1. TANGO International April 30, 2014
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
2008
Stewardship of the nutrition system dysfunctional and deeply fragmented
New evidence base introduced in the 2008 Lancet Series, identified critical 1,000 day window
Pinpointed a package of highly effective interventions for reducing undernutrition
Proposed a group of “high burden” countries as priorities for increased investment
2013
Nutrition significantly elevated on the global agenda
Launch of the Scaling Up Nutrition (SUN) Movement in 2010: a major step toward improved stewardship of nutrition architecture
Nearly every major development agency has published a policy document on undernutrition
Donors have increased ODA to basic nutrition by more than 60 percent between 2008 and 2011, amidst a very difficult fiscal climate
Nutrition is now more prominent on the agendas of the United Nations, the G8 and G20 and supporting civil society

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

5. Nutrition-sensitive Interventions and Programs
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
Examples:
Agriculture and food security
Social safety nets
Early child development
Maternal mental health
Women’s empowerment
Child protection
Schooling
Water, sanitation and hygiene
Health and family planning services

6. A 10% increase in GDP/PC leads to a 6% reduction in stunting
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. Nutrition-sensitive Programs Can Impact Nutrition: Through Empowerment of Women
There is evidence that men and women allocate food and other resources differently
Evidence shows:
Positive associations between dimensions of women’s empowerment and improved maternal and child nutrition
Negative associations between disempowerment (e.g. domestic violence) and child nutrition outcomes
Positive impacts of cash transfers and agricultural programs on measures of women’s empowerment

9. Targeted Agricultural Programs
Have impacts on several underlying determinants of nutrition:
Livelihoods and income
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. Impact of agricultural productivity intervention on reducing gender gaps in use of production inputs
Evidence of benefits of targeting
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
Ag productivity interventions include improved varieties/breeds, better technologies for soil management, animal care, and irrigation

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

33. Multi-Sectoral Resilience Assessment Joint Problem Analysis
Among chronically vulnerable populations exposed to food security shocks
Joint Problem Analysis
Involving diverse stakeholders and contextualized
at the sub-national level
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
Promote social and economic policies that support resilience
Provide basic social services
Strengthen governance functions, including formal and customary institutions
Develop institutional capacity: public management; accountability systems; technical skills in data collection, analysis, monitoring; early warning; risk analysis
Promote representativeness within governance structures
Improve infrastructure systems (roads, communications, market systems)
Promote peace building and conflict resolution mechanisms
Support effective social protection mechanisms (formal and informal safety nets)
Integrated Resilience Program
Well Being Outcomes that are Resilient
Development Indicators (food security, nutrition, poverty)
Theory of Change
Transformative Capacity

34. Baseline 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 measures
End-line Well-being and Basic Conditions Measures
Resilience Response Measures
Disturbance Measures (shocks/stresses)
Baseline Well-being and Basic Conditions 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
Poverty measure
Proposed Analytical Framework for
Measuring Food Security Resilience
Indicators
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, (%)
(Source: Adapted from Smith and Haddad 2014)
Figure 1. APM-G2S Targeted Variables & the Estimated Contributions of Underlying Determinants to Reductions in Stunting, (%) (Source: Smith and Haddad 2014)
Food Production
Environment
33.4%
Food Production
Environment
33.4%
Health
Environment
38.6%
Health
Environment
38.6%
Gender Equity
Environment
27.9%
Gender Equity
Environment
27.9%

38. (Source: Adapted from Smith and Haddad 2014)
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 food security
Resources for care
Resources for health
Sustainability &Resilience
In-kind
food trans-fers
Cash
income
Food
produc-tion
Caregiver physical
& mental status
Caregiver resource control & autonomy
Caregiver knowledge & beliefs
Environ-mental safety/
shelter
Health-care
avail-ability
Adequate sanitation
Safe water supply
CC/
NRM
Voucher-CCT
Value-Chains/
Micro-Finance
Produc-tion
IYCF/
Maternal Nutrition
Women’s
Empower-ment
IYCF/
Maternal Nutrition
Maternal Health
WASH
Produc-tion
Window of Opportunity ( ):
IYCF/Maternal Nutrition & Maternal Health, & Women’s Empowerment
(5 countries)
Results chain
CC/
NRM
Food
Aid
Reform
Value-Chains/
Micro-Finance
FNS
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