G20 Development Working Group: Food Security Pillar 70232 Nutrition Interventions for the Most Vulnerable and Access to Humanitarian Supplies: Progress and Prospects Prepared by the World Bank and other members of the UN System High Level Task Force on Food Security June 3rd 2011 Report to G20 Development Working Group: Food Security Pillar: June 3rd 2011 Provision of Nutrition Interventions for the Most Vulnerable and Ensuring access to Humanitarian Supplies: Progress and Prospects Introduction 1 This report relates to the food security pillar of the declaration on Development by G20 Leaders of the G20 Seoul Summit. It responds to a request from Brazil, Canada, France and Japan (co-facilitators on Food Security), on behalf of the co-chairs of the G20 Development Working Group. It contributes to Food Security Pillar Action 2 - the mitigation of risk associated with food insecurity and price volatility, and enhancement of protection for the most vulnerable. It focuses on enhancing human and social capital within communities at risk through a) ensuring access to humanitarian supplies and b) addressing the nutritional needs of the most vulnerable. It complements reports produced by others working on food security, including “Price volatility in food and agricultural markets: Policy Responses� prepared by nine international organizations under the coordination of FAO and OECD. 2 The report is in three sections: i. Progress by nations and outstanding challenges: Assessing the progress of countries‟ efforts to protect groups that are food insecure, vulnerable to the effects of high and volatile food prices, and at risk of under-nutrition; ii. Ongoing actions: Identifying options for supporting humanitarian assistance within poor communities and achieving better nutritional outcomes, especially among pregnant and lactating women; iii. Key areas for G20 engagement: Proposing ways in which G20 engagement will enhance human capital through the scale-up of nutritional (SUN) outcomes [the SUN movement] and improving the impact of humanitarian assistance. 1 Progress by Nations and Outstanding Challenges 1.1 Food insecurity, vulnerability to food price volatility and risk of under-nutrition 3 The world-wide extent of hunger and child under-nutrition remains surprisingly high given current trends in poverty reduction. In 2010 FAO estimated that 925 million people experience chronic hunger (30% of the population in Sub-Saharan Africa and 15% of the population in Asia and the Pacific) and nearly 2 billion lack the micronutrients they need for good health. Levels of child under-nutrition (both chronic and acute) remain unacceptably high, particularly in Africa. The percentage of children underweight1 fell in developing countries from 29% in 1990 to 18% in 2010, but it is still well short of the 2015 MDG target of 14.5%2. In Africa the fall has been much less – from 21.5% to 19%. The percentage of children stunted in developing countries fell from 44% in 1990 to 29% in 2010: in Africa the percentage reduced slightly - from 40% in 1990 to 39% in 2010. Progress has not matched the aspirations of the MDG goal for reduction in poverty and hunger. 4 Food and nutrition security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life (World Food Summit 1996). The extent of food insecurity is influenced by the degree to which nutritious foods are available to households, accessed by them and used by all their members - as and when required. Their use of nutrients – including protein, vitamins, minerals and energy – is also affected by environmental sanitation, adequacy of basic health services, and child care practices3. Household members susceptible to under-nutrition include (a) young children (whose nutrient needs are relatively high and who are often unwell) and (b) pregnant and lactating women. They are particularly at risk when diets lack the required nutrients, women are unable to provide adequate care for their children, basic health care is not accessible and the interval between births is short. Page 1 Report to G20 Development Working Group: Food Security Pillar: June 3rd 2011 Provision of Nutrition Interventions for the Most Vulnerable and Ensuring access to Humanitarian Supplies: Progress and Prospects 5 Vulnerability assessments4 in more than 60 countries indicate that household food costs have increased by 15% between June 2010 and March 2011. The increases have exacerbated existing levels of poverty and have increased the number of poor people by 44 million5. In households spending 60%-80% of their income on food, the increases in cost have resulted in reductions in the quantity - and nutritional quality – of consumption, and less cash available for health care and education. A recent analysis from Indonesia shows that the income elasticity of micronutrient consumption (iron, calcium, and vitamin B1) is significantly higher when prices rise, compared to a normal year6. The demands of food production and sustaining livelihoods frequently lead to agricultural, marketing and child care demands that compete for women‟s time and force them to make difficult choices. When prices rise, the need to earn more to access food for the household reduces women‟s time for child care – and, if children are sick their nutrient needs increase, they lose more nutrients due to sickness such as diarrhea, and their mothers may not be in a position to ensure their children get the nourishment they need. In summary, rising food prices will lead to increased severity of under-nutrition in individuals already at risk and an increase in the numbers likely to be affected. 1.2 The development of comprehensive approaches to tackle Food and Nutrition Insecurity 7 In 2008 food price spikes triggered renewed interest in agriculture and food security after nearly three decades of inattention. They illuminated the potential impact of high food prices to increase risks of under-nutrition7. They led world leaders to recognize that the first Millennium Development Goal (MDG) – reduction in poverty and hunger – will not be realized without intense focus on households at risk of food and nutrition insecurity. 8 Between 2008 and 2010 national policymakers and development partners increased their focus on longer term investments in food security, sustainable production systems, climate change mitigation, social protection and better functioning international trading systems. This comprehensive approach to food security was the focus for discussion in the Hokkaido Toyako G8 Summit hosted by Japan in 2008, the Madrid meeting on Food Security for All (January 2009), the G8‟s initiative on Food Security in l‟Aquila, July 2009 with its pledge of $22 billion support over three years, the November 2009 summit on World Food Security with its five Rome principles, the revitalized Committee for Food Security (CFS), the G20 request for the set-up of the Global Agriculture and Food Security Programme (GAFSP), and the establishment of the Aquila Food Security Initiative (AFSI) review group to track disbursements, align action and monitor results. 9 The UN System developed its Comprehensive Framework for Action on Food Security in 2008 and updated it in 2010 so that it addresses both food and nutrition security - with increased reference to nutrition-sensitive development as well as specific nutritional interventions. 1.3 The social and economic case for focusing on under-nutrition within the context of food price volatility 10 Under-nutrition in the period between conception and 2 years of age leaves children with irreversible deficits that compromise future human capital. It limits future educational achievement, reduces productivity during adulthood, and increases risks of illness and death. Under-nourished societies are less resilient in the face of shocks and have lower prospects for economic growth in the longer-term. These adverse impacts – on individuals and societies - can be prevented if those at risk benefit from effective safety nets. Stunting in these early years is linked to a 0.7 grades loss of schooling, a 7 month delay in starting school and a more than 10 percent potential reduction in lifetime earnings for these children and 2-3% losses in GDP8. Children who suffer from iodine deficiency have, on average, about a 13 IQ-point loss9. Page 2 Report to G20 Development Working Group: Food Security Pillar: June 3rd 2011 Provision of Nutrition Interventions for the Most Vulnerable and Ensuring access to Humanitarian Supplies: Progress and Prospects 11 Investments in infant and child nutrition between conception and two years of age can avert the deaths of 1 million children per year, mitigate against disease and reduce the burden on health care systems, increase school attendance and educational attainment and improve economic prosperity and the ability of all citizens to reach their full potential. In economic terms, the benefit cost ratios of these investments are estimated to be 15.8 to 110. Investing in nutrition also enhances the resilience of societies in the face of price volatility and other shocks: well-nourished children are less damaged by shocks and bounce back more rapidly than those who are under-nourished. 2 Ongoing actions 2.1 Scaling-Up Nutrition (SUN) investments to address the nutritional needs of the most vulnerable women and young children: progress and next steps 12 As food prices remain volatile, and exhibit an upward trend on many local markets, the population groups and countries most at risk of increasing hunger and under-nutrition are being identified. The circumstances under which they become vulnerable are being assessed and strategic responses are being developed. For example, analysis from Indonesia shows that while cash transfers are effective during crises, specific vitamin and mineral supplementation and fortification programmes are also required to ensure that at risk households - in particular their pregnant and lactating women, and young children, can access essential micro-nutrients. 13 A framework for Scaling up Nutrition (SUN) was developed with a wide range of partners (IOs, World Bank, Civil Society, and bilateral agencies) in 2009-2010 to reflect the consensus on how best to ensure reductions in levels of under-nutrition especially among pregnant and lactating women and young children. The Framework calls for both nutrition specific interventions and nutrition-sensitive investments. It envisages that food security, public health and social protection actions are integrated at local level to develop optimal local responses to under-nutrition. 14 Specific nutrition interventions are provided at scale to individuals and households at risk of, or affected by, under-nutrition. They include nutrition education about the use of available foods and resources within the constraints and opportunities households face, breast-feeding promotion, vitamin and mineral supplements, appropriate nutrient-dense foods for young children, the fortification of staple foods and the manufacture of nutrient-dense products for at-home fortification of young children‟s diets. In many settings these call for market-based interventions that involve businesses working in partnership with civil society and governments. 15 Nutrition–sensitive investments involve several sectors and could include ensuring that agriculture and social protection programmes have a greater impact on nutrition outcomes. Only sustainable development at local level can address complex issues related to biodiversity, health, poverty and culture: the challenge is to ensure priority attention to nutrition as these different dimensions are brought together. This might mean, for example, ensuring that food used for safety nets is nutritious and, where necessary, fortified with minerals and vitamins. It may also mean that agriculture investments prioritize small–holder farmers and lead to the increased availability of (and access to) a diversity of foods that includes meat, fish, dairy products, vegetables and fruits. Nutrition education is critically important for informing those who purchase and consume food and shape locally-appropriate food systems. Page 3 Report to G20 Development Working Group: Food Security Pillar: June 3rd 2011 Provision of Nutrition Interventions for the Most Vulnerable and Ensuring access to Humanitarian Supplies: Progress and Prospects 16 The SUN Framework, launched jointly by several stakeholders in April 2010 during the IMF/World Bank Spring Meetings, has now been endorsed by over 100 partners. The Road Map for Scaling-Up Nutrition was developed in 2010 to offer means through which stakeholders could work together in support of national efforts to bring nutrition actions to scale. 17 The Framework and the Road Map for Scaling-Up Nutrition are now the foundations of the SUN Movement through which multiple actors are working together to support national efforts to scale up nutritional outcomes. They have a particular focus on good nutrition during the 1000 days between the start of pregnancy and a child‟s second birthday. The SUN movement was launched during the UN General Assembly Summit on the Millennium Development Goals in September 2010: stakeholders agreed to help participating countries scale up efforts so as to achieve improved nutritional outcomes within a thousand days – by June 2013. 18 The governments of several countries have elected to become “early risers� in the Scaling-Up Nutrition movement. They are investing in policies and actions that are expected to demonstrate significant progress within the next two to three years, and be sustainable thereafter. They focus particularly on making agriculture and social protection investments more nutrition-sensitive. This calls for applied research that addresses links between agriculture (specifically smallholder farming) and nutrition, and innovative, more responsive and efficient social protection systems. National authorities encourage whole-of-government agreement on the best strategies for nutrition-specific interventions and nutrition-sensitive development. To ensure that these are implemented in synergy across multiple sectors they build multi-stakeholder platforms which facilitate collective accountability for effective action. Governments may request external support for research, capacity strengthening, financial resources and the monitoring of progress across sectors: the SUN Movement seeks to ensure that these are made available in a more coordinated, predictable and responsive manner. 19 Non-governmental organizations (representing civil society, farmers and consumers), as well as businesses and research groups, are engaging in people-private-public partnerships to support the SUN movement. Development partners – including bilateral donor agencies, the World Bank and other development banks, and foundations – are aligning their support to national SUN plans. Among the international organizations, the World Bank as well as FAO, UNICEF, WFP and WHO are gearing up their support for country actions. The Heads of these four agencies joined forces within the REACH (Renewed Efforts against Child Hunger) initiative to assist countries to accelerate progress towards MDG 1 through joint UN programming and advocacy for nutrition - leveraging each agency‟s comparative advantage. The World Bank, at the request of partners in the SUN movement, is developing operational guidance on how to make agriculture and social protection programs more nutrition-sensitive. WHO, at the request of Ministers of Health in the World Health Assembly 2010, is helping countries to develop plans and monitor their implementation. Nutrition is also being addressed within the revitalized Committee on World Food Security (CFS). The reformed UN Standing Committee on Nutrition (SCN) is helping to harmonize UN efforts – including provision of support to SUN - at global level. A study of the Stewardship of the SUN Movement will be completed in September 2011. 2.2 Ensuring access to humanitarian supplies: progress and prospects 20 As food prices are likely to continue increasing it is essential to ensure that communities at risk – particularly small-scale producers in rural areas - can increase and diversify food availability in response to growing demand while, at the same time, improving their own income. This requires a policy emphasis that promotes resilient food systems, the production and use of micro-nutrient rich foods, sustainable farming practices, local processing and markets where all people can access nutritionally diverse foods Page 4 Report to G20 Development Working Group: Food Security Pillar: June 3rd 2011 Provision of Nutrition Interventions for the Most Vulnerable and Ensuring access to Humanitarian Supplies: Progress and Prospects close to their homes. It may need to emphasize horticulture, animal husbandry and/or fortification of staples with micronutrients. 21 But many households remain vulnerable to the effects of high food prices: their governments will seek ways to mitigate their impact on household assets and income. They are implementing policies to encourage sustainable livelihoods and sustain purchasing power in vulnerable households, focusing social protection schemes on those most at risk, and prioritizing the surveillance of dietary intake and nutritional outcomes. International organizations are ensuring that they are ready to work with countries as they implement these strategies. 22 First: while better information is available on food prices, more rigorous analyses are needed of their causes and trends, combined with reliable data on production, stocks and supply pipelines, and well- functioning early warning systems that are based on examination of household vulnerabilities, coping strategies, access to nutrients and changes in food consumption. 23 Second: countries seek to build up in-country social protection systems – and food reserves - so that vulnerable population groups can be enabled to access the nutritious food they need through responsive social protection programmes. Preparing these in advance of demand increases capacity for immediate scaling-up when needs are acute, and helps ensure that they are sensitive to nutrition needs at different stages of the life-cycle. To this end, developing countries, particularly low income net food importing countries, will wish to establish food security and vulnerability monitoring systems, which include, where possible, food consumption and nutrition surveillance systems. Knowledge of people‟s vulnerabilities to different kinds of shock can aid the design of social protection. It will be easier to scale up existing interventions in response to need than to introduce new ones from scratch. 24 Brazil, Mexico and Ethiopia have shown the value of well-designed and executed social protection programmes for reducing the risks of hunger and malnutrition and mitigating impact of price rises, while creating development opportunities, building human capital and encouraging economic growth. Where possible, these programs should build on existing systems - such as those in Georgia (with a well-established, well governed and scalable registry system), Jordan and the Philippines. Cambodia and Indonesia are in the process of establishing similar systems, and evidence suggests that even quite modest safety net systems provide a springboard for intervention in crisis. The operation of any safety net should reflect people‟s needs and the context for the response. It may include physical cash transfers or paper vouchers, though new technologies mean that resources can reach those in need through a range of innovations including scratch cards, electronic vouchers, smart cards and remittances via mobile telephones. 25 To protect vulnerable populations these response systems should be able to detect the most vulnerable, including children who suffer from moderate and severe acute malnutrition and ensure that they receive treatment and their families benefit from livelihood support. International organizations, civil society groups and businesses are assisting national authorities to prevent and treat malnutrition among children who are at increased risk of dying. 26 When well-developed and responsive national safety-nets are absent, international organizations (IOs) with a strong operational capacity can partner with nations to help set them up so they can be scaled-up relatively quickly in times of need. IOs can avert disasters even in the absence of well- developed social safety nets, by maintaining high levels of preparedness, close relations with local institutions and the capacity to purchase food and nutrients both regionally and locally. For example, pre- positioning food in strategic locations permits preparation for timely and efficient responses and should be accompanied (when possible) by the use of cost-effective forward purchasing and pipeline management techniques. This requires predictable and flexible funding. Page 5 Report to G20 Development Working Group: Food Security Pillar: June 3rd 2011 Provision of Nutrition Interventions for the Most Vulnerable and Ensuring access to Humanitarian Supplies: Progress and Prospects 27 Third: Countries seek to work with smallholder farmers and local traders to ensure that food production is increased and sold into well-functioning markets. Risk-management innovations like market-based weather risk insurance schemes and public-private partnerships for local purchase (that involve farmers‟ organizations and civil society) can be particularly helpful. WFP‟s „Purchase for Progress‟ is a good example of such an initiative. In 2010 WFP purchased US$1.25 billion of food, 975 million from developing countries - the highest amount ever - ensuring that WFP‟s purchasing power was used to directly invest in the agricultural potential of developing countries. Linking these sorts of initiatives to efforts such as those by Harvestplus can also increase the supply of nutrient enhanced staple foods, by ensuring the adoption of bio-fortified staple varieties as they come online. These new lines include higher iron and zinc rice, vitamin A enhanced sweet potatoes, high iron beans and high vitamin maize. All these are either available now or will become available over the next 2 to 3 years. 28 With support from some G20 members, IOs are also identifying market failures in agriculture and nutrition: and they are developing innovative “pull mechanisms� (AGPM) to address them. Inspired by the pilot Advance Market Commitment for pneumococcal vaccines, the AGPM would establish financial incentives for private sector engagement to resolve market failures both in agriculture and in food and nutrition security. Payments would be made only when results triggers are met, whether through the development or adoption of needed products (e.g., environmentally friendly fertilizers, improved seeds or nutritious food products) or the achievement of development goals (e.g. aflatoxin-free crops). 29 Fourth: Ensuring that Governments build on and implement the commitments made at the Rome World Food Summit in 2009 to exempt humanitarian food purchases, from export restrictions or extraordinary taxes imposed to protect domestic food supply. 3 Potential Contributions by the G20 30 It is appropriate that the G20 Development Working Group is involved in support for national efforts to prevent hunger and malnutrition among the vulnerable – including those who are particularly hard-hit by lack of access to food because of rising prices and limited purchasing power. It is relevant that G20 leaders are making a strong commitment to improving world food security. It is desirable that they highlight the importance of nutrition security, referring as appropriate, to “food and nutrition security�. 31 Recommendations: i Political, technical and financial backing to national efforts for Scaling-Up Nutrition G20 leaders support national governments that are committed to Scaling Up Nutrition with offers of political, technical and/or financial backing for (a) vulnerability monitoring and analytical work on how best agriculture, health, social development, employment, education and other sectors‟ policies can contribute – in a sustainable manner - to optimal nutritional outcomes [through the combined work of G20 research institutes, innovative financing like the proposed “pull� mechanisms for addressing market failures in agriculture and nutrition and links to the proposed Agriculture Market Information System (AMIS)]; Page 6 Report to G20 Development Working Group: Food Security Pillar: June 3rd 2011 Provision of Nutrition Interventions for the Most Vulnerable and Ensuring access to Humanitarian Supplies: Progress and Prospects (b) multi-sectoral nutrition strategies to scale-up nutrition-specific interventions and nutrition-sensitive development - taken to scale through multiple sectors with internationally recognized indicators for monitoring and reporting [building on systems developed through the AFSI review group‟s on-going work on accountability, and in line with the emphasis on policy coherence in the Seoul Action Plan on Development]; (c) people-private-public partnerships for nutrition through public sector, civil society, businesses, researchers, organizations of smallholder farmers and other stakeholders [within the context of south-north, south-south and triangular co-operation]. ii Safety Nets for Access to Nutritious Food G20 leaders call for an acceleration of national efforts to build capacity for social protection systems: these should include safety nets which (a) ensure that these are targeted to vulnerable groups, including women and young children, (b) are activated and scaled-up in times of need, including at times of extreme food price volatility, (c) respond effectively to early warnings from national and international agencies and (d) receive necessary financial support from national authorities and the international community. iii Predictable access to nutritious food through humanitarian assistance (a) G20 leaders call for sustained, predictable, and flexible multilateral funding (i) to ensure vulnerable nations and populations can access nutritious food through targeted, needs-based humanitarian assistance to cope with the impact of high and volatile food prices, and (ii) to improve functioning of emergency food reserves and food security information systems [taking account of the proposed Code of Conduct on emergency food reserves which will compile best practice in national and regional systems as set out in the International Organizations‟ report on Food Price Volatility]; (b) G20 leaders call for purchases of humanitarian food (including by WFP) to be exempted from food export restrictions and/or extraordinary taxes, so that humanitarian food can be purchased, exported and/or transited regardless of any prohibitions, restrictions or extraordinary taxes imposed; and resolve to bring this commitment and call to the UN General Assembly and to the WTO. Page 7 Report to G20 Development Working Group: Food Security Pillar: June 3rd 2011 Provision of Nutrition Interventions for the Most Vulnerable and Ensuring access to Humanitarian Supplies: Progress and Prospects Annex Examples of Nutrition-Specific Interventions • Definition: interventions that have nutritional improvement as the primary goal • Outcomes: • Ensuring that all women are in the best possible position to ensure optimum nutrition for themselves and their children (a) in pregnancy (b) when breastfeeding their children, and (c) when providing complementary foods to their children – especially when children are ill and women face many demands on their time; • Encouraging local markets to offer nutritional diversity within food products (continuously available and accessible throughout the year with nutrients in a form that is capable of being utilized); • Ensuring that appropriate nutrients are accessible and capable of being utilized through safety net programmes (whether food, voucher and/or cash based); • Ensuring a nutritional focus within maternal, new-born and child health programmes, as well as HIV and TB programming, with special attention to at risk communities, supporting ante-natal nutrition, breast feeding, complementary feeding, hygiene, adequate vitamin and minerals; nutritional management of infections and therapeutic feeding for those suffering from severe acute malnutrition . Nutrition-Sensitive Development  Definition : Nutritional outcomes as one goal of national development policies in several sectors  Outcomes:  Ensuring optimal nutritional impact of all agriculture and food security programmes through research, action and close monitoring;  Ensuring optimal nutritional impact of social protection programmes and targeting of safety nets for vulnerable communities and population groups (women, young children and chronically ill, particularly people living with HIV or people being treated for tuberculosis),  Incorporating nutritional considerations within child and adult education,  Analyzing the nutritional impact of employment generation, agriculture and rural development, social protection, climate change, poverty reduction and emergency response programmes and taking action as appropriate. Page 8 Report to G20 Development Working Group: Food Security Pillar: June 3rd 2011 Provision of Nutrition Interventions for the Most Vulnerable and Ensuring access to Humanitarian Supplies: Progress and Prospects ENDNOTES 1 The term malnutrition can be used to describe individuals who are under-weight or over-weight, as well as those affected by vitamin and mineral deficiencies. Underweight (too small) is defined as low weight-for-age and is one of the indicators used in tracking MDG 1c. It can imply either stunting (shortness) or wasting (thinness) or both. Stunting is defined as low height-for-age and implies long-term under-nutrition and frequent episodes of illness. Wasting (too thin) is low weight-for-height and describes a recent severe process, usually a consequence of acute food deprivation or severe illness. Underweight, wasting and stunting are commonly used as indicators of under-nutrition among children, and the data for assessing the indicators are commonly collected. Wasting is often used to identify those in need of health during emergency situations, stunting is used for tracking longer term development. 2 Global Database on Child Growth and Malnutrition - http://www.who.int/nutgrowthdb/estimates/en/index.html 3 Definitions from IFPRI and International Conference on Nutrition, 1990 4 This refers to Vulnerability assessments by the World Food Programme. 5 Estimate by the World Bank 6 Skoufias et al, World Bank, 2011. 7 http://www.unscn.org/files/Publications/Briefs_on_Nutrition/SCN_2-pager_advocacy_brief.doc 8 World Bank: Repositioning Nutrition as Central to Development; 2006 9 One study in Latin America estimated that stunting results in significant economic losses, with estimated losses in GDP of up to 11 percent (The social and economic impact of child under-nutrition in Central America and Dominican Republic, The Cost of Hunger Study, ECLAC/WFP, 2007) 10 Horton and Shekar, Scaling up Nutrition, What will it cost? World Bank, 2009 Page 9