Subsidized food consumption systems in low income countries : the Pakistan experience

"#2063"--handwritten on coverIncludes bibliographical reference

Filling a dietary data gap? Validation of the adult male equivalent method of estimating individual nutrient intakes from household-level data in Ethiopia and Bangladesh

https://www.sciencedirect.com/science/article/pii/S0306919217306851Published versio

Effective delivery of social and behavior change communication through a Care Group model in a supplementary feeding program

Background: In 2014, an intervention aimed at increasing the oil in corn soy blend (CSB) porridge prepared by caregivers of children with moderate acute malnutrition was implemented in Southern Malawi. This analysis describes the flow of key messages delivered through the Care Group model during this intervention. Methods: The intervention provided a supplementary food ration of CSB and oil and used a Care Group model in which healthcare workers were trained to deliver social and behavior change communication (SBCC) to care group volunteers who then delivered messages to caregivers of beneficiary children. Healthcare workers also delivered messages to caregivers directly. Interviews and focus groups were conducted with all three groups in order to determine the exchange of key messages about ingredient use, storage, and purpose, which were analyzed descriptively. Results: Analysis of SBCC flow and information exchange showed that 100% of caregivers reported learning about the amounts of oil and CSB to use while preparing porridge and over 90% of caregivers, healthcare workers, and care group volunteers reported talking about it. Focus groups confirmed an effective flow of communication among these three groups. Conclusion: This analysis evaluated the flow of key SBCC messages through multiple, overlapping lines of communication among healthcare workers, care group volunteers, and caregivers; the effective transmission of these SBCC messages through this model may contribute to the success of a supplementary feeding intervention program. Trial registration: The study was registered at ClinicalTrials.gov (NCT01873196)

Assessing infant cognition in field settings using eye-tracking: a pilot cohort trial in Sierra Leone

Objectives To investigate the feasibility of eye-tracking-based testing of the speed of visual orienting in malnourished young children at rural clinics in Sierra Leone. Design Prospective dual cohort study nested in a cluster-randomised trial. Setting 8 sites participating in a cluster-randomised trial of supplementary feeding for moderate acute malnutrition (MAM). Participants For the MAM cohort, all infants aged 7-11 months at the eight sites were enrolled, 138 altogether. For controls, a convenience sample of all non-malnourished infants aged 7-11 months at the same sites were eligible, 60 altogether. A sample of 30 adults at the sites also underwent eye-tracking tests as a further control. Interventions Infants with MAM were provided with supplementary feeding. Outcome measures The primary outcomes were feasibility and reliability of eye-tracking-based testing of saccadic reaction time (SRT). Feasibility was assessed by the percent of successful tests in the infants. Reliability was measured with intraclass correlation coefficients (ICCs). Secondary outcomes were mean SRT based on nutritional state as well as and changes in mean SRT after supplementary feeding of MAM children. Results Infants exhibited consistent orienting to targets on a computer screen (>95% of valid trials). Mean SRTs had moderate stability within visits (ICCs 0.60-0.69) and across the 4-week test-retest interval (0.53) in infants; the adult control group had greater SRT stability (within visit ICC=0.92). MAM infants had a trend toward higher adjusted SRT at baseline (difference=12.4 ms, 95% CI -2 to 26.9, p=0.09) and improvement in SRT 4 weeks thereafter (difference=-14 ms, 95% CI -26.2 to -1.7, p=0.025) compared with age-matched controls. Conclusions The results demonstrate the feasibility of eye-tracking-based testing in a resource-poor field setting and suggest eye-tracking measures have utility in the detection of group level effects of supplementary feeding.</p

Design and implementation considerations for consumer-oriented food subsidies

The effectiveness and efficiency of a subsidy program depend heavily on the specifics of implementation. Design of subsidy programs should take into account a number of factors, such as political acceptability, leakage of benefits to households outside the target group, cost, and nutritional effectiveness. This chapter discusses specific ways in which these factors can be considered in program implementation and then discusses the relative advantages and disadvantages of the commonest types of food price subsidy programs as they relate to conditions in individual countries.PRIFPRI1DG

Pakistan's ration system: Distribution of costs and benefits

Pakistan's ration system was established in 1942 to deal with shortages of basic goods caused by wartime disruption in supply. At that time, the ration shops handled wheat and sugar, tea, matches, kerosene, yarn, and cotton cloth. After partition, the system was continued to control hoarding and profiteering of scarce goods. All trade in wheat was rationed and controlled by the government until the 1960s when, as a result of several years of favorable weather, supplies became plentiful. Rationing was abolished, but the shops continued to sell atta (whole wheat flour), which the government obtained through its guaranteed price support scheme, with no limitation on quantity.PRIFPRI1DG

Food-Based Safety Nets and Related Programs

Food-based safety net programs support adequate consumption and contribute to assuring livelihoods. They differ from other safety net programs in that they are tied to the provision of food, either directly, or through cash-like instruments (food stamps, coupons) that may be used to purchase food. Since food provided through a safety net program may be substituted for a household’s current consumption, freeing up income for other uses, food-based transfers represent a contribution to household real income or purchasing power. Because food is often seen as the domain of women, women in a household are likely to have control over the use of transfers of food, and of cash-like instruments tied to food. The fact that women control food-related transfers is one possible explanation of the fact, widely documented, that transfers in the form of food or tied to food are more likely to increase households’ net food consumption than are equivalent cash transfers. Food-based programs can be designed to be self-targeting to the poor. Because food-linked coupons or stamps are restricted in use, they are likely to be less desirable than cash. If the use of coupons is restricted to inferior, less-preferred foods, the self-targeting effect will be greater. Direct provision of food may be self-targeting because of the limited choice of commodities; because the foods may be inferior in terms of consumption patterns (though not nutritionally inferior); and because there may be inconvenience associated with receiving bulky commodities. Ordinarily, cash is considered preferable to food, but in crisis situations when food supply is disrupted, food may be preferred. Providing cash or cash-like stamps or coupons in situations where supply is limited and (in the short run) unresponsive to increased demand will only drive up prices. Public provision of food is generally more politically acceptable than cash transfers, because food is a merit good. The commonest types of food-based transfers are supplementary feeding programs, food for work programs, and food stamp programs. Supplementary feeding programs provide a direct transfer of food to target households or individuals. The commonest forms are maternal and child feeding and school feeding. The food may be prepared and eaten on-site (e.g., in child feeding centers or school feeding programs), or given as a “dry ration” to take home. Even if targeted to an individual (child, pregnant or lactating mother), supplementary food is shared among household members. In the case of on-site feeding, the meal eaten on site may be substituted for a home-prepared meal. Supplementary feeding is often provided as an incentive for participation in public services such as primary health care (pre- and post-natal and well-baby care) and education. To achieve nutritional improvement, supplementary food needs to be provided in the context of a more comprehensive program of health care and health and nutrition education. In school feeding programs, food provided on site may contribute to improved learning by alleviating short-term hunger, in addition to its effects as a food supplement and as an incentive to attend school. Food for work programs provide wages in the form of food for public works. Because the provide a source of guaranteed employment, they constitute a true safety net, but only households with able-bodies members can benefit. Effective food for work programs can build infrastructure that contributes to long term food security. Food stamp programs provide stamps or coupons that may be used for the purchase of food, or of particular foods. The stamps may be denominated in value terms or in terms of quantities of specific foods. Food stamps may be used in local stores, so they are more convenient to use than bulk commodities; they are less distorting than direct food distribution; and they can strengthen local retail establishments. Use of stamps requires a reliable system for printing and distributing the stamps, and a good banking system to assure that retailers can redeem the stamps for cash. As with supplementary feeding, food stamps are often provided in conjunction with primary health care or schooling, as an incentive for participation, though there are also stand-alone food stamp programs that function more like cash transfers. Food-based transfers in emergency situations include direct provision of family rations, supplementary feeding of vulnerable groups such as infants, children, and pregnant or lactating women, and therapeutic feeding of acutely malnourished individuals in a hospital-like setting. In many emergency situations, such as refugee or IDP camps, food transfers are the only source of food, and may constitute the only resources a household receives. The purposes of food-based transfer programs vary widely, and include income support, guarantee of a minimum level of consumption, improved participation in socially beneficial programs, and nutritional improvement. Costs also vary widely depending on the size of the transfer, the size of the target group, and the logistical difficulty of distribution. Cost-effectiveness depends on the specific objective(s); cost-effectiveness comparisons are difficult because of the multiple objectives often served by a single program. The multiple types of food-based transfer programs should be viewed as complements to each other, rather than alternatives, because they serve different populations and have distinct gfood, hunger, welfare