Chapter 2 - Agriculture, food security and nutrition

Definitions

The food chain: Production-to-consumption linkages

Food production, food supply and nutritional status trends in Sub-Saharan Africa

National policies affecting food security and nutrition

Other factors affecting food security and nutrition

Policies and actions needed to improve household food security and nutrition

Chapter 2 - Agriculture, food security and nutrition

This chapter is concerned with the interactions among agriculture, food security and nutrition in sub-Saharan Africa. It starts with the definition of basic terms that will be used throughout the book and goes on to look at the various forms of malnutrition and their causes. An overview is then given of food production, food supply and nutritional status trends in sub-Saharan Africa over the past 25 to 30 years. To put these trends into context, different macro- and national-level factors, including policies, that have influenced and will continue to influence the achievement of national food security and individual nutritional well-being are examined. Among the most pressing problems facing sub-Saharan African countries are the effects of rapid population growth, environmental degradation, civil conflict and acquired immunodeficiency syndrome (AIDS). Understanding these problems and how they affect a country's productive capacity and its ability to feed future generations is the first step towards overcoming them.

Definitions

Food security

Food security may have different meanings for different people. The International Conference on Nutrition (ICN), held in Rome in 1992, defined food security as "access by all people at all times to the food needed for a healthy life" (FAO/WHO, 1992a). Essentially, in order to achieve food security a country must achieve three basic aims. It must:

· ensure adequacy of food supplies in terms of quantity, quality and variety of food;

· optimize stability in the flow of supplies;

· secure sustainable access to available supplies by all who need them.

Adequate food availability at the national, regional and household levels, obtained through markets and other channels, is the cornerstone of nutritional well-being. At the household level, food security implies physical and economic access to foods that are adequate in terms of quantity, nutritional quality, safety and cultural acceptability to meet each person's needs. Household food security depends on an adequate income and assets, including land and other productive resources owned. Food security is ultimately associated with access to nutritionally adequate food at household level, i.e. the ability of households or individuals to acquire a nutritionally adequate diet at all times. The normative dimensions of household food security, defining household food security in ideal terms, are graphically presented in Figure 1. The conditions necessary for achieving and maintaining household food security are discussed in detail in Chapter 3.

It is important to note at this stage that the achievement of household food security may not necessarily result in improvements in the nutritional status of all household members. Access to nutritionally adequate food guarantees neither adequate consumption by all individuals within the household nor the appropriate biological utilization of the food consumed. How does household food security then relate to human nutritional status, as expressed in biological or physiological terms?

The answer is that household food security can be translated into good nutritional status if household members have nutrition security, a condition that combines:

· access to nutritionally adequate and safe food;

· sufficient knowledge and skills to acquire, prepare and consume a nutritionally adequate diet, including those to meet the special needs of young children;

· access to health services and a healthy environment to ensure effective biological utilization of foods consumed.

Actual nutritional well-being is then determined by a number of interrelated factors, which besides food security include health and sanitation, adequate supplies of safe water, parents' education, time to prepare food and care of vulnerable individuals within the household. Household food security is thus one of the prerequisites for good nutritional status. For a model of the factors that determine nutritional outcome see Figure 2.

FIGURE 1 - The normative dimensions of household food security

Source: Adapted from Frankenberger et al, 1993.

Nutrition and nutritional status

Nutrition is the science that explains the role of food and nutrients in the human body during growth, development and maintenance of life. In its broader context, nutrition has also been defined as being concerned with "... how food is produced, processed, handled, sold, prepared, shared, and eaten and what happens to food in the body - how it is digested, absorbed, and used" (King and Burgess, 1993). Nutritional status refers to the nutritional state of the body, as expressed according to scientifically tested parameters such as weight, height, age or combinations of these. Using these parameters, an individual can be assessed as having good or poor nutritional status.

FIGURE 2 - Determinants of nutrition security: basic causes and links

Source: Adapted from FAO, 1996c.

Note: 1. Basic causes; 2. Structural/institutional conditions, areas of public action; 3. Market conditions;

4. Micro-level conditions (household, intrahousehold, gender).

Factors influencing nutritional status

Nutrition security is influenced by a wide range of factors that may lead to inadequate or excessive nutrient intakes or may impair nutrient utilization. The factors most directly influencing nutritional status are analysed under the categories of food security, health, and knowledge and care (see Figure 2). Each of these is essential to attain good nutritional status, and they often interact with each other. To ensure optimal nutritional outcome, simultaneous action in all three areas is needed, requiring not only well-coordinated efforts at household and community levels, but also appropriate national development policies and strategies to support local efforts. National development policies, including macroeconomic and agricultural policies, though usually not included in the domain of nutrition, can also affect nutritional well-being.

It is well recognized that poverty is the principal cause of malnutrition (FAO/WHO, 1992g). Acute and chronic undernutrition and most micronutrient deficiencies primarily affect the poor and deprived people who do not have access to adequate food, live in unsanitary environments without access to sufficient and clean water and basic services and lack access to appropriate education and information.

Household food security and nutrition. In sub-Saharan Africa, where approximately 70 percent of the population live in rural areas, crop and animal production, fisheries and forestry activities are direct sources of food and provide income with which to buy food. Increased and diversified production of food for family consumption or as a source of income is a basic prerequisite for improved household food security. Better home and community food processing, preservation and storage and access to marketing facilities can also contribute to household food security by alleviating seasonal shortages in food supply and stabilizing market prices. Agricultural practices and technology as well as the establishment of small-scale agro-processing industries can significantly increase employment and income-generating opportunities and thus positively affect household access to food. Food safety and quality, secured through effective food quality control at all stages of production, processing and handling, also influence nutritional well-being. With regard to infant nutrition, the extent of breastfeeding is important, and hygienic preparation and handling of food are crucial for disease prevention and proper child growth.

Health and nutrition. Various infections, notably diarrhoeal and respiratory diseases, measles, malaria, intestinal parasites and infection with human immunodeficiency virus (HIV)/AIDS have a major impact on nutritional status. The interaction of infection and inadequate food consumption causing growth retardation in children leads to a vicious circle, the malnutrition-infection complex. To break the circle it is necessary to improve environmental health conditions by addressing problems of contaminated water, insanitary disposal of human excrete and household wastes, and poor food and personal hygiene in homes and places of food processing and marketing.

Access to health services is vital, especially in rural areas, where the prevention, timely treatment and proper management of infectious diseases can make an important contribution towards improving nutritional levels. Immunization programmes to prevent disease, curative and antenatal services, oral rehydration, the effective promotion of breastfeeding and proper weaning practices, the feeding of sick children and nutrition education are important in minimizing the risk of undernutrition.

Knowledge, care and nutrition. Malnutrition can occur even when a household has access to adequate amounts of nutritious foods as well as access to sanitation and health services. While adequate incomes, greater food availability and expanded health services are necessary for adequate nutrition, they will not bring about improvements unless households are able to take advantage of them. In this context, sufficient knowledge and the ability to care for vulnerable individuals are of critical importance. Care consists of the time, attention and support provided in the household (mainly by the mother and daughters and to a much lesser extent by the father) and in the community to meet the physical, mental and social needs of growing children and other family members.

In many instances it is especially important to ensure that women have access to the resources (e.g. income-generating opportunities), labour-saving technology (e.g. appropriate farming practices, extension and credit), infrastructure (e.g. water wells and flour mills) and knowledge and education they need in order to care better for themselves and their families. In addition, legislation to improve women's status in society and legal access to land and other productive resources is essential for the future nutritional well-being of family members. Men should also be encouraged to strengthen their role as providers of care. In addition, it is necessary to devote increasing attention to development of community care structures such as day-care centres for young children and for the sick and dying (e.g. people with HIV/AIDS), especially as urbanization and other social forces weaken traditional patterns of family care.

The food chain: Production-to-consumption linkages

To nourish is "to sustain with food"; food is a necessity of life, and all creatures must eat to live. Food acquisition is therefore a major preoccupation of all animals. Humans are virtually unique among animals in the practice of agriculture. Cultivation of the soil and domestication of plants and animals are widely recognized as major developments in the progress of human societies that have diversified their food acquisition strategies. Today, however, many individuals and many human societies suffer from lack of food. On any given day perhaps 1 000 million individuals eat less than they need. In any given year several million people die from hunger-related causes, and hundreds of millions experience retarded growth and reduction in their physical and mental abilities because of faulty or inadequate nutrition. Why should this be so? Is global food production inadequate to meet the needs of the world population?

Clearly this is not the case. If the world's grain production that is available for human consumption were converted into energy and protein, the total would be significantly greater than the amount of these nutrients needed for human survival. During the past three decades the growth of global food production has been faster than the increase in the world's population, yet hundreds of millions of poor people do not share in this abundance. Food production at the macro level is linked to food consumption and nutritional status at the micro level (i.e. the household and the individual) by a complex network of interactions. Understanding how these interactions work can be an important stage in addressing the problems of poverty, food insecurity and malnutrition and identifying actions to attain nutritional wellbeing.

Food insecurity or lack of access to a nutritionally adequate diet in a household or community can take various forms. For example, chronic food insecurity exists when food supplies are persistently insufficient to supply adequate nutrition for all individuals. Low-income groups, such as the urban poor, rural landless and smallholder farmers and pastoralists, are the most vulnerable to food insecurity. Such groups often lack sufficient income and/or cannot produce enough food for adequate nutrition. Transitory food insecurity occurs when there is a temporary decline in access to adequate food because of instability in food production, food prices or incomes, as occurred, for example, during the serious droughts in the Sahel and the Horn of Africa from 1983 to 1985 and in southern Africa in the early 1990s. Transitory food insecurity is not necessarily a one-off event, as witnessed in the Horn of Africa, which has been threatened by recurrent droughts since the early 1980s. Famine in this and other parts of Africa has largely been averted since the mid- 1980s through efforts such as the strengthening of early warning of impending food shortages and more rapid responses to such warnings through disaster prevention and preparedness measures (e.g. seed distribution), including food aid interventions.

The distinction between chronic and transitory food insecurity refers to the time dimension of the food problem, i.e. whether it is persistent or short-term. A further distinction between national and individual insecurity can be made, which refers to the macro and micro dimensions of the problem. National food insecurity exists when a country is unable to meet its domestic food requirements through production, imports or run-down of stocks and reserves. National food security is not the same as national self-sufficiency. Although supply security can be achieved through a policy of self-sufficiency, it can also be achieved through food imports or by a combination of imports and domestic production. Few countries are entirely self-sufficient with regard to food. The degree to which staple food supply needs should be met through imports rather than domestic production remains a key policy issue in African countries. Discussion of this issue is, however, beyond the scope of this book.

Even though total food supply may be secure in a country or a region, households or individuals may not have access to adequate food. In other words, sufficient supply at the national level does not necessarily guarantee access at the household level. Household food security, however, is only possible in a situation that ensures adequate national or local food supplies. This relationship shows that it is very important for policy-makers to distinguish food security at the national, regional and household levels. The next section demonstrates the relationship between macro- and micro-level food security by looking at national food production, food supply and nutritional status trends in Africa over the past three decades.

Food production, food supply and nutritional status trends in Sub-Saharan Africa

Agriculture is the backbone of the economies of most sub-Saharan African countries. In 1994, 69 percent of the economically active population in sub-Saharan Africa were engaged in agriculture, as compared with 84 percent in 1961 (FAO, 1995f).

Table 4 shows average annual production (in tonnes) and rates of growth of major food crops in sub-Saharan Africa during four periods. The analysis is based on five-year averages up to 1985 and a four-year average for 1991 to 1994, to reflect the long-term changes over the time span 1961 to 1994. The rate of growth in production of cereals increased from an average of 1.3 percent during the period 1961 to 1965 to 3.6 percent during the period 1971 to 1975. It remained stable at a rate of 2.5 percent from the period 1981 to 1985 to the period 1991 to 1994. Among the grains the fastest growth in output was achieved in rice, but its effect on growth of total cereal output was limited because of the relatively small share of rice in cereal production. It is notable that the growth rate of pulse production has declined substantially since the 1960s and that the rate of growth of production of oil crops, after suffering a rapid decline during the 1980s, recovered significantly during the early 1990s.

For sub-Saharan Africa as a whole, exports of cereals declined and imports expanded rapidly during the 1970s and 1980s (Table 5). Imports nearly doubled between the 1960s and 1970s and trebled from then to the 1990s, reflecting both structural food deficits resulting from rapid population growth and food shortfalls caused by drought and civil disruption in various parts of Africa, especially during the 1980s and early 1990s. In the mid-1980s, 20 percent of the staple food requirements of sub-Saharan Africa were provided by imports. This proportion is predicted to rise by the end of the 1990s (FAO, 1992e).

Since the 1980s availability of basic food staples for consumption has expanded as follows: cereals and cereal products by 30 percent, roots and tubers by 40 percent, pulses by 35 percent and oil crops by 33 percent (Table 6). Population growth is the main factor responsible for increases in food supply and energy requirements. For the region as a whole, the estimated annual rate of population growth for the last three decades was about 3 percent as compared with a rate of growth in food production of around 2 percent and rate of growth in cereal production of 2.5 percent (Table 4). A significantly greater growth in food production will be needed in the future if dependence on commercial or concessionary imports is to be avoided.

Table 4 - Average annual food production and its rate of growth for sub-Saharan Africa, 1961-1975 to 1991-1994

Crop Group	Mean 1961-1965		Mean 1971-1975		Mean 1981-1985		Mean 1991-1994
	Production ('000 tonnes)	Growth rate (%)	Production ('000 tonnes)	Growth rate (%)	Production ('000 tonnes)	Growth rate (%)	Production ('000 tonnes)	Growth rate (%)
Wheat	900	3.2	1 300	1.2	1 500	-3.4	2 200	-0.4
Rice, paddy	3 600	3.8	5.2	4.5	6 600	2.9	10 800	3.3
Cereals, total	32 700	1.3	39 300	3.6	45 600	2.5	59 800	2.5
Roots and tubers	49 700	3.3	66 000	3.2	77 800	2.9	113 500	2.5
Pulses, total	3 200	3.7	4100	2.0	4 400	-1.8	5 900	0.3
Oil crops, primary	3 900	2.0	4 200	1.8	3 900	-0.4	5 000	3.2

Source: FAO, 1995f.

Table 5 - Average annual exports and imports of basic food staples for sub-Saharan Africa, 1961-1965 to 1991 - 1993

Crop Group	Mean 1961-1965			Mean 1971-1975			Mean 1981-1985			Mean 1991-1994
	Imports	Exports	Net tradea	Imports	Exports	Net trade	Imports	Exports	Net trade	Imports	Exports	Net trade
Cereals, total	2000	700	-1300	3836	1906	-2930	9254	646	-8607	11667	671	-10996
Pulses, total	66	190	124	51	213	161	116	122	6	219	128	-91
Oilseeds	23	2 383	2 360	53	1308	1255	61	430	369	103	368	265

Source: FAO, 1995f.

^a Net trade = exports minus imports.

Table 6 - Food available for consumption for sub-Saharan Africa, 1961-1965 to 1991-1992 (`000 tonnes)

Crop group	Mean 1961-1965	Mean 1971-1975	Mean 1981-1985	Mean 1991-1992
Cereals and cereal products, including beer	27 920	34 393	47 046	60 937
Starchy roots and products	38935	50147	60693	85335
Pulses and products	2 420	3 059	3 504	4 721
Oil crops and products	1 594	2 269	3 236	4 294

Source: FAO, 1995f.

Population data, unlike those of other developing regions, show that growth rates for sub-Saharan Africa are still increasing. It is projected that the overall population growth rate between 1990 and the end of the twentieth century will be 3 percent faster than the population growth of the region during the previous decade. Figure 3 shows population, food production and per caput dietary energy supply (DES) trends from 1961 to 1995, indicating that food production and DES have not kept pace with population growth. Although it is not evident in Figure 3 (because the graph is based on indexes), data suggest that in sub-Saharan Africa food production was adequate to meet local demand until about 1973 (FAO, 1992e). Since then, however, per caput output has been on the decline.

How can data of the type just given, expressing production and food availability for consumption in terms of tonnage of food commodities, be used to assess the adequacy of national food supplies in nutritive terms? One answer is to use food balance sheets, which are compiled annually by FAO from country-level data on the production and trade of food commodities. Based on these data in addition to available information on seed rates, waste coefficients, stock changes and types of utilization (i.e. feed, food, other uses), a supply/utilization account in weight terms is prepared for each commodity. Besides giving information on individual commodities, FAO food balance sheets also provide total availability estimates by aggregating the food component of all commodities after conversion into nutritive values. These values, combined with population data, are used to calculate estimates of a country's per caput DES, protein and fat. A food balance sheet for Kenya is shown in Table 7.

DES (i.e. food available for direct human consumption per person per day) is expressed in kilocalories (kcal) per day. Its significance as an indicator of national nutritional status is that it relates food availability to a theoretical energy allowance. This is an average allowance for planning purposes, representing the daily energy supply required to maintain body weight and to support light activity. It is calculated as 1.54 times the basal metabolic rate (BMR).¹ If a population's access to food is below this level of per caput energy availability, it follows that, even if it is assumed that the distribution of available food supplies is not very unequal, the majority of the population would be classified as chronically undernourished.

¹ The basal metabolic rate is defined as the minimal rate of energy expenditure compatible with life. It is measured under standard conditions of immobility in the fasting state at an environmental temperature of 26° to 30°C, which ensures no activation of heat-generating processes. It is dependent on a physiological requirement which varies with the body weight, age and sex of the individual. BMR is a very theoretical quantity, and strictly speaking, calculation of energy allowances would require a breakdown of the population by age and sex. Such a breakdown would not be justified by the precision of the production data, which, in the case of non-cereal foodstuffs, are often subject to quite a large margin of error. Therefore, simplifying factors are used to estimate the average BMR of the population and hence per caput energy requirements. Energy requirements for light activity range from 1961 to 2072 kcal per day.

FIGURE 3 - Trends in population, food production and dietary energy supply for sub-Saharan Africa, expressed as indexes (1989-1991 base year = 100)

Source: FAO, 1997b.

Notes: The indexes show values relative to the base year, which is assigned the value of 100. The food production index is derived from the value in United States dollars of food produced per caput. The DES index is calculated from figures for dietary energy supply in kilocalories per person per day. The population index refers to the aggregate population.

Table 7 - Food balance sheet for Kenya - average 1990-1992

Product	Domestic supply ('000 tonnes)						Domestic utilization ('000 tonnes)					Per caput supply
	Production	Imports	Stock changes	Exports	Total	Feed	Seed	Processing	Waste	Other uses	Food	Quantity per year (kg)	Energy per day (kcal)	Protein per day (g)	Fat per day (g)
Cereals	2 806	472	-25	84	3 219	146	55	99	108	-1	2 812	115.2	979	26.0	9.3
Starchy roots	1 564				1 564		37		104		1 424	58.3	157	1.9	0.2
Sugar crops	4 499				4 499			4 229			270	11.1	8	0.1
Sweeterters	484	96	20	1	559			24			535	21.9	213
Pulses	205	7	-18	23	207		28		23		156	6.4	59	3.8	0.3
Treenuts	13			4	9						9	0.4	1		0.1
Oilcrops	101	3		9	95		4	59	5		27	1.1	12	0.4	1.0
Vegetable oils	24	138	-25	2	185					19	166	6.8	163	0.1	18.4
Vegetables	643			38	605				64		541	22.2	15	0.8	0.1
Fruit (excluding wine)	926	2		140	787			3	101		683	28.0	53	0.6	0.1
Beverage crops	288	3		261	31						31	1.3	2	0.3
Spices	6				6						6	0.2	2	0.1	0.1
Alcoholic beverages	541	1	-1	5	538					8	530	21.7	33	0
Meat	383			5	378						378	15.5	76	6.1	5.6
Offals	59				59						59	2.4	7	1.2	0.2
Animal fats	14	7			21					5	16	0.7	15		1.7
Milk (excluding butter)	2 312	9		2	2 320	36			118	2	2 164	88.7	154	7.6	8.5
Eggs	42				42		3		11		28	1.2	4	0.3	0.3
Fish, seafood	200	4		22	182	4					178	7.3	14	2.2	0.5
Total													1 967	51.9	46.4
Vegetable products													1 691	34.5	29.7
Animal products													276	17.4	16.7

Source: FAO, 1995f.

Chronic undernutrition and nutritional deficiencies

The chronically undernourished are defined as those people whose estimated average daily energy intake over a year falls below that required to maintain body weight and support light activity (FAO/WHO, 1992g). The appropriate term used for the estimate is "chronic dietary energy deficiency" or "chronic undernutrition", reflecting the proportion of the population that has inadequate access to food.

Table 8 shows the per caput food supplies for direct human consumption in sub-Saharan Africa for three periods between 1969 and 1992, and Table 9 gives estimates of the incidence of chronic undernutrition in developing regions for the same periods as well as projections of chronic undernutrition to the year 2010. The data show that in Africa the proportion of chronically undernourished people rose from 38 to 43 percent between 1969 and 1992, but the absolute numbers of people with inadequate access to food doubled, rising from 103 million to 215 million in the same period. This is not surprising, especially in view of the rapid population growth (around 3 percent annually) and droughts, recurrent in some countries, during the 1980s and early 1990s. War and civil conflicts also inevitably contributed to the deterioration in food security.

Table 8 - Per caput dietary energy supplies: 1969-1971, 1979-1981 and 1990-1992

Country	Population (millions)	Per caput DES (kcal/day)			Annual growth rate (%)
	1990-1992	1969-1971	1979-1981	1990-1992	1969-1971 to 1990-1992
Algeria	25.6	1 830	2 620	2 900	2.20
Angola	9.5	2 110	2 160	1 840	0.66
Benin	4.8	2 160	2 190	2 520	0.74
Botswana	1.3	2 150	2 160	2 320	0.36
Burkina Faso	9.3	1 730	1 680	2 140	1.00
Burundi	5.7	2 100	2 040	1 950	-0.35
Cameroon	11.9	2 320	2 350	2 040	-0.60
Central African Republic	3.1	2 360	2 270	1 720	-1.50
Chad	5.7	2 170	1 680	1 810	-0.87
Congo (Republic of)	2.3	2 060	2 220	2 210	0.33
Côte d'Ivoire	12.4	2 420	2 820	2 460	0.07
Egypt	53.6	2 510	3 130	3 340	1.36
Ethiopia	51.4	1 700	1 810	1 620	-0.26
Gabon	1.2	2 180	2 400	2 490	0.64
Gambia	0.9	2 200	2 030	2 320	0.26
Ghana	1 5.5	2 200	1 910	2 090	-0.25
Guinea	5.9	2 170	2 260	2 400	0.47
Kenya	24.4	2 200	2 150	1 970	-0.53
Lesotho	1.8	2 000	2 260	2 260	0.57
Liberia	2.6	2 230	2 400	1 780	-1.08
Libya	4.7	2 440	3 440	3 290	1.43
Madagascar	12.4	2 450	2 440	2 160	-0.61
Malawi	10.0	2 360	2 280	1 910	-1.02
Mali	9.5	2 050	1 800	2 230	0.42
Mauritania	2.1	1 940	2 110	2 610	1.41
Mauritius	1.1	2 320	2 670	2 780	0.85
Morocco	25.7	2 420	2 720	3 000	1.02
Mozambique	14.5	1 940	1 920	1 740	-0.50
Namibia	1.5	2 180	2 210	2 190	0.03
Niger	8.0	1 990	2 240	2 190	0.46
Nigeria	112.1	2 380	1 960	2 100	-0.58
Rwanda	7.3	2 040	2 090	1 860	-0.44
Senegal	7.5	2 460	2 450	2 310	-0.31
Sierra Leone	4.3	2 170	2 110	1 820	-0.82
Somalia	7.7	1 810	1 870	1 590	-0.62
South Africa	38.9	2 800	2 820	2 810	0.02
Sudan	25.9	2 190	2 260	2 150	-0.08
Swaziland	0.8	2 310	2 480	2 680	0.70
Tanzania, United Republic	26.9	1 740	2 280	2 110	0.90
Togo	3.6	2 300	2 240	2 290	-0.01
Tunisia	8.2	2 200	2 810	3 260	1.69
Uganda	18.1	2 300	2 130	2 220	-0.15
Former Zaire	38.6	2 160	2 070	2 090	-0.14
Zambia	8.4	2 210	2 180	2 020	-0.42
Zimbabwe	10.3	2 160	2 230	2 080	-0.19
Sub-Saharan Africa	501	2 140	2 080	2 040	-
Africa	656.9	2 220	2 280	2 290	0.15
World	5 358.8	2 440	2 580	2 720	0.50

Source: FAO, 1995f.

Table 9 - Estimates and projections of chronic undernutrition in developing regions

Region/year (three-year average)	Total population (millions)	Undernourished
		Percentage of total population	Persons (millions)
Sub-Saharan Africa
1969-71	268	38	103
1979-81	357	41	148
1990-92	500	43	215
2010	874	30	264
Near East and North Africa
1969-71	178	27	48
1979-81	233	12	27
1990-92	317	12	37
2010	513	10	53
East Asia
1969-71	1 147	41	475
1979-81	1 393	27	378
1990-92	1 665	16	268
2010	2 070	6	123
South Asia
1969-71	711	33	238
1979-81	892	34	303
1990-92	1 138	22	255
2010	1 617	12	200
Latin America and the Caribbean
1969-71	279	19	53
1979-81	354	14	48
1990-92	443	15	64
2010	593	7	40
Total
1969-71	2 583	35	917
1979-81	3 228	28	905
1990-92	4 064	21	839
2010	5 668	12	680

Source: FAO, 1996b.

The number of chronically undernourished people in a country can be estimated by combining data on DES with information about the distribution of food supplies (see Table 9). Such estimates are useful guides, at the national level, for analysing trends in food adequacy. However, it is important to remember that such information may be misleading, as it relates only to the potential average availability of energy supplies; it does not provide a direct assessment of food consumption at the household or individual level. Moreover, because of inequity in the distribution of the available food among the households, a significant proportion of the households are likely to have consumption levels that are below minimum standards, even if the per caput DES is higher than the per caput energy requirements.

A proper assessment of the proportion of households or individuals in the undernourished category requires information from sample surveys that measure the nutritional levels of households or individuals in the population, i.e. food consumption or dietary surveys, and anthropometric surveys. However, nationally representative surveys are costly and time-consuming and have been undertaken in very few countries. FAO has developed a methodology that uses DES data in combination with information regarding the variation of the distribution among households obtained from available national household surveys in order to estimate the prevalence of undernutrition in developing countries (FAO, 1996a).

Energy deficiency is not the only parameter of nutritional status. Micronutrient deficiencies frequently occur in association with protein-energy malnutrition in sub-Saharan Africa. These deficiencies affect all population groups to a lesser or greater extent, depending on age, physiological state and geographical location. They are particularly serious for children under five years of age and pregnant and lactating women.

FAO has estimated that about 215 million people in sub-Saharan Africa suffer from chronic undernutrition. Anaemia caused by iron-folate deficiency and parasitic infections affects another 206 million people on the continent. Iodine deficiency disorders and vitamin A deficiency are also of high public health importance, with 181 million and 52 million people at risk, respectively (see Table 3). These aspects of nutritional status are discussed in detail in Chapter 8.

Malnutrition contributes substantially to high rates of child illness and death. Mortality rates in children under five years of age are estimated to be 40 times higher in sub-Saharan Africa than in affluent countries. It is estimated that there are about 4 475 000 deaths of children under five in sub-Saharan Africa per year (UNICEF, 1995) and that malnutrition underlies about 30 percent of these deaths (WHO, 1995a).

National policies affecting food security and nutrition

Many of the policies pursued by African countries during the 1970s and 1980s successfully achieved aggregate national food security. Despite achieving national food security in terms of average energy availability per caput, however, these countries did not achieve adequate consumption for all individuals and groups within the country (FAO, 1992e). An analysis of the causes of, and the potential policy responses to, food insecurity affecting many people in Africa in the past three decades is far beyond the scope of this book. However, the section that follows provides a brief overview of the major policy instruments used by governments to attain national food security.

The evolution of African food security policies

In the post-independence period, many African nations were eager to modernize their economies by seeking rapid growth of the industrial sector. They often favoured urban-biased development strategies to the detriment of the agricultural sector, which did not receive the kind of financial, infrastructural and political support needed for its development. In the late 1960s it became apparent that the industrialization strategies were not meeting the objectives that had been set. The interdependence of agriculture and industry was recognized and with it the need for development of the agricultural sector. The change in emphasis in favour of agriculture was reinforced by the increased population projections and the recognition in the 1970s that in order to attack the problem of rural poverty, smallholder agriculture needed immediate attention.

To meet domestic demand, maximize food production and increase marketed supplies of food, many African countries embarked on food security strategies focused on achieving food self-sufficiency during the late 1970s and early 1980s, using policies designed to maximize domestic output of staple crops. In the countries of the Southern African Development Community (SADC) [until 1992 the Southern African Development Coordination Conference (SADCC)], policies included subsidies on agricultural inputs in food production, increases in consumer prices of staple foods and promotion of large-scale irrigation schemes.

In the SADC countries the focus of food policies rapidly moved beyond self-sufficiency via maximization of domestic production to increasing and stabilizing the marketed supply of staple foods. This reorientation of policy acknowledged that the marketed supply of food fluctuates much more than total production, which is the case because subsistence producers predominate in the region. In poor production years, such producers retain sufficient food for household consumption needs, at the expense of the share of crops released into the market for sale. Because of the resulting fluctuations in the market supply of food which occurred in many SADC countries during the 1970s and 1980s, State marketing boards and private traders were often unable to meet the increasing food demands of their growing urban sectors and the rural landless.

Policies aimed at increasing and stabilizing the market supply of foods included: increases in producer prices of food crops; intensified marketing activities on the part of State marketing boards; and development of national strategic grain reserves. Although these strategies managed to increase the market supply of food, individual food security often suffered, as higher producer prices often necessitated increases in consumer prices. Hence, it became necessary for governments not only to stabilize prices but also to lower consumer prices to the level demanded by urban consumers.

In many countries, stabilization of prices has been achieved through the food marketing activities of the State marketing boards, which adhere to government-controlled prices and have access to public funds often needed for subsidizing producer and consumer prices. Along with an overvalued exchange rate, price stabilization has been used to keep domestic food prices low. This type of cheap-food policy has resulted in subsidized food imports and implicit taxation of non-food exports, while the domestic producer prices of food commodities are either suppressed or, more often, supported by increased input price subsidies. Although an overvalued exchange rate permits cheap food imports, it is also an important factor in keeping consumers poor. Overvalued exchange rates slow economic growth as exports become too expensive for buyers abroad. At the same time they lower incentives for agricultural production of export crops. The combination of these two factors reduces the demand for unskilled labour and creates unemployment. For many African countries the fiscal costs of this type of cheap-food policy placed a high financial burden on the government budget which could no longer be sustained by the early 1980s. Many countries began to dismantle the associated policy regimes as part of structural adjustment and macroeconomic stabilization programmes.

Structural adjustment policies and the agricultural sector

The economic situation in many African countries during the 1980s was strongly influenced by the external economic crisis and world recession, but also by internal policies which had favoured rapid growth of a very costly public sector. External trade forms a significant proportion of gross domestic product (GDP) in most African countries. However, with the sharp decline in commodity prices in the late 1970s and the rise of export prices following the oil crises in 1979, declines in export revenue were accompanied by a rapid buildup of debt to finance increased levels of domestic spending.

Import levels had risen in many African countries in response to the short-lived commodity boom of the mid- 1970s. The public sector, in particular, increased its consumption and investment expenditure in many countries. When commodity prices dropped, import levels were not reduced fast enough, and the financial deficit was met by foreign borrowing. The burden of this borrowing was made heavier by the rise in world interest rates, which led to extremely high debt-servicing demands. By the early 1980s, many African countries, having borrowed heavily, were faced with mounting inefficiencies and declining growth rates. Table 10 shows, for example, the dramatic increase in Nigeria's outstanding external debt and total debt service costs between 1971 and 1987.

In response to recommendations from the World Bank and the International Monetary Fund, many governments embarked on structural adjustment programmes in the 1980s. One of the aims of structural adjustment was to reverse the unfavourable bias against agriculture in the domestic economy. Strategies directed towards this objective included: eliminating food subsidies; raising official producer prices and consumer prices while promoting market liberalization; and reducing foreign exchange deficits. Other measures included: the dissolution of marketing boards; removal of subsidies on agricultural inputs such as fertilizers and pesticides; and promotion of food and cash crop exports.

The impact of structural adjustment on agriculture

The impact of adjustment policies on agricultural performance has been variable in different African countries. However, overall agricultural performance during the 1980s has been judged as disappointing. The annual average growth rate between 1980 and 1985 was 0.9 percent, as compared with the target of 3.9 percent; in per caput terms this represented a negative growth rate of 2.4 percent (FAO, 1992e).

Table 10 - Nigeria's outstanding external debt and total debt service, 1971 to 1987

Year	Total outstanding debt		Value of exports	Total debt service	Debt service ratio
	(N million)	(US$ million)	(N million)	(N million)
1971	214.5	308.9	1293.4	29.9	2.3
1973	276.9	420.9	2369.2	30.8	1.3
1975	349.9	559.2	4925.5	32.7	0.7
1977	496 9	762.9	7630.7	25.6	0.3
1979	1 611.5	2 824.6	10 836.8	182.9	1.7
1981	2 331.2	3 667.7	10 470.1	518.6	5.0
1983	10 577.7	14 130.1	7 502.5	1 335.2	17.8
1985	17 290.6	17 997.5	11 214.8	3 718.0	33.2
1987	86 550.8	26 200.0	30 239.9	3 590.6	11.9
1988a	146 410.0	29 282.0	26 600.5	6630.5	30.0

Source: Igbedioh, 1990. Reproduced with the permission of Butterworth-Heinemann, Oxford, UK

^a Estimates as at end of 1988 (Nigerian Economist, 1989).

The fact that African agriculture has not met the expectations of the designers and implementers of the adjustment policies does not mean, however, that all the policies have failed. Rather, the policies implemented, primarily price incentives to farmers, appear to have been insufficient, as they often bypassed the subsistence sector. The complex circumstances of African agriculture require more than price policy reform. Other problems also need to be addressed, including poor agricultural marketing structures, infrastructure, storage and transport facilities, lack of credit, land scarcity, poor input supply and other physical constraints facing the sector. Structural adjustment policies have paid insufficient attention to these problems, which helps explain the disappointing performance of agriculture and its weak ability to provide employment and incomes to those people who depend on it for their livelihoods.

In recent years, the SADC and many African governments have come to realize that attaining food self-sufficiency, increasing and stabilizing market supplies and stabilizing producer and consumer prices do not necessarily guarantee food security at the household level. This micro-level objective has now become the focus of food security policies throughout much of the region. Although achieving household food security requires many of the policy instruments referred to earlier such as strategies for increased production, supply stabilization and price stabilization, focusing on these latter objectives will seldom achieve the broader objective of household and individual food security.

The exact policy mix required to achieve household food security will vary according to country circumstances. What has become clear, however, is that much broader policy instruments are required, including policies related to employment, land distribution, macroeconomic growth, distribution of the gains from economic growth, population growth, incomes and income stabilization. With respect to agriculture, more support will be necessary for extension work, credit availability, irrigation and encouragement of greater use of inputs such as fertilizer and improved seed.

Because of agriculture's central role in generating employment and income in rural areas throughout the region, policies aimed at increasing agricultural production and productivity are essential for improved household food security and nutrition in sub-Saharan Africa. This does not mean, however, that the focus must only be on food production for domestic consumption. Studies undertaken by researchers at the International Food Policy Research Institute (IFPRI) in the Gambia, Kenya and Rwanda showed that cash crop production can result in significant increases in household income and improved household food security (Kennedy and Haddad, 1992). In this context, it is important to emphasize not only the absolute level of income, but also the control of income and the source, as these can significantly influence household food security. Researchers at IFPRI and others found that income controlled by women, particularly in Africa, is more likely to be spent on food. Households with more women-controlled income were found to be more likely than others at similar income levels to be food secure. This implies that a shift in the control of income from women to men might have negative effects on household food security despite increases in overall income. The promotion of cash versus non-cash crops is discussed in Chapter 4.

Other factors affecting food security and nutrition

Environment and nutrition

This section highlights the agriculture-nutrition linkages in relation to the nature of technology utilization. In the past, African farmers and pastoralists developed farming systems according to their environment. The dominant forms of land use were shifting cultivation in the humid tropics and nomadic grazing in the semi-arid areas. Yields were low, and relatively large areas were needed to support a small population. Recent years have witnessed rapid growth in population and increasing expansion into marginal areas where available resources are being stretched to the limit. The result has been environmental degradation with gully, sheet and wind erosion, degraded vegetation, declining soil fertility and desert encroachment.

Food-insecure households do not deliberately degrade their resource base; on the contrary, they are usually fully aware that their food security is at risk if their environment is threatened.

Population growth directly increases consumption needs and forces many farm families into marginal areas where conservation practices are essential. FAO has estimated that half of African farmers live in environments with a highly vulnerable natural resource base. Such areas include cleared forest soils of fragile structure, steeply sloping lands and dryland areas with limited rainfall. In addition, the increased demand for fuelwood for cooking may leave marginal lands permanently denuded of soil cover and subject to erosion. Such loss of productivity in the resource base inevitably reduces food supplies and increases food insecurity and nutritional stress, particularly among vulnerable groups. Reduction in the availability of fuel or time for cooking (as women have to walk further to gather wood) could also result in preparation of fewer cooked meals or inadequate reheating of foods, thus decreasing food consumption by children and increasing the risk of microbial contamination of food.

Pressures on land are further complicated by changes in the patterns of traditional land tenure. When farmers are no longer certain of their continuing rights of access to community land for food production, they may be reluctant to invest cash and labour in that land on a long-term basis, especially since effective measures to conserve soil and water and to increase productivity require considerable inputs.

Policies determining access to land and security of land tenure, as well as those that encourage investment in land (e.g. irrigation and greater use of inputs such as fertilizer and improved seeds), are key to increased food crop productivity, greater food availability and adequate nutrition. In marginal areas, appropriate agricultural technology can go a long way towards stabilizing food availability and facilitating food access for the poor.

Population growth, migration and nutrition

Rapid population growth and urbanization were identified above as major factors influencing food production, food demand and nutritional status trends in Africa. Figure 3, which showed trends in population, food production and dietary energy supply in sub-Saharan Africa as a whole from ] 961 to 1995, indicated that per caput food production in sub-Saharan Africa has been declining since the early 1970s. This decline has had serious consequences for general economic growth, import demand, agricultural-sector incomes, domestic food prices and nutritional outcomes.

Not only rapid population growth, hut also population structure and population migration affect food production and the nutritional well-being of people. In recent years life spans and child survival have improved in some African countries. Figures 4 and 5 show the age distribution in developing and more developed countries, respectively. It is evident from these data that the proportion of nonproducers (the base and apex of the pyramid) to the active labour force (the middle section) is very different in the two examples. In a country with a very high proportion of young children to support, the economic burden on the productive age groups is correspondingly high. Children less than 15 years of age now constitute 44.2 percent of the total population in sub-Saharan Africa, while children under five years of age constitute 17.4 percent (UN, 1994a). The high dependency ratio has arisen from a rapid increase in births and recent reductions in infant and child deaths.

FIGURE 4 - Population pyramid, less developed countries

Source: FAO, 1992f.

FIGURE 5 - Population pyramid, more developed countries

Source: FAO, 1992f.

The current age distribution means that there is a huge potential for continued population increase in Africa as young people move into child-bearing age. Even if the total fertility rate were to drop immediately to the replacement level of 2.2 births per woman, it would take about 100 years for Africa's population to begin to stabilize, and the population would then be 80 to 100 percent larger than it is now (FAO, 1992f). Present strategies to achieve sustained increases in food production will fail unless they are combined with measures to slow population growth and create alternative employment opportunities. However, the increased population also points to a potential wealth of human resources, which, if given access to education, health and the means to work, could positively influence both economic and agricultural growth.

The current shortage of adults in the most productive age groups in a number of African countries is exacerbated by migration of the working-age population, especially young male workers. Rural-to-urban migration is increasing fast and accounts for at least half of the population growth of African cities, which is 5 percent overall. Just under 30 percent of sub-Saharan Africans were estimated to live in towns and cities in 1990 (Figure 6). It is estimated that by the year 2000, 27 of the world's largest cities will be in developing countries (World Bank, 1989).

Reasons for rural-to-urban migration include: population pressure on agricultural land; pursuit of employment or better-paid employment; pursuit of higher education; and expectation of better social amenities including housing, water and health care. Migration may be seasonal or permanent, but either way it often causes the major burden of farming to fall on women, children and older men, while the demand for additional food to provide for the city dwellers continually increases. The effects of urbanization on food consumption patterns and nutrition are discussed in Chapter 4.

FIGURE 6 - Population and urbanization in sub-Saharan Africa, 1960-2020

Source: World Bank, 1989.

Note: Figures for 1990 and 2020 are projections based on declining fertility rate

Another type of migration which is serious in Africa is that of refugees or displaced persons. People become refugees when they flee to a neighbouring country out of fear of persecution in their own country. People may also be displaced within or outside their own country following natural events such as droughts. Most often, however, displacement is a result of disasters of human origin such as civil conflict and war. These conflicts tend to be protracted and to devastate the economies of the countries involved.

It is estimated that one of every two refugees in the world in 1990 was African. The refugee population in Africa grew from an estimated 1 million in 1970 to about 18.5 million in mid-1994 (including internally displaced persons) (UN ACC/SCN, 1994). Some of the countries hosting large refugee populations during the 1980s and 1990s, such as Ethiopia, Malawi, Somalia, the Sudan, Uganda and former Zaire, are among the poorest and are unable to feed their own populations adequately. Other countries such as Kenya and the United Republic of Tanzania have had their economic growth slowed by influxes of refugees.

International assistance providing food, medicine, shelter and basic health care is essential to enable African countries to render basic services to refugees. Despite this assistance, unprecedented levels of malnutrition and mortality were observed in refugee and displaced populations in sub-Saharan Africa from 1985 to 1995, caused by a combination of lack of adequate food rations and high levels of communicable disease. Even when refugee or displaced populations are protected from starvation, they are often exposed to micronutrient deficiencies because they are dependent on just a few selected foodstuffs. In recent years there have been outbreaks of scurvy (vitamin C deficiency) among refugee populations in Somalia (1981 /82), the Sudan (1985/86) and Ethiopia (1988/89) and of pellagra (niacin deficiency) among Mozambican refugees in Malawi (1990/91).

The five worst situations in 1995 were those of refugees and displaced persons from and within Rwanda and Burundi, Liberia and Sierra Leone, Mozambique, Somalia and the Sudan (UN ACC/SCN, 1995). In Rwanda and Burundi alone it was estimated that more than 2 million people were severely malnourished and an additional 3 million at high risk from malnutrition in 1994 (UN ACC/SCN, 1994). In such situations, control of communicable diseases is as crucial as the provision of adequate food or of money to buy food. The future nutritional status of populations in many parts of sub-Saharan Africa will depend to a large extent on the development of policies and measures to resolve local conflict and the provision of sufficient resources to prevent and mitigate such situations. Famines resulting from armed conflict should be considered at the highest political level and confronted through continuous diplomatic efforts.

HIV/AIDS and its impact on household food security and nutrition

The malnutrition-infection complex, which is described in Chapter 3, most commonly affects children. It is also a significant factor among adults. Energy and nutrient deficiencies, often coupled with infections and parasitic diseases, hinder adult physical performance and work capacity. The resulting loss of productivity may often entail serious consequences for the food security of affected households. Few infections have the potential for as profound an effect on food production capacities and nutritional status in Africa as HIV, which causes the disease AIDS. The precise impact of HIV/AIDS on food production is still not clear in view of its relatively recent on set in epidemic proportions. However, present morbidity and mortality rates show that in many countries AIDS is likely to have a significant impact on the ability of people to produce, transport, sell and buy food.

In rural districts HIV infection levels have been estimated to exceed 30 percent for some age groups. Conservative estimates suggest that AIDS-related mortality could reduce the adult labour force by as much as one-quarter by the year 2010. In addition to the direct impact on farms, the serious indirect socio-economic consequences include disappearance of traditional family welfare structures, loss of a trained workforce and reduced family income. The number of orphans is rapidly increasing in all severely affected countries, with the result that traditional coping strategies, where they still exist, may soon be overwhelmed.

Patterns of malnutrition will be determined by the prevalence of HIV in given communities and the efficacy of community-based coping strategies. For example, in rural areas where women have an active role in agricultural production and up to 20 percent of women attending antenatal clinics are HIV positive, a significant decline in the number of adults in the workforce is inevitable. In some rural communities of sub-Saharan Africa, HIV/AIDS is now resulting in labour shortages for both farm and domestic work. Besides losing the AIDS patient's labour through sickness and subsequent death, family members have to divert time to care for the sick and consequently neglect farm and off-farm activities. The result is loss of potential income. Box 1 illustrates how the livelihood of a young family is affected through sickness and death.

A decrease in food production and a threat to household and community food security are very likely in view of the high numbers of household heads and their spouses dying of AIDS in some agrarian communities. Further consequences include a decline in the nutritional and health status of farm families, which is already being witnessed in severely AIDS-affected communities where there has been a change in the volume and kinds of crops produced; a decline in educational status as children are forced to leave school; changes in the social system as households adapt to HIV/AIDS (i.e. the breakup of families, a growing incidence of female-headed households and increasing numbers of orphans and rural poor). The impact of HIV/AIDS is likely to be most severe among already vulnerable groups such as the malnourished and the food insecure. In any event, careful assessment of the nutritional impact of AIDS on non-infected household members is required.

The direct costs of treating AIDS patients (drugs, doctors' fees, hospitalization, etc.) are enormous and greatly surpass available resources in Africa. AIDS prevention measures urgently need to be introduced or strengthened, through health education, to enable people to protect themselves against HIV infection. A major consequence of HIV/AIDS is increased pressure on the household labour economy; the most important programme and policy responses, therefore, are those that enable people to cope with the results of labour loss. There are also implications for the targeting of assistance to women and children and in some cases to widowed men who are raising children. Policy responses should also endeavour to integrate all aspects of poverty relief, domestic and farm labour, the educational needs of orphans and other young people, food security and nutrition and income generation.

Box 1 - The impact of AIDS on the livelihood of a young family: The story of Joseph and his family Joseph, 35, and his wife Vincentia, 33, had four girls and one boy, ranging in age from four to 12. Joseph had married a second wife who left him when he became sick in 1989. Prior to his illness and death, farm work was mainly carried out by his first wife. Joseph was a farmer and a successful small goods trader in a fishing village about 10 miles (16 km) away from his home village. On his one acre (0.4 ha) of land he had a new house and a banana plantation. The family used to rent land and plant cassava, sweet potatoes and groundnuts. They owned five cows and it traditionally was Joseph's responsibility to transfer the cow dung from the cattle kraal to the banana plantation in order to maintain soil fertility. Joseph's plans had been to purchase additional land for cultivation. However, these plans were soon abandoned when Joseph started suffering from multiple illnesses in 1989 and was bedridden for several months in 1991. During this time his wife was forced to abandon the field she had ploughed for groundnuts so as to be able to look after her ailing husband. Joseph was no longer able to spread the banana plantation with cow dung. Therefore the yield of the banana plantation started slowly to decline because of lost fertility. In 1991, Joseph died of AIDS. In June 1992, Vincentia fell seriously sick and was bedridden for three months. During her illness the banana plantation as well as the fields for cassava and sweet potato gradually turned from weeds to bush. Joseph's wife died in October 1992. The cows were also neglected and when they became sick, there was no money to buy veterinary drugs and all five head of cattle died. Recently, Joseph's 27-year-old brother has attempted to reclaim the banana plantation. In addition, he has started to keep pigs and chickens on his late brother's piece of land. He also would like to keep cattle, but lacks the money to buy the animals. Joseph's two eldest children are staying with him, while the three younger ones are cared for by the maternal grandmother, who is herself of advanced age and in ill health.

Source: FAO, 1944b.

Policies and actions needed to improve household food security and nutrition

Knowledge concerning appropriate actions for ending hunger and malnutrition has markedly increased over the past three decades. The ICN's focus on food, health, care and education factors is part of an emerging international consensus concerning the causes of malnutrition and represents a shift in emphasis from the more narrow food supply approaches of the 1960s and 1970s.

Participants at the ICN discussed a broad range of strategies and actions for improving nutrition which are structured along the lines of the major factors causing malnutrition (FAO/WHO, 1992a). The actions discussed range from macroeconomic policies through various agricultural and income policies to specific direct nutrition programmes and interventions. It was emphasized that efforts to improve nutrition must from the outset attack the detrimental reinforcing linkages among food insecurity, disease, poor sanitation, inadequate education and undernutrition. Otherwise, the progress made through specific agricultural or health measures alone will have limited effect on nutritional improvement. The ICN's World Declaration on Nutrition is reproduced in Annex 3.

In support of the ICN, the Rome Declaration on World Food Security, approved by the World Food Summit in Rome in 1996, calls on all governments to accelerate the efforts and facilitate the actions needed to achieve the goals of food security and improved nutrition. The following are priority areas of attention.

Promotion of nutrition-friendly agriculture and food technology

The role of agriculture and of agriculturists in the economic growth of Africa is clear. There is an urgent need to increase the efficiency of present resource utilization while simultaneously conserving and, where possible, enhancing the productive capacity of the resource base. The strategy must involve sound land-use planning and subsequent implementation of actions to match demands with the potentials of both the land and its people. The key to successful implementation is commitment to economic growth, which should be compatible with securing sustainable livelihoods and improved quality of life for the poorest communities.

In some rural areas the overriding nutritional problems are more closely associated with a shortage of jobs than with a shortage of food. Poor households are very likely to contain malnourished members. Women and children are often the most severely affected. Growth in the food and agriculture sector is vital for the alleviation of poverty and for ensuring an adequate and stable food supply for most of the population in developing countries. Producer incentives and new technologies that increase production and employment in the agricultural sector, including the establishment of small- and medium-scale food-processing facilities, can help augment incomes, alleviate poverty and improve food security.

Increased production and diversification of food need to be promoted in such a way as to offer particular benefit to the rural poor. Measures should include targeted interventions to increase the productivity of small-scale farmers such as production incentives, development of an efficient marketing infrastructure and more research on rain-fed and disadvantaged areas. The impact of such programmes on nutrition can be strikingly enhanced if they are accompanied by effective extension services, credit availability for men and women and encouragement of the use of inputs such as fertilizer and improved seeds. Although productivity growth is the key to development, it must be realized that technology alone can achieve little. However, technology combined with investment in people -especially education for men and women farmers, particularly on nutrition, health and population - can show high rates of return.

Nutritional considerations in production policies and programmes can avoid some of the adverse effects sometimes associated with new technology and can foster nutritional well-being. Developing and testing appropriate technologies for diverse agro-ecologies will remain a major task for decades to come. The health and nutrition risks of technological change (see also section on irrigated agriculture in Chapter 4) must be mitigated through appropriate technology design. There is substantial scope for agricultural, public health and nutrition workers and researchers to collaborate on improving the designs of agricultural programmes.

In countries and regions that frequently suffer serious food shortages, such as those prone to drought, programmes in the agricultural sector are frequently complemented by public measures such as income and employment generation programmes and direct food transfers (e.g. food price subsidies, food rationing and food stamps) as a means of stabilizing household food security and maintaining nutrition levels for the poorest. A cost-effective but organizationally more demanding alternative, however, is a system of direct nutrition interventions.

Direct nutrition actions

Direct nutrition actions aimed at addressing immediate nutrition problems work best when they actively involve those who are affected. Such actions address problems associated with access to food (e.g. through supplementary feeding or targeted feeding programmes), micronutrient deficiencies (micronutrient programmes), poor nutritional knowledge and behaviour (nutrition education programmes), detrimental health-nutrition linkages (health and sanitation programmes) or a combination of these. Considerable progress has been made in the effectiveness of direct nutrition interventions since the mid-1980s. The scope for further strengthening of the best practices of such programmes and their potential for achieving rapid nutritional improvement should be underlined.

Targeted supplementary feeding. Feeding programmes are generally aimed at persons especially vulnerable to malnutrition, usually children and women of child-bearing age at low income levels. Feeding programmes are often a relatively acceptable means of achieving targeted income transfer, and in countries with inadequate market structures and functioning they have shown more potential for increasing food intake than comparable cash income transfers. School feeding programmes often have the combined target of increasing school enrolment and improving the nutritional status of schoolchildren. Many countries combine such programmes with nutrition education and school gardening. Such programmes can be a very cost-effective mechanism for food-based targeted transfers.

Protecting consumers through improved food quality and safety. A safe food and water supply of adequate quality is essential for proper nutrition. Food safety and quality control ensure that the desirable characteristics of food are retained throughout production, handling, processing, packaging, distribution and preparation, in turn promoting healthy diets, reducing food losses and encouraging domestic and international trade. Effective food quality and safety control programmes are essential and may comprise a variety of measures, such as laws, regulations and standards together with systems for effective inspection and monitoring including laboratory analysis.

Micronutrient programmes. Considerable and successful actions have been taken since the mid-1980s in the area of overcoming micronutrient deficiencies. Still, increased efforts are necessary. A combination of actions needs to be adopted to increase the availability of micronutrient-rich foods, to promote adequate food processing and preservation techniques, to disseminate education related to food and nutrition, to promote dietary diversification, to establish legislation and implement programmes for food fortification and supplementation and to implement appropriate public health measures.

Promoting healthy diets and lifestyles through education. Promoting better eating habits and positive health behaviour is one of the most challenging tasks in overall efforts to improve nutrition. In addition to access to a variety of safe and affordable foods, people need accurate information as to what constitutes a healthy diet and how to meet their nutritional needs. The ICN's Plan of Action for Nutrition called for the implementation of nutrition education programmes at all levels which should involve the mass media, primary and secondary schools, community participation programmes, extension staff and higher-level education as channels for communicating nutrition information. The limitations of nutrition education must, however, also remain in perspective. Many desirable behavioural changes require household resources (including time) for appropriate responses. Nutrition education may thus be most effective in combination with other poverty-reducing and nutrition-enhancing actions.

Nutrition/health and integrated nutrition programmes. Since nutrition problems have multiple causes, it seems logical to design policies and programmes in a multifaceted way to achieve effective nutrition improvement. One of the most effective methods of identifying and targeting nutrition and health interventions is to monitor children's growth. The ICN has called on governments to develop and strengthen growth monitoring and health care systems. While growth monitoring alone does not necessarily change nutritional status, it does provide important information to be used in actions such as food supplementation, nutrition education and medical referral, when needed. Integrated nutrition projects typically couple growth monitoring of young children found to be nutritionally at risk and nutrition counselling for their mothers with targeted interventions (on-site feeding, health checks, immunization, family planning, etc.). Emphasis is also placed on intersectoral collaboration, as narrow sectoral approaches that focus exclusively on health, agriculture or education cannot tackle the nutrition problem effectively.

Community participation. Households, and women and mothers in particular, usually have the desire and often also the knowledge to improve the nutrition of their vulnerable members. Success is impeded by a lack of resources, including the lack of a voice in relevant community decisions. Empowerment of the vulnerable is therefore needed in community nutrition actions. Empowerment can be fostered directly and indirectly through the assignment of resources and leadership tasks to women in community-based nutrition programmes or through guidance and assistance in group formation, combined with provision of knowledge and skills to these groups.

Among resource control issues, access to even small amounts of land (e.g. garden plots for women) has remained an important component of household food security in low- and middle-income countries. It is necessary to give renewed consideration to women's control over resources and land and its relation to household food security. Advocacy of widespread access to home gardens, in peri-urban as well as rural areas, and appropriate agricultural services for this subsector should be pursued in many low-income countries.

Building organizational capacity. Only if the urgency and significance of the food security and nutrition situation are readily apparent will appropriate action be taken and national and international support for such action be sustained. The availability of organizational capacity in nutrition is essential for effective implementation of nutrition interventions and for monitoring changes in the nutrition situation to evaluate the effects of nutrition policies and programmes and to adjust them to suit changing circumstances. The "learning by doing" approach, so effectively employed in some countries, is considered a viable alternative to "perfect" planning prior to action. It is imperative that the governmental organizations, particularly ministries, as well as the non-governmental organizations (NGOs) involved in nutrition actions be well coordinated by an established framework. It is necessary to create a legal basis for mandatory coordination at the national level in order to ensure that food security and nutrition improvement actions are sustained and consistent. Improving nutrition is not an issue for short-lived task forces, but a challenge requiring long-term commitment.