the time is now: improving food security and nutrition for the poorest

THE TIME IS NOW:
IMPROVING FOOD SECURITY AND
NUTRITION FOR THE POOREST
ZENEBA MUHIA WITH HER HUSBAND SAID MOHAMMED AND CHILDREN OUTSIDE THEIR HOME, BUILT FROM EUCALYPTUS TREES AND CORRUGATED IRON SHEETING. (CHILDREN,
CLOCKWISE, FROM LEFT: AHAMED, 2, FATIMA, 11, MOHAMMED, 7, ABDU, 4 AND ALGANESH, 6.) PHOTO: CAROLINE IRBY FOR CONCERN WORLDWIDE, SOUTH WOLLO, ETHIOPIA.

INTRODUCTION FROM THE
CHIEF EXECUTIVE
Since our founding in 1968 in response to the famine in Biafra,
Nigeria, Concern Worldwide has pursued its mission to help people
living in absolute poverty achieve major, sustainable improvements
in their lives. Now, 43 years later, in 25 countries, Concern remains
steadfastly committed to working with the world’s poorest people to
transform their lives. Hunger is often the most visible manifestation
of extreme poverty, and in the midst of increasingly volatile food
price increases and natural disasters, Concern is more determined
than ever before to empower the poorest to effectively produce and
manage their own food supplies, and to eradicate malnutrition and
child hunger and their root causes.
In all the places in which Concern works, we are
continually confronted by the scourge of undernutrition.
Lives are cut wretchedly short, the potential of millions of
children is blighted, and the productivity and prosperity of
nations are undermined. The loss and suffering caused
by hunger are utterly unacceptable in our time, especially
because we know that solutions exist.
The statistics are sobering. Over 35 percent of the
preventable deaths among children under five every year
are associated with undernutrition. Lack of adequate
nutrition causes irreversible physical and mental stunting
in an estimated 195 million children per year. About 55
million children suffer from wasting (acute malnutrition),
with low weight for their height: this is equal to the total
population of children under five living in industrialized
countries. Undernutrition is also a concentrated problem,
and one inextricably linked with poverty: over 90% of
undernourished children live in just 36 countries.
The very nature of hunger demands an urgent response.
Adequate nutrition is critically important during the 1,000
days from pregnancy to two years of age. There is now
conclusive evidence of the impact of undernutrition
on infant and child mortality and its largely irreversible
long-term effects on health and cognitive and physical
development. Ensuring adequate nutrition in the first
years of life is essential to improving health outcomes.
We know when to act. We also know that cost-effective
and high-impact interventions exist. With this knowledge
comes a responsibility to act.
multilaterals and the private sector to save the lives and
protect the futures of the most marginalized and vulnerable
children as we do today. While this is vital to affecting
change, political commitments must be accompanied by
policy change backed up by additional resources.
There are challenges ahead, but they are not insurmountable
if there is political commitment and the will to work together
to address both the effects and the root causes of hunger.
Concern’s work is the result of systemic, global vision,
but its results are best viewed from the ground in the
real stories of partners coming together to improve food
security and scale up nutrition. This booklet offers a brief
“on-the-ground” view of Concern’s contribution to food
security and nutrition and of our commitment to innovation
and partnership in the fight against hunger. Examples
include our partnership with the International Food Policy
Research Institute (IFPRI) on a project in Zambia to
Realign Agriculture to Improve Nutrition (RAIN); Concern’s
leadership in the development of the Community-
Based Management of Acute Malnutrition (CMAM),
a decentralized approach with the potential to save
millions of children’s lives; Concern’s work in conservation
agriculture; our innovative, integrated, early response
to a massive food crisis in Niger; our groundbreaking
Innovations for Maternal, Newborn and Child Health
initiative and our national and global advocacy efforts
to scale up nutrition. We believe that we have reached
a turning point in the fight to end child hunger, and we
are proud to share stories of our ongoing and renewed
efforts to promote the health of the poorest people in
our world.
This evidence has underpinned a number of recent political
and policy initiatives aimed at improving early childhood
nutrition. Never before have we had as much knowledge,
evidence, and political will combined with grassroots
mobilization and collaboration between civil society, donors,
2

ENDING CHILD HUNGER: A TURNING
POINT FOR GLOBAL ACTION
In 2008, the British medical journal the Lancet issued a five-part series
on nutrition that provided evidence on the impact of early childhood
undernutrition. The most common form of malnutrition across the world is
micronutrient deficiency, which affects 2 billion people. The most widespread
deficiencies highlighted were in vitamin A, zinc, iodine and iron.
THE EVIDENCE
While illness can cause malnutrition, malnourished
children are more at risk of contracting illnesses such as
diarrhea, malaria and pneumonia. Their growth is more
likely to be stunted. Malnourished girls are more likely to
give birth to low birth-weight offspring, contributing to a
multi-generational cycle of malnutrition. Impaired cognitive
function leads to lower educational performance and
economic productivity, which means that child undernutrition
hinders economic development. Where childhood
malnutrition is pervasive, the loss to GDP can be as high as
2 to 3 percent, not including the indirect costs of malnutrition
such as healthcare and lost wages due to illness.
The barriers children, young women and mothers face
in meeting their nutrition needs include poverty, lack of
education on healthy diets and infant care, lack of access
to a diverse variety of nutritious foods, lack of access to
adequate health care and sanitation, restrictive cultural
practices, and low social status.
In most countries of Sub-Saharan Africa, over 20 percent
of women have a low body mass index and about 11 percent
of children in the developing world are born small. In
countries where gender inequality is great, high rates of
hunger also occur because female members of a household
will “eat least and eat last.”
Low rates of exclusive breastfeeding (in developing
countries this rate is less than 50 percent) also inhibits
a child’s growth and development and “suboptimal”
breastfeeding results in the death of 1.4 million young
children each year. Complementary foods, ideally
introduced at 6 months, may also be unavailable,
of poor nutritional quality, or are introduced too early
or too late.
But the issue of undernutrition does not end there.
The Lancet also identified proven and cost-effective
interventions focused on the “window of opportunity”
from minus 9 months to two years of age.
Catherine Msigwa, Tanzania. Photographer: Mike Goldwater, 2008
3

The steps that need to be taken are well understood.
They include:
■ a number of direct nutrition-specific interventions
focusing on pregnant women and children under the
age of two
■ broader multi-sectoral approaches such as supporting
agricultural development, improving social protection
and ensuring access to healthcare
Building on the Lancet series, a World Bank study in
2009 identified a package of 13 such interventions
for the 1000 days between pregnancy and age 2.
They would be delivered as part of wider public health
programmes or, in the case of fortified foods, through
private markets. They are summarised in Table 1.
TABLE 1: EVIDENCE-BASED DIRECT INTERVENTIONS
TO PREVENT AND TREAT UNDERNUTRITION
PROMOTING GOOD NUTRITIONAL PRACTICES ($2.9 BILLION)
■ Breastfeeding
■ Complementary feeding for infants after the age of six months
■ Improved hygiene practices, including hand-washing
INCREASING INTAKE OF VITAMINS AND MINERALS ($1.5 BILLION)
Provision of micronutrients for young children and their mothers
■ Periodic Vitamin A supplements
■ Therapeutic zinc supplements for diarrhea management
■ Multiple micronutrient powders
■ De-worming drugs for children (to reduce losses of nutrients)
■ Iron-folic acid supplements for pregnant women to prevent and treat anemia
■ Iodized oil capsules where iodized salt is unavailable
Provision of micronutrients through food fortification for all
■ Salt iodization
■ Iron fortification of staple foods
THERAPEUTIC FEEDING FOR MALNOURISHED CHILDREN WITH
SPECIAL FOODS ($6.2 BILLION)
■ Prevention or treatment for moderate undernutrition
■ Treatment of severe undernutrition (“severe acute malnutrition”) with
ready-to-use therapeutic foods (RUTF).
Source: Scaling up Nutrition: What will it cost Horton et al, 2009.
This study estimated the total costs of the 13 interventions
in the 36 highest burden countries at $11.8 billion
annually and that these interventions would save the lives
of 1 million children annually.
The benefits of investing in early childhood nutrition
have been highlighted by the Copenhagen Consensus
Panel, a panel of leading economists, who ranked the
provision of micronutrients as the world’s best investment
for development. Vitamin A and zinc supplementation for
children came in top yielding benefits worth $1 billion per
year for an annual investment of $60 million.
FROM FARM TO FORK
In parallel with direct health interventions, global
investments in agriculture and food security present a real
opportunity to address maternal and child undernutrition.
The price the international community pays for not
tackling undernutrition is significant, and as such, this
opportunity should be seized. Nutrition security depends
on food security which, in turn, depends on sustainable
agricultural development.
In February 2011, over 1,000 stakeholders from the
nutrition, agriculture and health sectors, including
Concern Worldwide, gathered in New Delhi, India to focus
on ways of leveraging agriculture for improving nutrition
and health. Protection of natural resources endangered
by climate change, adequate support for small holder
farmers, and addressing micronutrient deficiency
will require integrated responses, developed at the
intersection of these three key sectors. The knowledge
gap on how agriculture can most effectively contribute
to nutrition and health outcomes needs to be filled, and
a commitment must be made to seek out and scale up
innovative solutions.
Better nutrition also requires improved access to markets,
for example, through community associations and publicprivate
partnerships.
More than 60 percent of farmers in Africa are women.
Empowering women in their roles as caregivers and
farmers will improve development. In recent years,
women working in the agriculture, forestry and fisheries
sectors have received only 7 to 9 percent of agricultural
development assistance. This needs to be addressed if
progress is to be realised.
THE SCALING UP NUTRITION
(SUN) FRAMEWORK
Spurred by the groundbreaking evidence in the Lancet,
as well as the food price crisis of 2008 that placed food
security and nutrition once again high on the political
agenda, a global multi-stakeholder effort led to the
development of a Scaling Up Nutrition (SUN) Framework
for Action and subsequent Roadmap. The SUN Framework
was agreed in early 2010 and launched in April. It serves
as a guide for the international community in efforts to
combat undernutrition and has been endorsed by over
100 partners from governments, civil society, international
organisations, the private sector, and academia.
Central to the SUN Framework is the recognition that
the real work will take place, and needs to take place,
at the country level. The Transition Team chaired by
the UN Secretary General’s Special Representative for
Food Security and Nutrition, Dr. David Nabarro, and task
forces will offer support and guidance to national level
processes and plans. Representatives from developing
countries are also part of the process and structure at
global level.
4

The SUN Framework was rapidly followed by the
development of “A Road Map for Scaling Up Nutrition,”
which was launched at the UN General Assembly Summit
for the Millennium Development Goals in September 2010.
The SUN Roadmap anticipates there will be (a) multistakeholder
platforms within countries participating in the
effort to Scale Up Nutrition, and that they will become
increasingly important as a means to ensure joint efforts
and a shared responsibility for results, (b) improved
sharing of experiences between countries and regions,
(c) joint action by different stakeholders to encourage
advocacy, (d) a major effort to stimulate relevant research,
(e) harmonized policy guidance, (g) better aligned assistance
from development partners, (h) stronger governance and
coordination of intergovernmental action, (i) support for
individuals as they become leaders for nutrition and
(j) a long-term commitment from national governments.
Some heads of Governments or senior officials have
already indicated their intention to participate in the
SUN movement to scale up nutrition, and to become
“early riser” countries. These include: Bangladesh,
Ethiopia, Guatemala, Malawi, Mozambique, Nepal, Niger,
Peru, Senegal, Tanzania, Uganda, Mali, Rwanda, Sierra
Leone, Ghana, Haiti, Zambia, and Benin.
MOVING FORWARD
The international nutrition community has accumulated
extensive evidence on undernutrition. Countries and their
partners have the knowledge and experience concerning
the management of multi-stakeholder platforms and
the capacities needed for scaling up nutrition. Global
momentum is building for a renewed effort to translate
these assets into large-scale improvements in the
nutrition of high-burden countries.
The coming years will be crucial for sustaining the
commitment, capacities and coordination for these efforts
to succeed. There are important roles in this process for all
stakeholders—national governments, donors, civil society,
and the private sector. Joint efforts and intersectoral support
towards a common goal will be paramount to achieving once
and for all the eradication of hunger and undernutrition.
Greenland
2010 GLOBAL HUNGER INDEX SCORES BY SEVERITY
Iceland
Sweden
Norway
Finland
Russian Federation
Estonia
United Kingdom
Denmark
Latvia
Lithuania
Canada
United States
of America
Mexico
Western Sahara
Ireland
Portugal
Morocco
Spain
Neth.
Bel.
France
Algeria
Germany
Lux. Czech Rep.
Slovakia
Austria
Switz. Hungary
Slov.
Croatia
Italy Bos. &
HerzṢerb.
Mont.
Mace.
Albania
Greece
Tunisia
Poland
Libya
Belarus
Ukraine
Mold.
Romania
Kazakhstan
Bulgaria
Georgia
Uzbekistan Kyrgyz Rep.
Armenia Azerb.
Turkey
Turkmenistan Tajikistan
Cyprus Syrian
Lebanon
Arab Rep.
Iran,
Afghanistan
Israel
Iraq Islamic Rep.
Jordan
Kuwait
Pakistan
Egypt,
Bahrain
Arab Rep.
Qatar
Saudi Arabia U.A.E.
Nepal
Bhutan
Bangladesh
Mongolia
China
N. Korea
S. Korea
Japan
Cuba
Dom. Rep.
Belize Jamaica Haiti
Honduras
Guatemala
Nicaragua
El Salvador
Panama
Trinidad & Tobago
Costa Rica
Venezuela, RB Guyana
French Guiana
Suriname
Colombia
Ecuador
Peru
Senegal
The Gambia
Guinea-Bissau
Guinea
Sierra Leone
Mauritania
Liberia
Mali
Niger
Burkina Faso
Benin
Nigeria
Côte Togo
d'Ivoire
Central African
Ghana
Republic
Cameroon
Equatorial Guinea
Congo,
Gabon Rep.
Chad
Congo,
Dem. Rep.
Sudan
Uganda
Rw.
Bur.
Kenya
Tanzania
Eritrea
Ethiopia
Yemen, Rep.
Djibouti
Somalia
Oman
India
Sri Lanka
Myanmar
Lao
PDR
Thailand
Cambodia
Vietnam
Brunei
Malaysia
Philippines
Indonesia
Papua
New Guinea
Brazil
Angola
Zambia
Malawi
Comoros
Timor-Leste
Chile
Bolivia
Paraguay
Namibia
Zimbabwe Mozambique
Botswana
Swaziland
Madagascar
Mauritius
Australia
Argentina
Uruguay
South
Africa
Lesotho
> 30.0 Extremely alarming
20.0–29.9 Alarming
10.0–19.9 Serious
5.0–9.9 Moderate
< 4.9 Low
No data
Industrialized country
Note: For the 2010 GHI, data on the proportion of undernourished are for 2004–06, data on
child underweight are for the latest year in the period 2003–08 for which data are available,
and data on child mortality are for 2008.
MAP: GLOBAL HUNGER INDEX 2010, PRODUCED BY CONCERN WORLDWIDE, INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE (IFPRI), AND WELTHUNGERHILFE
HUNGER FACTS
■ 925 million people do not have enough to eat and 98 percent of them live in developing countries.
■ Women make up a little over half of the world’s population, but they account for over 60 percent of the world’s hungry.
■ One out of four children in developing countries is underweight.
5

Moses Kerokara, Emanual Tara and Mita Davis from Grand Bassa in Liberia. Mita is
one of the farmers benefiting from the services of the Concern supported ‘Farmers
Resource Centre’. Photographer: Christopher Herwig, 2007
CONCERN WORKS TO IMPROVE
FOOD AND NUTRITION SECURITY
Concern’s core mission is to make sustainable improvements in the lives of
the extreme poor. Chief among these improvements is the eradication of
hunger and child undernutrition, which are both a cause and a consequence
of poverty. The promotion of food and nutrition security has therefore been
central to Concern’s work since the organisation was founded in 1968. Our
programmes work across multiple sectors in 25 countries to improve the
food production asset base and livelihood options of the extreme poor while
reducing vulnerability to natural, social and economic shocks. Concern also
responds to communities’ immediate needs in emergencies through the
direct provision of a range of goods and services.
Recognising that increased availability and even
increased access to food does not ensure sustained
nutrition security, Concern also supports more direct
nutrition interventions to ensure food is optimally utilised
and to support those who, in spite of food security
interventions, fall through the cracks and require
treatment. Among these direct interventions, Concern has
particular expertise in the community-based management
of acute malnutrition (CMAM), and also supports
behavioural change communication to directly improve
infant and young child feeding and health and hygiene
practices. Finally, Concern supports programmes to
improve access to quality health care services in
12 countries and to quality water, sanitation and hygiene
(WASH) facilities in 18 countries. These health and
WASH programmes work to both directly reduce child
mortality due to disease and to indirectly reduce child
undernutrition, of which disease is an underlying cause.
6

Concern has been a global leader in the development of
the community-based management of acute malnutrition
(CMAM). Working in partnership with Valid International,
Concern piloted this new approach in three countries in
2002/2003, at a time when treatment was limited to a
grossly insufficient inpatient-only model. The innovative
approach, which has proven successful at achieving high
coverage, early detection and effective treatment of acute
malnutrition (wasting and nutritional oedema), has now
been widely adopted as best practice by the UN and the
majority of governments and non-governmental agencies.
This remarkable global shift to adopt the CMAM
approach and the improvements in treatment access
that have resulted are in large part due to the strategic
partnership forged between Concern and Valid and the
agencies’ joint commitment to community-led problem
analysis; innovation; quality documentation, synthesis and
dissemination of evidence; followed by ongoing technical
support and advocacy for scale-up.
Concern remains committed to the scale-up of quality
CMAM and continues to directly and indirectly (through
government partners) support CMAM in ten countries:
Malawi, Ethiopia, Sudan (North and South), Kenya, Niger,
Rwanda, Haiti, Uganda, Nepal and Somalia and previously
in Timor and DR Congo. Concern also continues to work
at global and national level through the development
of CMAM implementation guidelines, training modules,
monitoring tools, and assessing the relative cost
effectiveness of CMAM and conducting joint research
with Valid on adapting CMAM for populations with high
HIV prevalence and alternative, lower-cost recipes for
ready-to-use therapeutic foods.
Concern recognises that the impact of interventions
on child nutrition can be improved, if there is a better
understanding of the factors which determine the extent
of this impact In order to contribute to the global evidence
on this link between food security interventions and child
nutrition and to improve its own programmes, Concern
has embarked on a new partnership with the International
Food Policy and Research Institute (IFPRI), with funding
from Irish Aid, to design an integrated agriculture-based
programme that will prevent undernutrition and actually
reduce the prevalence of stunting in children under
five years.
Scaling up evidence-based interventions is essential to
achieving impact. Concern is currently working to identify
barriers to scale up of key health interventions and develop
innovative solutions to overcoming them through its
Innovations in Maternal, Newborn and Child Health Initiative.
REALIGNING AGRICULTURE TO IMPROVE
NUTRITION (RAIN)
Concern and the International Food Policy Re-search Institute (IFPRI)
have recently embarked on a partnership to design and rigorously
evaluate a project to prevent stunting in young children by realigning
a package of agriculture-based interventions to specifically improve
nutrition components.
The programme, currently being implemented in Mumbwa District,
Zambia is working to understand and address the underlying causes
of undernutrition. Like many traditional food security interventions, the
RAIN project aims to effectively improve food availability and access.
One of the defining differences of the RAIN approach will be the
emphasis on understanding the key impact pathways linking agriculture
and other interventions to improved nutritional outcomes for children
under two years of age and actually designing the core agricultural
interventions to achieve those outcomes. In this way, RAIN aims to go
beyond the traditional objectives of food security programmes (e.g.
increased yields, reported increase in meals per day) and to focus on
measureable improvements in nutrition security.
Saïd Mohammed on his plot of land at the Korichefe irrigation site,
South Wollo zone, Ethiopia. Photographer: Caroline Irby, 2007
Critical issues such as the nutritional profile of crops, methods of
food storage and preservation, constraints and opportunities for
optimal infant and young child feeding, and the decision making
power and workload of women will be carefully considered during the
design phase. Essential components will be incorporated to address
these issues, including promotion of nutritious crops/small livestock,
women-focused appropriate technology, intensive behaviour change
communication, links with health care and empowerment of women.
7

CONSERVATION AGRICULTURE
Concern has been promoting Conservation Agriculture in Zimbabwe since 2006,
with impressive results. Concern has also introduced CA as part of an EU Food
Facility project in Tanzania and has initiated a CA project in North Korea. In
May 2010 Concern announced a major pilot project in Zambia and Malawi
aimed at training 6,400 farmers in the techniques of Conservation Agriculture.
This pilot project is being funded by an Accenture Global Giving Grant.
WHAT IS CONSERVATION AGRICULTURE
Almost three quarters of the land in sub-Saharan Africa
is partially or severely degraded. This has come about
as a result of excessive soil disturbance, the reduction
in nutrients caused by monoculture, late planting and
the lack of investment in agriculture. The consequent
reduction in yields is a major problem, most especially for
poor farmers, many of them women, farming small plots
of land.
Conservation agriculture has three key principles:
do not disturb the soil; keep the soil covered (using
crop residues as mulch); and rotate the crops. In
addition, Concern promotes the use of small amounts
of carefully selected fertilisers. Together, these simple
techniques reduce the energy needed to farm, maintain
the natural soil structure, help avoid excessive depletion
of nutrients and maximise the benefits (while minimising
the cost) of fertiliser.
Conservation agriculture is a radically different way of
producing crops which leads to higher yields and earlier
harvests, even in dry years. It uses techniques that reduce
both erosion and the energy and workload needed to
plant crops, conserves soil moisture and enables farmers
to plant as soon as the rains start. This approach typically
improves yields of maize by 70% without fertiliser; it more
than trebles yields when fertiliser is introduced.
Conservation agriculture uses resources more efficiently
and improves flexibility. In Zimbabwe we achieved our
results using relatively simple appropriate technology
such as planting pits or simple ox-drawn rippers—tools
which have deep penetration but cause minimum
disturbance to the soil. These save both time and effort
and help increase yields.
Conservation Agriculture is not a “silver bullet”—it is not
appropriate for some soil types and some plants. But
it can and is making a difference to the livelihoods of
very many food insecure people in sub Saharan Africa
and beyond. Moreover, it is sustainable. Many current
practices are not.
Concern used the Household
Economy approach to evaluate the
impact of Conservation Agriculture
by comparing poor and very poor
farmers who had adopted CA with
farmers in the same wealth group
who practise traditional agriculture
Total Kg Produced Per Farmer
1000
800
600
400
200
CROP PRODUCTION (Gokwe North)
0
CA V. Poor
V. Poor CA Poor Poor GKN
millet cowpeas groundnuts sorghum maize
8

Women in Gokwe, Zimbabwe present their registration cards at a Concernmanaged
cash distribution point. Photo: Elena Ruiz Roman, Zimbabwe
EMERGENCY RESPONSE
Concern works in some of the most poorest and vulnerable countries in the
world. All of our countries of operation are affected by disasters—many of
which are predictable and recurrent. Working with communities to mitigate the
risk and impact of these disasters is an essential component of our work, and
in many locations we work to improve community resilience and to establish
information/early warning systems to help poor communities better prepare for
and mitigate against the impact of disasters. Aware that mitigation measures
cannot prevent all disasters from occurring, we also pride ourselves on the
speed and appropriateness of our emergency responses.
The purpose of our interventions is to address the
immediate needs of disaster affected populations
through enhancing their capacity to cope. This may
comprise the distribution of food and other essential
life saving interventions—access to clean water, shelter,
or the means of assisting in the rapid recovery of their
productive capacity and assets.
In 2010, Concern responded to 41 emergencies in
14 countries. Eighteen of these emergencies occurred
in areas of conflict, some in conflict zones where
Concern has been active for many years such as
Somalia, South Sudan and Chad. The main responses
occurred in three countries affected by massive
crises—Haiti, Pakistan and Niger (please see box
on next page).
In January 2010, a devastating earthquake hit Haiti, causing
one of the largest natural disasters in history. More than
220,000 were killed and millions were made homeless
in the immediate aftermath of the earthquake. Concern
responded by distributing NFIs (non-food items), providing
water and sanitation facilities, managing camps, providing
cash-for-work and cash transfers, and nutrition and
emergency education interventions. We also provided
temporary shelter (e.g. tents) and have constructed transitional
shelters for families. As Haiti began to move from emergency
response to reconstruction, it was faced with another disaster
as cholera began to spread towards the end of 2010, killing
more than 4,000 people. We have increased our water and
sanitation programmes as a result, providing latrines, soap
and clean water as well as carrying out hygiene promotion.
Our response in Haiti has helped 130,000 people.
9

NIGER
Millet is the crop that keeps most people alive in Niger. But drought and
failed rains in 2010 led to massive crop failure of millet and other staples,
leaving 60 percent of the country’s population facing hunger.
Concern Worldwide began tracking the first signs of the food crisis in
October 2009. We launched an innovative, integrated, early response to
reach 280,000 of the most vulnerable before the food ran out— before large
numbers of children became severely malnourished.
Concern focused on mobilizing early to prevent and mitigate the
onset of severe malnutrition. The multi-sector response in Tahoua, one
of the country’s most food insecure regions, involved: distributing drought
resistant seeds and fertilizer; screening, referring, and reinforcing the
Ministry of Health’s capacity to provide nutrition support to pregnant women,
breastfeeding mothers, and children under five; and an innovative initiative that
started distributing emergency cash—before the crisis—to the most vulnerable
women in 160 villages via mobile phones and manual cash transfers.
Initial results show that Concern’s response in Niger successfully prevented
and averted a nutrition emergency in its target communities:
■ Concern nutrition surveys undertaken with the Department of Health
show that “global acute malnutrition” rates in Tahoua District were at
11.7 percent—below the emergency threshold of 15 percent.
■ Eighty percent of villages that were rated as being at risk of extreme food
shortages in December 2009 had above-average harvests in 2010.
Concern is in the process of completing research in partnership with Tufts
University to analyze the impact of its different types of interventions on
nutrition status in Tahoua. To help improve the effectiveness of responses
to food crises, Concern will share the results of this research with the
Government of Niger and the wider humanitarian community to help find
better, more cost-effective ways to prevent and fight hunger.
Agaycha Awikguini, a 50-year-old widow receives her first emergency
cash transfer from Concern. Photo: Niger, Concern Worldwide
2010 also saw Pakistan face one of its worst
humanitarian disasters as floods ravaged the country,
which killed nearly 2,000 people but affected more
than 20 million across four provinces. Concern launched
its largest ever emergency response in the country,
providing approximately one million people with
emergency assistance including drinking water, latrines,
shelter, non-food items, food packages, debris removal
kits, and emergency medical services. Concern in
Pakistan is responsible for overseeing the disbursement
of the US Office for Overseas Disaster Assistance
(OFDA) funded ‘Responding to Pakistan’s Internally
Displaced’ (RAPID) grant to organizations providing
humanitarian assistance in emergency situations
in Pakistan.
Extreme weather is a major cause of emergencies,
with Concern implementing 14 emergency programmes
in response to climate related disasters in 2010. We
continued to work to mitigate the effects of drought in
Ethiopia, Kenya and Niger, while flooding prompted us
to respond in Afghanistan, Ethiopia, India, Pakistan,
South Sudan and Tanzania.
The nature of our interventions varies according to the
needs identified on the ground. In circumstances where
food is available in the market but people are unable
to access it because of lack of money, we may seek to
inject cash into the local economy by transferring limited
amounts of cash to the very poorest. Such cash transfer
programmes are carried out by our teams in Niger,
Zimbabwe, India, Kenya, Sierra Leone and Zambia. We
are using mobile phone technology to transfer cash to
poor people in Niger—and have done so in Kenya and
other countries. In Zimbabwe, Concern and WFP (World
Food Programme) are co-operating in a pilot project
intended to assess the relative effects of giving people
cash, food or part cash and part food in order to deal
with “the hunger season” in that country. An evaluation
of the Zimbabwe project by Oxford Policy Management
in 2010 highlights that recipients of the transfers were
able to obtain sufficient staple food for the duration
of the project, and the transfer of cash, cash and food,
and food were all found to have positive impacts on
intra-household relations. Following the evaluation
the composition of the transfers has been modified
to a more cost-effective and locally appropriate
combination of food and cash.
Recognising the need to foresee and better prepare
for emergencies, Concern is moving to a process where
risk and vulnerability is better understood and longer
term development programmes seek to mitigate against
these. Examples of Disaster Risk Reduction include
Watershed Management (building bunds to trap water,
building channels to divert excess water) and Natural
Resource Management (e.g. rotation of pastures,
corralling). This is an aspect of our work which will
become ever more important as the effects of climate
change make themselves felt.
10

Participants of Concern’s Municipal Health Partnership Program Kurigram, Bangladesh attending an information session
on disadvantaged mothers’ basic rights in accessing health care services. Photo: Allyson Brown, Concern Worldwide
ADVOCACY
Concern Worldwide is a “doing” organisation. For more than forty years we have
been active on the ground in dozens of countries helping poor people to cope
with the effects of poverty, natural disasters and conflict. Yet, we acknowledge
that this work is not enough. We look to go further in using the experience
derived from our work to inform and influence the people who make the
decisions and formulate the policies which influence the lives of the poor.
In the developing world itself our role is to support local
partners in their interaction with decisions makers. Our
role is to facilitate local people in having their voices heard.
■ In Orissa, India Concern works with partners, tackling
corrupt practices and seeking to ensure that people
receive their state entitlements.
■ In Sierra Leone, Concern advocated for the introduction
of free health care for pregnant women and young
children. This has now been implemented by the Sierra
Leone Government.
■ In Bangladesh, Concern’s “We are People Too” campaign
succeeded in persuading Dhaka City Corporation to
extend its birth registration to the thousands of people
who live in the City’s streets thereby giving pavement
dwellers equal entitlement to services.
particular women famers. Concern UK leads our work on
this issue through the “Unheard Voices” Campaign.
In Europe, the United States and globally we participate
in key forums, bringing our expertise to bear to influence
development and humanitarian policy at the highest
levels, including the 1,000 Days Partnership.
Concern is an active participant in the activities of
Concord, Voice and ICVA, and also of Interaction in the
United States. Concern is also active in the Nutrition
Action Group which comprises a small number of NGO’s
advocating in the area of Nutrition and Maternal Health
and a member of the Contact Group which acted in an
advisory role during the reform process of the Committee
on Food Security of the FAO.
In Ireland, Concern has worked in concert with Irish Aid
in sharing learning and experience. Concern’s CEO, Tom
Arnold, served on the “Hunger Task Force” charged by
the Irish Government with developing a national strategy
to combat hunger in the Developing World. The need
to combat hunger and its primary cause, poverty, is the
central focus Concern’s advocacy work.
In that context Concern looks to direct attention to the
needs of marginal farmers (farming but hungry) and in
Concern has a special focus on the effectiveness of aid.
Concern is taking a lead role in the work of Alliance 2015
in monitoring the performance of the European Union in
looking to meet the Millennium Development Goals.
Concern co-operates with Welthungerhilfe and IFPRI
to produce the Global Hunger Index which analyses
and calculates world hunger according to a number of
different criteria. The 2009 Index focussed on gender
inequality. The 2010 Index focuses on nutrition.
11

concernworldwide.org
ABOUT CONCERN WORLDWIDE
Concern Worldwide is a non-governmental, international, humanitarian organization dedicated to the
reduction of suffering and working towards the ultimate elimination of extreme poverty in the world’s
poorest countries.
Concern’s mission is to help people living in absolute poverty achieve major improvements in their lives
that last and spread without ongoing support from Concern Worldwide.
Republic of Ireland
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Dublin 2
T +353 1 417 7700
F +353 1 475 7362
E info@concern.net
Northern Ireland
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Belfast BT1 2LW
T +44 28 9033 1100
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E belfastinfo@concern.net
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Chicago, IL 60604
T +1 312 431 8400
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E info.usa@concern.net
USA
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New York, NY 10017
T +1 212 557 8000
F +1 212 557 8004
E info.usa@concern.net
RURAL KAJIADO, KENYA. PHOTO: KENYA, CONCERN WORLDWIDE