1. Page 1 The PepsiCo Foundation Meeting March 31, 2008 International Food Aid Conference Kansas City - April 15, 2008 The Evolving Role of Food Aid in Reducing Malnutrition – An NGO Perspective Heather Danton Advisor, Livelihoods

2. Page 2 Malnutrition Magnitude of the Problem 150 million children under 5 undernourished 35% of child deaths (under 5 yrs) are attributable to undernutrition (3.5 million annually) 1 every 9 seconds Maternal undernutrition during pregnancy and lactation impacts child’s nutritional status For those who survive, stunting impacts are irreversible, with permanent reductions on physical growth, intellectual development, and economic productivity

3. Page 3 Global Distribution of Stunting 90% of stunted children live in just 36 countries Source: REACH

4. Page 4 Save the Children US Food Aid Programming in 2007 Uganda Malawi Mozambiqu e Banglades h Indonesi a Pakista n Tajikista n Bolivi a Ethiopi a Guatema la Haiti Honduras Mali Nicaragua Sudan

5. Page 5 Save the Children US Food Aid Allocations in 2007 Total Program Value: $99 million

6. Page 6 Save the Children US Food Security Conceptual Model Reduced Hunger & Malnutrition Adequate Availability of Food Adequate Access to Food Optimal Utilization of Food Resiliency to shocks Source: Webb and Rogers (2003)

7. Page 7 Addressing Malnutrition The Window of Opportunity Source: Shrimpton et al., 2001 We target children under the age of two

8. Page 8 Addressing Malnutrition Proven Interventions We focus on proven interventions

9. Page 9 Addressing Malnutrition Poor Coverage of Interventions Source: Lancet Volume 362, PP. 65-71 We work to reduce the coverage gap

10. Page 10 Intended Impact: Reduced Malnutrition in Children Strategic Objective Increase the Use of Key Nutrition Related Practices and Services Reducing Malnutrition The SC Approach

11. Page 11 Reducing Malnutrition SC Priority Interventions PracticesServices Nutrition Immediate Breastfeeding Exclusive Breastfeeding through 6 months of age Timely introduction of appropriate complementary foods Vitamin A supplementation (Maternal and Child) Iron supplementation Iodine supplementation Health Proper disposal of feces Hand washing at appropriate times Appropriate home care for Illness, including oral rehydration therapy for children with diarrhea Timely referral of seriously ill children Timely appropriate treatment of malnutrition, pneumonia, diarrhea, and malaria, including zinc therapy for diarrhea

12. Page 12 Intended Impact: Reduced Malnutrition in Children Strategic Objective Increase the Use of Key Nutrition Related Practices and Services Behaviors Reducing Malnutrition The SC Approach

13. Page 13 Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Behaviors Intermediate Result 1: Increased Access to, & Availability of, food and health services Intermediate Result 3: Improved Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Intermediate Result 2: Increased Quality Of Services Intended Impact: Reduced Malnutrition in Children Reducing Malnutrition The SC Approach

14. Page 14 Reducing Malnutrition SC’s Use of Food Aid Monetization: Cash for comprehensive nutrition programming Direct Distribution: Preventive Rations Incentive Rations Recuperative Rations Development Programs 2007

15. Page 15 Reducing Malnutrition The Evolving Role of Food Aid Three Trends in SC Food Aid Programming: Trend 1: Monetization to Direct Distribution Trend 2: Development to Emergencies Trend 3: Dry Rations to Ready to Use Foods

16. Page 16 The Evolving Role of Food Aid Trend 1: Monetization to Distribution Declining CASH resources for development food aid programming Cost/benefit ratio of delivering food is on the increase Decreased ability to affect behavior and create change at scale Save the Children Development Food Aid Programs – Monetization 2006 to 2007

17. Page 17 The Evolving Role of Food Aid Trend 2: Development to Emergency Clear shift in the relative size of Save the Children’s portfolio and future growth Emerging questions regarding emergency food aid: –Effectiveness of Supplementary Feeding (SC- UK publication and an upcoming global meeting to explore this subject) –Food aid versus Cash-based programming

18. Page 18 The Evolving Role of Food Aid Trend 3: Ready to Use Foods (RUF)

19. Page 19 The Evolving Role of Food Aid Trend 3: SC RUF Portfolio Growth 200320042005200620072008 1. Ethiopia 2. Sudan 3. Malawi 4. Mozambique 5. Pakistan 6. Bangladesh 7. Haiti 8. Uganda

20. Page 20 The Evolving Role of Food Aid Trend 3: SC RUF Priorities Emergency Programs: Community-based Therapeutic Care (CTC) Development Programs: Community-based Management of Acute Malnutrition (CMAM) HIV/AIDS: “Food by Prescription” PEPFAR Potential for Prevention: Lipid-Based Nutrient Supplements