Institute Notes: A Dialogue on Overcoming Hunger and Poverty

Day 4 - Food and Medicine are Just the Start

Our arrival in Burkina Faso is a shock to the system. Just off of the landing strip is the bare hulk of a plane that is slowly being devoured for parts. Like carrion, it’s in a semi-state of disembowelment. Steel bones jabbing at various angles into the clear sky are almost all that is left of it. The heat of the afternoon sun plays off what is left of its shining metallic skin. Even before we leave the airport, the magnitude of poverty in the country hits us squarely in the gut.

From a conversation with Burkina’s WFP Country Director, Anna Lisa Conte, we know hunger has increased across the country. Already vulnerable and suffering seasonal food insecurity, many families faced sharp declines in health and nutrition as a result of the spike in food prices. In response WFP, along with partners such as CRS, have put in place a number of emergency measures including a program that provides families with vouchers they can use to purchase food.

Malnutrition lurks even in the grain belt of Burkina Faso. The major bread basket of the country also has one of the highest rates of malnutrition. The paradox of hunger amidst plenty is in full view as we visit an emergency feeding center for malnourished children in Kirsi, a small nutrition and health clinic near Yako. The clinic is run by Medecins Sans Frontieres (MSF) and provides therapeutic feeding to malnourished children. On the day we are at the clinic more than three dozen children were registered to receive assistance from the clinic because they were suffering severe malnutrition. Eleven were sent to the nearby hospital because diseases such as diarrhea threatened their very life.

After years of experience, trial, error and improvement, the model MSF utilizes for treating malnourished children is down to a fine routine. The recovery rate is high, exceeding 90 percent. Yet, it is also clear, that the critical emergency assistance MSF is providing is not being matched by other interventions that will make emergency feeding programs unnecessary.

At least there is some hope that this will change. In the last few years, the government has been proactive in addressing nutrition as a unique problem requiring specific attention. They have created a Nutrition Directorate within the Ministry of Health and have written a National Nutrition Strategy to help coordinate the activities of the many NGOs and donor agencies currently working to promote child and maternal health. A good start, but as the scenes from the clinic demonstrate, much work remains to be done.

Further Support for More Flexible Food Aid

For some time Bread for the World and other groups have been calling for a more flexible, responsive approach to addressing both chronic and urgent hunger needs around the globe.  (See Bread for the World’s 2006 position paper, “Feeding a Hungry World.”) A key component of a reformed US food aid program is local and regional procurement (“LRP”) – the capability, currently denied under U.S. food aid law, to purchase needed food in or near the area of need, thus reducing cost and response time.   The U.S. Government Accountability Office – the GAO – in a just-released report, has made a significant and welcome contribution to the debate on this issue. The report’s subtitle – “Local and Regional Procurement can Enhance the Efficiency of U.S. Food Aid, but Challenges May Constrain Its Implementation” – is nothing if not cumbersome, but does accurately communicate the bottom line message.

Although the use of U.S. Government funds for LRP has, until very recently, been precluded, use of LRP by other donors, including U.S. NGOs with their own resources,  is widespread and on the increase. The World Food Program (WFP), the largest global food aid distributor, increased its purchases in developing countries from $171 million in 2001 to over $1 billion in 2008. Nearly 80 percent of WFP food aid is now sourced from developing countries. And even in the U.S. the idea of LRP is beginning to gain traction, with several studies completed or underway, and limited funds actually being made available for such procurement.

The most significant GAO finding is that local and regional procurement does unquestionably reduce costs and improve timeliness. LRP is more cost effective in almost every case: WFP’s costs for food procured in sub-Saharan Africa (SSA) and Asia were lower by 34 and 29 percent, respectively, than the cost of comparable food shipped from the U.S. (For Latin America the cost differential was negligible.)
Further, LRP can significantly speed up response: Delivery time for international in-kind food aid donations for SSA countries averaged 147 days, while local and regional procurements averaged 35 and 41 days, respectively – a reduction of up to 75 percent.

Kansas City 2009 -- Impressions of the International Food Aid Conference

The overall tone from the most recent International Food Aid Conference (April 6-8) differed from the past several such events in its relative lack of contentiousness and its clear focus on the issue of global food security. My four main take-aways were:

• The skirmishes over commodity vs. cash food aid have been put aside, at least for now. All participants appeared to agree that both are necessary, and that it’s not a productive use of time and resources to continue squabbling: The commodity supporters don’t seem inclined to resist the increasing use of cash (a total of $200 million in the 2008 supplemental and 2009 omnibus) for food aid, as long as it doesn’t come from Title II, and the cash supporters seem resigned to the fact that the agriculture committees in Congress are never going to agree to use Title II resources for the purchase of food outside the U.S. 
• There was a marked increase in attention to nutrition, particularly for children under two years of age. The importance of this issue was cited repeatedly, with one afternoon session devoted exclusively to the subject. The increasing availability of cash for food creates opportunities to address nutrition.
• The global food price crisis has eased somewhat, but we’re in for a prolonged period of short supplies and price volatility, rendering increasing productivity and rural incomes in areas of short supply all the more urgent.
• The focus of the Foreign Agriculture Service (FAS) is changing in a significant way, from simply flogging U.S. agricultural commodities to more of a development orientation, looking at longer term market development. The new Administrator of FAS and his boss, the Undersecretary for Food and Foreign Agriculture, both come out of a development background.

My colleague commented on one facet of the Secretary of Agriculture’s speech to the Conference – the increase in funding for Food for Education -- in his post on April 8. The Secretary’s speech primarily addressed the broad issue of global food security and seemed aimed more at the media and larger public than the delegates. His main point seemed to be that while we in the U.S. may be going through some difficult economic times, now is NOT the time to cut back on our international food aid and agricultural development commitments. Rather, we need to step up our efforts, both in terms of short-term (food aid) and long-term (agricultural development) interventions. This is not a time for looking inward. Invoking the example of the loaves and fishes, the Secretary remarked that we need to “remove the fear of sharing.”

Vilsack in KC: "No Child in the World Should Go to Bed Hungry"

Agriculture Secretary Tom Vilsack addressed the attendees of the Kansas City International Food Aid Conference (for background on the Conference, see this post). The big news was a pledge to provide an additional $80 million in food aid for use in the McGovern-Dole Food for Education Program. This increased support would amount to an 80 percent increase in program funding over the 2008 appropriations level. The additional funding will be focused on four countries: Angola, Guinea-Bissau, Niger and Uganda.   

Food for Education programs like McGovern-Dole have been successful in improving school enrollment and participation rates, and should be applauded. There may be other (perhaps more efficient) ways of achieving the same results, conditional cash transfers, for example. As with other US development assistance, giving goods or services in-kind (made in the U.S. or from companies based here for the most part) is the preferred option to cash though.

What strikes me most about today's announcement is that the proposed increase in funding for McGovern-Dole will not necessarily make the program more effective, particularly in addressing nutritional need. The program's legislation includes the option of

"the procurement of agricultural commodities and the provision of financial assistance to carry out - ... (2) maternal and infant and child nutrition programs for pregnant women, nursing mothers, and childre 5 years of age or younger."

To date, however, no money has been focused on this aspect of McGovern-Dole, and it's unlikely that additional funds will be used to target these populations. At a time when hunger and malnutrition are on the rise, it would seem to make sense to direct additional resources to meeting the needs of the most vulnerable populations, pregnant women, new mothers, and children younger than 2. Vilsack's announcement will do little to address this situation.

Kansas City Confab: Making Food Aid Work

This week food aid experts from NGOs, private processing and shipping companies, and the U.S. government are gathering in Kansas City for the Annual International Food Aid Conference. In the past Bread has brought concerns about flexibility and efficiency to the Conference. My Colleague Charlie Uphaus is attending again this year, but with the added issue of nutrition on his agenda.

We've produced a two-page brief outlining our concerns, specifically highlighting the fact that the current mix and formulation of bulk food aid does little to meet the nutritional needs of pregnant women, mothers, young children and others at increased risk of malnutrition. We recommend three basic actions that need to be taken to improve the nutritional effectiveness of US food aid:

• Add new foods and reformulating the current commodities available for purchase through US food aid programs.
• Prove technical and financial assistance to scale up efforts to fortify and process locally-produced, nutritionally appropriate foods.
• Combine food aid with others interventions such as nutrition education and improvements in access to health care, clean water and sanitation facilities in order to effectively reduce malnutrition.

The "Perfect Metaphor?"

The “perfect storm” was certainly the metaphor of choice at last week’s Food Aid Convention to describe the increased demand, high fuel prices and drought that have combined to drive global food prices to unprecedented highs, further impoverish the very poor and hungry and jeopardize prospects for achievement of the Millennium Development Goals. Its repetitive use, however, can serve to obfuscate as well as enlighten. A storm – even a “perfect” one -- is a short-term phenomenon. Almost everyone agreed that what we’re facing is a long-term problem – a prolonged season of bad weather. Consumer demand in China and India will continue to grow, and high petroleum prices will continue to encourage use of farm output for biofuels. Climate change will render production more variable, increasing market instability.

What to do? Everyone also agreed that a combination of short and long-term responses is needed: we need to meet immediate food needs while pursuing other reforms (in trade, economic policies) and increasing investment in agricultural productivity that will serve to encourage increased supply. But consensus begins to evaporate when it comes to specific remedies. All do agree on the need for more money for food, given the steep and continuing increase in food costs. But should that aid be cash or in-kind? Should Congress maintain a “safebox” for developmental food aid programs designed to address the longer term problem of food production, or commit all available resources to meeting the immediate needs? Is the administration’s continued effort to get authorization of local and regional procurement a timely and appropriate response to the crises, or a divisive diversion that will end up undermining political support for food aid? What is the most appropriate, effective means of encouraging increased production in chronically food insecure countries? All of these questions left on the table are reflective of the different interests and agendas in play around what should be a straightforward program – assuring that people receive adequate nutrition on a sustainable basis.

Global Food Prices and U.S. Policy

In yet another ratcheting up of attention to the soaring cost of food and the implications for the world’s poor, the head of the UN’s World Food Program, Josette Sheeran (formerly an Under Secretary of State), advises that it is considering plans to ration food aid. Food prices rose 40 percent last year, due primarily to rising demand. The FAO has estimated that, as a result, poor countries could see their cereal import bill rise by more than a third this year, with Africa projected to see a nearly 50 percent increase. Sheeran notes that, “If food is twice as expensive, we can bring half as much in for the same price. . . . It will take increased contributions to make sure we can meet those already assessed needs.” This is especially critical in many conflicted and remote areas where the WFP is the only source of food for many people.

Alleviating Food Shortage through Commodity Exchange Market in Ethiopia

As in many African countries , agriculture is the lifeline of Ethiopia. Of the 80 million people in the country, 10 million are farmers. Farmers grow cereals including wheat, maize, sorghum, barley, sesame, and the Ethiopian grain "teff." One barrier faced by Ethiopian farmers is market access. In some cases farmers travel more than 12 miles from their homes to get information about food prices. Often this information is incomplete or the farmer does not know the price but sell their products to local traders which do not benefit them.  Fortunately, there are ways to change this.

Last year an Ethiopian economist, Eleni Gebre-Medhin, outlined her ambitious plan to create the first commodities market in Ethiopia. In her inspiring speech she says, “imagine the farmer goes to a warehouse where you have constant updates with the latest market prices”. This plan would create “wealth, minimize risk for farmers and turn the world's largest recipient of food aid into a regional food basket”. Eelni states that "there is no place in the world and no time in history that small farmers have had to bear the burden of risk that African farmers bear today."  I had to admit, I was overjoyed listening to her speech and think that this is an important step to help the country on its way out of poverty.

Local Purchases Create win-win Situations to Hunger

Recently, food insecurity has become a burning topic in my home country. This is reflected in my phone calls home. I call Ethiopia very often and my usual question of “what’s new?” seems to have the same answer in the past months: everything, including food, has become very expensive. As the price of food increases, many people in developing countries will find a greater reliance on food aid. In 2008 WFP identified what is referred as “hunger global hotspots” - Afghanistan, Chad, DRC, Ethiopia, Iraq, Kenya, Somalia and Zimbabwe. Part of the problem in these countries may be local availability of food, but a much bigger problem, and the one that is faced in Ethiopia is that food is simply becoming more expensive.

Last year my professor attending a conference at Western Michigan University challenged a group of economic experts on the issue of rising food prices: why does the Ethiopian government continue to claim that the economy is going strong while millions of their own citizens can’t afford to buy enough food because of high prices? The response he received was as unconvincing to him as it was to me, and in any case what I hear on the ground is different from their response.

Food Aid Disappointment

Among the many disappointments in a disappointing Senate farm bill is the absence of any significant reform in this country’s international food aid program. Despite overwhelming evidence of the inefficiencies and inequities in the current system, and despite valiant efforts by individuals and groups, the vested interests appear to have once again prevailed. 

The most significant reform, proposed by the Administration and supported by Bread and a number of both faith-based and secular NGOs, would have authorized the use of up to 25 percent of the food aid budget ($300 million per year) for procurement of food in and around the country where it was needed, thus reducing the cost, cutting response time and encouraging local producers and markets to supply the needs. (Instead, current law mandates that all food aid be procured in the US and shipped on US-flag vessels. According to a recent GAO study, overhead, including shipping costs, now accounts for over 60 percent of food aid budget.) This proposal was reduced in the Senate agriculture committee to a four-year “pilot program,” with total funding of $100 million. But when it came to the Senate floor, even this pilot was stripped out and transferred to the foreign assistance act, with funding to come from the already over-taxed international disaster assistance account. 

To be sure, providing explicit direction to undertake such a study could be regarded as a baby step forward – if the appropriators come up with the money. However, the basic outcome -- effectively denying food aid implementers the option of using food aid resources to procure food locally when lives are at stake simply to preserve the existing procurement and shipping entitlements -- is simply unconscionable.