6
The Global Response to the Crises

A wide constellation of people and organizations work on nutrition and food security issues. These include, for example, multilateral United Nations (UN) agencies, bilateral government agencies, nongovernmental organizations, universities, research institutions, foundations, and the private sector. As described by moderator Hans Herren of the Millennium Institute, the following presentations helped workshop participants understand the landscape of the global nutrition field, the people and organizations who work in it, and their respective roles, functions, and capacities to respond to the outcomes of the recent food price and economic crises.

INTRODUCTION TO THE GLOBAL NUTRITION LANDSCAPE

Ruth Levine, Ph.D.,

Vice President for Programs and Operations; Senior Fellow

Center for Global Development


The Center for Global Development recently published a document titled Global Nutrition Institutions: Is There an Appetite for Change? The project followed work done for the Lancet series on maternal and child undernutrition, in which some key weaknesses were identified in the way international institutions are organized and work together, and the level of funding and capacity they have (Morris et al., 2008). The paper took a closer look at these issues with the hope of provoking thinking and conversation about how the institutional arrangements could be improved to serve the current needs of the international nutrition community (Levine and Kuczynski, 2009).



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6 The Global Response to the Crises A wide constellation of people and organizations work on nutrition and food security issues. These include, for example, multilateral United Nations (UN) agencies, bilateral government agencies, nongovernmental organi- zations, universities, research institutions, foundations, and the private sector. As described by moderator Hans Herren of the Millennium Institute, the follow - ing presentations helped workshop participants understand the landscape of the global nutrition field, the people and organizations who work in it, and their respective roles, functions, and capacities to respond to the outcomes of the recent food price and economic crises. INTRODUCTION TO THE GLOBAL NUTRITION LANDSCAPE Ruth Leine, Ph.D., Vice President for Programs and Operations; Senior Fellow Center for Global Development The Center for Global Development recently published a document titled Global Nutrition Institutions: Is There an Appetite for Change? The project fol- lowed work done for the Lancet series on maternal and child undernutrition, in which some key weaknesses were identified in the way international institutions are organized and work together, and the level of funding and capacity they have (Morris et al., 2008). The paper took a closer look at these issues with the hope of provoking thinking and conversation about how the institutional arrangements could be improved to serve the current needs of the international nutrition com - munity (Levine and Kuczynski, 2009). 

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00 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS Global Nutrition Landscape Comprised of Many Actors, Spread Thinly A large set of different roles needs to be filled in any sector or across any sec- tors, and the nutrition and food security areas are no exception (Table 6-1). Owing to historical and other factors, there is persistent confusion and sometimes con - flict around which institutions play which roles and how they do that together. One role could be characterized as that of setting norms. In this area, the World Health Organization undertakes work, and the UN Standing Committee on Nutrition also acts as a forum for UN agencies to discuss topics on this subject. Research activity is principally being undertaken by academic institutions and in specialized research institutions. Generally, research is quite widely dis - seminated but often without a defined role to play in policy and programmatic decisions. TABLE 6-1 Illustrative Organizations Active in International Nutrition Category Organization Key Role(s) Related to Nutrition Multilateral Agencies UNICEF Program implementation focused on maternal and child health, norms, and standard setting. Focus is on nutrition security, micronutrients, breast-feeding, and emergency response. United Nations Standing Network of food and nutrition Committee on Nutrition professionals. Promotes cooperation among UN agencies and partner organizations, including NGOs, in support of community, national, regional, and international efforts to end malnutrition. The World Bank Project and sector financing to countries with loans on near commercial and soft terms. Supports government implementation of projects and policy reforms with technical assistance from The World Bank staff and consultants. World Food Implementation of emergency Programme response and food aid. Provides (WFP) logistics and support through development programs. Operates school feeding programs.

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0 THE GLOBAL RESPONSE TO THE CRISES TABLE 6-1 Continued Category Organization Key Role(s) Related to Nutrition World Health Organization Sets standards, and establishes (WHO) policies and programs. Biomedical and public health focus on reduction of micronutrient malnutrition, growth assessment, and surveillance. Bilateral Agencies Canadian International Donor with focus on Development Agency micronutrient and other technical (CIDA) interventions, such as vitamin A programming and iodine. U.S. Agency for International Largest bilateral donor; focus Development (USAID) on targeted maternal and child health projects, micronutrient interventions. Nongovernmental Organizations Academy for International Short-term technical assistance, Development product research and marketing. CARE Technical support. Focus on the delivery of food commodities and resources during emergencies. Global Alliance for Supports public-private Improved partnerships to address Nutrition micronutrient deficiencies. Helen Keller International Intervention delivery; research, and advocacy functions. Focus on nutrition, child survival, and eye health. Manoff Group Intervention delivery, communications and behavior- centered programming. Micronutrient Intervention delivery and Initiative research. Focus on micronutrient and vitamin deficiencies, vitamin A supplements, fortification. PATH Development of new diagnostics for micronutrient deficiencies; innovation in biofortified foods. Universities and Research Institutions Consultative Group on Research; alliance of members, International Agricultural partners and 15 international Research (CGIAR) agricultural centers. Focus on food security.

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0 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS TABLE 6-1 Continued Category Organization Key Role(s) Related to Nutrition Cornell University Training and research, including basic science, community nutrition, policy development. Instituto de Investigación Research and program Nutricional implementation, teaching and (Lima, Peru) training services in health and nutrition. Focus on community health in Peru. International Center for Development of biofortified Tropical Agriculture foods. (CIAT) International Food Policy Scientific research and related Research Institute (IFPRI) activities; supported by CGIAR; focus on food security and poverty reduction. Implementing HarvestPlus. Johns Hopkins University Research and training in public Bloomberg School of health nutrition. Public Health London School of Hygiene Research and training in public and Tropical Medicine health nutrition. Mahidol University, Research and policy analysis, Thailand training, and consultation. Private Sector Danone Grameen Danone partnerships to promote local entrepreneurship in nutrition. Unilever Partnership with the WFP to improve the nutrition and health of poor school-aged children. Philanthropies Bill & Melinda Gates Focus is on reducing Foundation micronutrient deficiencies and undernutrition in vulnerable groups, particularly women and children less than 2 years through Global Health Program; Global Development Program includes grant making to increase quantity and quality of staple foods. Children’s Investment Fund Emerging emphasis on nutrition and food security as part of long- term development programs. SOURCE: Levine and Kuczynski, 2009.

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0 THE GLOBAL RESPONSE TO THE CRISES A small number of funders are active in international nutrition. The U.S. Agency for International Development (USAID) and the Canadian International Development Agency have been longstanding financial supporters among the development agencies. There are now some new entrants into funding nutrition and food security efforts, including Irish Aid, the United Kingdom (UK) Depart - ment for International Development, the European Union (EU), and the Bill & Melinda Gates Foundation. On the implementing side, there are large international nongovernmental organizations (NGOs) such as Save the Children and CARE. Important imple- menters are also governments in developing countries where, within ministries of health, social protection, and to some extent ministries of agriculture, there are nutrition-related activities underway, funded either through domestic sources or with external support. Several entities are involved in policy development, advocacy, and build- ing capacity. The major UN agencies—including the United Nations Children Fund (UNICEF), the World Health Organization (WHO), and the World Food Programme (WFP)—all play roles across many of those different domains: implementation, research, generating and allocating funding, setting norms, and building capacity. Major Challenges Three inherent characteristics of the field of nutrition make it a special challenge institutionally, as well as in terms of communication to policy mak - ers. First, there is not always a clear, direct link between nutritional status and tangible, measurable outcomes such as lives lost. As a result, the international nutrition community ends up being dependent on disability-adjusted life years (DALYs), which are not very compelling or intuitively understood. Further, it is not entirely clear under what health problem (or even social problem) nutrition broadly fits, because poor nutrition contributes to many types of poor health out - comes; in this way, nutrition is everyone’s problem, but no one’s responsibility. In addition, there are quite profound measurement errors that interfere with the ability of institutions and policy makers to determine what to do about nutrition. Both under- and overnutrition are relative constructs without necessarily a very direct line to a biomedical result. To motivate action and attract champions and clear lines of action, this lack of a direct link to a tangible outcome is a major challenge for global nutrition actors. Second, nutrition is part of the poverty and social justice agenda. It is more about the distribution of resources in a society than anything else. As a result, it is not entirely clear who the nutrition “constituency” is. Relative to the size of the problem and compared to some other problems for which biomedical solutions (vaccines, drugs) dominate, there are few technological solutions. Nutrition has to do with the social determinants of health as well as a set of individual behaviors,

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0 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS which complicates categorizing nutrition as a specific, tractable health issue in need of a solution. The third inherent characteristic of nutrition that makes it institutionally complicated is how profoundly it spans sectors—primarily health and agriculture. These two sectors, unfortunately, do not have a long track record of successfully working together or having a mutual understanding. The current arrangement of institutions, and the interactions among them, does not seem able to handle either the broad nutrition challenges that have per- sisted for decades or the more immediate challenge of food security amidst the economic crisis. Funders encounter a fractious environment of institutions and groups attempting to establish norms and priorities and advocating their own technical solutions or implementation approaches. Groups with particular inter- ests defend their territory, which is not surprising in an environment of restrained resources, but this undermines other messages about priorities. Partially as a result, decision makers at the national and subnational levels often receive con- tradictory or confusing guidance from international partners and face a somewhat chaotic set of program ideas and implementations to support. Does the Nutrition Community Have What It Takes to Respond to the Current Challenges? Six elements are commonly found among successful large-scale public health achievements (Levine, 2007). One is adequate, reliable, and long-term funding. This is clearly missing from the nutrition sector relative to the size of the prob - lem. Funding for nutrition programs is low. Relatively few international agencies have made significant commitments at the national level. With some exceptions, domestic resources for nutrition programs are low. The second element that is essential for success is the existence of genuine champions and leadership at the international and national levels. Such champi- ons for nutrition are also missing at the moment. Nutrition is not very prominent on the global health agenda. Those in the nutrition community have a track record of talking within the nutrition community; they gravitate toward technical sub- jects and have difficulty broadly communicating consistent messages, not only about the importance of under- and overnutrition, but also about a set of actions that with sufficient resources could make a major positive difference. The third element necessary for success is technological innoation within effectie deliery systems. That does not mean a magic bullet. What has been observed in other global health successes is that there is a real momentum established when a new approach or new idea is “packaged” and talked about in a coherent way. There is a lot of promise within the nutrition community, and there are some excellent examples from the past, but much debate remains about the most promising approaches, especially regarding the appropriate role

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0 THE GLOBAL RESPONSE TO THE CRISES of the private sector as a delivery channel and as a partner in addressing nutrition challenges. The fourth element is technical consensus among the recognized expert community, including both at the national level and internationally, about the magnitude of the problem and the way forward. Much progress has occurred in nutrition in the past few years, with the Lancet series in particular providing clear evidence and a synthesis of evidence about the window of opportunity from birth to 2 years. The series identified a set of interventions that has now been reasonably well evaluated (Bhutta et al., 2008). At the same time, there is still some debate around that technical consensus; there are remaining questions about ready-to-use therapeutic feeding, for example. There is little agreement about what the connections should (or can) be between the health, nutrition, and agricultural communities and their interventions. The fifth element of success is good management on the ground, often termed capacity. Currently, major capacity gaps are observed in nutrition. This lack of capacity can be attributed to the persistent shortages in funding as well as the sectoral spread of responsibilities. In international agencies, there are not many positions that focus full-time on nutrition; at a country level, similar situa - tions lead to weak on-the-ground capacity. The final element that is required for success is effective use of information for awareness creation, monitoring, learning, and ealuation. The nutrition com- munity has suffered from insufficient translation of the evidence that does exist to decision makers at the policy level. The Way Forward Recently, within the international nutrition community, much discussion has focused on the lack of institutional capacity and other weaknesses. There is a real recognition that there are institutional problems to solve. There are questions about which members of the UN family will emerge to take the lead in bringing players together to define coherent messages to nonnutrition policy communities, advocating for more resources, and becoming a channel for those resources to be used. It is unlikely that members of the nutrition community themselves are going to spontaneously solve these problems. Instead, what may be required is a high- level mandate for institutional change. Ideally, that mandate should come from leaders in the developing world through the vehicle of the G20 or other forum. Short of that, the mandate should come from some of the major funding agencies working together to lay out a set of expectations about how institutions should and could learn to allocate roles and work together. At the same time, there need to be adequate resources or additional resources devoted to bolstering institutional capacity within the key UN agencies and others,

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0 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS so that there can be a response to that mandate. The institutional leadership—the key coordinating institution—needs to come from within the UN family. Serious engagement of the private sector is an element that needs to be fostered. Significant new resources need to be brought to bear (at a minimum internationally, but ideally from affected countries themselves) to help with the processes of establishing a technical consensus, building the evidence, scaling up key programs, and monitoring their results. THE ROLE AND CAPACITY OF FOUNDATIONS IN RESPONDING TO THE CRISES Haddis Tadesse, M.P.A., Policy and External Relations Officer The Bill & Melinda Gates Foundation The Bill & Melinda Gates Foundation believes that people are trapped in poverty and ill health not because of how smart or dedicated they are, but simply because of where they were born and, consequently, whether they have access to tools, technologies, vaccines, health care, or the general environment necessary to lead a healthy and productive life. The Bill & Melinda Gates Foundation cannot be involved in every important development issue; instead, a few key questions drive its decisions about which issues to focus on: What issues affect the most people? What issues have been neglected? Where can the Foundation make the greatest impact? The Global Development Program The Bill & Melinda Gates Foundation gives about 50 percent of its resources to global health, about 25 percent to U.S. programs that focus mostly on educa - tion, and about 25 percent to global development, of which agricultural develop - ment is the largest program. The Global Development Program was designed with a set of key principles: • Philanthropy plays an important but limited role. The Bill & Melinda Gates Foundation can take risks, move quickly, and catalyze change, but large-scale, sustainable change is driven by markets and governments. The Bill & Melinda Gates Foundation sees its role as complementing and strengthening governments, not competing with or replacing them. • The focus must be on benefitting individuals. There are many ways to approach and quantify development. Individual people are the lens through which the Bill & Melinda Gates Foundation views and measures success. • The greatest impact can be achieved by focusing on a few key, long-term issues.

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0 THE GLOBAL RESPONSE TO THE CRISES More than 1 billion people live on less than $1 a day, and about 1 billion people are chronically hungry. This kind of grinding poverty often reduces life to a daily struggle for survival. Food, water, shelter, health care, and education can seem like luxuries. A majority of the people who live on less than $1 a day rely on agriculture but struggle to grow enough food to eat. Because the Bill & Melinda Gates Foundation is concerned with reducing hunger and poverty, agriculture was an obvious place to start. The story of agricultural progress parallels the story of human progress. Over the past 200 years, nearly every part of the developed world has seen an agricultural transformation that has dramatically reduced poverty and hunger. When agriculture flourishes, so does society; where it doesn’t, hunger and poverty take root. Yet agriculture in developing countries has been neglected by country governments and donors over the past several decades. That neglect has produced a lower level of food production than is necessary. Farmers in Africa and in South Asia face starkly different circumstances than those in more prosperous regions. While of course African farms should not necessarily look like farms in the United States, they lend themselves to compari - son. A typical farmer in the United States will have a large tract of land; a tractor equipped with a global positioning system (GPS), air drill, and other technologies that analyze soil; variable fertilizer applications; access to the best scientists in the world; and a global supply chain. The experience of a typical farmer in Africa is vastly different. She has a very small amount of land; no reasonable access to input or output; no roads; no extension services; no access to credit; no marketing information; and, should production fall, there is no safety net to protect her. For Africans, farming is a risky and unforgiving enterprise. Agricultural Goal of the Gates Foundation The goal of the Bill & Melinda Gates Foundation is simple, yet ambitious. It is to help 150 million farming families move out of poverty while significantly improving child and household nutrition. The approach begins and ends with the small farmer. Everything the Bill & Melinda Gates Foundation does is focused on him or, more likely, her. Women are at the center of these efforts, and the impact of each grant on gender is considered. The Bill & Melinda Gates Foundation focuses on sub-Saharan Africa and South Asia simply because about 80 percent of the people who make less than $1 a day live in those regions. The results the Bill & Melinda Gates Foundation seeks include increased household incomes, child weights, and the quality and quantity of diets. The story of one small farmer’s success—of growing, harvesting, and selling—is bound in the larger story of agriculture. Success requires not only quality seeds and healthy soils, but also good information, access to markets, and supportive policies. This is why the Bill & Melinda Gates Foundation is pursuing

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0 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS improvements along the entire agricultural value chain. Obstacles to success in this space span sectors, and so do solutions. The Bill & Melinda Gates Founda - tion partners with organizations in the public and private sector in developing and developed countries. Since its inception, the Bill & Melinda Gates Foundation has given 136 grants with a total commitment of $1.2 billion. The average size of grants is about $9.2 million. By far, the largest grantee is the Alliance for Green Revolu - tion in Africa, which is a Nairobi-based organization led by Africans. The current chair of the alliance is former UN Secretary-General Kofi Annan; its mission is to usher a uniquely African Green Revolution on the continent. In Africa, the Bill & Melinda Gates Foundation’s grants represent less than 5 percent of the total global commitment of $9 billion for agriculture and agricultural spending in Africa. Lessons Learned The Bill & Melinda Gates Foundation has learned that the major determi- nant of success is the design of programs. The Bill & Melinda Gates Foundation chooses programs that are focused on the customer—in this case, smallholder farmers, and particularly women. Another lesson learned is that the Bill & Melinda Gates Foundation cannot merely invest in science, technology, and production. Instead, market access pro - grams, in which farmers have the ability to market their crops, earn income, and reinvest in their own agriculture, are key to empowerment and sustainability. Additionally, the quality of partnerships defines the success of the Bill & Melinda Gates Foundation. The organization itself does not implement any projects on the ground; in this way, partners are paramount. Public-private part - nerships offer a powerful opportunity to respond to the challenges of a global problem. By combining resources, merging expertise, and sharing risks, partner- ships can deliver results. For partnerships to succeed in these joint ventures, each partner needs their roles defined clearly, based on the strength that each partner brings. Results of such partnerships must be tracked over time. For example, the cocoa partnership aims to raise incomes through improved knowledge and productivity by working with a dozen multinational corporations to double the income of 200,000 cocoa-farming families in five African countries. When a single family achieves this goal, it is a great success. When such success is experienced by entire communities, it is development. Although it is not the Bill & Melinda Gates Foundation’s core competency, the foundation has initiated some short-term, emergency grants around food security during the food crisis in multiple countries.

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0 THE GLOBAL RESPONSE TO THE CRISES Solutions and Investment Ideas The following solutions and investment ideas were offered by the Bill & Melinda Gates Foundation: • Research—If agriculture is to change for the better, the international agri- culture community needs to identify and fund research with the greatest promise. • In-country investment—Using new funding modalities, rapid and effec- tive expansion of donor financing for agriculture is needed. • Support local transformative efforts—On-the-ground initiatives that are tailored to local farmers need to be supported. • Build human capacity network—A large cadre of well-trained, motivated agricultural scientists and extension workers must be created. • Reinvest in agricultural value chain—Private companies that look beyond corporate social responsibility and find neutral business value should be identified. • Invest in livestock—Investing in livestock is critical and contributes to nutrition, risk mitigation, and crop protection. • Protect food security in biofuel production—Biofuel needs to be produced in a manner that protects food security. • Expand feeding programs—Appropriate strategies for local procurement of food must be established. (The WFP is the leading agency in this effort.) • Infrastructure—Agricultural growth and poverty reduction depend on investment in agriculture. • Pilot large-scale programs in country—Large-scale pilot farm programs intended to stand as models should be supported. Even with all these opportunities available, there are still great challenges and risks ahead. To succeed over the long term, agriculture needs to be both environmentally and economically sustainable for the small farmer. Climate change is a major issue that farmers are facing, and it particularly affects the poor in developing countries. The world population is projected to be 9 billion by 2050; nearly 50 percent more people will need to be fed on less arable land than currently exists today. The Bill & Melinda Gates Foundation is optimistic about the future. Devel - oping countries are making enormous progress. The incredible benefits from science and technology that have been witnessed over the past several years will continue. Renewed attention is being given to hunger and agriculture. Success is possible, and great partners around the world will make it happen.

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 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS tion security, especially when considering the consequences of undernutrition for young children. If action is not taken at a very early age, the consequences of undernutrition can lead to lifelong negative impacts, and, ultimately, an entire lost generation. UNICEF applied $50 to $60 million of its own resources to stimulate a pack- age of immediate relief with a focus on nutrition security for vulnerable groups. Throughout this process, UNICEF had regular contact with the WFP and WHO on the types of interventions supported, the role of other agencies, and which countries would receive UNICEF’s focus. This is an indication of the strong col - laboration between UN agencies during the crisis. Forty-two countries were selected, based on high under-five mortality rates, high malnutrition rates, and high HIV rates. UNICEF realized that the high food prices may have an impact on households affected by HIV, who likely already manage on a very meager income and are net buyers of food. Impact of UNICEF Response to Food Price Crisis UNICEF’s funds were distributed quite rapidly. Almost all of the selected countries received funds (over and above their already available budgets) by the end of July, and 70–80 percent of these funds were actually used. About 80 per- cent of the funds were used for the expansion of nutrition and health programs; 28 countries worked on evidence building and the enhancing of data availability. For example, 9 countries in West Africa conducted smart surveys, seven are in the pipeline, and a number of other studies and data collection efforts were made, including the strengthening of surveillance in Zimbabwe. Another noted impact was a rapid increase in the treatment of children suf - fering from severe and acute malnutrition. In 2007, UNICEF distributed about 4 million kilograms of ready-to-use therapeutic foods, and in 2008 that number jumped to 10 million kilograms. With this increase, an estimated 750,000 to 1 million children suffering from severe and acute malnutrition were treated. The use of multiple micronutrients was also expanded. For example, in Afghanistan, Cambodia, Indonesia, and Laos, large groups of people were reached (with a focus on children 6 to 24 months of age) with micronutrient supplements to improve the quality of their complementary food. A significant number of countries, such as Angola, the Congo, Ethiopia, Mali, Malawi, and Kenya, further improved their infant feeding programs. Also accompanying this outreach was an increase in the capacity of national institutes and NGOs to carry out this work. To expand outreach, basic community workers and health workers in the field must be enabled to implement programs and educate mothers. Much capacity strengthening occurred in 25 countries, including Benin, Cambodia, Liberia, Mozambique, and Zambia. For example, prior to the crisis in Mozambique, the provision of immunizations, impregnated bed nets, vitamin A supplements, and deworming medication was effectively

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 THE GLOBAL RESPONSE TO THE CRISES accomplished only once a year. In 2008, as a consequence of the food crisis and with UNICEF support, Mozambique modified its programs to be implemented twice a year, leading to an enormous increase in coverage with essential interven- tions. Finally, UNICEF also supported a number of social safety net programs. For example, cash support was provided in Madagascar, Ethiopia, and Malawi. Without knowing to what extent these interventions will translate into lasting changes in wasting or stunting rates or in other indicators, it is safe to assume that at least a number of indicators will have shifted. UNICEF has reached more children with treatment of severe and acute malnutrition and, in this way, pre - vented child deaths. A substantial number of children were reached with vitamin A supplements, and the first steps were taken to improve infant feeding in a number of countries. The focus on “nutrition security” is of crucial importance when considering the lives of children and the consequences they will face in later life. THE ROLE AND CAPACITY OF THE WFP IN RESPONDING TO THE CRISES Martin Bloem, M.D., Ph.D., Chief for Nutrition and HIV/AIDS Policy World Food Programme Evolution of the WFP’s Focus on Nutrition Over the past 2 to 3 years, the WFP has undergone significant changes. Owing to the new leadership of Josette Sheeran in combination with external circumstances, the agency developed a new strategic plan. The transition has been quite dramatic as the WFP has moved from a food agency to a food assistance agency. Twenty years ago, the WFP provided direct food assistance and food trans - fers, mainly from Europe, the United States, and Canada to lower-income regions. In contrast, today almost 70 percent of the WFP’s budget is in cash, so the WFP is able to buy food locally. Local procurement is different from shipping food internationally; it is cost-effective, but has required new strategies in food assistance. Another major deviation from the past at the WFP is a move away from the focus on acute hunger; today, the WFP focuses on acute and chronic hunger. Suddenly, programs must focus on stunting and other chronic problems. This transition occurred through much consultation with the WFP’s donors because it has many consequences in how such problems are tackled. In the context of the new strategic plan, the focus on nutrition is taken very seriously. Josette Sheeran declared nutrition as extremely important for the WFP because it is necessary for an agency that delivers food assistance to 80 to 100 million people every year to have a positive impact on nutrition. The WFP no

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 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS longer focuses merely on delivering food, but also on “what is in the food bas - ket.” The connection between access to food and nutrition has not always been assumed, so this too is a new way of thinking. The WFP designed a “nutrition improvement strategy” that is based on the Lancet series and designates an impor- tant role for the private sector. The WFP’s Role in Responding to the Food Crises In an effort to align the WFP’s strategy for responding to the current food price and economic crises with other UN agencies, an issue brief was written. This document described how to improve nutritional status under the current circumstances, focusing intently on the importance of micronutrients. Early in 2009, the Gandolfo meeting was held in Rome to discuss the poten- tial implications of the economic crisis, climate change, and high food prices on nutrition. A consensus from this meeting was published in the Journal of Nutrition. Another outcome of the Gandolfo meeting was an issue brief with the following recommendations. First, more funding is needed in the field of nutri - tion to implement all of the new, proven strategies. A second recommendation is to focus on target groups, in particular minus 9- to 24-month-old children and women. Historically, the WFP did not focus on particular groups, so this is a fundamental change that aligns the WFP with the broader nutrition community. The third recommendation is that inadequate diets need to be supplemented with micronutrient powders or lipid-based products. The fourth recommendation is to enable access to nutritious foods. In the past, UN agencies only focused on the known market-based production channels. Now, it is broadly understood that it is also important to focus on the market base, and to do this in two different ways—through buying locally and partnering with the private sector. One WFP program, the P4P program, works with small farmers so they can buy locally. Local products, however, may not be capable of improving nutritional status, so a value chain is needed. The community’s food processing needs improvement through the help of local industries (supported by larger companies). The WFP has many partnerships with the private sector. One noteworthy partnership is with DSM Nutritional Products, a Dutch vitamins and minerals company. The WFP’s partnership with DSM began in 2007 with an interest in novel food products, funding, and enormous technical support that led to great progress in a short period of time. The WFP has benefitted greatly from this partnership and has pushed DSM to work with local customers in WFP recipient countries. For example, the WFP uses micronutrient powders that are not avail - able in local markets, so must be imported. If DSM were to sell to local markets, the WFP could purchase micronutrient powders in the local market. An added benefit of a local supply of such products is that they don’t require extensive social marketing because local populations become aware of the products on their

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 THE GLOBAL RESPONSE TO THE CRISES own. Today the private sector plays a much larger role in the WFP’s programs than merely funding. Last year, the WFP’s budget was around $5.6 billion, and the private-sector contribution was about $100 million in total. Partnerships at the local level are extremely important. The WFP’s new strategic plan involves partnerships with local governments, local NGOs, inter- national NGOs, local private-sector organizations, and international private-sector organizations. While partnerships come with their own challenges, this new model is a promising solution that is only possible when both parties have com - mon local data, analysis, and goals. THE ROLE AND CAPACITY OF FAO IN RESPONDING TO THE CRISES Hafez Ghanem, Ph.D., Assistant Director-General, Economic and Social Deelopment Department Food and Agriculture Organization Reforming Global Governance for Food Security and Nutrition The last major food crisis to face the world was in the mid-1970s. At that time, there was a call for strengthened global governance of food security, which led to the 1974 World Food Conference, and the establishment of the World Food Coun- cil and the Committee on World Food Security (CFS). The CFS was established to serve as a forum in the United Nations system to examine major problems and issues affecting the world food situation and to review and follow-up on policies concerning world food security. The Committee was useful when it began and played a large role in supporting major initiatives in support of world food security in the mid-1970s, including a call for funding for the Green Revolution and invest- ments in South Asia, which led to a reduction in hunger. But the world has changed. In 2009, after some progress in hunger reduction until the mid-1990s, there is again a large increase in the number of hungry people in the world, coupled with decreased investment in agriculture. The current trading system in agriculture is neither fair nor efficient. Biofuels provide opportunities for some farmers, but also present great risks for food security. Climate change is also playing a significant role in agriculture and food security, where agriculture can both be a great contributor to carbon emissions as well as be greatly affected by climate change. More recently, the impact of high and volatile food prices and the financial and economic crises have exacerbated the already high levels of chronic hunger and malnutrition in the world. The importance of these factors and their implications for world food security all highlight the need for a renewed mechanism of governance to address funda- mental weaknesses in the mechanisms governing global food security. There is general agreement that the CFS’s performance has been inadequate, which leaves a

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 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS vacuum in the global system of governance. The CFS should be renewed to focus more on key issues affecting global food security and include broader participation of key partners in the design and implementation of a food security policy agenda at global, regional, and national levels. In order to improve upon the global governance structures, the members of FAO have begun the process of reforming the Committee to make it more focused and useful in addressing world food security issues. The process is ongoing. The overall goals are to redefine the role of the Committee on World Food Security so that it can be more action-oriented and to expand Committee membership beyond FAO’s member states, to include broader participation from other key stakeholders, such as representatives from the NGO/CSO private sector and other UN agencies. FAO Reform FAO itself is also undergoing a major reform. An extensive external evalua- tion of FAO—the first one of its kind for a major UN agency—concluded that if FAO did not exist, it would have to be reinvented. However, FAO as it currently exists needs major changes. The FAO reform involves introducing new or revised structures and mecha - nisms, including for management of the organization, new personnel systems, a new organizational culture, and new and improved governance of FAO itself. This reform is an important part of FAO’s response to the current economic and financial crisis because unless the institution is modernized and able to seize opportunities, it will not properly address those most in need. For decades, FAO has been arguing and advocating for the importance of investing in food security and nutrition; for decades it has been ignored. Sud- denly, politicians are paying more attention and are now demanding that FAO and the broader international food, nutrition, and agriculture communities respond and rise to meet these new challenges. FAO must seize this opportunity to become a more effective and efficient organization in order to help address the needs of the billion undernourished people in the world. Initiative to Support Farmers During the Food Price Crisis A specific FAO initiative in response to the food crisis is to help farmers in developing countries increase their productivity in the short run through supply of seeds and fertilizers. This initiative started with seed money from FAO and the Spanish government, but now obtains major support from the European Commis- sion and covers 88 countries. As one would expect (especially economists), when food prices go up, sup- ply responds and production increases. This was evident in response to the higher food prices of 2008, where the supply of cereals for the world increased by more than 10 percent. Interestingly, that increase in supply came almost exclusively

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 THE GLOBAL RESPONSE TO THE CRISES from developed countries. Developing countries’ output increased by only 1.5 percent—all from India, China, and Brazil. Poor farmers in developing countries were unable to buy fertilizers or seed, and had insufficient access to markets. For them, the high prices were not an opportunity they could seize. FAO’s initiative supports farmers in the developing world in order to allow them to seize the opportunity offered by high commodity prices. It is a short-term initiative, because it does not deal with the fundamental structural problems in the agricultural system, but it is important to allow these poor farmers to respond. THE ROLE AND CAPACITY OF WHO IN RESPONDING TO THE CRISES Francesco Branca, M.D., Ph.D., Director, Department of Nutrition for Health and Deelopment World Health Organization WHO Response to the Food Crisis WHO responded to the global food crisis by pursuing the following tasks: • Monitor the health and nutritional status of member states’ populations. • Support countries in scaling up nutrition action, such as managing severe malnutrition, promoting breast-feeding and complementary feeding prac - tices, improving access to specific micronutrient supplements, delivering primary health care services, and promoting food hygiene. • Support countries in strengthening and implementing integrated national nutrition policies. • Develop and scale up social protection actions related to health and nutri - tion, such as working with member states to promote free or low-cost working health services. • Support member states in assessing and addressing the health and nutri - tional effects of food insecurity, including building capacity and train - ing national counterparts and WHO teams, as well as designing plans and programs that can mobilize resources through the Comprehensive Framework for Action, UN Central Emergency Response Fund, and other , international mechanisms. Strategic Focus WHO has more than 100 offices, but not many are dedicated to nutrition exclusively. About 20 percent of staff has some focus on food and nutrition. In reaction to the crisis, then, WHO was forced to reflect on its role and strategy

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0 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS in order to optimize its resources for nutrition. WHO produced a strategic paper suggesting that the organization focus on the following areas: • Development and operationalization of integrated food and nutrition policies. • Intelligence of needs and response. • Development of evidence-based program guidance. • Country-level advocacy and technical assistance. WHO is seen as a “convener” within the UN family, so these initiatives were additionally proposed to WHO’s sister agencies. In the area of food and nutrition policies, WHO has been analyzing mem- ber countries’ readiness to accelerate action in nutrition. The objective of such analysis is to assess existing gaps and constraints and to identify opportunities ssess to integrate and expand nutrition-related actions in countries. An action plan is developed with recommendations to guide harmonized action for improved nutri- tion. Additionally, a baseline of current nutrition status and nutrition action in the 36 countries with the highest burden is established. As a normative agency, WHO must provide technical guidance to member states. Offering guidance in collecting nutrition information and establishing national nutrition surveillance systems is an important normative role WHO plays. A new global database, the Nutrition Landscape Information System, will be launched very soon. This system provides an interface of country profiles with all of the country data collected through WHO’s nutrition databases, as well as some of the data from sister agencies on policy implementation and other food security indicators. Partnerships WHO believes in the importance of working in partnerships and is engaged in a number of partnerships, including the UN Standing Committee on Nutri - tion and the REACH initiative. WHO also works at the regional level to create partnerships. A new initiative, the Pan American Alliance for Nutrition and Development, was created to propose and implement comprehensive, intersectoral coordinated programs that are sustained over time, operate within the framework of human rights, and take a gender-sensitive and intercultural approach that contributes to reducing malnutrition and accelerating the attainment of the MDGs. This new alliance will look at effective interventions and advocate in high-burden countries for greater action in nutrition (WHO, 2009).

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 THE GLOBAL RESPONSE TO THE CRISES DISCUSSION This discussion section encompasses the question-and-answer sessions that followed the presentations summarized in this chapter. Workshop participants’ questions and comments have been consolidated under general headings. Leadership It was suggested by some workshop participants that UN agencies should take the lead in nutrition issues. At the same time, the view was expressed that nutrition departments in UN agencies rank low in the organizations; as a result, individuals with nutrition expertise are not in senior leadership roles. Some leadership mechanisms were explored, such as the H8 mechanism, which is used in health. While perhaps not particularly effective, it does guarantee that the heads of agencies and important organizations talk about a topic on a regular basis. Without such a mechanism, when the heads of UN agencies come together, the chance that they talk for a significant period of time on nutrition is quite minimal. The Standing Committee on Nutrition (SCN) was discussed. At the moment, the SCN is not officially related to any higher-level UN reporting mechanism— not to the heads of agencies, not to the UN Economic and Social Council, not to any other chamber, which makes it a voluntary mechanism that could be more effective if structured differently. Nutrition Interventions Can Deliver It is helpful for programs to convince funders that programs can change nutritional status. For example, vitamin A and salt iodization programs have been successful in delivering change in nutritional status at a relatively low price. Recently, many countries in sub-Saharan Africa have demonstrated sub - stantial increases in breast-feeding rates. If these success stories are documented by countries, a sense of trust that nutrition programs can “deliver” is built with donors. In this way, it is the nutrition community’s responsibility to convince people that nutrition is important. It influences mortality, influences a country’s development, and influences the development of children over a long period of time. There is no longer disagreement on these facts because data exist, but now convincing evidence needs to show that nutrition interventions can “deliver” at a reasonable price. Collaboration One workshop participant felt that real incentives to work collaboratively are still absent in the international nutrition community. From an institutional

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 IMPACTS OF THE GLOBAL FOOD PRICE CRISIS perspective, resources for staff and activities are made available by funders if requested by an individual agency. In terms of funding, there seem to be more incentives for acting individually and autonomously than in a coherent way that is fully aligned with what national governments might see as a priority. Another participant disagreed, stating that one of the reasons resources in food and nutri - tion have been lacking is because of the fragmentation. Evidence is beginning to show that alignment is proving attractive to funders. Coordination Mechanism for Funding Funding for food and nutrition varies from level to level and subject to sub- ject. One area where the food and nutrition community needs to move toward harmony is on the coordination of what happens with money that goes through multilateral channels. One participant suggested that if governments want to access resources, they currently have to “knock on lots of different doors,” pres - ent multiple applications, and deal with many different people. A solution (that was credited to Jeff Sachs) is that of a vertical fund that would lump all the donor money into one place, much like the Global Fund to Fight AIDS, Tuberculosis and Malaria. It was also suggested that a coordinating mechanism is needed to make sure that when money comes from different multilateral and bilateral agencies, particularly at the country level, there is a very clear and transparent process for which national authorities can get information about what money they might be able to access and how they can access it. Additionally, this mechanism would help the multilateral agencies themselves in responding collectively to a national request. Lessons Learned from Tobacco Control Obviously the tobacco and food sector are dramatically different. The suc - cesses seen through the Framework Convention on Tobacco Control are often referred to, however, in discussions of food and nutrition policy. The tobacco control community recognized the need for UN coherence, and the priorities of the different UN agencies were clarified. For example, when WHO took charge of a UN-wide agreement on the roles of The World Bank, FAO, UNICEF, Inter- national Monetary Fund, and WHO, progress began. This had broad implications at the country level, because people saw the importance of defining various agen - cies’ approaches, such as FAO dealing with tobacco supply, while WHO dealt with demand reduction. A second lesson learned from tobacco control is the importance of getting a stronger voice from local NGOs throughout the process of negotiation. Tobacco control witnessed incredible organization of NGOs who held everyone to account and gave support. In the nutrition world, there are few major indigenous voices

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 THE GLOBAL RESPONSE TO THE CRISES from developing countries that are active in the major debates. Part of the prob - lem the nutrition community faces has to do with not hearing the outrage from local voices. Finally, it should be noted that tobacco control was a legally driven process. There was a regular convening of governments, NGOs, and the private sector (including the pharmaceutical industry) at every major meeting. The fact that trade, health, agriculture, and all of the complex interests were represented meant that common constituencies moved ahead at the same time. In terms of food and nutrition, part of the problem is in delineating the responsibility of WHO and FAO. Going back to the 1946 constitution, the role of WHO on food and nutrition relative to FAO is very “fuzzy.” Additionally, the WFP didn’t exist at that time, but it now plays a very strong and critical role, so it also needs to be built into the process. “Food and Nutrition Security” Tactic It was suggested that the international nutrition community begin referring to “food and nutrition security” all in one expression. Food security is on the map, but nutrition security and food security are not the same concept, and nutrition policies are somehow seen as separate from food security; if policies and programs for food and nutrition security are discussed jointly, it might make a big impact. Another participant noted the importance of differentiating between food safety and nutrition in the context of food security. There is some controversy among FAO membership around the focus on nutrition versus food safety. REFERENCES Bhutta, Z. A., T. Ahmed, R. E. Black, S. Cousens, K. Dewey, E. Giugliani, B. A. Haider, B. Kirkwood, S. S. Morris, H. Sachdev, and M. Shekar. 2008. What works? Interventions for maternal and child undernutrition and survival. Lancet 371(9610):417-440. Gates, B. 2008. Making Capitalism More Creatie. Retrieved January 29, 2009, from http://www. time.com/time/business/article/0,8599,1828069,00.html. Grebmer, K. V., B. Nestorova, A. Quisumbing, R. Fertziger, H. Fritschel, R. Pandya-Lorch, and Y. Yohannes. 2009. Global Hunger Index: The Challenge of Hunger: Focus on Financial Crisis and Gender Inequality. Cologne, Germany: International Food Policy Research Institute. Levine, R. 2007. Case Studies in Global Health: Millions Saed. Sudbury, MA: Jones and Bartlett Publishers. Levine, R., and D. Kuczynski. 2009. Global Nutrition Institutions: Is There an Appetite for Change? Washington, DC: Center for Global Development. Morris, S. S., B. Cogill, and R. Uauy. 2008. Effective international action against undernutri- tion: Why has it proven so difficult and what can be done to accelerate progress? Lancet 371(9612):608-621. PepsiCo. 2007. PepsiCo 00 Annual Report: Performance with Purpose. Retrieved February 2, 2010, from http://www.pepsico.com. Sheeran, J. 2008. Innovating against hunger and undernutrition. Global Forum Update on Research for Health 5:174-176.

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