection

Schooling Water, sanitation and hygiene

Health and family planning services

6

Nutrition-sensitive Programs Can Impact Nutrition:Through Increases in Income

A 10% increase in GDP/PC

leads to a 6% reduction in

stunting

7

Income Growth Can Have Unintended Consequences of Increasing Risks of Overweight and Obesity

A 10% increase in GDP/PC

leads to a 7% increase in overweight

and obesity in women

8

Nutrition-sensitive Programs Can Impact Nutrition:Through Empowerment of Women

Evidence shows: Positive associations between dimensions of women’s empowerment and improved maternal and child nutrition

Positive impacts of cash transfers and agricultural programs on measures of women’s empowerment

There is evidence that men and women allocate food and other resources differently

Negative associations between disempowerment (e.g. domestic violence) and child nutrition outcomes

9

Targeted Agricultural Programs

Have impacts on several underlying determinants of nutrition:

Livelihoods and income

Household food security

Diet quality

Women’s income and empowerment

…and complement global efforts to stimulate agricultural productivity − increasing producer incomes

while protecting consumers from high food prices

Potential Areas of Engagement • Integrated Ag/Nutrition/Health programs

– Plan water and sanitation interventions together with agriculture interventions to reduce the incidence of disease and improve nutritional status.

• Value Chain programs– More research is needed to identify opportunities where the nutritional benefits of agriculture interventions can be

improved by addressing constraints at various points along the value chain

• Agricultural Technology interventions– Facilitate improved communication about how different technologies can be combined to maximize diet diversity and

nutrition.

• Capacity-building approaches– Use community-based participatory research to develop and implement community-based nutrition programs

Global Trends• The global food system is failing to meet everyone’s right

to sufficient nutritious food in a sustainable manner• Nearly one billion people are hungry in the world today

and another one billion do not have access to a nutritionally balanced diet

• Population growth will reach over 9 million by 2040, adding two billion more people than there are today

• Consumption patterns in developed countries and a growing middle class in developing countries are creating a disproportionate demand on the earth’s resources

Agriculture Global Trends• The global food system is failing to meet everyone’s right

to sufficient nutritious food in a sustainable manner• Nearly one billion people are hungry in the world today

and another one billion do not have access to a nutritionally balanced diet

• Population growth will reach over 9 million by 2040, adding two billion more people than there are today

• Consumption patterns in developed countries and a growing middle class in developing countries are creating a disproportionate demand on the earth’s resources

Agriculture Global Trends• Diet changes due to increased prosperity in the developed and developing

world has increased the demand for meat, eggs, and dairy leading to more pressure to grow corn and soybeans for animal feed

• Every year 1.3 billion tons of food, or about one third of all food produced globally ends up wasted or lost. The amount wasted and loss is more than enough to feed the worlds hungry

• Industrial countries waste food a the retail and consumer end; developing countries suffer food losses in production processes through post harvest losses, spoilage and improper storage

• Almost half of all harvested fruits, vegetables and roots and tubers are wasted or left to rot in landfills; 30% of all cereals and seafood are wasted; and 20% of meat and dairy products are lost every year

• Loss or waste of food drives up food prices, and leads to more squandering of water, energy and land

Agriculture Global Trends

• Climate change is having both a direct and indirect effect on food and nutrition security

• It leads to a decrease in crop yields due to extreme and less predictable weather patterns

• Shortages of clean water can lead to illnesses that influence food absorption

• The poorest and most vulnerable areas of the world are disproportionately affected; poor women bear the brunt of this

Why a Focus on Smallholder Farmers

• Smallholder farmers produce the bulk of the food consumed and women play a major role in agriculture production throughout the world

• Global climatic changes threaten the livelihoods and food and nutrition security of small holders and rural laborers and threaten access to food for people living in towns and cities

• Smallholder farming will suffer the most from climate change

• Thus the future food and nutrition security of smallholder farmers is very much tied to environmental security

Johnathan Foley’s Five Step Plan to Feed the Planet

• Freeze Agriculture’s Footprint-do not promote agricultural expansion• Grow more on farms we have-be more efficient on where we grow,

what we grow and how we grow• Use resources more efficiently-achieve higher yields while reducing

environmental impacts; conserve water to get more crop per drop• Shift diets-only 55% of the world’s crop calories feed people directly;

36% is fed to livestock or used as biofuels and industrial products. We need to find more efficient ways to grow meat to free up substantial amounts of food

• Reduce Waste-reducing waste is one of most efficient options for boosting food availability. This will involve reducing waste in industrial countries and reducing post harvest losses in developing countries

• CARE has a comparative advantage in supporting smallholder women farmers as part of this global strategy to feed the planet

Value Chains and Smallholder Agriculture

• Value chain interventions are most successful when they are demand driven, participatory, and incorporate the private sector

• Good practice in value chain investments include a sound market analysis, building mechanisms to mitigate shocks (insurance), linking to complementary social protection programs, investing in multiple complementary activities (inputs, irrigation, business skill training) and addressing constraints in the enabling environment (land tenure, labor laws, women’s rights)

Potential Areas of Engagement• To address the growing crises of food and nutrition security,

climate change, and smallholder vulnerability, sustainable small holder food systems should be a major entry point for CARE

• The focus should be on enhancing smallholder farming systems for women farmers embedded in viable ecosystems adjusting to climate change. (The ACRES SUPER approach)

• This will allow CARE to focus on its strengths (multi-sectoral community based approaches, women’s empowerment, climate change, market engagement through value chains, and nutrition)

Gender – Key Issues and LinkagesReproductive health: •Women, for both physiological and social reasons, are more vulnerable than men to reproductive health problems. •Reproductive health problems, including maternal mortality and morbidity, are a major, preventable cause of death and disability for women in developing countries •Failure to provide information, services and conditions to help women protect their reproduction health therefore constitutes gender-based discrimination and a violation of women’s rights to health and life

Stewardship of natural resources: •Women in developing nations are usually in charge of securing water, food and fuel and of overseeing family health and diet. •Therefore, they tend to put into immediate practice whatever they learn about nutrition and preserving the environment and natural resources

Gender – Key Issues and Linkages

Economic empowerment:

• More women than men live in poverty.

• Economic disparities persist partly because women do much of the unpaid work within families and communities falls, and due to

• discrimination in the economic sphere

Educational empowerment:

• About two thirds of the illiterate adults in the world are female

• Higher levels of women's education are strongly associated with lower infant mortality, lower fertility, and higher levels of education and economic opportunity for their children.

Political empowerment:

• Social and legal institutions still do not guarantee women equality in basic legal and human rights, in access to or control of land or other resources, in employment and earning, and social and political participation.

• Laws against domestic violence are often not enforced on behalf of women

Gender IntegrationAn extensive study by the World Bank (2011) shows that women can contribute significantly to the growth of the agricultural sector and the reduction of hunger and poverty. • Women’s contribution is critical for the development of

agriculture when they are empowered with the following: 1) decision-making control over agricultural production activities; 2) control over the use of household income; 3) leadership roles in the community, and 4) ability to control their own time

• Women’s leadership affects not only their households but also their entire community if they have the opportunity to play the key roles mentioned above.

Impact of agricultural productivity intervention on reducing gender gaps in use of production inputs

Evidence of benefits of targeting

22

Evidence gaps

Evidence indicates that non-targeted, non-gendered agricultural productivity interventions have very limited impact on women’s use of production inputs

After 30 years of acknowledging the importance of gender equality, examination of the gendered constraints facing women as producers and marketers, and interventions designed to address those constraints, are in their infancy

Impact of agriculture and nutrition projects on women’s empowerment

In terms of agriculture production, decision-making over and access to credit, control over income, leadership in the community, and time use:

– when these interventions increase the income-earning capacity of women it enables them to increase their bargaining power within the household

• The majority of gendered productivity interventions in the literature indicates that gendered productivity and nutrition interventions have directly and positively increased women’s level of participation in agricultural production and household nutrition strategies

Impact of value chain commercialization interventions on access to employment

A review of the literature identified three successful types of interventions:

1) value chain interventions where both women and men are included in the planning stages and where mutually beneficial enterprises are selected to prevent men taking over women’s enterprises once profitable2) interventions that promote an enabling environment for improving women’s participation in value chains

Impact of value chain commercialization interventions on access to employment

• Gendered interventions have better results in increasing women’s participation in value chain commercialization by effectively increasing their capacity to take advantage of innovations and linkage to supply chains as well as improving their working conditions and rights

• There is also evidence that when women are able to retain income from their own business, their entire household benefits from better nutrition, health, and education as well as providing role models for other women

Potential Areas of EngagementImpact of women’s empowerment on poverty and

hunger

Evidence gaps

Interventions that are designed to empower women are still few and women’s constraints in various areas need to be better measuredStudies that measure the link between women’s empowerment and increased access to and control of assets are not availableNeed to measure whether or not programs that are designed to empower women in general are more efficient at reducing poverty and hunger than empowerment programs that include productivity and nutrition and commercialization. Household income data need to be disaggregated by gender to measure increase in women’s income

Resilience• There is now wide agreement that the interactions among climate

change trends, ecosystem fragility and geo-political instability have produced new configurations of risks that are increasingly difficult to predict.

• The combined effect of these new risk configurations has in turn placed a more pronounced set of negative pressures on the agro-ecological systems, economic resources, and social institutions that affect the well-being of the poor.

• Viewed by many as a strategic approach to deal with the range of unpredictable risks that undermine well-being, resilience has recently emerged as a key concept for policy and program development.

Prologue Activity – past few years

Defining Resilience• The provision of a clearly stated definition of resilience is critical

point of departure for measurement. • While resilience has received a good deal of attention, it would be

fair to say that the field has not reached consensus on a definition.

• CARE’s definition in its resilience strategy for the Sahel is:

“The capacity of families, communities and systems to absorb, adapt to, and recover from shocks and stresses (e.g. drought, high food prices, land degradation, climate change, population growth, conflict) in ways that support economic and social development and growth.”

Defining Resilience

• The Resilience Technical Working Group definition of resilience is the following:

“Resilience is the capacity that ensures adverse stressors and shocks do not have long-lasting adverse development consequences”• Defining resilience as a capacity means that resilience

is comprised of a set of ex ante and ex post attributes and supports that should positively shift the relationship between shocks and development outcomes (this is important to measurement)

Conceptual Frameworks• Adoption of a conceptual framework for the assessment of

resilience is important for providing a comprehensive picture of the specific elements that contribute to resilience and clarifying the types of information that must be collected in order to adequately measure it.

• Over the past five years, considerable work has gone into the development of conceptual frameworks of resilience that help users understand how shocks and stresses affect livelihood strategies and household well-being, and help identify the key leverage points to be used in a theory of change, which in turn informs programming designed to enhance resilience

Disturbancee.g., natural

hazard, conflict, food shortage,

fuel price increase

Vulnerability pathway

Resilience pathway

Shocks

Stresses

Live

lihoo

d A

sset

s

Stru

ctur

es/p

roce

sses

Live

lihoo

d St

rate

gies

Expo

sure

Sens

itivi

ty

Cont

ext

Leve

l of a

ggre

gatio

n

Bounce back better

Bounce back

Recover but worse than before

Collapse

Food Security

Adequate nutrition

Environmental security

Food Insecurity

Malnutrition

Environmental degradation

Adaptive state to shock

Reaction to disturbancee.g., survive, cope, recover, learn, transform

Livelihood Outcomes

Absorptive, adaptive and transformative

capacities

Contexte.g., social, ecosystems,

political, religious, etc.

(-)

( + )

Resilience Framework

Multi-Sectoral Resilience AssessmentAmong chronically vulnerable populations exposed to food security shocks

Joint Problem AnalysisInvolving diverse stakeholders and contextualized

at the sub-national level

Adaptive Capacity- Promote diverse livelihood strategies that ensure against

different types of risks- Promote asset accumulation and diversification- Activities that encourage the expansion of aspirations- Improve human capital (health, education, nutrition)- Enable improved access to credit - Support smallholder market linkages- Improve access to technologies- Strengthen diverse social networks- Promote gender empowerment- Support for healthy ecosystems (land, water, biodiversity)

Absorptive Capacity- Strengthen and maintain Informal safety nets

- Support local peace building, conflict mitigation and natural resource management through informal governance structures

- Strengthen risk reduction, risk mitigation and risk coping mechanisms (community-based early warning, contingency plans, household savings)

- Strengthen capacity for community organization and collective action

- Strengthen governance functions, including formal and customary institutions- Promote representativeness within governance structures- Improve infrastructure systems (roads, communications, market systems)- Support effective social protection mechanisms (formal and informal safety nets)

- Promote social and economic policies that support resilience- Provide basic social services - Develop institutional capacity: public management; accountability systems; technical

skills in data collection, analysis, monitoring; early warning; risk analysis- Promote peace building and conflict resolution mechanisms

Integrated Resilience Program

Well Being Outcomes that are ResilientDevelopment Indicators (food security, nutrition, poverty)

Theory of Change

Transformative Capacity

• Food security• Health/

nutrition index • Asset index• Access to

services index• Infrastructure• Ecological/

ecosystem services index

• Psychosocial measure

• Poverty measures

End-

line

Wel

l-bei

ng a

nd B

asic

Con

ditio

ns M

easu

res

Resi

lienc

e Re

spon

se M

easu

res

Dist

urba

nce

Mea

sure

s (sh

ocks

/str

esse

s)

Base

line

Wel

l-bei

ng a

nd B

asic

Con

ditio

ns M

easu

res

Frequency, duration, intensity of:

Covariate shocks/ stressors• Drought• Flood• Health shocks• Political crises• conflict• Market prices• Trade/policy

shocks

Idiosyncratic shocks/stressors• Illness/death• Loss of income• Crop failure• Livestock losses

Absorptive Capacity • Coping behavior• Risk management• Informal safety nets• Conflict mitigation• Disaster mitigation & EWS• Savings groups• Bonding social capital

• Food security• Health/

nutrition index• Asset index• Access to

services index• Infrastructure• Ecological/

ecosystem services index

• Psychosocial measure

• Poverty measure

Proposed Analytical Framework for Measuring Food Security Resilience

Indicators Indicators Indicators Indicators

Adaptive Capacity• Human capital• Debt and credit• Use of assets & info• Psychosocial• Livelihood diversification• Bridging Social capital

Transformative Capacity • Governance mechanisms• Community networks• Protection and security• Use of basic services• Use of formal safety nets• Use of markets• Use of Infrastructure• Policies/regulations• Linking social capital

Challenges

• Limited ability to facilitate transformational change: The ability of most NGOs to improve transformative capacity, particularly at a national level, is often limited by external factors beyond their control.

• Funding mechanisms: Many NGO efforts focus on short-term, stand-alone projects rather than on longer-term programs

• Competition among NGOs: Limited financial resources can result in competition between NGOs and other actors

Opportunities

• A number of opportunities have the potential to positively influence and shape NGO approaches to enhancing resilience capacity. – Many donors are committed to new and more

flexible funding mechanisms that link humanitarian and development activities

– Partnering with private interests may prove effective in advocating for infrastructure investment in marginalized or underserved areas that are not being served by government initiatives.

Health Environment38.6%

Gender EquityEnvironment27.9%

Food ProductionEnvironment33.4%

Figure 1. APM-G2S Targeted Variables & the Estimated Contributions of Underlying Determinants to Reductions in Stunting, 1970-2012 (%) (Source: Smith and Haddad 2014)

Health Environment38.6%

Gender EquityEnvironment27.9%

Food ProductionEnvironment33.4%

Figure 1. CARE Target Variables & the Estimated Contributions of Underlying Determinants to Reductions in Stunting, 1970-2012 (%) (Source: Adapted from Smith and Haddad 2014)

Window of Opportunity (2008-2012): IYCF/Maternal Nutrition & Maternal Health, & Women’s Empowerment

(5 countries)

Food produc-

tion

Cashincome

In-kindfood

trans-fers

Caregiver knowledge & beliefs

Caregiver physical & mental

status

Caregiver resource

control & autonomy

Safe water supply

Adequate sanitation

Health-care

avail-ability

Environ-mental safety/shelter

Figure 2. CARE Activities & Impact Paths on the Determinants of Child Nutritional Status (Source: Adapted from Smith and Haddad 2014)

Value-Chains/Micro-Finance

Produc-tion

CC/NRM

WASH

Food Aid

Reform

Maternal Health

Sustainability &Resili

ence

IYCF/Maternal Nutrition

Context, long-term results

FLJ & NP (WO) Activities

Results chain

Political & economic structure, Socio-cultural environment, & Potential resources -- environment, technology & people

Child’s nutritional status

Child’s dietary intake

Care for mothers & children Health environment & services

Child’s health status

Household food security

Resources for food security Resources for healthResources for care

FNS (N@C)Activities

Value-Chains/Micro-Finance

CC/NRM

Women’s Empower

-mentProduc-

tion

Voucher-CCT

IYCF/Maternal Nutrition

Gender & Empowerment, Governance , Policy & Advocacy, and Emergency Cross-cutting Themes

Figure 3. UNICEF Unifying Framework for Child Malnutrition[1] with Points of Influence for CARE Core Program Interventions(Source: CARE 2012, Nutrition at the Center: An Integrated Approach to Maternal and Child Nutrition, Proposal)

[1] Source: UNICEF, 1997

Key points from CARE staff discussion

Strengths in FSN:• Gender and work with women smallholder farmers• Value chains, financial services• Adaptation to climate change• Water, and water in agriculture/WASH/nutrition• Food aid reform influence, especially in advocacy• Strong, innovative health team• Innovative, collaborative initiatives underway

– ACRES, Shouhardo, GRAD, Pathways • Technical expertise in Nutrition• Participation in regional and international bodies

Key points from CARE staff discussion

Critical gaps:• Program design

– Not enough integrated design; still work in silos– Little technical expertise outside of specific projects readily available – Emergency and development interventions weakly connected

• Knowledge management – Good work not being captured

• M&E technical capacity to capture evidence weak• not available to other parts of the organization to use for design, advocacy• CARE not recognized for work it is doing

• Time and resource constraints– Little flexibility to work on integrated design– No prioritization on a few focus areas (willingness to drop areas)– Limited TA available; not tapping enough to research institutions

Key points from CARE staff discussion

Opportunities:• Globally there are evidence gaps in many areas where CARE is focusing:

– Gendered approaches to food security– Impact of smallholder agriculture initiatives on nutrition– Impact of climate change adaptation on smallholder production and incomes, and

resilience• Areas for innovation and action research

– Women’s empowerment and resilience– Smallholder Sustainable Food Systems as the focal point for Nutrition, Climate Change,

Market Engagement, Water and Women’s empowerment• Strategic Partnerships

– With research institutions with similar goals (expand university and agricultural research linkages)

– Extend/access technical expertise (cadre of regional/local technical experts to draw upon for M&E, and Knowledge Management