FNS Landscape Review

1. FNS Landscape Review TANGO International April 30, 2014

2. Countries With High Burden of Malnutrition These 34 countries account for 90% of the global burden of malnutrition

3. Shifts in the Nutrition Landscape

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

5. Examples: Agriculture and food security Social safety nets Nutrition-sensitive Interventions and Programs Early child development Maternal mental health Women’s empowerment Child protection Schooling Water, sanitation and hygiene Health and family planning services Interventions or programs that address the underlying determinants of fetal and child nutrition and development— food security; adequate caregiving resources at the maternal, household and community levels; and access to health services and a safe and hygienic environment—and incorporate specific nutrition goals and actions Nutrition-sensitive programs can serve as delivery platforms for nutrition-specific interventions, potentially increasing their scale, coverage and effectiveness

6. Nutrition-sensitive Programs Can Impact Nutrition:Through Increases in Income A 10% increase in GDP/PC leads to a 6% reduction in stunting

7. Income Growth Can Have Unintended Consequences of Increasing Risks of Overweight and Obesity A 10% increase in GDP/PC leads to a 7% increase in overweight and obesity in women

8. Evidence shows: Positive associations between dimensions of women’s empowerment and improved maternal and child nutrition Nutrition-sensitive Programs Can Impact Nutrition:Through Empowerment of Women Positive impacts of cash transfers and agricultural programs on measures of women’s empowerment There is evidence that men and women allocate food and other resources differently Negative associations between disempowerment (e.g. domestic violence) and child nutrition outcomes

9. Have impacts on several underlying determinants of nutrition: Livelihoods and income Targeted Agricultural Programs Household food security Diet quality Women’s income and empowerment • …and complement global efforts to stimulate agricultural productivity − increasing producer incomes while protecting consumers from high food prices

10. Potential Areas of Engagement • Integrated Ag/Nutrition/Health programs • Plan water and sanitation interventions together with agriculture interventions to reduce the incidence of disease and improve nutritional status. • Value Chain programs • More research is needed to identify opportunities where the nutritional benefits of agriculture interventions can be improved by addressing constraints at various points along the value chain • Agricultural Technology interventions • Facilitate improved communication about how different technologies can be combined to maximize diet diversity and nutrition. • Capacity-building approaches • Use community-based participatory research to develop and implement community-based nutrition programs

11. Global Trends • The global food system is failing to meet everyone’s right to sufficient nutritious food in a sustainable manner • Nearly one billion people are hungry in the world today and another one billion do not have access to a nutritionally balanced diet • Population growth will reach over 9 million by 2040, adding two billion more people than there are today • Consumption patterns in developed countries and a growing middle class in developing countries are creating a disproportionate demand on the earth’s resources

12. Agriculture Global Trends • The global food system is failing to meet everyone’s right to sufficient nutritious food in a sustainable manner • Nearly one billion people are hungry in the world today and another one billion do not have access to a nutritionally balanced diet • Population growth will reach over 9 million by 2040, adding two billion more people than there are today • Consumption patterns in developed countries and a growing middle class in developing countries are creating a disproportionate demand on the earth’s resources

13. Agriculture Global Trends • Diet changes due to increased prosperity in the developed and developing world has increased the demand for meat, eggs, and dairy leading to more pressure to grow corn and soybeans for animal feed • Every year 1.3 billion tons of food, or about one third of all food produced globally ends up wasted or lost. The amount wasted and loss is more than enough to feed the worlds hungry • Industrial countries waste food a the retail and consumer end; developing countries suffer food losses in production processes through post harvest losses, spoilage and improper storage • Almost half of all harvested fruits, vegetables and roots and tubers are wasted or left to rot in landfills; 30% of all cereals and seafood are wasted; and 20% of meat and dairy products are lost every year • Loss or waste of food drives up food prices, and leads to more squandering of water, energy and land

14. Agriculture Global Trends • Climate change is having both a direct and indirect effect on food and nutrition security • It leads to a decrease in crop yields due to extreme and less predictable weather patterns • Shortages of clean water can lead to illnesses that influence food absorption • The poorest and most vulnerable areas of the world are disproportionately affected; poor women bear the brunt of this

15. Why a Focus on Smallholder Farmers • Smallholder farmers produce the bulk of the food consumed and women play a major role in agriculture production throughout the world • Global climatic changes threaten the livelihoods and food and nutrition security of small holders and rural laborers and threaten access to food for people living in towns and cities • Smallholder farming will suffer the most from climate change • Thus the future food and nutrition security of smallholder farmers is very much tied to environmental security

16. Johnathan Foley’s Five Step Plan to Feed the Planet • Freeze Agriculture’s Footprint-do not promote agricultural expansion • Grow more on farms we have-be more efficient on where we grow, what we grow and how we grow • Use resources more efficiently-achieve higher yields while reducing environmental impacts; conserve water to get more crop per drop • Shift diets-only 55% of the world’s crop calories feed people directly; 36% is fed to livestock or used as biofuels and industrial products. We need to find more efficient ways to grow meat to free up substantial amounts of food • Reduce Waste-reducing waste is one of most efficient options for boosting food availability. This will involve reducing waste in industrial countries and reducing post harvest losses in developing countries • CARE has a comparative advantage in supporting smallholder women farmers as part of this global strategy to feed the planet

17. Value Chains and Smallholder Agriculture • Value chain interventions are most successful when they are demand driven, participatory, and incorporate the private sector • Good practice in value chain investments include a sound market analysis, building mechanisms to mitigate shocks (insurance), linking to complementary social protection programs, investing in multiple complementary activities (inputs, irrigation, business skill training) and addressing constraints in the enabling environment (land tenure, labor laws, women’s rights)

18. Potential Areas of Engagement • To address the growing crises of food and nutrition security, climate change, and smallholder vulnerability, sustainable small holder food systems should be a major entry point for CARE • The focus should be on enhancing smallholder farming systems for women farmers embedded in viable ecosystems adjusting to climate change. (The ACRES SUPER approach) • This will allow CARE to focus on its strengths (multi-sectoral community based approaches, women’s empowerment, climate change, market engagement through value chains, and nutrition)

19. Gender – Key Issues and Linkages Reproductive health: • Women, for both physiological and social reasons, are more vulnerable than men to reproductive health problems. • Reproductive health problems, including maternal mortality and morbidity, are a major, preventable cause of death and disability for women in developing countries • Failure to provide information, services and conditions to help women protect their reproduction health therefore constitutes gender-based discrimination and a violation of women’s rights to health and life Stewardship of natural resources: • Women in developing nations are usually in charge of securing water, food and fuel and of overseeing family health and diet. • Therefore, they tend to put into immediate practice whatever they learn about nutrition and preserving the environment and natural resources

20. Gender – Key Issues and Linkages Economic empowerment: • More women than men live in poverty. • Economic disparities persist partly because women do much of the unpaid work within families and communities falls, and due to • discrimination in the economic sphere Educational empowerment: • About two thirds of the illiterate adults in the world are female • Higher levels of women's education are strongly associated with lower infant mortality, lower fertility, and higher levels of education and economic opportunity for their children. Political empowerment: • Social and legal institutions still do not guarantee women equality in basic legal and human rights, in access to or control of land or other resources, in employment and earning, and social and political participation. • Laws against domestic violence are often not enforced on behalf of women

21. Gender Integration An extensive study by the World Bank (2011) shows that women can contribute significantly to the growth of the agricultural sector and the reduction of hunger and poverty. • Women’s contribution is critical for the development of agriculture when they are empowered with the following: • 1) decision-making control over agricultural production activities; • 2) control over the use of household income; • 3) leadership roles in the community, and • 4) ability to control their own time • Women’s leadership affects not only their households but also their entire community if they have the opportunity to play the key roles mentioned above.

22. Evidence of benefits of targeting Impact of agricultural productivity intervention on reducing gender gaps in use of production inputs Evidence indicates that non-targeted, non-gendered agricultural productivity interventions have very limited impact on women’s use of production inputs After 30 years of acknowledging the importance of gender equality, examination of the gendered constraints facing women as producers and marketers, and interventions designed to address those constraints, are in their infancy Evidence gaps

23. Impact of agriculture and nutrition projects on women’s empowerment In terms of agriculture production, decision-making over and access to credit, control over income, leadership in the community, and time use: • when these interventions increase the income-earning capacity of women it enables them to increase their bargaining power within the household • The majority of gendered productivity interventions in the literature indicates that gendered productivity and nutrition interventions have directly and positively increased women’s level of participation in agricultural production and household nutrition strategies

24. Impact of value chain commercialization interventions on access to employment A review of the literature identified three successful types of interventions: 1) value chain interventions where both women and men are included in the planning stages and where mutually beneficial enterprises are selected to prevent men taking over women’s enterprises once profitable 2) interventions that promote an enabling environment for improving women’s participation in value chains

25. Impact of value chain commercialization interventions on access to employment • Gendered interventions have better results in increasing women’s participation in value chain commercialization by effectively increasing their capacity to take advantage of innovations and linkage to supply chains as well as improving their working conditions and rights • There is also evidence that when women are able to retain income from their own business, their entire household benefits from better nutrition, health, and education as well as providing role models for other women

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

27. Resilience • There is now wide agreement that the interactions among climate change trends, ecosystem fragility and geo-political instability have produced new configurations of risks that are increasingly difficult to predict. • The combined effect of these new risk configurations has in turn placed a more pronounced set of negative pressures on the agro-ecological systems, economic resources, and social institutions that affect the well-being of the poor. • Viewed by many as a strategic approach to deal with the range of unpredictable risks that undermine well-being, resilience has recently emerged as a key concept for policy and program development.

28. Prologue Activity – past few years

29. Defining Resilience • The provision of a clearly stated definition of resilience is critical point of departure for measurement. • While resilience has received a good deal of attention, it would be fair to say that the field has not reached consensus on a definition. • CARE’s definition in its resilience strategy for the Sahel is: “The capacity of families, communities and systems to absorb, adapt to, and recover from shocks and stresses (e.g. drought, high food prices, land degradation, climate change, population growth, conflict) in ways that support economic and social development and growth.”

30. Defining Resilience • The Resilience Technical Working Group definition of resilience is the following: “Resilience is the capacity that ensures adverse stressors and shocks do not have long-lasting adverse development consequences” • Defining resilience as a capacity means that resilience is comprised of a set of ex ante and ex post attributes and supports that should positively shift the relationship between shocks and development outcomes (this is important to measurement)

31. Conceptual Frameworks • Adoption of a conceptual framework for the assessment of resilience is important for providing a comprehensive picture of the specific elements that contribute to resilience and clarifying the types of information that must be collected in order to adequately measure it. • Over the past five years, considerable work has gone into the development of conceptual frameworks of resilience that help users understand how shocks and stresses affect livelihood strategies and household well-being, and help identify the key leverage points to be used in a theory of change, which in turn informs programming designed to enhance resilience

32. Resilience Framework Context e.g., social, ecosystems, political, religious, etc. Disturbance e.g., natural hazard, conflict, food shortage, fuel price increase Absorptive, adaptive and transformative capacities Adaptive state to shock Reaction to disturbance e.g., survive, cope, recover, learn, transform Livelihood Outcomes Resilience pathway (-) Food Security Adequate nutrition Environmental security Food Insecurity Malnutrition Environmental degradation Shocks Bounce back better Exposure Bounce back Context Level of aggregation Structures/processes Livelihood Assets Livelihood Strategies Sensitivity Stresses Vulnerability pathway Recover but worse than before Collapse ( + )

33. Well Being Outcomes that are Resilient Development Indicators (food security, nutrition, poverty) Transformative Capacity • Strengthen governance functions, including formal and customary institutions • Promote representativeness within governance structures • Improve infrastructure systems (roads, communications, market systems) • Support effective social protection mechanisms (formal and informal safety nets) • Promote social and economic policies that support resilience • Provide basic social services • Develop institutional capacity: public management; accountability systems; technical skills in data collection, analysis, monitoring; early warning; risk analysis • Promote peace building and conflict resolution mechanisms • Adaptive Capacity • Promote diverse livelihood strategies that ensure against different types of risks • Promote asset accumulation and diversification • Activities that encourage the expansion of aspirations • Improve human capital (health, education, nutrition) • Enable improved access to credit • Support smallholder market linkages • Improve access to technologies • Strengthen diverse social networks • Promote gender empowerment • Support for healthy ecosystems (land, water, biodiversity) • Absorptive Capacity • - Strengthen and maintain Informal safety nets • Support local peace building, conflict mitigation and natural resource management through informal governance structures • Strengthen risk reduction, risk mitigation and risk coping mechanisms (community-based early warning, contingency plans, household savings) • Strengthen capacity for community organization and collective action Integrated Resilience Program Theory of Change Joint Problem Analysis Involving diverse stakeholders and contextualized at the sub-national level Multi-Sectoral Resilience Assessment Among chronically vulnerable populations exposed to food security shocks

34. Proposed Analytical Framework for Measuring Food Security Resilience Indicators Indicators Indicators Indicators Baseline Well-being and Basic Conditions Measures Disturbance Measures (shocks/stresses) End-line Well-being and Basic Conditions Measures • Food security • Health/ nutrition index • Asset index • Access to services index • Infrastructure • Ecological/ ecosystem services index • Psychosocial measure • Poverty measure • Food security • Health/ nutrition index • Asset index • Access to services index • Infrastructure • Ecological/ ecosystem services index • Psychosocial measure • Poverty measures • Frequency, duration, intensity of: • Covariate shocks/ stressors • Drought • Flood • Health shocks • Political crises • conflict • Market prices • Trade/policy shocks • Idiosyncratic shocks/stressors • Illness/death • Loss of income • Crop failure • Livestock losses • Absorptive Capacity • Coping behavior • Risk management • Informal safety nets • Conflict mitigation • Disaster mitigation & EWS • Savings groups • Bonding social capital Resilience Response Measures • Adaptive Capacity • Human capital • Debt and credit • Use of assets & info • Psychosocial • Livelihood diversification • Bridging Social capital • Transformative Capacity • Governance mechanisms • Community networks • Protection and security • Use of basic services • Use of formal safety nets • Use of markets • Use of Infrastructure • Policies/regulations • Linking social capital

35. Challenges • Limited ability to facilitate transformational change: The ability of most NGOs to improve transformative capacity, particularly at a national level, is often limited by external factors beyond their control. • Funding mechanisms: Many NGO efforts focus on short-term, stand-alone projects rather than on longer-term programs • Competition among NGOs: Limited financial resources can result in competition between NGOs and other actors

36. Opportunities • A number of opportunities have the potential to positively influence and shape NGO approaches to enhancing resilience capacity. • Many donors are committed to new and more flexible funding mechanisms that link humanitarian and development activities • Partnering with private interests may prove effective in advocating for infrastructure investment in marginalized or underserved areas that are not being served by government initiatives.

37. Figure 1. CARE Target Variables & the Estimated Contributions of Underlying Determinants to Reductions in Stunting, 1970-2012 (%) (Source: Adapted from Smith and Haddad 2014) Figure 1. APM-G2S Targeted Variables & the Estimated Contributions of Underlying Determinants to Reductions in Stunting, 1970-2012 (%) (Source: Smith and Haddad 2014) Health Environment 38.6% Food Production Environment 33.4% Food Production Environment 33.4% Health Environment 38.6% Gender Equity Environment 27.9% Gender Equity Environment 27.9%

38. Figure 2. CARE Activities & Impact Paths on the Determinants of Child Nutritional Status (Source: Adapted from Smith and Haddad 2014) Child’s nutritional status Child’s dietary intake Child’s health status Household food security Care for mothers & children Health environment & services Resources for health Resources for food security Resources for care Caregiver knowledge & beliefs Adequate sanitation In-kind food trans-fers Safe water supply Caregiver resource control & autonomy Cash income Sustainability &Resilience Health-care avail-ability Environ-mental safety/ shelter Food produc-tion Caregiver physical & mental status IYCF/ Maternal Nutrition WASH CC/ NRM Produc-tion Value-Chains/ Micro-Finance Voucher-CCT Women’s Empower-ment IYCF/ Maternal Nutrition Maternal Health Window of Opportunity (2008-2012): IYCF/Maternal Nutrition & Maternal Health, & Women’s Empowerment (5 countries) Results chain Produc-tion Value-Chains/ Micro-Finance Food Aid Reform CC/ NRM FNS (N@C) Activities FLJ & NP (WO) Activities Gender & Empowerment, Governance , Policy & Advocacy, and Emergency Cross-cutting Themes Political & economic structure, Socio-cultural environment, & Potential resources -- environment, technology & people Context, long-term results

39. Figure 3. UNICEF Unifying Framework for Child Malnutrition[1] with Points of Influence for CARE Core Program Interventions • (Source: CARE 2012, Nutrition at the Center: An Integrated Approach to Maternal and Child Nutrition, Proposal) [1] Source: UNICEF, 1997

40. Key points from CARE staff discussion Strengths in FSN: • Gender and work with women smallholder farmers • Value chains, financial services • Adaptation to climate change • Water, and water in agriculture/WASH/nutrition • Food aid reform influence, especially in advocacy • Strong, innovative health team • Innovative, collaborative initiatives underway • ACRES, Shouhardo, GRAD, Pathways • Technical expertise in Nutrition • Participation in regional and international bodies

41. Key points from CARE staff discussion Critical gaps: • Program design • Not enough integrated design; still work in silos • Little technical expertise outside of specific projects readily available • Emergency and development interventions weakly connected • Knowledge management • Good work not being captured • M&E technical capacity to capture evidence weak • not available to other parts of the organization to use for design, advocacy • CARE not recognized for work it is doing • Time and resource constraints • Little flexibility to work on integrated design • No prioritization on a few focus areas (willingness to drop areas) • Limited TA available; not tapping enough to research institutions

42. Key points from CARE staff discussion Opportunities: • Globally there are evidence gaps in many areas where CARE is focusing: • Gendered approaches to food security • Impact of smallholder agriculture initiatives on nutrition • Impact of climate change adaptation on smallholder production and incomes, and resilience • Areas for innovation and action research • Women’s empowerment and resilience • Smallholder Sustainable Food Systems as the focal point for Nutrition, Climate Change, Market Engagement, Water and Women’s empowerment • Strategic Partnerships • With research institutions with similar goals (expand university and agricultural research linkages) • Extend/access technical expertise (cadre of regional/local technical experts to draw upon for M&E, and Knowledge Management