the time is now: improving food security and nutrition for the poorest
the time is now: improving food security and nutrition for the poorest
the time is now: improving food security and nutrition for the poorest
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THE TIME IS NOW:<br />
IMPROVING FOOD SECURITY AND<br />
NUTRITION FOR THE POOREST<br />
ZENEBA MUHIA WITH HER HUSBAND SAID MOHAMMED AND CHILDREN OUTSIDE THEIR HOME, BUILT FROM EUCALYPTUS TREES AND CORRUGATED IRON SHEETING. (CHILDREN,<br />
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<br />
CHIEF EXECUTIVE<br />
Since our founding in 1968 in response to <strong>the</strong> famine in Biafra,<br />
Nigeria, Concern Worldwide has pursued its m<strong>is</strong>sion to help people<br />
living in absolute poverty achieve major, sustainable improvements<br />
in <strong>the</strong>ir lives. Now, 43 years later, in 25 countries, Concern remains<br />
steadfastly committed to working with <strong>the</strong> world’s <strong>poorest</strong> people to<br />
trans<strong>for</strong>m <strong>the</strong>ir lives. Hunger <strong>is</strong> often <strong>the</strong> most v<strong>is</strong>ible manifestation<br />
of extreme poverty, <strong>and</strong> in <strong>the</strong> midst of increasingly volatile <strong>food</strong><br />
price increases <strong>and</strong> natural d<strong>is</strong>asters, Concern <strong>is</strong> more determined<br />
than ever be<strong>for</strong>e to empower <strong>the</strong> <strong>poorest</strong> to effectively produce <strong>and</strong><br />
manage <strong>the</strong>ir own <strong>food</strong> supplies, <strong>and</strong> to eradicate mal<strong>nutrition</strong> <strong>and</strong><br />
child hunger <strong>and</strong> <strong>the</strong>ir root causes.<br />
In all <strong>the</strong> places in which Concern works, we are<br />
continually confronted by <strong>the</strong> scourge of under<strong>nutrition</strong>.<br />
Lives are cut wretchedly short, <strong>the</strong> potential of millions of<br />
children <strong>is</strong> blighted, <strong>and</strong> <strong>the</strong> productivity <strong>and</strong> prosperity of<br />
nations are undermined. The loss <strong>and</strong> suffering caused<br />
by hunger are utterly unacceptable in our <strong>time</strong>, especially<br />
because we k<strong>now</strong> that solutions ex<strong>is</strong>t.<br />
The stat<strong>is</strong>tics are sobering. Over 35 percent of <strong>the</strong><br />
preventable deaths among children under five every year<br />
are associated with under<strong>nutrition</strong>. Lack of adequate<br />
<strong>nutrition</strong> causes irreversible physical <strong>and</strong> mental stunting<br />
in an estimated 195 million children per year. About 55<br />
million children suffer from wasting (acute mal<strong>nutrition</strong>),<br />
with low weight <strong>for</strong> <strong>the</strong>ir height: th<strong>is</strong> <strong>is</strong> equal to <strong>the</strong> total<br />
population of children under five living in industrialized<br />
countries. Under<strong>nutrition</strong> <strong>is</strong> also a concentrated problem,<br />
<strong>and</strong> one inextricably linked with poverty: over 90% of<br />
undernour<strong>is</strong>hed children live in just 36 countries.<br />
The very nature of hunger dem<strong>and</strong>s an urgent response.<br />
Adequate <strong>nutrition</strong> <strong>is</strong> critically important during <strong>the</strong> 1,000<br />
days from pregnancy to two years of age. There <strong>is</strong> <strong>now</strong><br />
conclusive evidence of <strong>the</strong> impact of under<strong>nutrition</strong><br />
on infant <strong>and</strong> child mortality <strong>and</strong> its largely irreversible<br />
long-term effects on health <strong>and</strong> cognitive <strong>and</strong> physical<br />
development. Ensuring adequate <strong>nutrition</strong> in <strong>the</strong> first<br />
years of life <strong>is</strong> essential to <strong>improving</strong> health outcomes.<br />
We k<strong>now</strong> when to act. We also k<strong>now</strong> that cost-effective<br />
<strong>and</strong> high-impact interventions ex<strong>is</strong>t. With th<strong>is</strong> k<strong>now</strong>ledge<br />
comes a responsibility to act.<br />
multilaterals <strong>and</strong> <strong>the</strong> private sector to save <strong>the</strong> lives <strong>and</strong><br />
protect <strong>the</strong> futures of <strong>the</strong> most marginalized <strong>and</strong> vulnerable<br />
children as we do today. While th<strong>is</strong> <strong>is</strong> vital to affecting<br />
change, political commitments must be accompanied by<br />
policy change backed up by additional resources.<br />
There are challenges ahead, but <strong>the</strong>y are not insurmountable<br />
if <strong>the</strong>re <strong>is</strong> political commitment <strong>and</strong> <strong>the</strong> will to work toge<strong>the</strong>r<br />
to address both <strong>the</strong> effects <strong>and</strong> <strong>the</strong> root causes of hunger.<br />
Concern’s work <strong>is</strong> <strong>the</strong> result of systemic, global v<strong>is</strong>ion,<br />
but its results are best viewed from <strong>the</strong> ground in <strong>the</strong><br />
real stories of partners coming toge<strong>the</strong>r to improve <strong>food</strong><br />
<strong>security</strong> <strong>and</strong> scale up <strong>nutrition</strong>. Th<strong>is</strong> booklet offers a brief<br />
“on-<strong>the</strong>-ground” view of Concern’s contribution to <strong>food</strong><br />
<strong>security</strong> <strong>and</strong> <strong>nutrition</strong> <strong>and</strong> of our commitment to innovation<br />
<strong>and</strong> partnership in <strong>the</strong> fight against hunger. Examples<br />
include our partnership with <strong>the</strong> International Food Policy<br />
Research Institute (IFPRI) on a project in Zambia to<br />
Realign Agriculture to Improve Nutrition (RAIN); Concern’s<br />
leadership in <strong>the</strong> development of <strong>the</strong> Community-<br />
Based Management of Acute Mal<strong>nutrition</strong> (CMAM),<br />
a decentralized approach with <strong>the</strong> potential to save<br />
millions of children’s lives; Concern’s work in conservation<br />
agriculture; our innovative, integrated, early response<br />
to a massive <strong>food</strong> cr<strong>is</strong><strong>is</strong> in Niger; our groundbreaking<br />
Innovations <strong>for</strong> Maternal, Newborn <strong>and</strong> Child Health<br />
initiative <strong>and</strong> our national <strong>and</strong> global advocacy ef<strong>for</strong>ts<br />
to scale up <strong>nutrition</strong>. We believe that we have reached<br />
a turning point in <strong>the</strong> fight to end child hunger, <strong>and</strong> we<br />
are proud to share stories of our ongoing <strong>and</strong> renewed<br />
ef<strong>for</strong>ts to promote <strong>the</strong> health of <strong>the</strong> <strong>poorest</strong> people in<br />
our world.<br />
Th<strong>is</strong> evidence has underpinned a number of recent political<br />
<strong>and</strong> policy initiatives aimed at <strong>improving</strong> early childhood<br />
<strong>nutrition</strong>. Never be<strong>for</strong>e have we had as much k<strong>now</strong>ledge,<br />
evidence, <strong>and</strong> political will combined with grassroots<br />
mobilization <strong>and</strong> collaboration between civil society, donors,<br />
2
ENDING CHILD HUNGER: A TURNING<br />
POINT FOR GLOBAL ACTION<br />
In 2008, <strong>the</strong> Brit<strong>is</strong>h medical journal <strong>the</strong> Lancet <strong>is</strong>sued a five-part series<br />
on <strong>nutrition</strong> that provided evidence on <strong>the</strong> impact of early childhood<br />
under<strong>nutrition</strong>. The most common <strong>for</strong>m of mal<strong>nutrition</strong> across <strong>the</strong> world <strong>is</strong><br />
micronutrient deficiency, which affects 2 billion people. The most widespread<br />
deficiencies highlighted were in vitamin A, zinc, iodine <strong>and</strong> iron.<br />
THE EVIDENCE<br />
While illness can cause mal<strong>nutrition</strong>, malnour<strong>is</strong>hed<br />
children are more at r<strong>is</strong>k of contracting illnesses such as<br />
diarrhea, malaria <strong>and</strong> pneumonia. Their growth <strong>is</strong> more<br />
likely to be stunted. Malnour<strong>is</strong>hed girls are more likely to<br />
give birth to low birth-weight offspring, contributing to a<br />
multi-generational cycle of mal<strong>nutrition</strong>. Impaired cognitive<br />
function leads to lower educational per<strong>for</strong>mance <strong>and</strong><br />
economic productivity, which means that child under<strong>nutrition</strong><br />
hinders economic development. Where childhood<br />
mal<strong>nutrition</strong> <strong>is</strong> pervasive, <strong>the</strong> loss to GDP can be as high as<br />
2 to 3 percent, not including <strong>the</strong> indirect costs of mal<strong>nutrition</strong><br />
such as healthcare <strong>and</strong> lost wages due to illness.<br />
The barriers children, young women <strong>and</strong> mo<strong>the</strong>rs face<br />
in meeting <strong>the</strong>ir <strong>nutrition</strong> needs include poverty, lack of<br />
education on healthy diets <strong>and</strong> infant care, lack of access<br />
to a diverse variety of nutritious <strong>food</strong>s, lack of access to<br />
adequate health care <strong>and</strong> sanitation, restrictive cultural<br />
practices, <strong>and</strong> low social status.<br />
In most countries of Sub-Saharan Africa, over 20 percent<br />
of women have a low body mass index <strong>and</strong> about 11 percent<br />
of children in <strong>the</strong> developing world are born small. In<br />
countries where gender inequality <strong>is</strong> great, high rates of<br />
hunger also occur because female members of a household<br />
will “eat least <strong>and</strong> eat last.”<br />
Low rates of exclusive breastfeeding (in developing<br />
countries th<strong>is</strong> rate <strong>is</strong> less than 50 percent) also inhibits<br />
a child’s growth <strong>and</strong> development <strong>and</strong> “suboptimal”<br />
breastfeeding results in <strong>the</strong> death of 1.4 million young<br />
children each year. Complementary <strong>food</strong>s, ideally<br />
introduced at 6 months, may also be unavailable,<br />
of poor <strong>nutrition</strong>al quality, or are introduced too early<br />
or too late.<br />
But <strong>the</strong> <strong>is</strong>sue of under<strong>nutrition</strong> does not end <strong>the</strong>re.<br />
The Lancet also identified proven <strong>and</strong> cost-effective<br />
interventions focused on <strong>the</strong> “window of opportunity”<br />
from minus 9 months to two years of age.<br />
Ca<strong>the</strong>rine Msigwa, Tanzania. Photographer: Mike Goldwater, 2008<br />
3
The steps that need to be taken are well understood.<br />
They include:<br />
■ a number of direct <strong>nutrition</strong>-specific interventions<br />
focusing on pregnant women <strong>and</strong> children under <strong>the</strong><br />
age of two<br />
■ broader multi-sectoral approaches such as supporting<br />
agricultural development, <strong>improving</strong> social protection<br />
<strong>and</strong> ensuring access to healthcare<br />
Building on <strong>the</strong> Lancet series, a World Bank study in<br />
2009 identified a package of 13 such interventions<br />
<strong>for</strong> <strong>the</strong> 1000 days between pregnancy <strong>and</strong> age 2.<br />
They would be delivered as part of wider public health<br />
programmes or, in <strong>the</strong> case of <strong>for</strong>tified <strong>food</strong>s, through<br />
private markets. They are summar<strong>is</strong>ed in Table 1.<br />
TABLE 1: EVIDENCE-BASED DIRECT INTERVENTIONS<br />
TO PREVENT AND TREAT UNDERNUTRITION<br />
PROMOTING GOOD NUTRITIONAL PRACTICES ($2.9 BILLION)<br />
■ Breastfeeding<br />
■ Complementary feeding <strong>for</strong> infants after <strong>the</strong> age of six months<br />
■ Improved hygiene practices, including h<strong>and</strong>-washing<br />
INCREASING INTAKE OF VITAMINS AND MINERALS ($1.5 BILLION)<br />
Prov<strong>is</strong>ion of micronutrients <strong>for</strong> young children <strong>and</strong> <strong>the</strong>ir mo<strong>the</strong>rs<br />
■ Periodic Vitamin A supplements<br />
■ Therapeutic zinc supplements <strong>for</strong> diarrhea management<br />
■ Multiple micronutrient powders<br />
■ De-worming drugs <strong>for</strong> children (to reduce losses of nutrients)<br />
■ Iron-folic acid supplements <strong>for</strong> pregnant women to prevent <strong>and</strong> treat anemia<br />
■ Iodized oil capsules where iodized salt <strong>is</strong> unavailable<br />
Prov<strong>is</strong>ion of micronutrients through <strong>food</strong> <strong>for</strong>tification <strong>for</strong> all<br />
■ Salt iodization<br />
■ Iron <strong>for</strong>tification of staple <strong>food</strong>s<br />
THERAPEUTIC FEEDING FOR MALNOURISHED CHILDREN WITH<br />
SPECIAL FOODS ($6.2 BILLION)<br />
■ Prevention or treatment <strong>for</strong> moderate under<strong>nutrition</strong><br />
■ Treatment of severe under<strong>nutrition</strong> (“severe acute mal<strong>nutrition</strong>”) with<br />
ready-to-use <strong>the</strong>rapeutic <strong>food</strong>s (RUTF).<br />
Source: Scaling up Nutrition: What will it cost Horton et al, 2009.<br />
Th<strong>is</strong> study estimated <strong>the</strong> total costs of <strong>the</strong> 13 interventions<br />
in <strong>the</strong> 36 highest burden countries at $11.8 billion<br />
annually <strong>and</strong> that <strong>the</strong>se interventions would save <strong>the</strong> lives<br />
of 1 million children annually.<br />
The benefits of investing in early childhood <strong>nutrition</strong><br />
have been highlighted by <strong>the</strong> Copenhagen Consensus<br />
Panel, a panel of leading econom<strong>is</strong>ts, who ranked <strong>the</strong><br />
prov<strong>is</strong>ion of micronutrients as <strong>the</strong> world’s best investment<br />
<strong>for</strong> development. Vitamin A <strong>and</strong> zinc supplementation <strong>for</strong><br />
children came in top yielding benefits worth $1 billion per<br />
year <strong>for</strong> an annual investment of $60 million.<br />
FROM FARM TO FORK<br />
In parallel with direct health interventions, global<br />
investments in agriculture <strong>and</strong> <strong>food</strong> <strong>security</strong> present a real<br />
opportunity to address maternal <strong>and</strong> child under<strong>nutrition</strong>.<br />
The price <strong>the</strong> international community pays <strong>for</strong> not<br />
tackling under<strong>nutrition</strong> <strong>is</strong> significant, <strong>and</strong> as such, th<strong>is</strong><br />
opportunity should be seized. Nutrition <strong>security</strong> depends<br />
on <strong>food</strong> <strong>security</strong> which, in turn, depends on sustainable<br />
agricultural development.<br />
In February 2011, over 1,000 stakeholders from <strong>the</strong><br />
<strong>nutrition</strong>, agriculture <strong>and</strong> health sectors, including<br />
Concern Worldwide, ga<strong>the</strong>red in New Delhi, India to focus<br />
on ways of leveraging agriculture <strong>for</strong> <strong>improving</strong> <strong>nutrition</strong><br />
<strong>and</strong> health. Protection of natural resources endangered<br />
by climate change, adequate support <strong>for</strong> small holder<br />
farmers, <strong>and</strong> addressing micronutrient deficiency<br />
will require integrated responses, developed at <strong>the</strong><br />
intersection of <strong>the</strong>se three key sectors. The k<strong>now</strong>ledge<br />
gap on how agriculture can most effectively contribute<br />
to <strong>nutrition</strong> <strong>and</strong> health outcomes needs to be filled, <strong>and</strong><br />
a commitment must be made to seek out <strong>and</strong> scale up<br />
innovative solutions.<br />
Better <strong>nutrition</strong> also requires improved access to markets,<br />
<strong>for</strong> example, through community associations <strong>and</strong> publicprivate<br />
partnerships.<br />
More than 60 percent of farmers in Africa are women.<br />
Empowering women in <strong>the</strong>ir roles as caregivers <strong>and</strong><br />
farmers will improve development. In recent years,<br />
women working in <strong>the</strong> agriculture, <strong>for</strong>estry <strong>and</strong> f<strong>is</strong>heries<br />
sectors have received only 7 to 9 percent of agricultural<br />
development ass<strong>is</strong>tance. Th<strong>is</strong> needs to be addressed if<br />
progress <strong>is</strong> to be real<strong>is</strong>ed.<br />
THE SCALING UP NUTRITION<br />
(SUN) FRAMEWORK<br />
Spurred by <strong>the</strong> groundbreaking evidence in <strong>the</strong> Lancet,<br />
as well as <strong>the</strong> <strong>food</strong> price cr<strong>is</strong><strong>is</strong> of 2008 that placed <strong>food</strong><br />
<strong>security</strong> <strong>and</strong> <strong>nutrition</strong> once again high on <strong>the</strong> political<br />
agenda, a global multi-stakeholder ef<strong>for</strong>t led to <strong>the</strong><br />
development of a Scaling Up Nutrition (SUN) Framework<br />
<strong>for</strong> Action <strong>and</strong> subsequent Roadmap. The SUN Framework<br />
was agreed in early 2010 <strong>and</strong> launched in April. It serves<br />
as a guide <strong>for</strong> <strong>the</strong> international community in ef<strong>for</strong>ts to<br />
combat under<strong>nutrition</strong> <strong>and</strong> has been endorsed by over<br />
100 partners from governments, civil society, international<br />
organ<strong>is</strong>ations, <strong>the</strong> private sector, <strong>and</strong> academia.<br />
Central to <strong>the</strong> SUN Framework <strong>is</strong> <strong>the</strong> recognition that<br />
<strong>the</strong> real work will take place, <strong>and</strong> needs to take place,<br />
at <strong>the</strong> country level. The Transition Team chaired by<br />
<strong>the</strong> UN Secretary General’s Special Representative <strong>for</strong><br />
Food Security <strong>and</strong> Nutrition, Dr. David Nabarro, <strong>and</strong> task<br />
<strong>for</strong>ces will offer support <strong>and</strong> guidance to national level<br />
processes <strong>and</strong> plans. Representatives from developing<br />
countries are also part of <strong>the</strong> process <strong>and</strong> structure at<br />
global level.<br />
4
The SUN Framework was rapidly followed by <strong>the</strong><br />
development of “A Road Map <strong>for</strong> Scaling Up Nutrition,”<br />
which was launched at <strong>the</strong> UN General Assembly Summit<br />
<strong>for</strong> <strong>the</strong> Millennium Development Goals in September 2010.<br />
The SUN Roadmap anticipates <strong>the</strong>re will be (a) mult<strong>is</strong>takeholder<br />
plat<strong>for</strong>ms within countries participating in <strong>the</strong><br />
ef<strong>for</strong>t to Scale Up Nutrition, <strong>and</strong> that <strong>the</strong>y will become<br />
increasingly important as a means to ensure joint ef<strong>for</strong>ts<br />
<strong>and</strong> a shared responsibility <strong>for</strong> results, (b) improved<br />
sharing of experiences between countries <strong>and</strong> regions,<br />
(c) joint action by different stakeholders to encourage<br />
advocacy, (d) a major ef<strong>for</strong>t to stimulate relevant research,<br />
(e) harmonized policy guidance, (g) better aligned ass<strong>is</strong>tance<br />
from development partners, (h) stronger governance <strong>and</strong><br />
coordination of intergovernmental action, (i) support <strong>for</strong><br />
individuals as <strong>the</strong>y become leaders <strong>for</strong> <strong>nutrition</strong> <strong>and</strong><br />
(j) a long-term commitment from national governments.<br />
Some heads of Governments or senior officials have<br />
already indicated <strong>the</strong>ir intention to participate in <strong>the</strong><br />
SUN movement to scale up <strong>nutrition</strong>, <strong>and</strong> to become<br />
“early r<strong>is</strong>er” countries. These include: Bangladesh,<br />
Ethiopia, Guatemala, Malawi, Mozambique, Nepal, Niger,<br />
Peru, Senegal, Tanzania, Ug<strong>and</strong>a, Mali, Rw<strong>and</strong>a, Sierra<br />
Leone, Ghana, Haiti, Zambia, <strong>and</strong> Benin.<br />
MOVING FORWARD<br />
The international <strong>nutrition</strong> community has accumulated<br />
extensive evidence on under<strong>nutrition</strong>. Countries <strong>and</strong> <strong>the</strong>ir<br />
partners have <strong>the</strong> k<strong>now</strong>ledge <strong>and</strong> experience concerning<br />
<strong>the</strong> management of multi-stakeholder plat<strong>for</strong>ms <strong>and</strong><br />
<strong>the</strong> capacities needed <strong>for</strong> scaling up <strong>nutrition</strong>. Global<br />
momentum <strong>is</strong> building <strong>for</strong> a renewed ef<strong>for</strong>t to translate<br />
<strong>the</strong>se assets into large-scale improvements in <strong>the</strong><br />
<strong>nutrition</strong> of high-burden countries.<br />
The coming years will be crucial <strong>for</strong> sustaining <strong>the</strong><br />
commitment, capacities <strong>and</strong> coordination <strong>for</strong> <strong>the</strong>se ef<strong>for</strong>ts<br />
to succeed. There are important roles in th<strong>is</strong> process <strong>for</strong> all<br />
stakeholders—national governments, donors, civil society,<br />
<strong>and</strong> <strong>the</strong> private sector. Joint ef<strong>for</strong>ts <strong>and</strong> intersectoral support<br />
towards a common goal will be paramount to achieving once<br />
<strong>and</strong> <strong>for</strong> all <strong>the</strong> eradication of hunger <strong>and</strong> under<strong>nutrition</strong>.<br />
Greenl<strong>and</strong><br />
2010 GLOBAL HUNGER INDEX SCORES BY SEVERITY<br />
Icel<strong>and</strong><br />
Sweden<br />
Norway<br />
Finl<strong>and</strong><br />
Russian Federation<br />
Estonia<br />
United Kingdom<br />
Denmark<br />
Latvia<br />
Lithuania<br />
Canada<br />
United States<br />
of America<br />
Mexico<br />
Western Sahara<br />
Irel<strong>and</strong><br />
Portugal<br />
Morocco<br />
Spain<br />
Neth.<br />
Bel.<br />
France<br />
Algeria<br />
Germany<br />
Lux. Czech Rep.<br />
Slovakia<br />
Austria<br />
Switz. Hungary<br />
Slov.<br />
Croatia<br />
Italy Bos. &<br />
HerzṢerb.<br />
Mont.<br />
Mace.<br />
Albania<br />
Greece<br />
Tun<strong>is</strong>ia<br />
Pol<strong>and</strong><br />
Libya<br />
Belarus<br />
Ukraine<br />
Mold.<br />
Romania<br />
Kazakhstan<br />
Bulgaria<br />
Georgia<br />
Uzbek<strong>is</strong>tan Kyrgyz Rep.<br />
Armenia Azerb.<br />
Turkey<br />
Turkmen<strong>is</strong>tan Tajik<strong>is</strong>tan<br />
Cyprus Syrian<br />
Lebanon<br />
Arab Rep.<br />
Iran,<br />
Afghan<strong>is</strong>tan<br />
Israel<br />
Iraq Islamic Rep.<br />
Jordan<br />
Kuwait<br />
Pak<strong>is</strong>tan<br />
Egypt,<br />
Bahrain<br />
Arab Rep.<br />
Qatar<br />
Saudi Arabia U.A.E.<br />
Nepal<br />
Bhutan<br />
Bangladesh<br />
Mongolia<br />
China<br />
N. Korea<br />
S. Korea<br />
Japan<br />
Cuba<br />
Dom. Rep.<br />
Belize Jamaica Haiti<br />
Honduras<br />
Guatemala<br />
Nicaragua<br />
El Salvador<br />
Panama<br />
Trinidad & Tobago<br />
Costa Rica<br />
Venezuela, RB Guyana<br />
French Guiana<br />
Suriname<br />
Colombia<br />
Ecuador<br />
Peru<br />
Senegal<br />
The Gambia<br />
Guinea-B<strong>is</strong>sau<br />
Guinea<br />
Sierra Leone<br />
Mauritania<br />
Liberia<br />
Mali<br />
Niger<br />
Burkina Faso<br />
Benin<br />
Nigeria<br />
Côte Togo<br />
d'Ivoire<br />
Central African<br />
Ghana<br />
Republic<br />
Cameroon<br />
Equatorial Guinea<br />
Congo,<br />
Gabon Rep.<br />
Chad<br />
Congo,<br />
Dem. Rep.<br />
Sudan<br />
Ug<strong>and</strong>a<br />
Rw.<br />
Bur.<br />
Kenya<br />
Tanzania<br />
Eritrea<br />
Ethiopia<br />
Yemen, Rep.<br />
Djibouti<br />
Somalia<br />
Oman<br />
India<br />
Sri Lanka<br />
Myanmar<br />
Lao<br />
PDR<br />
Thail<strong>and</strong><br />
Cambodia<br />
Vietnam<br />
Brunei<br />
Malaysia<br />
Philippines<br />
Indonesia<br />
Papua<br />
New Guinea<br />
Brazil<br />
Angola<br />
Zambia<br />
Malawi<br />
Comoros<br />
Timor-Leste<br />
Chile<br />
Bolivia<br />
Paraguay<br />
Namibia<br />
Zimbabwe Mozambique<br />
Botswana<br />
Swazil<strong>and</strong><br />
Madagascar<br />
Mauritius<br />
Australia<br />
Argentina<br />
Uruguay<br />
South<br />
Africa<br />
Lesotho<br />
> 30.0 Extremely alarming<br />
20.0–29.9 Alarming<br />
10.0–19.9 Serious<br />
5.0–9.9 Moderate<br />
< 4.9 Low<br />
No data<br />
Industrialized country<br />
Note: For <strong>the</strong> 2010 GHI, data on <strong>the</strong> proportion of undernour<strong>is</strong>hed are <strong>for</strong> 2004–06, data on<br />
child underweight are <strong>for</strong> <strong>the</strong> latest year in <strong>the</strong> period 2003–08 <strong>for</strong> which data are available,<br />
<strong>and</strong> data on child mortality are <strong>for</strong> 2008.<br />
MAP: GLOBAL HUNGER INDEX 2010, PRODUCED BY CONCERN WORLDWIDE, INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE (IFPRI), AND WELTHUNGERHILFE<br />
HUNGER FACTS<br />
■ 925 million people do not have enough to eat <strong>and</strong> 98 percent of <strong>the</strong>m live in developing countries.<br />
■ Women make up a little over half of <strong>the</strong> world’s population, but <strong>the</strong>y account <strong>for</strong> over 60 percent of <strong>the</strong> world’s hungry.<br />
■ One out of four children in developing countries <strong>is</strong> underweight.<br />
5
Moses Kerokara, Emanual Tara <strong>and</strong> Mita Dav<strong>is</strong> from Gr<strong>and</strong> Bassa in Liberia. Mita <strong>is</strong><br />
one of <strong>the</strong> farmers benefiting from <strong>the</strong> services of <strong>the</strong> Concern supported ‘Farmers<br />
Resource Centre’. Photographer: Chr<strong>is</strong>topher Herwig, 2007<br />
CONCERN WORKS TO IMPROVE<br />
FOOD AND NUTRITION SECURITY<br />
Concern’s core m<strong>is</strong>sion <strong>is</strong> to make sustainable improvements in <strong>the</strong> lives of<br />
<strong>the</strong> extreme poor. Chief among <strong>the</strong>se improvements <strong>is</strong> <strong>the</strong> eradication of<br />
hunger <strong>and</strong> child under<strong>nutrition</strong>, which are both a cause <strong>and</strong> a consequence<br />
of poverty. The promotion of <strong>food</strong> <strong>and</strong> <strong>nutrition</strong> <strong>security</strong> has <strong>the</strong>re<strong>for</strong>e been<br />
central to Concern’s work since <strong>the</strong> organ<strong>is</strong>ation was founded in 1968. Our<br />
programmes work across multiple sectors in 25 countries to improve <strong>the</strong><br />
<strong>food</strong> production asset base <strong>and</strong> livelihood options of <strong>the</strong> extreme poor while<br />
reducing vulnerability to natural, social <strong>and</strong> economic shocks. Concern also<br />
responds to communities’ immediate needs in emergencies through <strong>the</strong><br />
direct prov<strong>is</strong>ion of a range of goods <strong>and</strong> services.<br />
Recogn<strong>is</strong>ing that increased availability <strong>and</strong> even<br />
increased access to <strong>food</strong> does not ensure sustained<br />
<strong>nutrition</strong> <strong>security</strong>, Concern also supports more direct<br />
<strong>nutrition</strong> interventions to ensure <strong>food</strong> <strong>is</strong> optimally util<strong>is</strong>ed<br />
<strong>and</strong> to support those who, in spite of <strong>food</strong> <strong>security</strong><br />
interventions, fall through <strong>the</strong> cracks <strong>and</strong> require<br />
treatment. Among <strong>the</strong>se direct interventions, Concern has<br />
particular expert<strong>is</strong>e in <strong>the</strong> community-based management<br />
of acute mal<strong>nutrition</strong> (CMAM), <strong>and</strong> also supports<br />
behavioural change communication to directly improve<br />
infant <strong>and</strong> young child feeding <strong>and</strong> health <strong>and</strong> hygiene<br />
practices. Finally, Concern supports programmes to<br />
improve access to quality health care services in<br />
12 countries <strong>and</strong> to quality water, sanitation <strong>and</strong> hygiene<br />
(WASH) facilities in 18 countries. These health <strong>and</strong><br />
WASH programmes work to both directly reduce child<br />
mortality due to d<strong>is</strong>ease <strong>and</strong> to indirectly reduce child<br />
under<strong>nutrition</strong>, of which d<strong>is</strong>ease <strong>is</strong> an underlying cause.<br />
6
Concern has been a global leader in <strong>the</strong> development of<br />
<strong>the</strong> community-based management of acute mal<strong>nutrition</strong><br />
(CMAM). Working in partnership with Valid International,<br />
Concern piloted th<strong>is</strong> new approach in three countries in<br />
2002/2003, at a <strong>time</strong> when treatment was limited to a<br />
grossly insufficient inpatient-only model. The innovative<br />
approach, which has proven successful at achieving high<br />
coverage, early detection <strong>and</strong> effective treatment of acute<br />
mal<strong>nutrition</strong> (wasting <strong>and</strong> <strong>nutrition</strong>al oedema), has <strong>now</strong><br />
been widely adopted as best practice by <strong>the</strong> UN <strong>and</strong> <strong>the</strong><br />
majority of governments <strong>and</strong> non-governmental agencies.<br />
Th<strong>is</strong> remarkable global shift to adopt <strong>the</strong> CMAM<br />
approach <strong>and</strong> <strong>the</strong> improvements in treatment access<br />
that have resulted are in large part due to <strong>the</strong> strategic<br />
partnership <strong>for</strong>ged between Concern <strong>and</strong> Valid <strong>and</strong> <strong>the</strong><br />
agencies’ joint commitment to community-led problem<br />
analys<strong>is</strong>; innovation; quality documentation, syn<strong>the</strong>s<strong>is</strong> <strong>and</strong><br />
d<strong>is</strong>semination of evidence; followed by ongoing technical<br />
support <strong>and</strong> advocacy <strong>for</strong> scale-up.<br />
Concern remains committed to <strong>the</strong> scale-up of quality<br />
CMAM <strong>and</strong> continues to directly <strong>and</strong> indirectly (through<br />
government partners) support CMAM in ten countries:<br />
Malawi, Ethiopia, Sudan (North <strong>and</strong> South), Kenya, Niger,<br />
Rw<strong>and</strong>a, Haiti, Ug<strong>and</strong>a, Nepal <strong>and</strong> Somalia <strong>and</strong> previously<br />
in Timor <strong>and</strong> DR Congo. Concern also continues to work<br />
at global <strong>and</strong> national level through <strong>the</strong> development<br />
of CMAM implementation guidelines, training modules,<br />
monitoring tools, <strong>and</strong> assessing <strong>the</strong> relative cost<br />
effectiveness of CMAM <strong>and</strong> conducting joint research<br />
with Valid on adapting CMAM <strong>for</strong> populations with high<br />
HIV prevalence <strong>and</strong> alternative, lower-cost recipes <strong>for</strong><br />
ready-to-use <strong>the</strong>rapeutic <strong>food</strong>s.<br />
Concern recogn<strong>is</strong>es that <strong>the</strong> impact of interventions<br />
on child <strong>nutrition</strong> can be improved, if <strong>the</strong>re <strong>is</strong> a better<br />
underst<strong>and</strong>ing of <strong>the</strong> factors which determine <strong>the</strong> extent<br />
of th<strong>is</strong> impact In order to contribute to <strong>the</strong> global evidence<br />
on th<strong>is</strong> link between <strong>food</strong> <strong>security</strong> interventions <strong>and</strong> child<br />
<strong>nutrition</strong> <strong>and</strong> to improve its own programmes, Concern<br />
has embarked on a new partnership with <strong>the</strong> International<br />
Food Policy <strong>and</strong> Research Institute (IFPRI), with funding<br />
from Ir<strong>is</strong>h Aid, to design an integrated agriculture-based<br />
programme that will prevent under<strong>nutrition</strong> <strong>and</strong> actually<br />
reduce <strong>the</strong> prevalence of stunting in children under<br />
five years.<br />
Scaling up evidence-based interventions <strong>is</strong> essential to<br />
achieving impact. Concern <strong>is</strong> currently working to identify<br />
barriers to scale up of key health interventions <strong>and</strong> develop<br />
innovative solutions to overcoming <strong>the</strong>m through its<br />
Innovations in Maternal, Newborn <strong>and</strong> Child Health Initiative.<br />
REALIGNING AGRICULTURE TO IMPROVE<br />
NUTRITION (RAIN)<br />
Concern <strong>and</strong> <strong>the</strong> International Food Policy Re-search Institute (IFPRI)<br />
have recently embarked on a partnership to design <strong>and</strong> rigorously<br />
evaluate a project to prevent stunting in young children by realigning<br />
a package of agriculture-based interventions to specifically improve<br />
<strong>nutrition</strong> components.<br />
The programme, currently being implemented in Mumbwa D<strong>is</strong>trict,<br />
Zambia <strong>is</strong> working to underst<strong>and</strong> <strong>and</strong> address <strong>the</strong> underlying causes<br />
of under<strong>nutrition</strong>. Like many traditional <strong>food</strong> <strong>security</strong> interventions, <strong>the</strong><br />
RAIN project aims to effectively improve <strong>food</strong> availability <strong>and</strong> access.<br />
One of <strong>the</strong> defining differences of <strong>the</strong> RAIN approach will be <strong>the</strong><br />
emphas<strong>is</strong> on underst<strong>and</strong>ing <strong>the</strong> key impact pathways linking agriculture<br />
<strong>and</strong> o<strong>the</strong>r interventions to improved <strong>nutrition</strong>al outcomes <strong>for</strong> children<br />
under two years of age <strong>and</strong> actually designing <strong>the</strong> core agricultural<br />
interventions to achieve those outcomes. In th<strong>is</strong> way, RAIN aims to go<br />
beyond <strong>the</strong> traditional objectives of <strong>food</strong> <strong>security</strong> programmes (e.g.<br />
increased yields, reported increase in meals per day) <strong>and</strong> to focus on<br />
measureable improvements in <strong>nutrition</strong> <strong>security</strong>.<br />
Saïd Mohammed on h<strong>is</strong> plot of l<strong>and</strong> at <strong>the</strong> Korichefe irrigation site,<br />
South Wollo zone, Ethiopia. Photographer: Caroline Irby, 2007<br />
Critical <strong>is</strong>sues such as <strong>the</strong> <strong>nutrition</strong>al profile of crops, methods of<br />
<strong>food</strong> storage <strong>and</strong> preservation, constraints <strong>and</strong> opportunities <strong>for</strong><br />
optimal infant <strong>and</strong> young child feeding, <strong>and</strong> <strong>the</strong> dec<strong>is</strong>ion making<br />
power <strong>and</strong> workload of women will be carefully considered during <strong>the</strong><br />
design phase. Essential components will be incorporated to address<br />
<strong>the</strong>se <strong>is</strong>sues, including promotion of nutritious crops/small livestock,<br />
women-focused appropriate technology, intensive behaviour change<br />
communication, links with health care <strong>and</strong> empowerment of women.<br />
7
CONSERVATION AGRICULTURE<br />
Concern has been promoting Conservation Agriculture in Zimbabwe since 2006,<br />
with impressive results. Concern has also introduced CA as part of an EU Food<br />
Facility project in Tanzania <strong>and</strong> has initiated a CA project in North Korea. In<br />
May 2010 Concern announced a major pilot project in Zambia <strong>and</strong> Malawi<br />
aimed at training 6,400 farmers in <strong>the</strong> techniques of Conservation Agriculture.<br />
Th<strong>is</strong> pilot project <strong>is</strong> being funded by an Accenture Global Giving Grant.<br />
WHAT IS CONSERVATION AGRICULTURE<br />
Almost three quarters of <strong>the</strong> l<strong>and</strong> in sub-Saharan Africa<br />
<strong>is</strong> partially or severely degraded. Th<strong>is</strong> has come about<br />
as a result of excessive soil d<strong>is</strong>turbance, <strong>the</strong> reduction<br />
in nutrients caused by monoculture, late planting <strong>and</strong><br />
<strong>the</strong> lack of investment in agriculture. The consequent<br />
reduction in yields <strong>is</strong> a major problem, most especially <strong>for</strong><br />
poor farmers, many of <strong>the</strong>m women, farming small plots<br />
of l<strong>and</strong>.<br />
Conservation agriculture has three key principles:<br />
do not d<strong>is</strong>turb <strong>the</strong> soil; keep <strong>the</strong> soil covered (using<br />
crop residues as mulch); <strong>and</strong> rotate <strong>the</strong> crops. In<br />
addition, Concern promotes <strong>the</strong> use of small amounts<br />
of carefully selected fertil<strong>is</strong>ers. Toge<strong>the</strong>r, <strong>the</strong>se simple<br />
techniques reduce <strong>the</strong> energy needed to farm, maintain<br />
<strong>the</strong> natural soil structure, help avoid excessive depletion<br />
of nutrients <strong>and</strong> maxim<strong>is</strong>e <strong>the</strong> benefits (while minim<strong>is</strong>ing<br />
<strong>the</strong> cost) of fertil<strong>is</strong>er.<br />
Conservation agriculture <strong>is</strong> a radically different way of<br />
producing crops which leads to higher yields <strong>and</strong> earlier<br />
harvests, even in dry years. It uses techniques that reduce<br />
both erosion <strong>and</strong> <strong>the</strong> energy <strong>and</strong> workload needed to<br />
plant crops, conserves soil mo<strong>is</strong>ture <strong>and</strong> enables farmers<br />
to plant as soon as <strong>the</strong> rains start. Th<strong>is</strong> approach typically<br />
improves yields of maize by 70% without fertil<strong>is</strong>er; it more<br />
than trebles yields when fertil<strong>is</strong>er <strong>is</strong> introduced.<br />
Conservation agriculture uses resources more efficiently<br />
<strong>and</strong> improves flexibility. In Zimbabwe we achieved our<br />
results using relatively simple appropriate technology<br />
such as planting pits or simple ox-drawn rippers—tools<br />
which have deep penetration but cause minimum<br />
d<strong>is</strong>turbance to <strong>the</strong> soil. These save both <strong>time</strong> <strong>and</strong> ef<strong>for</strong>t<br />
<strong>and</strong> help increase yields.<br />
Conservation Agriculture <strong>is</strong> not a “silver bullet”—it <strong>is</strong> not<br />
appropriate <strong>for</strong> some soil types <strong>and</strong> some plants. But<br />
it can <strong>and</strong> <strong>is</strong> making a difference to <strong>the</strong> livelihoods of<br />
very many <strong>food</strong> insecure people in sub Saharan Africa<br />
<strong>and</strong> beyond. Moreover, it <strong>is</strong> sustainable. Many current<br />
practices are not.<br />
Concern used <strong>the</strong> Household<br />
Economy approach to evaluate <strong>the</strong><br />
impact of Conservation Agriculture<br />
by comparing poor <strong>and</strong> very poor<br />
farmers who had adopted CA with<br />
farmers in <strong>the</strong> same wealth group<br />
who pract<strong>is</strong>e traditional agriculture<br />
Total Kg Produced Per Farmer<br />
1000<br />
800<br />
600<br />
400<br />
200<br />
CROP PRODUCTION (Gokwe North)<br />
0<br />
CA V. Poor<br />
V. Poor CA Poor Poor GKN<br />
millet cowpeas groundnuts sorghum maize<br />
8
Women in Gokwe, Zimbabwe present <strong>the</strong>ir reg<strong>is</strong>tration cards at a Concernmanaged<br />
cash d<strong>is</strong>tribution point. Photo: Elena Ruiz Roman, Zimbabwe<br />
EMERGENCY RESPONSE<br />
Concern works in some of <strong>the</strong> most <strong>poorest</strong> <strong>and</strong> vulnerable countries in <strong>the</strong><br />
world. All of our countries of operation are affected by d<strong>is</strong>asters—many of<br />
which are predictable <strong>and</strong> recurrent. Working with communities to mitigate <strong>the</strong><br />
r<strong>is</strong>k <strong>and</strong> impact of <strong>the</strong>se d<strong>is</strong>asters <strong>is</strong> an essential component of our work, <strong>and</strong><br />
in many locations we work to improve community resilience <strong>and</strong> to establ<strong>is</strong>h<br />
in<strong>for</strong>mation/early warning systems to help poor communities better prepare <strong>for</strong><br />
<strong>and</strong> mitigate against <strong>the</strong> impact of d<strong>is</strong>asters. Aware that mitigation measures<br />
cannot prevent all d<strong>is</strong>asters from occurring, we also pride ourselves on <strong>the</strong><br />
speed <strong>and</strong> appropriateness of our emergency responses.<br />
The purpose of our interventions <strong>is</strong> to address <strong>the</strong><br />
immediate needs of d<strong>is</strong>aster affected populations<br />
through enhancing <strong>the</strong>ir capacity to cope. Th<strong>is</strong> may<br />
compr<strong>is</strong>e <strong>the</strong> d<strong>is</strong>tribution of <strong>food</strong> <strong>and</strong> o<strong>the</strong>r essential<br />
life saving interventions—access to clean water, shelter,<br />
or <strong>the</strong> means of ass<strong>is</strong>ting in <strong>the</strong> rapid recovery of <strong>the</strong>ir<br />
productive capacity <strong>and</strong> assets.<br />
In 2010, Concern responded to 41 emergencies in<br />
14 countries. Eighteen of <strong>the</strong>se emergencies occurred<br />
in areas of conflict, some in conflict zones where<br />
Concern has been active <strong>for</strong> many years such as<br />
Somalia, South Sudan <strong>and</strong> Chad. The main responses<br />
occurred in three countries affected by massive<br />
cr<strong>is</strong>es—Haiti, Pak<strong>is</strong>tan <strong>and</strong> Niger (please see box<br />
on next page).<br />
In January 2010, a devastating earthquake hit Haiti, causing<br />
one of <strong>the</strong> largest natural d<strong>is</strong>asters in h<strong>is</strong>tory. More than<br />
220,000 were killed <strong>and</strong> millions were made homeless<br />
in <strong>the</strong> immediate aftermath of <strong>the</strong> earthquake. Concern<br />
responded by d<strong>is</strong>tributing NFIs (non-<strong>food</strong> items), providing<br />
water <strong>and</strong> sanitation facilities, managing camps, providing<br />
cash-<strong>for</strong>-work <strong>and</strong> cash transfers, <strong>and</strong> <strong>nutrition</strong> <strong>and</strong><br />
emergency education interventions. We also provided<br />
temporary shelter (e.g. tents) <strong>and</strong> have constructed transitional<br />
shelters <strong>for</strong> families. As Haiti began to move from emergency<br />
response to reconstruction, it was faced with ano<strong>the</strong>r d<strong>is</strong>aster<br />
as cholera began to spread towards <strong>the</strong> end of 2010, killing<br />
more than 4,000 people. We have increased our water <strong>and</strong><br />
sanitation programmes as a result, providing latrines, soap<br />
<strong>and</strong> clean water as well as carrying out hygiene promotion.<br />
Our response in Haiti has helped 130,000 people.<br />
9
NIGER<br />
Millet <strong>is</strong> <strong>the</strong> crop that keeps most people alive in Niger. But drought <strong>and</strong><br />
failed rains in 2010 led to massive crop failure of millet <strong>and</strong> o<strong>the</strong>r staples,<br />
leaving 60 percent of <strong>the</strong> country’s population facing hunger.<br />
Concern Worldwide began tracking <strong>the</strong> first signs of <strong>the</strong> <strong>food</strong> cr<strong>is</strong><strong>is</strong> in<br />
October 2009. We launched an innovative, integrated, early response to<br />
reach 280,000 of <strong>the</strong> most vulnerable be<strong>for</strong>e <strong>the</strong> <strong>food</strong> ran out— be<strong>for</strong>e large<br />
numbers of children became severely malnour<strong>is</strong>hed.<br />
Concern focused on mobilizing early to prevent <strong>and</strong> mitigate <strong>the</strong><br />
onset of severe mal<strong>nutrition</strong>. The multi-sector response in Tahoua, one<br />
of <strong>the</strong> country’s most <strong>food</strong> insecure regions, involved: d<strong>is</strong>tributing drought<br />
res<strong>is</strong>tant seeds <strong>and</strong> fertilizer; screening, referring, <strong>and</strong> rein<strong>for</strong>cing <strong>the</strong><br />
Min<strong>is</strong>try of Health’s capacity to provide <strong>nutrition</strong> support to pregnant women,<br />
breastfeeding mo<strong>the</strong>rs, <strong>and</strong> children under five; <strong>and</strong> an innovative initiative that<br />
started d<strong>is</strong>tributing emergency cash—be<strong>for</strong>e <strong>the</strong> cr<strong>is</strong><strong>is</strong>—to <strong>the</strong> most vulnerable<br />
women in 160 villages via mobile phones <strong>and</strong> manual cash transfers.<br />
Initial results show that Concern’s response in Niger successfully prevented<br />
<strong>and</strong> averted a <strong>nutrition</strong> emergency in its target communities:<br />
■ Concern <strong>nutrition</strong> surveys undertaken with <strong>the</strong> Department of Health<br />
show that “global acute mal<strong>nutrition</strong>” rates in Tahoua D<strong>is</strong>trict were at<br />
11.7 percent—below <strong>the</strong> emergency threshold of 15 percent.<br />
■ Eighty percent of villages that were rated as being at r<strong>is</strong>k of extreme <strong>food</strong><br />
shortages in December 2009 had above-average harvests in 2010.<br />
Concern <strong>is</strong> in <strong>the</strong> process of completing research in partnership with Tufts<br />
University to analyze <strong>the</strong> impact of its different types of interventions on<br />
<strong>nutrition</strong> status in Tahoua. To help improve <strong>the</strong> effectiveness of responses<br />
to <strong>food</strong> cr<strong>is</strong>es, Concern will share <strong>the</strong> results of th<strong>is</strong> research with <strong>the</strong><br />
Government of Niger <strong>and</strong> <strong>the</strong> wider humanitarian community to help find<br />
better, more cost-effective ways to prevent <strong>and</strong> fight hunger.<br />
Agaycha Awikguini, a 50-year-old widow receives her first emergency<br />
cash transfer from Concern. Photo: Niger, Concern Worldwide<br />
2010 also saw Pak<strong>is</strong>tan face one of its worst<br />
humanitarian d<strong>is</strong>asters as floods ravaged <strong>the</strong> country,<br />
which killed nearly 2,000 people but affected more<br />
than 20 million across four provinces. Concern launched<br />
its largest ever emergency response in <strong>the</strong> country,<br />
providing approximately one million people with<br />
emergency ass<strong>is</strong>tance including drinking water, latrines,<br />
shelter, non-<strong>food</strong> items, <strong>food</strong> packages, debr<strong>is</strong> removal<br />
kits, <strong>and</strong> emergency medical services. Concern in<br />
Pak<strong>is</strong>tan <strong>is</strong> responsible <strong>for</strong> overseeing <strong>the</strong> d<strong>is</strong>bursement<br />
of <strong>the</strong> US Office <strong>for</strong> Overseas D<strong>is</strong>aster Ass<strong>is</strong>tance<br />
(OFDA) funded ‘Responding to Pak<strong>is</strong>tan’s Internally<br />
D<strong>is</strong>placed’ (RAPID) grant to organizations providing<br />
humanitarian ass<strong>is</strong>tance in emergency situations<br />
in Pak<strong>is</strong>tan.<br />
Extreme wea<strong>the</strong>r <strong>is</strong> a major cause of emergencies,<br />
with Concern implementing 14 emergency programmes<br />
in response to climate related d<strong>is</strong>asters in 2010. We<br />
continued to work to mitigate <strong>the</strong> effects of drought in<br />
Ethiopia, Kenya <strong>and</strong> Niger, while flooding prompted us<br />
to respond in Afghan<strong>is</strong>tan, Ethiopia, India, Pak<strong>is</strong>tan,<br />
South Sudan <strong>and</strong> Tanzania.<br />
The nature of our interventions varies according to <strong>the</strong><br />
needs identified on <strong>the</strong> ground. In circumstances where<br />
<strong>food</strong> <strong>is</strong> available in <strong>the</strong> market but people are unable<br />
to access it because of lack of money, we may seek to<br />
inject cash into <strong>the</strong> local economy by transferring limited<br />
amounts of cash to <strong>the</strong> very <strong>poorest</strong>. Such cash transfer<br />
programmes are carried out by our teams in Niger,<br />
Zimbabwe, India, Kenya, Sierra Leone <strong>and</strong> Zambia. We<br />
are using mobile phone technology to transfer cash to<br />
poor people in Niger—<strong>and</strong> have done so in Kenya <strong>and</strong><br />
o<strong>the</strong>r countries. In Zimbabwe, Concern <strong>and</strong> WFP (World<br />
Food Programme) are co-operating in a pilot project<br />
intended to assess <strong>the</strong> relative effects of giving people<br />
cash, <strong>food</strong> or part cash <strong>and</strong> part <strong>food</strong> in order to deal<br />
with “<strong>the</strong> hunger season” in that country. An evaluation<br />
of <strong>the</strong> Zimbabwe project by Ox<strong>for</strong>d Policy Management<br />
in 2010 highlights that recipients of <strong>the</strong> transfers were<br />
able to obtain sufficient staple <strong>food</strong> <strong>for</strong> <strong>the</strong> duration<br />
of <strong>the</strong> project, <strong>and</strong> <strong>the</strong> transfer of cash, cash <strong>and</strong> <strong>food</strong>,<br />
<strong>and</strong> <strong>food</strong> were all found to have positive impacts on<br />
intra-household relations. Following <strong>the</strong> evaluation<br />
<strong>the</strong> composition of <strong>the</strong> transfers has been modified<br />
to a more cost-effective <strong>and</strong> locally appropriate<br />
combination of <strong>food</strong> <strong>and</strong> cash.<br />
Recogn<strong>is</strong>ing <strong>the</strong> need to <strong>for</strong>esee <strong>and</strong> better prepare<br />
<strong>for</strong> emergencies, Concern <strong>is</strong> moving to a process where<br />
r<strong>is</strong>k <strong>and</strong> vulnerability <strong>is</strong> better understood <strong>and</strong> longer<br />
term development programmes seek to mitigate against<br />
<strong>the</strong>se. Examples of D<strong>is</strong>aster R<strong>is</strong>k Reduction include<br />
Watershed Management (building bunds to trap water,<br />
building channels to divert excess water) <strong>and</strong> Natural<br />
Resource Management (e.g. rotation of pastures,<br />
corralling). Th<strong>is</strong> <strong>is</strong> an aspect of our work which will<br />
become ever more important as <strong>the</strong> effects of climate<br />
change make <strong>the</strong>mselves felt.<br />
10
Participants of Concern’s Municipal Health Partnership Program Kurigram, Bangladesh attending an in<strong>for</strong>mation session<br />
on d<strong>is</strong>advantaged mo<strong>the</strong>rs’ basic rights in accessing health care services. Photo: Allyson Brown, Concern Worldwide<br />
ADVOCACY<br />
Concern Worldwide <strong>is</strong> a “doing” organ<strong>is</strong>ation. For more than <strong>for</strong>ty years we have<br />
been active on <strong>the</strong> ground in dozens of countries helping poor people to cope<br />
with <strong>the</strong> effects of poverty, natural d<strong>is</strong>asters <strong>and</strong> conflict. Yet, we ack<strong>now</strong>ledge<br />
that th<strong>is</strong> work <strong>is</strong> not enough. We look to go fur<strong>the</strong>r in using <strong>the</strong> experience<br />
derived from our work to in<strong>for</strong>m <strong>and</strong> influence <strong>the</strong> people who make <strong>the</strong><br />
dec<strong>is</strong>ions <strong>and</strong> <strong>for</strong>mulate <strong>the</strong> policies which influence <strong>the</strong> lives of <strong>the</strong> poor.<br />
In <strong>the</strong> developing world itself our role <strong>is</strong> to support local<br />
partners in <strong>the</strong>ir interaction with dec<strong>is</strong>ions makers. Our<br />
role <strong>is</strong> to facilitate local people in having <strong>the</strong>ir voices heard.<br />
■ In Or<strong>is</strong>sa, India Concern works with partners, tackling<br />
corrupt practices <strong>and</strong> seeking to ensure that people<br />
receive <strong>the</strong>ir state entitlements.<br />
■ In Sierra Leone, Concern advocated <strong>for</strong> <strong>the</strong> introduction<br />
of free health care <strong>for</strong> pregnant women <strong>and</strong> young<br />
children. Th<strong>is</strong> has <strong>now</strong> been implemented by <strong>the</strong> Sierra<br />
Leone Government.<br />
■ In Bangladesh, Concern’s “We are People Too” campaign<br />
succeeded in persuading Dhaka City Corporation to<br />
extend its birth reg<strong>is</strong>tration to <strong>the</strong> thous<strong>and</strong>s of people<br />
who live in <strong>the</strong> City’s streets <strong>the</strong>reby giving pavement<br />
dwellers equal entitlement to services.<br />
particular women famers. Concern UK leads our work on<br />
th<strong>is</strong> <strong>is</strong>sue through <strong>the</strong> “Unheard Voices” Campaign.<br />
In Europe, <strong>the</strong> United States <strong>and</strong> globally we participate<br />
in key <strong>for</strong>ums, bringing our expert<strong>is</strong>e to bear to influence<br />
development <strong>and</strong> humanitarian policy at <strong>the</strong> highest<br />
levels, including <strong>the</strong> 1,000 Days Partnership.<br />
Concern <strong>is</strong> an active participant in <strong>the</strong> activities of<br />
Concord, Voice <strong>and</strong> ICVA, <strong>and</strong> also of Interaction in <strong>the</strong><br />
United States. Concern <strong>is</strong> also active in <strong>the</strong> Nutrition<br />
Action Group which compr<strong>is</strong>es a small number of NGO’s<br />
advocating in <strong>the</strong> area of Nutrition <strong>and</strong> Maternal Health<br />
<strong>and</strong> a member of <strong>the</strong> Contact Group which acted in an<br />
adv<strong>is</strong>ory role during <strong>the</strong> re<strong>for</strong>m process of <strong>the</strong> Committee<br />
on Food Security of <strong>the</strong> FAO.<br />
In Irel<strong>and</strong>, Concern has worked in concert with Ir<strong>is</strong>h Aid<br />
in sharing learning <strong>and</strong> experience. Concern’s CEO, Tom<br />
Arnold, served on <strong>the</strong> “Hunger Task Force” charged by<br />
<strong>the</strong> Ir<strong>is</strong>h Government with developing a national strategy<br />
to combat hunger in <strong>the</strong> Developing World. The need<br />
to combat hunger <strong>and</strong> its primary cause, poverty, <strong>is</strong> <strong>the</strong><br />
central focus Concern’s advocacy work.<br />
In that context Concern looks to direct attention to <strong>the</strong><br />
needs of marginal farmers (farming but hungry) <strong>and</strong> in<br />
Concern has a special focus on <strong>the</strong> effectiveness of aid.<br />
Concern <strong>is</strong> taking a lead role in <strong>the</strong> work of Alliance 2015<br />
in monitoring <strong>the</strong> per<strong>for</strong>mance of <strong>the</strong> European Union in<br />
looking to meet <strong>the</strong> Millennium Development Goals.<br />
Concern co-operates with Welthungerhilfe <strong>and</strong> IFPRI<br />
to produce <strong>the</strong> Global Hunger Index which analyses<br />
<strong>and</strong> calculates world hunger according to a number of<br />
different criteria. The 2009 Index focussed on gender<br />
inequality. The 2010 Index focuses on <strong>nutrition</strong>.<br />
11
concernworldwide.org<br />
ABOUT CONCERN WORLDWIDE<br />
Concern Worldwide <strong>is</strong> a non-governmental, international, humanitarian organization dedicated to <strong>the</strong><br />
reduction of suffering <strong>and</strong> working towards <strong>the</strong> ultimate elimination of extreme poverty in <strong>the</strong> world’s<br />
<strong>poorest</strong> countries.<br />
Concern’s m<strong>is</strong>sion <strong>is</strong> to help people living in absolute poverty achieve major improvements in <strong>the</strong>ir lives<br />
that last <strong>and</strong> spread without ongoing support from Concern Worldwide.<br />
Republic of Irel<strong>and</strong><br />
52-55 Lower Camden Street<br />
Dublin 2<br />
T +353 1 417 7700<br />
F +353 1 475 7362<br />
E info@concern.net<br />
Nor<strong>the</strong>rn Irel<strong>and</strong><br />
47 Frederick Street<br />
Belfast BT1 2LW<br />
T +44 28 9033 1100<br />
F +44 28 9033 1111<br />
E belfastinfo@concern.net<br />
Engl<strong>and</strong> & Wales<br />
13/14 Calico House<br />
Clove Hitch Quay<br />
London SW11 3TN<br />
T +44 207 801 1850<br />
F +44 207 223 5082<br />
E londoninfo@concern.net<br />
USA<br />
332 South Michigan Avenue<br />
Suite 630<br />
Chicago, IL 60604<br />
T +1 312 431 8400<br />
F +1 312 431 8830<br />
E info.usa@concern.net<br />
USA<br />
355 Lexington Avenue<br />
19th Floor<br />
New York, NY 10017<br />
T +1 212 557 8000<br />
F +1 212 557 8004<br />
E info.usa@concern.net<br />
RURAL KAJIADO, KENYA. PHOTO: KENYA, CONCERN WORLDWIDE