Report of the Food Aid and Food Security Assessment: A Review of the Title II Development Food Aid Program Patricia Bonnard Patricia Haggerty Anne Swindale with Gilles Bergeron James Dempsey March 2002 This report was made possible through the support provided to the Food and Nutrition Technical Assistance (FANTA) Project by the Office of Food for Peace and the Office of Program, Policy and Management of the Bureau for Democracy, Conflict and Humanitarian Assistance and the Office of Health and Nutrition of the Bureau for Global Health at the U.S. Agency for International Development, under terms of Cooperative Agreement No. HRN-A-00-98- 00046-00 awarded to the Academy for Educational Development (AED). The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development. Published March 2002 Recommended citation: Bonnard, Patricia, Patricia Haggerty, Anne Swindale, Gilles Bergeron, and James Dempsey. 2002. Report of the Food Aid and Food Security Assessment: A Review of the Title II Development Food Aid Program. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, D.C. Copies of the report can be obtained from: Food and Nutrition Technical Assistance Project Academy for Educational Development 1825 Connecticut Avenue, NW Washington, D.C. 20009-5721 Tel: 202-884-8000 Fax: 202-884-8432 Email: fanta@aed.org Website: www.fantaproject.org TABLE OF CONTENTS Acknowledgements......................................................................................................................... i List of Acronyms ........................................................................................................................... ii Executive Summary.......................................................................................................................iv I. Introduction.............................................................................................................................. 1 A. Objectives........................................................................................................................... 1 B. Program Scope and Assessment Methods.............................................................................. 2 II. Food Aid and Food Security Policy Paper: Its Background and Evolution............................... 4 A. Summary of the Food Aid and Food Security Policy Paper of 1995......................................... 4 B. Evolution of Food Security Objectives for Title II Food Aid................................................... 7 C. Defining Food Security........................................................................................................ 8 D. Adopting Food Security Objectives....................................................................................... 9 III. Overall Efforts to Implement the Food Aid and Food Security Policy Paper..........................11 A. Evolution in Title II Development Programming...................................................................11 B. Policy Paper Management and Implementation Priorities......................................................20 IV. Agricultural Sector Assessment ..............................................................................................41 A. Introduction........................................................................................................................41 B. Overview of the Agricultural Productivity Sector..................................................................41 C. Program Achievements.......................................................................................................42 D. Program Design and Implementation....................................................................................47 E. Monitoring and Evaluation for Availability and Access Intervention......................................61 V. Household Nutrition: Maternal and Child Health and Nutrition Sector Assessment ...............63 A. Introduction........................................................................................................................63 B. Program Achievements.......................................................................................................67 C. Program Design and Implementation....................................................................................72 D. Monitoring and Evaluation of MCHN Programs...................................................................83 VI. Food for Education Sector Assessment ...................................................................................84 A. Introduction........................................................................................................................84 B. Overview of the Food for Education Sector ..........................................................................84 C. Program Achievements.......................................................................................................85 D. Program Design and Implementation....................................................................................86 E. Conclusion.........................................................................................................................93 VII. Recommendations for the Title II Development Food Aid Program......................................94 A. Implementation of the Policy Paper Programmatic and Management Priorities.......................94 B. Agricultural Productivity Sector ..........................................................................................96 C. Household Nutrition: Maternal Child Health and Nutrition Sector..........................................97 List of Tables Table 1 Countries Selected for Field Visits............................................................................... 3 Table 2 Range of Title II Agricultural Interventions by Objective .............................................42 Table 3 Agricultural and Natural Resource Management Results Achieved...............................43 Table 4 Major Title II MCHN Intervention Areas and Approaches ...........................................65 Table 5 Availability of MCHN Performance Indicators in IPTTs..............................................68 Table 6 MCHN Sector Results Based on IPTT Impact/IR Indicator Data ..................................70 List of Figures Figure 1 Number of DAPs by Region, FY 1994–FY 2001..........................................................13 Figure 2 Title II Development Resources in Dollars by Region, FY 1994–FY 2001.....................13 Figure 3 Distribution of Title II Development Resources in Dollars by Region, FY 1994-FY 2001, as a Percent of Resources..............................................................14 Figure 4 Percent of DAPs with a Health and Nutrition Component, FY 1994–FY 2001 ...............16 Figure 5 Percent of DAPs by Technical Sector, FY 1997–FY 2001 ............................................16 Figure 6 Distribution of Total Title II Development Dollar Resources by Technical Sector, FY 1998–FY 2001.....................................................................................................17 Figure 7 Percent of DAPs with Priority Technical Sector Components by Region, FY 1997–FY 2001…………………………………………………………..…...............17 Figure 8 Percent of Title II Development Commodities Used for Direct Distribution and Monetization, FY 1994–FY 2001 .........................................................................27 List of Appendices Appendix 1 Assessment Team...................................................................................................99 Appendix 2 List of DAPs Reviewed for the Agriculture Sector Assessment................................100 Appendix 3 List of DAPs Reviewed for the Household Nutrition: Maternal Child Health and Nutrition Sector Assessment ...........................................................................101 Appendix 4 List of DAPs Reviewed for the Food for Education Sector Assessment....................102 Appendix 5 Bibliography of Selected Cooperating Sponsor Documents, DAP Evaluations and Other Cited References...................................................................................103 Appendix 6 List of People Contacted.......................................................................................112 Appendix 7 FAFSA Country Field Visit Selection Tables..........................................................117 Appendix 8 FAFSA Advisory and Consultative Groups ............................................................121 Appendix 9 Title II Generic Indicator List................................................................................122 List of Annexes Annex Microfinance and Small Business Development Services: High Impact Programs for Food Security.........................................................................................123 Annex Table .........................................................................................................................141 i Acknowledgments The U.S. Agency for International Development (USAID) Bureau for Democracy, Conflict and Humanitarian Assistance, Office of Food for Peace conceived of and provided financial support for the Food Aid and Food Security Assessment (FAFSA). The team is grateful for the opportunity to contribute to USAID’s efforts to strengthen the potential of the Title II development program to achieve sustainable improvements in the food security of vulnerable households in developing countries. However, the opinions expressed herein are those of the authors and do not necessarily reflect the views of the USAID. The FAFSA could not have been completed without the involvement and support of a wide range of individuals. The team wishes to thank USAID and Cooperating Sponsor staff for their input, time and attention. The USAID, Cooperating Sponsor and Expert Advisory Groups provided useful guidance in the development and refinement of the scope of work. The Mission and Cooperating Sponsor staff in the field visit countries – Benin, Bolivia, Ghana and Mozambique – were very helpful in arranging the visits and ensuring the team fully benefited from the relatively short time in-country. The team also wishes to thank the reviewers of the various drafts for their thoughtful comments, in particular: Rene Berger, Thoric Cederstrom, Eunyong Chung, Ralph Cummings, Flynn Fuller, David Garms, Miriam Labbok, Tom Marchione, Donald McClelland, Jean Meyer Capps, Rich Newberg, Mike Pozniak, Mara Russell, John Sanders, Steve Sposato, Bobbie van Heaften and Alice Willard. The team is grateful for the editorial guidance received from the FAFSA Edit Group, led by Tom Marchione. Staff from the Food and Nutrition Technical Assistance (FANTA) project provided essential production and logistic support, and their help is gratefully acknowledged: Tony Castleman, Julienne Hayford-Winful, Juliette Jack Banerjee, Angela Johnson, Alain Otarola and Annette Sheckler. Heddy Reid edited the final version. FANTA’s Project Director, Bruce Cogill, provided valuable support and encouragement throughout the long process. Eunyong Chung, of USAID’s Bureau for Global Health, Office of Health and Nutrition provided insight and support for the assessment, and her efforts are greatly appreciated. ii List Of Acronyms ACDI/VOCA Agricultural Cooperative Department International/ Volunteers in Overseas Cooperative Assistance ADRA Adventist Development and Relief Agency ARI Acute respiratory illnesses BDS Business development services CARE Cooperative for Assistance and Relief Everywhere CGIAR Consultative Group on International Agricultural Research CHW Community health worker CRS Catholic Relief Services CS Cooperating Sponsor DA Development Assistance funds DAP Development Assistance Program, Title II DCHA Bureau for Democracy, Crisis and Humanitarian Response, USAID DHS Demographic and Health Survey Program FACG Food Aid Consultative Group FACS Food-assisted child survival FAFSA Food Aid and Food Security Assessment FAM Food Aid Management FANTA Food and Nutrition Technical Assistance Project FFE Food for Education program FFP Office of Food for Peace, DCHA, USAID FFP/DP Office of Food for Peace, Development Programs Division FFW Food for work FHI Food for the Hungry, Inc. FY Fiscal Year GAO General Accounting Office GMP Growth monitoring and promotion HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome IEC Information, education and communication IFA Iron and Folic Acid IMCI Integrated Management of Childhood Illnesses INHP Integrated Nutrition and Health Project (CARE India) IPTT Indicator Performance Tracking Table IR Intermediate result ISA Institutional Strengthening Agreement ISG Institutional Support Grant, USAID KPC Knowledge, Practice and Coverage Survey LAC Latin America and the Caribbean Bureau, USAID LIFE Leadership and Investment in Fighting an Epidemic initiative, USAID LOA Life of activity M&E Monitoring and Evaluation MCH Maternal child health MCHN Maternal child health and nutrition MDO Microenterprise Development Office, USAID iii ME Microenterprise MED Microenterprise development MF Microfinance MFI Microfinance institution MOA Ministry of Agriculture MOH Ministry of Health MT Metric ton NARC National Agriculture Research Center NGO Non-governmental organization OICI Opportunities Industrial Centers International ORT Oral rehydration therapy PCI Project Concern International PHN Office of Population, Health and Nutrition, USAID P.L. 480 Public Law 480, the Agriculture Trade and Assistance Act of 1954 PLWA People living with AIDS PTA Parent-Teacher Association PVC Office of Private and Voluntary Cooperation, USAID PVO Private voluntary organization R4 Results Report and Resource Request SCF Save the Children Federation SFP School feeding program SME Small- or medium-sized enterprises SO Strategic Objective STD Sexually transmitted disease THR Take-home ration TNS Technoserve USAID United States Agency for International Development VHW Village health worker WFP United Nations World Food Programme WHO United Nations World Health Organization WV World Vision, Inc. iv EXECUTIVE SUMMARY This is the report of an assessment, commissioned by U.S. Agency for International Development’s (USAID) Office of Food for Peace (FFP), of the evolution of the Title II development (non-emergency) food aid program since the Food Aid and Food Security Policy Paper was issued in 1995. The main findings of the assessment include: greater focus of the Title II development program on the most food insecure regions and countries, especially in sub￾Saharan Africa; increased programmatic emphasis on improving agricultural productivity and household nutrition, including a dramatic improvement in the design of Title II agricultural and nutrition programs with the integration of complementary activities such as technical assistance and training, largely funded by monetization, the sale of food aid commodities to generate local currencies for logistic and other program costs; better results and results reporting; and better collaboration among partners. Recognizing this progress, this assessment report identifies program weaknesses and makes recommendations to FFP, Cooperating Sponsors (CSs), Missions and other stakeholders for strengthening the program over the coming years. The importance of transparency, consistency, flexibility and communication in the management of the program by FFP is emphasized. The primary objective of U.S. food aid programs is to enhance the food security of the poor in developing countries. In 1995, USAID issued the Food Aid and Food Security Policy Paper that defined the general purposes and use of Title II emergency and development (non-emergency) food aid resources in support of this objective. The Policy Paper represented a fundamental shift in three components of Title II development activities: programming and geographic focus, performance reporting, and resource integration. The Policy Paper set forth the following major goals and priorities for shifting the emphasis of Title II programs: · Reduction in the level of chronic undernourishment in the most food insecure regions and households, especially in sub-Saharan Africa and South Asia. · Reduction of household malnutrition, especially in children and mothers, and the causes of malnutrition, particularly low agricultural productivity. · Application of results management to Title II development programs. · Greater attention and more resources allocated to strengthening the development and management capacity of USAID's food aid partners. · Integration of Title II programs with Missions’ strategies and integration of U.S. food resources with complementary resources from CSs, USAID, other donors and host country governments. · Support for a shift away from relieving immediate food needs towards building sustainable medium- and long-term food security, including greater emphasis on local capacity-building. · Recognition of a relief-to-development framework. · Commitment to building a better partnership among all food aid partners. FFP commissioned this assessment of the Title II Development Assistance Programs (DAPs) to determine the degree of success DAPs have had in achieving and reporting on the food security goals set forth in the 1995 Policy Paper. The Food Aid and Food Security Assessment involved v a broad range of consultations. Information and data were collected from FFP, other USAID offices, Title II CSs and during field visits to Benin, Bolivia, Ghana and Mozambique. Specifically, the objectives of the assessment were to: 1. Describe how the Title II development program changed its regional and sectoral priorities. 2. Assess management and implementation priorities, especially management for results and resource integration. 3. Determine the results achieved in the agriculture, household nutrition and education sectors, using a qualitative assessment methodology and the best readily available quantitative data. 4. Recommend future program and legislative directions. Shifts in Regional and Sectoral Priorities From FY 1995 to FY 2001, the Title II P.L. 480 development program increased from 45 programs valued at $280 million to 84 programs valued at $380 million in 28 developing countries in sub-Saharan Africa, Asia and Latin America and the Caribbean. In FY 2001, household nutrition programs accounted for 35 percent of program value, agriculture programs for 49 percent, education programs and humanitarian assistance programs for 8 percent each, and non-agriculture-related microenterprise for 1 percent. Since the Policy Paper was issued, the Title II program has increased its focus on the most food insecure regions and countries, especially in sub-Saharan Africa, and increased its program emphasis on improving agricultural productivity and household nutrition. The Title II program has increased the proportion and amount of overall resources and programs devoted to sub￾Saharan Africa from approximately $60 million to $140 million and from 22 to 45 programs. The shift to South Asia is less obvious. The number of South Asian programs increased only recently–after a decrease in the first 5 years following the release of the Policy Paper–from five to nine, but with a relatively smaller value increase from approximately $120 million to $135 million. There has been a concomitant decrease in the proportion of resources for the Latin American and Caribbean region since FY 1995. Programs in Latin American countries with relatively lower levels of food insecurity (food deficits) and food insecure populations have been replaced with programs in countries with greater numbers of food insecure and the programs within those countries have been increasingly focused on the most food insecure populations. There was a marked increase in the proportion of programs that incorporated household nutrition from 53 percent in FY 1995 to 67 percent in FY 2001, peaking at 83 percent in FY 1997. The decrease since FY 1997 was due to an increase in the number of new programs that did not include a household nutrition component but favored agricultural programming. Since FY 1997, the percentage of DAPs with agricultural components increased from 70 percent to 81 percent. Still, the proportion of Title II development resources in the two priority sectors–household nutrition and agricultural productivity–has remained fairly constant at approximately 80 percent since FY 1998. The shifts in resource allocation between the priority sectors reflect an emphasis on longer term-solutions to food insecurity, in accordance with the intent of the Policy Paper. vi Two trends with significant implications for food security are the HIV/AIDS pandemic and African urbanization. The HIV/AIDS pandemic has not been adequately addressed in DAPs; modifications reflecting the effects of HIV/AIDS on the food security objectives of health and nutrition interventions and agricultural programs are still quite limited. CSs require assistance in designing new types of programs that take into account the reduction in labor and the significant drain on household and community resources that result from HIV/AIDS. A growing body of literature suggests that there is an increasing concentration of poverty and food insecurity in rapidly expanding urban centers. The Title II portfolio does not reflect this evident trend and, moreover, FFP and the Missions have steered CSs away from working with urban populations to focus on rural areas, even when there are clearly documented urban food insecurity problems. FFP should apply the same food security rationale and criteria to a DAP that addresses food insecurity in an urban setting as it applies to a DAP with a rural focus. Achievements and Constraints in Management and Implementation of Title II Over the past 6 years, CSs have made considerable progress in program assessment, program design, resource integration, partnering and capacity-building, while facing some significant constraints. Program assessments have advanced considerably as the technical sophistication of CSs has increased, although gaps remain. Review of DAP proposals submitted over time shows significant improvement in identifying and describing critical country-level food security problems; most assessments incorporate a participatory methodology. However, the improvement in macro-level diagnostics is not matched by quantitative data collection and analysis at the local level. Greater incorporation of local data into the design of DAPs would strengthen the results. Monitoring and evaluation systems have been developed that focus on reporting to the Mission and FFP. However, the use of information for field program management needs strengthening. In the area of program design and integration, CSs have increased and maintained a predominant focus on the Policy Paper priority sectors and have developed small-scale, locally affordable and appropriate innovations in agriculture and health and nutrition. CSs have increased resource and programmatic integration in DAPs, although there is need for improvement. As emphasized in the Policy Paper, they have focused attention on building local capacity so that, in the future, people can use knowledge and skills in agriculture and health and nutrition, and earn income to feed themselves. Capacity-building of local partners is a high priority and major focus for all CSs. Unfortunately, the time required for sufficient capacity development often exceeds the 5-year time frame of DAPs. Despite the focus on capacity-building, most DAPs lack a clearly defined and adhered-to exit strategy. Many CSs seem to have expectations that they will be continually re-funded to work in their current countries. Sustainable capacity in communities and households will not be achieved if CSs do not eventually leave. Capacity-building intermediate objectives and affiliated activities need to stress the skills considered essential to sustainability, and comprise an important element of the exit strategy of a DAP. vii Partnerships and collaboration within and between Title II and Mission programs have increased substantially since the mid-1990s when the Policy Paper was issued. Missions have worked with governments, donors and CSs to develop food security and/or nutrition strategies that identify the main determinants of food security and malnutrition, the location of the food insecure populations and the priority interventions necessary to address food insecurity. Missions have been able to use Title II food aid resources to support their broader development objectives by integrating Title II programs in their Strategic Plans. Comparisons of DAPs from the mid-1990s with those developed after 2000 illustrate a clear shift in the intensity and sophistication of partnerships. The partnerships described in the new DAPs (FY 2002-FY 2006) should strengthen the results of both the Title II program and the Missions’ country strategies, encourage local participation and enhance sustainability. The principal management and implementation constraints are in policy guidance, friction between USAID and its partners over the mix of cash and food resources and the transparency and timeliness of FFP’s management. For example, the Title II program continues to lack a clear relief-to-development framework from which to build program policy and develop appropriate program designs and sequencing. There is a constant tension arising from the pressure to use commodity resources as food and the need for cash resources for sustainable impacts. The Policy Paper emphasizes that to achieve sustainable results, food distribution activities need to be combined with complementary program interventions funded from monetization, Section 202(e) or other cash funding sources. The bulk of new complementary cash resources has been gained from monetization of food aid. Over the past 7 years, the proportion of food aid monetized has increased from 28 percent to 75 percent of all Title II development food aid resources. This has made it difficult to meet the 75 percent value-added mandate1 . Consultations with people across the spectrum of food aid stakeholders reveal that the value￾added mandate has created considerable friction among food aid partners and other food aid constituents, although this has ebbed somewhat in recent years. According to FFP’s partners, resolution of issues surrounding the mandate has not been completely transparent. The importance of transparency, consistency, flexibility and communication continually surfaced in discussions with food aid partners. A common concern expressed by CSs and USAID staff relates to the timeliness of the DAP guidelines. Although CSs receive drafts of the guidelines for comment and discussion, the final versions are often issued late in the process, shortly before the DAP proposal submission date. Frequent changes in administrative procedures in an attempt to balance the multiple objectives of the program and the legislation make it difficult and more costly for CSs to follow through on planned program designs and achieve expected results. Two common complaints were inconsistency and a lack of transparency in the review process, and too much emphasis on political or administrative issues at the expense of important technical 1 P. L. 480, section 204(b)(1), Use of “Value-Added Commodities” requires that: “…in making agricultural commodities available under this title, the Administrator shall ensure that not less than 75% of the quantity of such commodities required to be distributed during each fiscal year be in the form of processed, fortified, or bagged commodities.” viii concerns. Concerns were also expressed about an inadequate number of technical reviewers and unclear roles and lines of authority. Sectoral Results, Lessons Learned and Constraints In the past 6 years, Title II program improvement has been dramatic in the priority sectors of agriculture and household nutrition, while the less emphasized education sector has made modest gains. Agriculture. Perhaps the most dramatic sectoral improvement has been in agriculture. The Title II agricultural portfolio has changed significantly since the Policy Paper was released. Prior to 1995, most Title II “agricultural” activities, such as road rehabilitation and reforestation, had only an indirect relationship to agriculture. There were very few production and marketing interventions. The change in the Title II agricultural portfolio following the 1995 Policy Paper implied a dramatic shift in Title II programming, implementation and accountability and the transition required considerable retooling by CSs. CSs have made significant progress in introducing new technologies and effective food security assessment tools and training materials. Over the review period, Title II agricultural programs have introduced appropriate technologies and practices that have increased yields (mostly basic grains and root crops) and reduced storage losses. While there is significant annual variability in yield results for nearly all DAPs, very few performed poorly over the entire life of the activity (LOA). Most programs succeeded in improving yields, and many exceeded their targets. During this period, successful collaboration between Title II programs and local and international agricultural research centers has steadily increased. Through Food for Work (FFW) activities, Title II resources have significantly contributed to the rehabilitation of critical infrastructure destroyed by natural disasters or during complex emergencies. CSs have been successful at organizing large numbers of farmer groups and marketing associations, distributing improved inputs and providing training. The extension staffs are well trained and hardworking. CSs have increasingly formed partnerships that facilitate local participation, improve results and enhance sustainability. There are, however, some weaknesses in the design and implementation of food availability and access interventions. First, although the seasonal food gap is nearly always described as a key characteristic of household food insecurity, CSs do not use well-established interventions to address it. Second, CSs do not adequately and consistently take into account the farmers’ perspective on adapting innovations. Third, CSs insufficiently analyze market constraints and opportunities, which contributes to significant deficiencies in the design of appropriate and profitable market-oriented interventions. Fourth, not enough emphasis is placed on sustainability and the design and follow-through of timely exit strategies. Fifth, with few exceptions, CSs need to place more emphasis on overcoming obstacles to incorporating women as active economic agents and full participants in their programs. Finally, the Title II program has not given sufficient consideration to rural liquidity constraints. Many of the Title II food access interventions have stalled or faltered because of cash flow and credit problems among rural households. ix Household Nutrition: Maternal Child Health and Nutrition (MCHN). Notable improvements in the quality of nutrition and health programming have been achieved in the years since the Policy Paper was released. MCHN programs have evolved from center-based efforts where growth monitoring and food supplementation were the major objectives to integrated community-based development programs with long-term health, nutrition and sustainability objectives. The Title II MCHN sector has made important advances in the health and nutrition of program participants in the last 6 years. Improvements in the nutritional status of children have been reported by more than half of the programs reviewed in a wide range of countries. Diarrheal disease has been reduced and immunization rates have increased. Improvements in key household-level nutrition and health behaviors and in the delivery of essential MCHN services have contributed to positive impacts on child nutrition and health status. Better program diagnosis and design have contributed to these notable achievements. Program designs are more locally appropriate as better problem assessment and diagnostic tools have been developed and community participation has significantly increased. CSs have developed alternative approaches for reaching vulnerable populations not reached by government health systems. MCHN programs are better targeted at the most vulnerable women and children. Supplementary feeding programs have been integrated with complementary activities designed to directly improve food consumption by the child/mother in the home and improve the biological utilization of food through the provision of essential health services and improvements in health care behaviors. However, a number of weaknesses are constraining programs from having a greater impact on nutrition and health. Many DAP proposals fall short of identifying key community and household level nutrition and health problems, particularly those related to behaviors that have a direct impact on nutrition. Title II programs have been successful at moving away from didactic approaches to nutrition education. However, the nutrition education curricula in many DAPs are too broad, incorporate topics that are not associated with DAP interventions and lack specificity in terms of behavior-change objectives. Direct provision of essential health services by CSs may create a disincentive for Ministry of Health (MOH) partners to seek long-term solutions to the problems they face in delivering services. Many of the DAPs reviewed are focused too much on delivering health services, thus limiting the potential impact that food and related inputs can have on nutritional status and neglecting the comparative advantage of food aid. Although MCHN programs are targeted at the most vulnerable women and children, inadequate attention is given to women’s nutrition in Title II MCHN programs, particularly maternal food consumption and dietary practice during adolescence, pregnancy and lactation. Food for Education (FFE): FFE programs integrate food with other resources to enhance educational outcomes, specifically educational opportunity, progress and achievement. Since the Policy Paper, CSs have proactively adapted their programs based on the lessons they have learned from experimenting with the FFE model. CSs have shifted from isolated food input x provision to a broader range of complementary interventions. These include targeting marginal groups, providing take-home rations, mobilizing Parent-Teacher Associations (PTAs) and using other donor and private resources to complement food with interventions such as provision of Vitamin A and deworming medicine. Assessment of the overall performance of Title II FFE programs is difficult due to lack of standardized annual monitoring indicators. Still, all FFE programs did some annual reporting on enrollment, drop-out and promotion rates. FFE programs appear to be increasing school enrollment overall and promotion rates are generally close to targets. Reducing drop-out rates appears to be more difficult than initially thought. Furthermore, CSs designing and implementing FFE programs would clearly benefit from a better understanding of the constraints and opportunities for increasing girls’ education. Key Recommendations Included here are the key recommendations of the assessment. These recommendations identify actions that have the most potential for improving Title II programming and management. Further detail on the key recommendations and additional recommendations for program improvements may be found in the report. Readers interested in a particular topic area should also refer to the related chapters. A. Implementation of the Policy Paper Programmatic and Management Priorities 1. FFP should adopt the following as the primary determinants of whether food aid is used in the form of food, local currency or a combination of both: the nature of the food security problem, the design of the appropriate solution, local market conditions, availability of complementary resources and CSs’ management and technical capacity (p. 30). 2. CSs should make greater efforts to find appropriate ways to use food to address food insecurity issues (p. 30). 3. Congress should expand funds available through the current P.L. 480, Title II, section 202(e) mechanism, create a complementary source of cash funds for Title II programming and/or fund internal transport, shipping and handling costs directly, so that a larger share of the proceeds from monetization would be available for programming. Congress should reevaluate the effectiveness of the value-added mandate (p. 30). 4. FFP should intensify its consultation with its food aid partners in formulating policy, particularly when the policy addresses a controversial issue (p. 39). 5. FFP should put priority on developing a relief-to-development strategy for Title II resources that recognizes the oscillatory and coincident nature of most relief and development transitions (p. 37). 6. FFP should prepare guidance on improving food security for HIV/AIDS-affected households and for households in urban and peri-urban environments (p. 19). xi 7. CSs should intensify efforts to integrate their Title II activities with other complementary development efforts or partners. Missions should improve integration of the Title II program with a broader spectrum of Strategic Objectives (p. 35). 8. CSs should focus on institutionalizing their strengthened capacity and improving quality control in the field (p. 26). 9. CSs and FFP should standardize the methodology for results reporting and widen the dissemination and use of best practices across the Title II program (p. 22). 10. FFP should allow greater flexibility in DAP length in conjunction with stricter exit criteria. CSs should assist communities to find alternatives to CS services early in the program cycle (p. 36). 11. FFP should establish clear, concise DAP guidelines and not rewrite them each year. CSs should be held accountable to the guidance that was in place at the time DAPs were approved (p. 39). 12. FFP should establish a clear line of authority and clarify for its Title II partners the roles of different management units within USAID (FFP, Regional Bureaus and Missions) (p. 39). B. Agricultural Productivity Sector 13. CSs and FFP should make sure that DAP proposals demonstrate knowledge of local farming systems and market opportunities, emphasize interventions that address the priority concerns and constraints of farm families and describe the information systems to be used to refine interventions during DAP implementation (p. 49). 14. CSs need to make sure that they adequately deal with three potential problem areas: 1) finding the right balance between food and cash crops, 2) dealing with household cash flow and liquidity constraints, and 3) closing the seasonal food gap through an increased focus on improved storage, small-scale post-harvest transformation, crop diversification and market opportunities (p. 49). 15. When a DAP includes a marketing component, it is absolutely necessary that the CS conduct a market study as part of the DAP proposal preparation and that it demonstrate adequate evidence of technical competency of the CS or a close collaborator (p. 57). 16. CSs should build a gender strategy into DAPs and commit to being persistent and creative in finding workable solutions throughout the LOA (p. 49). xii C. Household Nutrition: Maternal Child Health and Nutrition Sector 17. CSs should put major emphasis on changing critical nutritional and health behaviors (p. 78). 18. CSs should continue to use growth monitoring and promotion as a key strategy to improve the nutritional status of children under 3 years old and improve referral and follow-up of malnourished children (p. 76). 19. CSs should focus increased attention on strategies to improve women’s nutrition (p. 79). 20. CSs should focus efforts with MOHs on the integration of nutrition into essential maternal and child health services (p. 82). 21. CSs should establish country-specific criteria and verification methods to ensure that the neediest communities are selected and food resources are not used ineffectively (p. 74). 1 I. Introduction A. Objectives The U.S. Agency for International Development (USAID) Office of Food for Peace (FFP) commissioned the Food Aid and Food Security Assessment (FAFSA) to determine the degree of success the Title II P.L. 480 development programs have had in achieving and reporting on the food security goals laid out in the 1995 Food Aid and Food Security Policy Paper (the Policy Paper). In particular, the FAFSA describes the strengths and limitations of the Title II development programs, identifies promising practices for future undertakings and makes recommendations for future directions of the Title II development program. The findings of the assessment are used to provide recommendations to FFP on future programming and technical feedback to Cooperating Sponsors (CSs) and Missions on improving the design, implementation and monitoring of their current and future Development Assistance Programs (DAPs). Specific objectives for the FAFSA included: 1. Outline how the Title II development program changed its sectoral and regional priorities to conform to the Policy Paper. 2. Assess how well planning and management improvements outlined in the Policy Paper have worked out in practice, such as management by results and resource integration. 3. Determine the degree to which results have been achieved in the principal programming sectors, using qualitative assessment and the best readily available quantitative data. Results should be viewed in terms of both the success in carrying out interventions and in achieving intermediate results, and how good implementation and intermediate results actually translated into desired impacts. 4. Identify promising practices, lessons learned and constraints to achieving results. 5. Recommend future program and legislative directions in light of the results, constraints and changes in the organizational and development environment. This chapter outlines the objectives and methods used to do the assessment. Chapter II presents a summary of the key elements of the Policy Paper and a short background on how the food security objectives of the Title II program evolved over the past few decades. Chapter III discusses efforts to implement the Policy Paper and focuses primarily on objectives one and two above. Chapters IV, V and VI present the three technical sector reviews: agriculture, health and nutrition, and education, respectively. These chapters summarize results to date and discuss the design and implementation factors that have helped or hindered in the achievement of desired results. They cover objectives three and four. Key recommendations and additional recommendations for program and policy improvements are found in Chapters III through VI. The final chapter lists the key recommendations. A review of microfinance and small business development services is included in the Annex. 2 B. Program Scope and Assessment Methods The assessment covers the entire Title II development program, although certain countries, programs and sectors are more thoroughly represented than others. The assessment focused on programs with at least 3 years of implementation after 1995, when the Policy Paper was put in place. At the time the assessment began in 2000, there were 79 Title II development programs operating in 28 developing countries; 20 in Africa, 2 in Asia, and 6 in Latin America and the Caribbean. Three overlapping approaches were used to assess this wide-ranging program: document reviews, field visits and consultations. 1. Document Reviews The assessment is based an extensive review of both published and “gray literature” (see Appendix 5). Of central importance was assessment of the agricultural productivity, household nutrition, and food for education sectors in DAP proposals (see Appendices 2, 3 and 4). The team2 also reviewed other written materials provided by CSs such as Results Reports, Previously Approved Activity (PAA) reports, mid-term and final evaluations and other program and technical documents; USAID policy documents; other food aid program assessments and background literature on food aid and food security. 2. Field Visits The objective of the field visits was to add depth to the assessment, and provide an opportunity for the FAFSA team to interact with Title II partners working in the field. Field visits did not evaluate particular CSs or Missions. Four countries were selected for field visits (Table 1) based on the following criteria: · Opportunities to see nearly the full spectrum of Title II CSs. · A good cross section of health/nutrition and agricultural activities. · Examples of other Title II development program sectors. · Experiences of programs in operation for 3 or more years. · Sites where country programs are significant in terms of dollars and/or tonnage. · Examples of programs in multiple regions. The field assessments consisted of: a review of USAID, CS and other relevant documents; interviews with key USAID, CS and partner institution staff and project beneficiaries; and visits to Title II project sites to observe project activities (both service provision and to a lesser extent infrastructure construction or rehabilitation) as well as farmer fields and health centers. 2 See Appendix 1 for a description of the team members. 3 Table 1. Countries Selected for Field Visits Country Cooperating Sponsors AG, HN or Both Bolivia ADRA, CARE, PCI, FHI Both Ghana ADRA, CRS, OICI, TNS AG Mozambique ADRA, Africare, CARE, FHI, SCF, WV Both Benin CRS HN AG: Agriculture HN: Health and Nutrition 3. The Consultative Process Observations from the field visits were combined with the extensive review of project documents covering the entire Title II program, and information drawn from the numerous consultations and interviews with staff of USAID and CSs (see Appendix 6 for a list of contacts). Input from local (in-country) food aid partners and beneficiaries was obtained through discussions conducted during the field visits. In keeping with the spirit of legislation governing Title II resources and the Policy Paper, the assessment was designed to employ a thorough consultative process, including partners from FFP, other USAID offices, and the Title II CSs. The five consultative groups constituted are described in Appendix 8. All food aid partners, including representatives of producer and processor groups, received a copy of the draft scope of work and detailed report outline for comment. 4 II. The Food Aid and Food Security Policy Paper: Its Background and Evolution A. Summary of the Food Aid and Food Security Policy Paper of 1995 The Food Aid and Food Security Policy Paper was written to guide program development and resource allocation for USAID food aid assistance, and to bring it into better conformity with the purposes of the 1990 amendments to P.L. 480 (“the 1990 Farm Bill”), discussed in section B below. It identifies programmatic and geographic priorities for emergency and development food aid programs, and aims to focus the program on the principal causes of food insecurity among the poor in the most food insecure countries. The discussion that follows focuses on the Policy Paper priorities for the Title II development program. The Policy Paper uses the standard USAID definition of food security3 . 1. Geographic Priorities–Sub-Saharan Africa and South Asia The Policy Paper views the Title II program in the broader context of the global effort to reduce the level of chronic undernourishment at the household level as well as child malnutrition and mortality, especially in the most food insecure regions and households in sub-Saharan Africa and South Asia. However, it does not preclude the use of Title II food aid in countries outside these two regions. Priority is given to countries that need food most and where food insecurity is greatest, and to developing countries where “progress is being made, but where there remain large numbers of poor and hungry people” (USAID, 1995). 2. Technical Sector Priorities–Household Nutrition and Agricultural Productivity Without being prescriptive, and using an inclusive definition of priority sectors, the Policy Paper places clear emphasis on the reduction of household malnutrition, especially in children and mothers, and its causes, particularly low agricultural productivity. However, it gives CSs the flexibility to propose other activities provided that they can demonstrate that the activities are critical to alleviating immediate, and preferably, longer-term food insecurity. According to the Policy Agenda section of the Policy Paper: … care will be taken not to allow short-term food security goals to create disincentives to longer-term self-reliance in food. A program which focuses on short-term hunger must also address longer-term constraints (USAID, 1995). For example, the Policy Paper notes that increased incomes (access) are critical to support greater effective demand and provide incentives to farmers to produce more. In addition, the Policy Paper recognizes the negative effects of disease and poor water and sanitation on utilization of ingested food. In addition to the priority sectors, CSs can propose activities in other sectors such as microenterprise and education provided they address local food security constraints. 3 USAID Determination 19, Definition of Food Security is discussed in section II.C. 5 3. Managing for Results The Policy Paper also extends the USAID re-engineering concept of Managing for Results to Title II development programs. In keeping with its mandate to employ performance-based management methods, the Policy Paper shifts USAID’s oversight focus from an emphasis on commodity monitoring and accountability, to one that stresses the food security impacts of Title II development programs on their intended beneficiaries. The responsibility for managing for results is to be shared by both the CSs and the Missions. In addition, USAID is to support CSs’ capacity-building and provide technical assistance in order to ensure results. 4. Strengthening Capacity of Food Aid Partners Strengthening the capacity of food aid partners is another element of the Policy Paper, which states that “greater attention and resources will be allocated to strengthening the program development and management capacity of USAID's food aid partners: the Private Voluntary Organizations, local non-governmental organizations and the World Food Program.” (USAID, 1995.) However, most of the discussion of capacity-building is focused on Managing for Results and local capacity-building for sustainability. 5. Resource Integration The Policy Paper recommends the integration of Title II programs with the Mission’s overall strategy and specific strategic objectives. Additionally, it places strong emphasis on the integration of U.S. food resources with other complementary resources from CSs, USAID and other donor and recipient country resources within an enabling environment for sustainable development. The Policy Paper states that food aid is most effective where “… it is programmed in conjunction with dollar funding for technical assistance and with local currency for logistical support and grass-roots development activities.” The Policy Paper stresses that food aid can reinforce the positive impact of other development programs such as nutrition education, child survival, agriculture and community development projects. This can be accomplished with direct distribution or monetization, the sale of food aid commodities to generate local currencies for logistic and other program costs. Using food aid in this way encourages CSs and Missions to pursue better integration of Title II resources with the other development resources and USAID programs. For example, in agriculture, USAID development assistance resources can support agricultural research on traditional food crops (e.g., millet, sorghum and cassava) and encourage the development of highly adapted food security crops (e.g., drought-resistance maize) and promising multi-purpose farm practices that integrate livestock and tree crops into the farming system. 6. Sustainability The framework outlined in the Policy Paper notes the need to shift the development food aid focus away from a concentration on relieving immediate food needs and toward building sustainable medium- and long-term food security. In fact, the Policy Paper states that building local capacity “… should be an important objective of all USAID activities, since it is essential both to improved food security and to sustainable development” and “… ultimately the success of food aid programs must be measured by sustainability of results” (USAID, 1995). To accomplish this aim, food aid interventions should support to a greater extent sustainable 6 income-generating activities (including improving agricultural productivity, natural resource management and microenterprise development) and place greater emphasis on local capacity￾building. This capacity-building is a way of creating sustainability and ensuring that progress continues even after assistance has terminated. 7. The Relief-to-Development Continuum The Policy Paper acknowledges that relief and development are part of a continuum, and that well-designed long-term food security efforts are the best “preventive strategy” for acute food aid needs. Similarly, the design of emergency programs influences how longer-term development efforts will ultimately progress. Development and relief interventions should be mutually reinforcing and work toward maintaining productive capacity, preventing migration, reinforcing development efforts and enhancing disaster management capacity. The Paper notes that relief interventions should be implemented according to the same principles that guide development interventions–they should build capacity, encourage participation and engender sustainability. Particularly relevant to the Title II development program is the need to devise interventions that can increase self-reliance “… in the face of natural and man-made disasters and promote rapid return to sustainable development.” The Policy Paper recognizes that a new relief-to-development framework is needed. 8. Strengthening the Food Aid Partnership: Guidance on Implementing the Title II Program The Policy Paper also emphasizes the importance of building a partnership among all food aid partners or those who participate in the Food Aid Consultative Group (FACG).4 The Policy Paper stipulates that procedures for implementation of the Title II program will be developed through consultation with CSs. New guidance is to assist USAID Missions and CSs in “… planning the orderly evolution of U.S. food aid programs.” To support this effort, USAID is to provide guidance on what has worked, but not restrict the flexibility of field managers. It is the responsibility of both USAID and CS field managers to “… decide how best to achieve food security.” USAID Missions are intended to be close partners in project planning and monitoring and evaluation (M&E), and will submit comments annually for each Title II project. In particular, the DAP proposals and annual reports of CSs, including M&E plans and objectives, benchmarks and indicators, will be subject to review and concurrence from Missions. Good communication and coordination between CSs and Missions in the development of strategic plans will help foster shared responsibility in planning and management of programs and make them stronger partners. 4 At the time the Policy Paper was written, the food aid partners included USAID, CSs, local non-governmental organizations (NGOs) or implementing partners of CSs, World Food Programme (WFP) and food producers, processors and transporters. 7 B. Evolution of Food Security Objectives for Title II Food Aid The Policy Paper responded to the shifting emphasis of the Agriculture Trade Development and Assistance Act of 1954 (Public Law 83-480), more commonly known as P.L. 480. The Act contains three titles authorizing a program to make U.S. agricultural commodities available for trade development and international assistance. After 36 years of implementation and change, sweeping amendments in 1990 put explicit primary emphasis on enhancing food security of the poor in developing countries. According to the U.S. Agriculture, Conservation and Trade Act of 19905 (the 1990 Farm Bill): It is the policy of the United States to use its agricultural productivity to promote the foreign policy of the United Sates by enhancing the food security of the developing world through the use of agricultural commodities and local currencies … The 1990 Farm Bill outlined the following uses of food aid that are specifically related to the Title II emergency and development programs. They exclude the items related to trade promotion and expansion of markets for U.S. commodities and include an item on sound environmental practices (Section 201: General Authority): · To address famine or other urgent or extraordinary relief requirements. · To combat malnutrition, especially in children and mothers. · To carry out activities that attempt to alleviate the causes of hunger, mortality and morbidity. · To promote economic and community development. · To promote sound environmental practices. · To carry out feeding programs. The 1990 Farm Bill also established a definition of food security (Section 403: Definitions): Access by all people at all times to sufficient food and nutrition for a healthy and productive life. The 1990 Farm Bill made several key changes to U.S. food aid administration. · The Bill explicitly designated the use of agricultural commodity assistance for food security aims, and added heavy emphasis on extending Title II assistance beyond the satisfaction of immediate food needs. · The Development Coordinating Committee, an interagency committee to administer food aid comprised of USAID and the U.S. Department of Agriculture, was disbanded and USAID was assigned sole responsibility to administer the Title II and Title III (government-to-government) programs. · Title II non-emergency government-to-government programs were eliminated. Development (non-emergency) commodity assistance was to be distributed by PVOs, cooperatives or international organizations such as the United Nations World Food Programme (WFP). The commodities could be distributed, sold or exchanged. It was 5 Also cited according to the short title “Agricultural Development and Trade Act of 1990” (USDA, 1990). This Act should not be confused with the “Agricultural Trade Development and Assistance Act of 1954” which initiated the U.S. food aid programs and is often referred as P.L. 480. 8 not until the 1990 Farm Bill that monetization became a basic food aid tool used to support cash expenses associated with implementing Title II development programs 6 . The 1990 Farm Bill significantly broadened the use of proceeds from commodity sales; they could be used for development programming in income generation, health, nutrition and agriculture. · The 1990 Farm Bill required increased coordination and integration of food aid with U.S. development assistance objectives and programs and with the overall development strategy of the recipient country. The Bill also called for special emphasis on activities to increase the nutritional impact of food aid programs. · Periodic General Accounting Office (GAO) evaluations of the food aid program were mandated. · The FACG was created, composed of U.S. Government and PVO representatives. C. Defining Food Security In 1992, USAID laid a critical foundation for a food aid and food security policy. It issued a definition of food security for the Agency, which closely mirrored that of the 1990 Farm Bill: When all people at all times have both physical and economic access to sufficient food to meet their dietary needs for a productive and healthy life. (USAID Policy Determination 19, April 1992.) This definition focuses on three distinct but interrelated dimensions of the concept, all of which are central to the attainment of food security: · Food availability: sufficient quantities of food from household production, other domestic output, commercial imports or food assistance. · Food access: adequate resources to obtain appropriate foods for a nutritious diet, which depends on income available to the household, on the distribution of income within the household and on the price of food. · Food utilization: proper biological use of food, requiring a diet providing sufficient energy and essential nutrients, potable water and adequate sanitation, as well as knowledge within the household of food storage and processing techniques, basic principles of nutrition and proper child care and illness management. This definition encompasses transitory and chronic food insecurity. Transitory food insecurity is common during the period just before harvest. It includes temporary food insecurity resulting from natural disasters or other negative shocks. In contrast, chronic food insecurity is associated with enduring conditions such as poverty or complex emergencies. This definition provides the framework for the Policy Paper, and it is the conceptual framework underlying this assessment. 6 Monetization was first proposed under the 1986 Farm Bill as a means to provide additional cash resources for transportation and handling of food commodities in particularly difficult and expensive environments such as Sub￾Saharan Africa. It originally set a minimum of 5 percent of the total value of non-emergency commodities. In 1988, at the urging of CSs, the minimum was raised to 10 percent, and the acceptable applications expanded to development programming needs. The 1996 Farm Bill raised the level again, from 10 to 15 percent. 9 D. Adopting Food Security Objectives Although the objectives of U.S. food aid shifted to emphasize food security, a 1993 review by the GAO, conducted at the request of the U.S. Congress, found that it was difficult to document the food security impacts of past food aid programs. According to the report, this was due, in part, to a lack of operational guidance from USAID to assist in the identification of food security objectives and evaluation methodologies for food aid programming: … it is difficult to determine whether food aid programs promote food security, in part because USAID has not established a clear policy and operational guidance to assist program managers in identifying food security objectives and evaluation methodologies for food aid programs (GAO, 1993). Among the GAO recommendations was the need for: · Guidance on how food aid programs could enhance food security. · Methods, indicators and data to evaluate impacts. · Complete and accurate Title II records. · Properly trained USAID Office of Food for Peace (FFP) staff. In 1995 USAID issued the Food Aid and Food Security Policy Paper to define the general purposes and uses of Title II development (non-emergency) food aid resources in support of enhanced food security in developing countries. The Policy Paper represented a fundamental shift in three components of Title II development activities: programming and geographic focus, performance reporting and resource integration. It has since served as the framework for approval of all Title II development program activities (for more details see Chapter III). Also in 1995, a GAO follow-on review determined that the majority (11 out of 13) of the recommendations from the 1993 report had been fulfilled or partially fulfilled. USAID had fully implemented the recommendation to establish clear guidance on how food aid programs enhance food security. The Agency had accomplished this through the issuance of the Policy Paper and annual operational guidance on its implementation. However, GAO concluded that USAID had only partially implemented the recommendations on monitoring and evaluating impact and collecting data for evaluation. As part of an effort to address this recommendation, FFP developed a strategic framework and list of indicators for monitoring and evaluating the impact of development food aid programs on food security (see discussion in Chapter III.B.1 and the Title II Generic Indicators list in Appendix 9). During 1995, FFP developed a new Strategic Plan for the Title II development program that supports the implementation of the policy directions contained in the Policy Paper. FFP defined a Strategic Objective of: … increased effectiveness of FFP’s partners in carrying out Title II development activities with measurable results related to food security with a primary focus on household nutrition (USAID, 1996a). 10 The focus of the Strategic Plan is on resource integration and on capacity-building and institutional strengthening of the partners both directly and indirectly. This is managed through negotiating better standards of what is required, acceptable, and feasible for quality development food aid programming. FFP also implements a program to directly strengthen private voluntary organizations (PVOs) through the Institutional Strengthening Agreement (ISA)7 program. ISA funds can be used to strengthen PVO headquarters technical and administrative capacity. The Federal Agriculture Improvement and Reform Act of 1996 (the 1996 Farm Bill) continued to emphasize the importance of the food security objective. It states that priority should be given to countries that, among other attributes, undertake measures to improve food security, agricultural development and poverty alleviation, and promote broad-based equitable and sustainable development. The 1996 Farm Bill also continued to require the Executive Office to present annually: … an assessment of the progress towards achieving food security in each country receiving food assistance from the United States Government, with special emphasis on the nutritional status of the poorest populations in each country. Although not explicitly restricting the types of activities to be supported with Title II resources, the 1996 Farm Bill implicitly placed greater emphasis on showing results on the nutritional status of the poorest populations as opposed to agricultural productivity or some other measure of food security. 8 The Bill also prohibited the USAID Administrator from denying a PVO request for funds simply because there wasn’t a USAID program in the country or there wasn’t a USAID objective consistent with the proposed activity. The 1996 Farm Bill expanded membership of the Food Aid Consultative Group (FACG) to include producer groups. It also broadened the scope of agents that could administer Title II programs, eliminating reference to PVOs and replacing it with “eligible organizations.” 7 ISAs were called Institutional Support Grants from 1993 to 1998, and Enhancement Grants from 1987 to 1992. 8 Between 1990 and 1995, enhancements to food security, as mandated by the 1990 Farm Bill, were being so broadly interpreted that any sustainable development activity could be viewed as a food security enhancement. The 1996 Farm Bill changed this. 11 III. Overall Efforts to Implement the Food Aid and Food Security Policy Paper The Food Aid and Food Security Policy Paper laid out the broad outlines of USAID’s strategy to use food aid to achieve food security results. Together, FFP, CSs, Missions and Regional Bureaus have influenced how Title II development resources are programmed, in what sectors, and where. This chapter discusses the results of this shared influence on the programming of Title II resources in priority geographic and technical sectors since the Policy Paper was issued, and steps taken by the food aid partners–FFP, CSs and Missions–to operationalize and implement the Policy Paper planning and management priorities. Lessons learned and recommendations to strengthen management and implementation of the Title II development program are also presented. A. Evolution in Title II Development Programming–Focus on Priority Geographic Regions and Sectors “…[T]he application of these priorities is expected to concentrate resources more heavily in Africa (particularly Title III resources) and South Asia…a growing share of total resources will be used for programs to enhance agricultural productivity and improve household nutrition. However, USAID will continue to approve new food aid activities in other regions of the world and in other program areas (particularly for the Title II development programs)…” (Policy Paper, p. 21.) 1. Geographic Priorities – Sub-Saharan Africa and South Asia The Policy Paper placed a clear priority on increasing the proportion of food aid going to countries of greatest need—primarily in sub-Saharan Africa but also, to a lesser extent, South Asia. However, it did not exclude programs in countries with relatively lower levels of overall food insecurity, where pockets of food insecurity affect large numbers of people. In FY 1995, just prior to the implementation of the Policy Paper, there were 45 DAPs valued at approximately $280 million9 . By FY 2001, the program increased to 84 DAPs valued at $380 million. Over this same period, there was a clear shift in the relative importance of sub-Saharan Africa in terms of the proportion of resources and, in particular, programs. The shift to South Asia was less obvious. The number of sub-Saharan African programs more than doubled between FY 1995 and FY 2001, from 22 to 55 DAPs (see Figure 1). The number of South Asian programs increased only recently, after a decrease in the first 5 years after the Policy Paper was issued. During that period, programs in Indonesia and the Philippines, countries with relatively lower levels of food insecurity, were closed. One new program in Bangladesh and four in Indonesia were approved in FY 2000 and FY 2001. The Indonesia programs, however, are relatively short-term activities developed in response to the devastating effects of El Niño and the economic and political crisis. 9 Data are from the FFP Information System (FFPIS). 12 There have been approximately 20 programs in Latin America and the Caribbean since the Policy Paper was issued, although there has been a shift in the composition of these programs. Programs in countries with relatively lower levels of food insecurity (food deficits) and food insecure populations (Ecuador, Dominican Republic) have been replaced with programs in countries with greater numbers of food insecure (Nicaragua, Guatemala). The programs within those countries have been increasingly focused on the most food insecure populations. The largest Latin American program, in Peru, is now in a multi-year phase-out, which will probably result in a significantly lower proportion of Title II resources going to the Latin America and the Caribbean region in the future. With the phase-out of the Peru program, the remaining Title II programs will be more focused on the most food insecure Latin American and Caribbean countries. The value of the Title II development program has increased by $100 million since the Policy Paper was issued in FY 1995. Approximately 81 percent of this increase was programmed in sub-Saharan Africa. About 12 percent of the increase was in South Asia, and 7 percent in Latin America and the Caribbean. Clearly, the priority placed by the Policy Paper on sub-Saharan Africa has been reflected in resource allocation decisions. However, the increase in the relative proportion of Title II development program value in sub￾Saharan Africa has lagged behind the growth in the proportion of programs in the region because programs in sub-Saharan Africa tend to be smaller than those in other regions. In FY 2001, 65 percent of DAPs were in sub-Saharan Africa but they accounted for only 38 percent of resources (see Figure 3). The average value of sub-Saharan DAPs in FY 2001 was $3.1 million, compared with $5.4 million in Latin America and $18.2 million in South Asia. Sub-Saharan DAPs tend to be smaller because of limited absorptive capacity and logistic difficulties in implementing food aid programs in Africa. This leads to significant management costs associated with implementation of the Policy Paper geographic priorities. CSs and the Agency need to manage a much larger number of programs in order to achieve significant resource growth in Africa. There has been a decrease in the proportion of resources going to South Asia and Latin America and the Caribbean region since FY 1995, although the absolute amount of resources going to both regions has increased (see Figures 2 and 3). The absolute increase in resources is greater in South Asia ($11.5 million) than in Latin American and the Caribbean ($7.2 million). 13 Figure 1. Number of DAPs by Region, FY 1994–FY 2001 0 10 20 30 40 50 60 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 # of DAPs Africa Asia Latin Am/Carib Figure 2. Title II Development Resources in Dollars by Region, FY 1994–FY 2001 0 20 40 60 80 100 120 140 160 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 $ million Africa Asia LAC 14 Figure 3. Distribution of Title II Development Resources in Dollars by Region, FY 1994– FY 2001, as a Percent of Resources 10% 15% 20% 25% 30% 35% 40% 45% 50% FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 % resources Africa Asia LAC 2. Technical Sector Priorities–Household Nutrition and Agricultural Productivity While granting field managers the flexibility to propose the activities they believe would have the greatest impact on food security, the Policy Paper clearly conveyed the Agency's priorities for allocating resources: “Title II resources will focus on improving household nutrition, especially in children and mothers, and on alleviating the causes of hunger, especially by increasing agricultural productivity.” Figures 5 through 7 present the data available since FY 1997 and FY 1998 on trends in programming in both of the priority sectors.10 There was a marked increase in the proportion of programs with household nutrition components in the second and third year after the Policy Paper was issued (see Figure 5). However, this proportion has dropped dramatically in the past 3 years, due to an increase in the number of new programs that do not contain a household nutrition component. The proportion of Title II development resources programmed in the two priority sectors—agricultural productivity and household nutrition—has remained fairly constant at approximately 80 percent since FY 1998. The other sectors, education, microenterprise and humanitarian assistance, clearly have received lower priority in resource allocation (see Figure 6). 11 10 Because of limitations in the FFPIS, the only trend data available since FY 1995 for the priority sectors are the percent of programs that include a household nutrition component, broadly defined (see Figure 4). For FY 1995 and FY 1996, this information is inferred from the number of programs that include direct distribution of maternal child health rations and review of the small number of 100 percent monetization programs to identify DAPs that addressed other components of maternal child health without including direct distribution. From FY 1997 through FY 2001, the information was provided by CSs and reported by FFP in its annual Results Report and Resource Request (R4). 11 Resources allocated to agriculture are likely to be inflated. Resources allocated to rural road rehabilitation are universally classified as agriculture, although roads are not uniquely linked to agricultural productivity. It is true that they reduce the costs of 15 The relative importance of each of the two priority sectors, however, has changed over time. Household nutrition activities accounted for 50 percent of the value of FY 1998 Title II development resources, when 76 percent of programs had household nutrition components. By FY 2001, the proportion of value had dropped to 39 percent, and only 67 percent of programs had household nutrition components. The proportion of Title II development resources going to agriculture activities had increased from 33 percent to 41 percent and the proportion of programs with agriculture components increased from 71 percent to 80 percent over the same period. These shifts also reflect a change in orientation away from short-term toward long-term solutions to food insecurity, in accordance with the intent of the Policy Paper. One factor contributing to the proportional shift between the two priority sectors is that, over time, an increasing proportion of sub-Saharan African programs has had agriculture components (see Figure 7). Unlike in Latin America and Asia, poverty and food insecurity in Africa, and hence Title II programming, is overwhelmingly rural. Many sub-Saharan African DAPs work exclusively in agriculture (see Appendix 2). As sub-Saharan African DAPs have increased in relative importance, both in percent of programs and percent of value, the influence of the sector composition of these programs is clearly manifest in a shift in the relative importance of agricultural productivity and household nutrition in the overall program. This shift in the relative importance of the priority sectors is of concern to FFP. Since the Policy Paper was issued, DAP Guidelines have been consistent in emphasizing household nutrition and agricultural productivity as priority program sectors. However, the FY 2001 Guidelines highlighted FFP’s concern about rising rates of malnutrition in sub-Saharan Africa, combined with the decreasing proportion and amount of resources going to household nutrition in sub￾Saharan African DAPs. The Guidelines stated that Title II programs should increase their focus on food-assisted child survival (FACS) efforts and other aspects of food utilization in response. A high proportion of Title II development resources are being programmed in the Policy Paper priority sectors of agricultural productivity and household nutrition. In addition to the quantitative focus on these sectors, however, the design, quality and likelihood of sustainable food security impacts of programs in these sectors have also improved under the influence of the Policy Paper. These qualitative improvements will be discussed in the sector-specific chapters later in this report. transportation, providing incentives for farmers to use more inputs and sell more produce, but they also increase access to health services and important household consumption goods. While FFP does have a preferred system of resource accounting, the CS field offices have had trouble instituting the guidelines. The FY 2001 guidance stated that water and sanitation should fall under health and irrigation under agriculture, but many CSs continue to include water and sanitation activities under agriculture. Similarly, FFP classifies microenterprise as income-earning non-farm activities, but many CSs group these types of activities under agriculture. Some microenterprise activities end up under health. Consequently, resource allocation to microenterprise is significantly underestimated. An additional caveat is that forward funding of activities is not reflected in the tables used to calculate the proportion of resources allocated to technical sectors, and this can create large annual fluctuations in program- and even country-level resources. 16 Figure 4. Percent of DAPs with a Health and Nutrition Component, FY 1994–FY 2001 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 Figure 5. Percent of DAPs by Technical Sector, FY 1997–FY 2001 0 10 20 30 40 50 60 70 80 90 FY97 FY98 FY99 FY00 FY01 % DAPs Health and Nutrition Agriculture Education Humanitarian Assist. Microenterprise 17 Figure 6. Distribution of Total Title II Development Dollar Resources by Technical Sector, FY 1998–FY 2001 0% 25% 50% 75% 100% FY98 FY99 FY00 FY01 % value Health and Nutrition Agriculture Education Humanitarian Assist. Microenterprise Figure 7. Percent of DAPs with Priority Technical Sector Components by Region, FY 1997–FY 2001 74 68 67 67 100 74 70 84 67 67 89 58 50 83 67 67 85 85 54 83 75 75 86 86 55 87 89 33 90 85 0 20 40 60 80 100 120 Health and Nutrition Agriculture Health and Nutrition Agriculture Health and Nutrition Agriculture % DAPs Africa Asia Latin America 18 Over time, DAP Guidelines issued by USAID’s Office of Food for Peace (FFP) have reflected shifts in relative priority placed on other sectors as FFP has attempted to balance the objective of increasing food security, different legislative mandates and stakeholder (e.g., CSs, producer groups) concerns and feedback. For example, in the first 2 years after the Policy Paper was issued, FFP discouraged proposals for humanitarian assistance and school feeding activities, because activities in these sectors were less likely to lead to sustainable food security impacts. Proposals for micro-enterprise activities were also discouraged, because of limited opportunities to use “food as food” (direct distribution). The proportion of Title II development resources programmed in the education sector remained fairly constant between FY 1998 and FY 2001 (see Figure 6). The proportion of resources programmed in the humanitarian assistance/general relief sector show a noticeable drop between FY 1998 and FY 1999, from 8.6 percent to 2.4 percent. Several CSs expressed concern about this decrease and lobbied for non-emergency humanitarian assistance in the annual appropriation. Although FFP resists earmarking because it decreases flexibility in programming, it agreed to double non-emergency programming in humanitarian assistance from $15 million to $30 million annually. By FY 2001, due in part to the increased focus on HIV/AIDS and the use of Title II non￾emergency resources under USAID’s Leadership and Investment in Fighting an Epidemic (LIFE) initiative, the total value of Title II non-emergency resources programmed for humanitarian assistance had increased to $41.6 million, or about 9 percent of total program resources. Efforts to phase out some large school feeding programs (e.g., Bolivia, Haiti) resulted in considerable political pressure from CSs, recipient countries and the U.S. Congress. At the same time, there was growing recognition that, if food were combined with efforts to increase the quality of education, longer-term food security benefits might result. Therefore, FFP guidance was modified to encourage the use of Title II food to enhance education quality, and encouraged Food for Education (FFE) activities that integrate food resources with programs to improve the quality of teaching (staff and curriculum) and school infrastructure. Chapter VI discusses in more detail the evolution in FFE programs since the Policy Paper was issued. Recent FFP DAP guidelines reflect a shift in the relative priority placed on microenterprise activities, in recognition of the critical importance of farm and non-farm income generation to food security. It remains to be seen how FFP will balance an increased emphasis on microenterprise with the constraints on the availability of monetization (further discussed in Section III.B.3.a below). Since the issuance of the Policy Paper, two trends with large and important implications for food security have emerged that have not been adequately reflected in FFP guidance. These are African urbanization and the HIV/AIDS pandemic. While a few CSs have taken advantage of the LIFE initiative to include a general relief HIV/AIDS component aimed at vulnerable children, a small portion of recent DAPs have mentioned HIV/AIDS and its prevalence in their target communities. Even fewer DAPs have clearly identified the potential risks and expected consequences with respect to achieving food security in areas with high HIV/AIDS prevalence. 19 Modifications to traditional health and nutrition and agricultural programs that reflect the effects of HIV/AIDS on the food security objectives of the programs are still quite limited. Many CSs do note that cassava cultivation requires less labor in production and therefore recommend promoting greater production. However, they fail to note that cassava is labor-intensive in processing and its nutritional quality is much lower than many other alternative foodstuffs. CSs require some assistance in creating new designs that can account for the reduced access to labor and the significant drain on household and community resources caused by HIV/AIDS. A 1999 World Resources Institute report projected that by 2000, an estimated 38 percent of Africa’s population would be classified as urban. Along with this growth in urban populations has been increasing concentration of poverty and food insecurity in urban areas (Rabinovitch, Nov. 1999). A growing body of literature suggests that urban agriculture is an increasingly important coping strategy and determinant of food security in rapidly expanding urban centers (Bonnard, August 2000, and UNPD, 2000). Capital and provincial cities in Uganda, Ghana, Tanzania and Zambia are becoming increasingly reliant on urban gardens, informal trade and post-harvest handling and processing. Small livestock and egg production are other fast growing subsectors in urban areas in many Title II countries (FAO, 1999). Because urban poverty and food insecurity are linked to many factors in addition to agriculture, non-agriculture access opportunities, based on a sound analysis of the food security situation, are needed for urban communities. Urban Food for Work (FFW) programs can target food insecure households, many of which are comprised of recent migrants from rural areas with limited urban skills. These programs can provide these households with additional resources to meet their food needs and some basic training that they can apply in seeking alternative employment opportunities. Yet, urban-oriented DAPs are conspicuously absent from the Title II program portfolio, and FFP and Missions have steered CSs away from working with urban populations in order to focus on rural areas, even when there are clearly documented urban food insecurity problems. FFP should apply the same food security rationale and criteria to a DAP that addresses food insecurity in an urban setting as it applies to a DAP with a rural focus. Key Recommendation: FFP should prepare guidance on improving food security for HIV/AIDS-affected households and for households in urban and peri-urban environments. FFP should support CSs in their efforts to move beyond relief and direct distribution to building self-reliance in the achievement of household food security for HIV/AIDS-affected populations. FFP should consider the merits of DAPs with an urban focus and prepare guidance on the role of agriculture in promoting better food security in urban and peri-urban environments. The guidance should also encourage, where appropriate, the training of migrants for alternative employment. 20 B. Policy Paper Management and Implementation Priorities 1. Managing for Results “USAID will shift its oversight focus…to the results of the programs…Detailed implementation guidance for the “Managing for Results” strategy will be developed in consultation with the PVOs.” (Policy Paper, pp. 21-22) One of the first actions carried out by USAID after the Policy Paper was issued was the drafting of a Strategic Framework for the Title II development program to put into effect the Policy Paper’s strategy for using Title II resources to maximize impacts on food security. The Framework had as its Strategic Objective (SO) “Sustained improvement in household nutrition and agricultural productivity for vulnerable groups served by USAID food aid activities.” Reflecting the Policy Paper’s emphases, improved household nutrition and agricultural productivity were the primary program areas addressed by the SO. The Framework identified four intermediate results (IRs). The principal determinants of household nutrition were reflected in two IRs: improved health, nutrition and maternal-child health services and practices, and improved water and sanitation infrastructure, services and practices. The principal determinants of agricultural productivity were also reflected in two IRs: improved natural resource management practices in marginal areas, and improved agricultural infrastructure and practices, including use of FFW/Cash for Work for improved roads. Based on this Strategic Framework, USAID identified a results framework and set of indicators that reflected the principal types of interventions likely to be implemented under the IRs. The indicators, selected through a series of discussions with CSs, Food Aid Management (FAM), USAID Missions, staff from USAID Regional and Central Bureaus, and academics, ultimately became known as the Title II Generic Performance Indicators for Development Activities (henceforth referred to as the Generic Indicators). (See Appendix 9 for a list of the Generic Indicators.) Although other types of interventions make up the Title II portfolio and required indicators, these were not considered to have broad applicability due to the technical program foci identified in the Policy Paper, and were not included in the Generic Indicators list. The Generic Indicators were developed to provide a basis for addressing the GAO recommendation “…that the AID Administrator…develop and systematically apply methodologies and performance indicators to monitor and evaluate the impacts of food aid programs on food security.”12 The Generic Indicators were meant to be a menu from which CSs could choose, based on program interventions and technical capacity. CSs were required to use the Generic Indicators or identify alternative indicators that were clearly linked to the food security problem being addressed and the activities selected. The consultative process of developing the Generic Indicators, along with CSs’ experience in developing results frameworks and using implementation guides, appears to have contributed to better understanding of what a performance indicator should look like, and what kinds of indicators are required for Managing for Results. 12 General Accounting Office, 1993, pp. 35-36. 21 Over the past 6 years, CSs have made considerable gains in designing and implementing their M&E plans. Within 2 years of the Policy Paper being issued, two-thirds to three-quarters of approved DAPs identified acceptable performance indicators, from a baseline of 20 percent of approved DAPs.13 A review of the Indicator Performance Tracking Tables (IPTTs) from numerous DAPs and other Title II performance reporting documents,14 and discussions with USAID and CS staff and technical experts familiar with Title II Monitoring and Evaluation (M&E) issues, highlight a number of positive advances and some continuing limitations in the ability of the Title II development program managers to Manage for Results. · The correspondence of performance tracking indicators to SOs and IRs has improved over recent years, but still requires further improvement. There is great variability in the way the indicators were ultimately defined, applied and reported. In general, CSs use many more indicators in their annual tracking plans than required by FFP. Many of these indicators are not very informative, due mostly to the way they are defined (or not defined), measured and/or presented. Limiting the number of indicators for reporting will not only improve the efficiency of M&E systems, but also reduce the adverse effects of modifying DAP objectives during the life of the project. Information on the number of people affected by the program is often missing or unclear. · Based on the need to report on legislative objectives and to respond to GAO recommendations, FFP required CSs to report one of the Generic Indicators of child growth (stunting or underweight) if they were implementing Maternal Child Health and Nutrition (MCHN) activities. However, this reporting requirement has not resulted in significantly improved ability to report on the overall impact of the program on nutritional status. · Most CSs have improved the reliability and timeliness of reporting, but there are still programs that continue to submit late and incomplete documents. Moreover, many CS partners, Missions and other USAID staff have expressed a lack of confidence in CS data and reported results. They are critical of the methods used, the execution of chosen methods and the lack of transparency. · More guidance is needed on data collection methodologies. A set of guides was developed by the Bureau for Global Programs Field Support and Research, Office of Population, Health and Nutrition’s (G/PHN’s) Food and Nutrition Monitoring (IMPACT) and Food and Nutrition Technical Assistance (FANTA) projects with FFP funding to assist in standardizing data collection methods for the Generic Indicators. While the guides have been widely used by CSs, they do not cover all of the Generic Indicators, some were not issued until several years after the Generic Indicators were developed, and not all contain suggested data collection instruments. Inclusion of suggested instruments might have contributed to greater consistency in the way data for the indicators are collected and the way the indicators are defined and reported. · CSs have made greater progress in building their capacity in the area of evaluation (because outside experts are often used) than in performance monitoring, although capacity in both areas still needs strengthening. · Monitoring and evaluation systems are designed for reporting to Missions and FFP, and not for program management. CSs do not regularly analyze M&E output to make use of results 13 Data are from the FFP R4 tracking system, maintained by the Food and Nutrition Technical Assistance Project. 14 Special studies, mid-term and final evaluation reports, although the latter are relatively scarce because most DAPs had not completed and/or submitted final evaluation reports at the time of the assessment. 22 or anecdotal information to understand outcomes and make appropriate adjustments. There is a need for more interpretation and analysis of M&E output– including simple descriptive statistics and economic and sensitivity analysis of the technologies and practices being promoted, especially in agriculture. · Endogenous and exogenous factors that are associated with apparent program success or failure are missing from most M&E systems. · Many M&E systems do not have adequate measures of capacity-building. Indicators do not measure key improvements in institutional and organizational capacity of intermediaries and beneficiaries in areas such as business acumen (understanding of price behavior, cost reduction options, how to locate new markets or how to effectively manage community￾based organizations), organizational efficiency and institutional sustainability. · Most M&E systems do not have adequate indicators measuring linkages between the sectors. These indicators are critical for program managers to assess the extent to which planned linkages are being made and are effective. One way to improve the quality and timeliness of M&E would be to reduce CSs’ responsibility for carrying out some of the more complex and burdensome evaluation activities such as the baseline and final evaluation surveys. It would be critical for CSs to maintain active involvement and decision-making authority in the design and execution of DAP evaluations, but more external technical assistance is certainly warranted. However, even with improvements in the quality of the data reported, USAID should exercise caution in using results information to compare effectiveness across DAPs. Comparisons need to consider the degree of difficulty in working with specific communities or households and differences in country environments (e.g., extremely poor and remote versus more accessible, drought-prone versus more fertile areas, etc.). These factors will affect cost per beneficiary and expected results. Key Recommendation: CSs and FFP should standardize the methodology for results reporting and widen the dissemination and use of best practices across the Title II program. FFP should provide additional resources and CSs and Missions should program greater assistance in data collection and reporting methods to insure greater consistency and comparability of reports, especially reports of nutritional status indicators. FFP, Missions and CSs should identify multiple strategies to improve the collection, dissemination and use of best practices and lessons learned within projects, within countries and across the Title II program. Additional Recommendations on Managing for Results · FFP should conduct a review of current and potential funding and programmatic mechanisms to reduce the burden of the baseline and final evaluation surveys on CSs. Options might include: the Bureau for Democracy, Crisis and Humanitarian Response (DCHA) could fund a small, representative number of independent and rigorous Title II program evaluations, directly or through Missions, enabling FFP to eliminate the requirement to evaluate each program; and FFP could establish an independent support program competitively awarded to a university or firm whose responsibility would be to assist CSs in designing and conducting surveys. 23 · CSs should regularly conduct or contract out narrowly defined follow-up studies to assess the on-going progress of specific components of the DAP in order to identify problems and recommend modifications to the design and implementation of the program. · CSs should limit performance indicators to a few that are directly related to the ultimate goal of household food security or at least one of the elements of food security–availability, access and utilization. The ‘menu’ CSs can choose these indicators from (e.g., the Generic Indicators) should be revised and expanded (see Chapters IV – VI for details). 2. Strengthening Capacity of CSs “Greater attention and resources will be allocated to strengthening the program development and management capacity of USAID’s food aid partners.” (Policy Paper, p. 2) FFP originally intended to use the Strategic Framework for the Policy Paper, and its associated Results Framework, as the Strategic Plan for FFP. However, FFP does not directly implement Title II activities. Its role is to facilitate and strengthen the partners’ capabilities to implement activities and demonstrate results through the provision of resources, guidance, and technical assistance. Therefore, FFP developed a Strategic Plan and Results Framework that focused on increasing the effectiveness of the Title II programs by strengthening program development and management capacity of USAID’s food aid partners15 and increasing integration of Title II programs and resources. With support from the Development Assistance-funded Institutional Support Grants (ISG) and Institutional Support Assistance (ISA) grants, CSs have implemented a range of actions that have strengthened the food security focus and impact of the Title II development program, and improved their ability to manage for results. One indicator of increased CS capacities included in the FFP Results Framework measures the overall quality of the DAP proposals submitted by CSs since the Policy Paper was issued. This indicator shows a steady increase in CS capacity in DAP proposal design from FY 1996, when no approved DAP satisfied at least 75 percent of proposal review criteria, to FY 1999, when two-thirds of approved DAPs satisfied at least 75 percent of proposal review criteria.16 DAP proposals are unsolicited proposals. CSs are not required to respond to a formal Request for Proposals and DAPs are not subject to a competitive procurement process for approval. However, the DAP proposals received since the Policy Paper was issued have largely reflected the emphasis of the paper and followed the guidelines issued by FFP. 15 USAID’s major efforts to strengthen PVO capacity have included: provision of DA-funded ISG, ISA and Title II￾funded 202(e) grants to PVOs to strengthen field and headquarters offices and to support FAM; administrative and information management support through FFP’s Institutional Support contract (Mendez-England & Associates and ARTI); technical support in program design, implementation, M&E, and dissemination of best practices through the Bureau for Global Programs Field Support and Research Office of Population, Health and Nutrition’s IMPACT and FANTA projects; and a partnership between DCHA’s Environmental Officer and the FAM Environmental Working Group for technical assistance and training to CSs in environmental review and compliance. 16 Data for this indicator are not available for FY 2000 because FFP was unable to obtain reliable data. The indicator has since been dropped from the Results Framework. 24 Review of DAP proposals submitted over time shows increasingly high quality in the identification and description of critical country-level food security problems. Most DAP proposals incorporate key national and regional indicators on the dimensions of food security, including levels of poverty, mortality, malnutrition, agricultural production, water and sanitation conditions, access to health services, and social and cultural barriers to improved nutrition. However, local-level quantitative information (district down to community) is used much less. This absence of local information is a problem because national and regional-level data alone are insufficient to design effective DAPs. A number of CSs have developed thorough and effective diagnostics, and most incorporate participatory methods that can be applied at the community level. These methods have helped CSs effectively identify and reach food insecure populations. However, greater incorporation of local findings into the designs of DAPs would strengthen results. Lack of local-level information is particularly notable in the MCHN sector, where many DAP proposals fall short of identifying key community and household-level nutrition and health problems, particularly those related to behaviors that directly impact on nutritional status. In part, this is because many of these problems require formative research, which costs too much for most CSs to undertake prior to funding. The result is that program objectives may be poorly focused. Local-level information is frequently unavailable for the design of agriculture marketing components, but the problem may be more easily addressed with fairly inexpensive marketing studies. CSs have increased efforts to target their DAPs to the neediest population groups. Most DAPs with household nutrition components target population groups most at risk for poor health, malnutrition, and death, i.e., pregnant and lactating women and children under 5 years of age.17 Agricultural programs concentrate on poor, small-scale farmers in difficult settings. Where necessary, CSs have shifted the geographic focus of DAPs to target the program on the most food insecure regions within the country, often with direction and support of FFP and the Missions (Mission efforts are discussed below under Section III.B.3.c: Resource Integration). New program approvals since FY 1998 have almost all been in low-income, food-deficit countries. CSs have focused predominantly on the Policy Paper priority sectors, and have developed small￾scale, locally affordable and appropriate innovations in agriculture and health and nutrition (details may be found in Chapters IV and V). As emphasized in the Policy Paper, they have focused attention on building local capacity so that, in the future, people can use knowledge and skills in agriculture and health and nutrition, and earn income to feed themselves. 17 In recent DAPs, CSs have increasingly targeted children under 2-3 years, a more vulnerable and at-risk age group. 25 CSs have increased capacity to Manage for Results, although there remain many areas for improvement. The majority of programs approved since FY 1997 have completed a baseline survey and set performance targets within the first year of program implementation. 18 Several CSs have hired or worked with local groups or international consultants with more experience and skills to conduct baseline (and mid-term/final) surveys, rather than trying to build local field office capacity to handle this technically complex but relatively infrequent task. CSs have increased resource and programmatic integration in the DAPs, although the possibility of further improvements certainly exists. This integration allows CSs to focus on activities that more closely reflect their capacities and comparative advantage. They have responded positively to opportunities to increase collaboration and coordination with Missions; other bilateral and multilateral donors; local government and NGOs; and other USAID-funded projects (e.g., PVC￾funded child survival programs, centrally funded Cooperating Agency projects such as Basic Support for Institutional Support for Child Survival (BASICS), Breastfeeding and Related Complementary Feeding and Maternal Nutrition (LINKAGES), NGO Networks for Health, Michigan State University Food Security Project; bilateral projects such as the Investment in Developing Export Agriculture Project (IDEA) in Uganda, the Agricultural Marketing and Poverty Alleviation Project (MAPA) in Bolivia and the Poverty Reduction and Alleviation (PRA) Project in Peru). CSs have taken a number of actions to strengthen their institutional capacity for the design, implementation, monitoring and evaluation of DAPs. All of the CSs have hired additional technical and/or M&E experts at headquarter offices to backstop field programs and have provided training and technical assistance to their headquarter and field staff in a range of program design and M&E themes, including baseline, rapid assessment and evaluation methodologies, anthropometric survey methods, sampling and data analysis. Some CSs have developed their own food security models and tools. However, the ability of headquarters-based staff to assure an equivalent level of DAP quality across field offices is variable. CSs have been active participants in the FACG and taken advantage of opportunities to provide feedback to FFP. They have also been active participants in Food Aid Management (FAM), the ISA-funded consortium of food aid PVOs. FAM has created a set of working groups, which enable collaborative development of food aid standards, particularly in the areas of monetization, M&E, environmental impact assessment, and local capacity-building. They have developed monetization and environmental documentation (Regulation 216) manuals and implemented training workshops on monetization and environmental impact assessment in the major Title II regions. FAM has produced M&E guides on health and nutrition baseline methods and tools, and program monitoring, and held workshops on sampling methods, data analysis and program monitoring, in collaboration with the FANTA project. FAM has also developed a widely used website and Food Security Resource Center with over 8,000 state-of-the-art references. 18 Data are from the FFP R4 tracking system, maintained by the FANTA project. Except for an unexplained drop in FY 1999, 88 to 100 percent of DAPs have implemented the baseline survey in a timely manner. There was an almost universal lack of baseline data prior to the Policy Paper. 26 The capacity of CSs to carry out the monetization process has improved significantly, although further improvements may be possible through more strategic collaboration with the private sector and staff technical training. CSs have benefited from resources available from 202(e), the ISG/ISA and monetization itself. They have shared expertise and worked collectively to bring about this growth in capacity. With support and encouragement from FFP and Missions, CSs in many countries have developed joint monetization programs. Such programs clearly increase the efficiency and effectiveness of monetization. FFP now requires joint monetization in any country with more than one CS program. Key Recommendation: CSs should focus on institutionalizing their strengthened capacity and improving quality control in the field. FFP should focus the next round of ISAs on supporting the CSs to do this. Additional Recommendation on Strengthening Capacity of Food Aid Partners · FFP should ensure that CSs receive the technical comments provided to FFP by reviewers of the DAP proposals and identify which, if any, comments must be addressed during the review. When these comments are not passed on, CSs lose an excellent opportunity to receive significant technical assistance at a time when it is still possible to correct critical flaws in their proposals. 3. Resource Integration “Food aid will be integrated to a greater extent with other development resources (particularly USAID resources).…food aid requires complementary investments to achieve maximum impact, and USAID Missions and PVOs need to ensure those resources will be available as food is delivered. Even with narrowly stated objectives, such as nutritional improvement in poor children, sustainable development is so complex a process that complementary interventions are necessary. These interventions can be financed with monetization, other local currency sources, or dollar funding. However, they all have their own costs and require significant management commitment.” (Policy Paper, p. 18.) This assessment focused on three types of integration: integration of complementary activities in DAP sectoral components through the use of different resources, i.e., food and cash, so that technical assistance, training and other necessary complementary interventions are provided; integration of sectoral components within DAPs to strengthen the linkage between activities in agriculture and improved nutrition; and integration of Title II programs with other USAID activities within Missions’ strategic planning. 27 a) Integration of Complementary Activities in Sectoral Components: The Influence of Monetization and the Legislative Mandates Since the Policy Paper was issued, Title II development programs have clearly evolved from activities focused on food distribution and public works (construction of schools, clinics, roads and other infrastructure) to activities with a primary focus on sustainable development. All of the agricultural productivity and household nutrition programs reviewed include complementary activities aimed at improving the capacity of households to meet their own food security needs through the provision of technical assistance, training and services designed to improve the physical and knowledge resource base of communities, households and individuals. One consequence of this evolution in programming has been the increasing share of Title II development resources that are monetized to provide the cash resources required for the complementary investments. FFP data on commodity use since FY 1994 show that the proportion of commodities used for direct distribution and monetization has switched (see Figure 8). Almost three-quarters of commodities in FY 1994 were used for direct distribution. By FY 2001, three-quarters of commodities were monetized. Figure 8. Percent of Title II Development Commodities Used for Direct Distribution and Monetization, FY 1994-FY 2001 72% 60% 66% 50% 44% 39% 37% 25% 28% 40% 34% 50% 56% 61% 63% 75% 0% 10% 20% 30% 40% 50% 60% 70% 80% 1994 1995 1996 1997 1998 1999 2000 2001 Direct distribution Monetization 28 While increasing the availability of resources through monetization is clearly a strategy supported by the Policy Paper, the decreasing amount of commodities used for direct distribution has had consequences. Because bulk commodities are often used in monetization components owing to their easier marketability, it has become increasingly difficult to meet the 75 percent value-added mandate.19 Blended and processed commodity producer groups have expressed concerns about the decline in the amount and predictability of the purchase of processed commodities, partly due to increased monetization. Commercial interests have expressed concern that monetization creates unfair competition with U.S. commercial interests in recipient countries. This perception exists even though CS monetization represents less than one fifth of one percent of U.S. grain exports. Furthermore, as part of their Bellmon analysis, CSs use the Usual Marketing Requirement, which if correctly specified should account for commercial market volumes. Finally, Congress has expressed concern that “…the Agency for International Development (AID) and Title II operational policies are not fully meeting both statutory mandates and the program’s primary humanitarian objective of providing U.S. agricultural products and commodities for feeding the needy worldwide (emphasis added). While encouraged by recent AID commitments to increase relief-type feeding programs, the conferees expect AID, to the extent practicable, in utilizing the funds provided herein, to ensure that the development programs, including monetization programs, comply with the statutory requirement that 75 percent of the commodities provided be in the form of highly nutritious value-added agricultural commodities.” (House of Representatives Conference Report on H.R. 4328, October 19, 1998.) It is important to note in the above quote from the Conference Report that the issue goes beyond the 75 percent value-added mandate per se. Technically, the value-added mandate could be met by monetizing bagged wheat, but the Conference Report states that Title II’s “primary humanitarian objective” is directly feeding people. Congress expects that development programs comply with the statutory requirement of “highly nutritious (emphasis added) value-added agricultural commodities,” even though the legislation20 makes no mention of “highly nutritious.” The addition of that phase clearly is focusing on the blended and/or fortified commodities. FFP has responded to these varied concerns by developing increasingly specific monetization guidelines. The guidelines prioritize 1) the use of monetization in the Policy Paper priority sectors of agricultural productivity and household nutrition programs; 2) monetization of value￾added commodities and 3) monetization activities which support or complement direct distribution of value-added commodities. For example, in the education and humanitarian assistance sectors, the guidelines restrict the use of monetization proceeds (and 202(e) funds) to cover only administrative and logistic costs related to Title II food distribution, not complementary program activities. Complementary activities in the education sector are 19 P. L. 480, section 204(b)(1) "Use of Value-Added Commodities" requires that: "...in making agricultural commodities available under this title, the Administrator shall ensure that not less than 75 percent of the quantity of such commodities required to be distributed during each fiscal year... be in the form of processed, fortified, or bagged commodities…" 20 P. L. 480, section 204(b)(1). 29 required for the reasons discussed in Section III.A.2, but must be funded from non-Title II sources. Monetization activities are further constrained by the condition in the guidelines that they would be allowed only where they would not disrupt commercial markets for agricultural commodities; in particular, monetization is not allowed in developed commercial markets for U.S. produced agricultural commodities. However, the monetization guidelines have not resulted in USAID being able to meet the 75 percent value-added mandate. In FY 2000, less than 60 percent of program commodities were value-added. In addition, as evidenced by Figure 8, the guidelines have not succeeded in significantly increasing the amount or the proportion of commodities used for direct distribution (which is always processed, bagged or blended commodities). In response to the continued high levels of monetization and lack of increase in direct distribution, FFP attempted to impose a minimum quota of 25 percent direct distribution at the country-level in the FY 2002 DAP guidelines. However, FFP did not provide a clear explanation of how the 25 percent direct distribution requirement would be applied, and many exceptions were made during the FY 2002 DAP review process. The 25 percent direct distribution requirement was dropped from the FY 2003 DAP guidelines, although FFP still strongly encourages the inclusion of direct distribution components in new DAP proposals. There is a constant tension arising from the pressure to utilize commodity resources as food in response to FFP directives or because opportunities to monetize are limited, and CSs’ need for cash resources to pay technical staff salaries (including program supervisors and extension agents). FFW can be a valuable resource for constructing and rehabilitating rural infrastructure (e.g., roads and irrigation) and restoring the natural resource base (e.g., reforestation and terracing). However, the effective utilization and sustainability of these types of interventions require significant follow-on training in the use, maintenance and repairs of infrastructure as well as organizational management and environmental awareness. This training requires cash resources. Similarly, household nutrition programs require cash resources for field staff and counterpart training activities, for support of Ministry of Health health service efforts, and for development of educational materials. To achieve sustainable results these types of activities need to be combined with the complementary capacity-building, funded from monetization or other cash funding sources, such as Development Assistance (DA), other donors or CSs themselves. Discussions with people across the spectrum of food aid stakeholders make it clear that the value-added mandate has created considerable friction among food aid partners and other food aid constituents, although this has ebbed somewhat in recent years. This friction has consumed a significant amount of time and resources on the part of all food aid partners and has constrained the building of partnerships. In an effort to fulfill legislative mandates, achieve benchmarks and use resources to achieve sustainable improvements in food security, FFP has had to grapple with conflicting interests and difficult tradeoffs. According to FFP’s partners, resolution of these issues has not always been completely transparent. The lack of transparency has tended to disorient the partners and increase the level of mistrust. 30 A second legislative mandate that has both influenced and complicated policy and program priorities is the mandate on Minimum Non-Emergency Assistance,21 which requires that no less than 1,550,000 metric tons be programmed annually for Title II development programs. USAID did not meet this mandate during the period assessed, although the program came close in FY 2000 (1.3 million metric tons).22 Pressure to meet the sub-minimum mandate made it harder for FFP to reject sub-standard DAPs, especially in the early years after the Policy Paper was issued. The difficulty in meeting mandates was an unforeseen, but perhaps not surprising, outcome of FFP’s efforts to develop a strategy for using Title II resources to maximize impact on food security. It reflects the incompatibility among the Policy Paper’s emphases on identifying approaches that lead to sustainable impacts on household and individual food security in the poorest countries; a focus on expanding programming in the sub-Saharan region, where absorptive capacity is constrained; the Title II legislation that requires a certain percentage of value added commodities to be used; and the reengineering of USAID that pressured operating units toward performance-based management. Analysis of causes of food insecurity and the increased focus on achieving sustainable results had led many CSs to implement programs that rely less on the direct distribution of food, either as rations or in on-site feeding programs. Key Recommendation: FFP should adopt the following as the primary determinants of whether food aid is used in the form of food, local currency or a combination of both: the nature of the food security problem, the design of the appropriate solution, local market conditions, availability of complementary resources and CSs’ management and technical capacity. FFP should not assign quotas for levels of direct distribution and monetization for any given country or program. Key Recommendation: CSs should make greater efforts to find appropriate ways to use food to address food insecurity issues. In some instances, this could require identifying partners that can provide cash resources to complement their use of food resources. Key Recommendation: Congress should expand funds available through the current P.L. 480, Title II, section 202(e) mechanism, create a complementary source of cash funds for Title II programming and/or fund internal transport, shipping and handling costs directly, so a larger share of the proceeds from monetization would be available for programming. Congress should re-evaluate the effectiveness of the value-added mandate (section 204b). To support a minimum level of production of blended cereal products, which are critical to emergency relief efforts, Congress should consider developing a new policy or set of policies to explicitly address this objective. This may enable the elimination of the value-added mandate, which is indirect and has compromised to some degree the food security objectives of the program and food aid partnership. At a minimum, a standard and transparent definition of what constitutes a value-added commodity should be established and consistently applied across all commodities. 21 P. L. 480 section 204(a)(2). 22 1,206,908 metric tons were programmed in FY 2001, according to FFPIS data received in October 2001. 31 b) Integration of Sectoral Components within DAPs: Agriculture-Nutrition Linkages Activities that link the nutrition and agriculture components of DAPs, such as promotion of home gardens with micronutrient-rich fruits and vegetables, and extension of nutrition education to additional family members, were few or weak in many of the programs reviewed. However, when agricultural programs are combined with well-designed health and nutrition education, significant changes in participant consumption behaviors have been reported. Field observations reveal that some CSs have developed innovative linkage activities, such as the broad-based use of the orange flesh sweet potato in Mozambique, and the promotion of home gardens along with commercial greenhouses in Bolivia, and that these have enhanced nutritional outcomes. CSs should involve agricultural technicians in home gardening activities for women led by nutrition/health promoters. Consideration should be given to both the nutritional and economic benefits to the household. The M&E systems in all DAPs reviewed contain few performance indicators of sector linkages, reflecting the probability that inadequate attention is being given to this. CSs need to make efforts to identify appropriate performance indicators of sector linkage and apply the results of these to program management. Evidence suggests that additional agricultural income in the form of own production or cash earnings is more likely to be spent on food if several conditions are met: the incremental income is earned or controlled by women; the income stream is regular or frequent, even if the absolute amounts are small; the income is in-kind (i.e., in the form of food); and training in health and nutrition practices is provided (FANTA, 2001, and Bonnard, 1999). Experience has shown that agriculture program impacts on nutrition are maximized where three conditions hold. First, the program should have a well-designed agricultural component effective at generating output, income, or added value and at drawing in smallholders, women and/or poorer households. Second, interventions should have well-designed nutrition components, providing well-tailored health and nutrition education to address specific local problems. Group-based agricultural interventions provide an ideal opportunity to deliver a small number of well-targeted reinforcing nutrition messages. Third, the agricultural, health and nutrition components should be mutually reinforcing. Development of complementary objectives and joint work plans between agricultural technicians and nutrition/health promoters within DAPs or through identification of local partners strengthens agriculture-nutrition linkages. Not all CSs have the capacity to directly implement these kinds of integrated programs. However, CSs with strong agricultural capacity that do not have capacity in health or nutrition could seek partnerships with other organizations to provide the health and nutrition-related components. Where nutrition problems are clearly poverty related, health and nutrition programs should seek enhanced integration with agriculture and other income-generation programs. 32 Recommendations on Agriculture-Nutrition Linkages · CSs should move more aggressively to design truly integrated DAPs where capacity exists or complement sector-specific DAPs (e.g., agriculture) with activities (health/nutrition) of another agent working within their geographic area. · CSs should increase the focus in nutrition education curricula on how to use available foods (Title II commodities plus farm output plus food purchased locally) in the home to improve nutritional status. c) Integration with Other USAID Programs and Resources Resource integration supports the “shared responsibility concept in planning and managing food programs” (USAID, 1995). Collaboration both within the Title II program and between the Title II program and Missions’ programs has increased substantially since the Policy Paper was issued in 1995. Comparisons of DAPs from the mid-1990s with those developed after 2000 illustrate a clear shift in the intensity and sophistication of partnerships, and the DAPs (FY 2002 – FY 2006) present full menus of CS partnerships. Although there are no performance indicators to monitor partnerships and integration, discussions with field staff and a review of documents indicates that these partnerships have strengthened the results of both the Title II programs and Missions’ country strategies, encouraged local participation and enhanced sustainability. The Policy Paper clearly envisaged Missions’ playing an important role in the implementation of the Policy Paper priorities, including the integration of Title II resources with other USAID programs. Most Missions have modified their programs to some degree to conform to the Policy Paper and subsequent guidance issued by FFP. However, there has been a lot of variation in the scope of Mission actions. The main focus of Mission actions since the Policy Paper was issued has been to develop country food security strategies, integrate Title II programs into Mission Strategic Plans, refocus Title II programs geographically to food insecure regions, develop common indicators to facilitate Mission reporting of Title II impacts, and encourage joint monetization activities, for example, as in Mozambique, Ethiopia, Madagascar, Peru and Bolivia. Many Missions have developed food security and/or nutrition strategies that identify the main determinants of food insecurity and malnutrition, where the food insecure population is located, and the priority interventions to address food insecurity. Missions and CSs have worked with governments, donors such as the European Union, World Bank and WFP and PVOs to develop food security maps that have facilitated the refocusing of the program on the most food insecure regions of the country. For example, the Peru Mission, in collaboration with the Peruvian government and other donors, has gone through two phases of program refocusing since the Policy Paper was issued. Peru first refocused the program on the most food insecure areas of the country, then modified that targeting to focus on an economic corridor approach that combined considerations of food insecurity/poverty with opportunities for development. 33 Missions have been able to use Title II food aid resources to support their broader development objectives by integrating Title II programs into their Strategic Plans. Most Missions have integrated Title II into their Strategic Plans either under a food security Strategic Objective (SO) or under economic growth and rural development, health or, to a lesser extent, education and human capacity development SOs. While the Title II agricultural programs have been successfully integrated with economic growth SOs, albeit with some tension between program objectives, there appears to be a missed opportunity with some other SOs such as governance. Whichever integration approach is taken, active involvement of Mission staff from the different technical sectors the Title II program addresses seems to be critical to program strength and quality. What appears to be a necessary condition is the interest and effort among all partners, both food aid and DA funded, to promote more interaction, collaboration and integration. Setting up a particular structure alone is insufficient. The collaborative process of developing food security maps and strategies and articulating where and how Title II programs fit into a Mission’s Strategic Plan has helped identify necessary complementary interventions, as separate DA-funded projects or as DA-funded interventions integrated into CSs’ Title II programs, as in Ethiopia and Mozambique. Missions have developed innovative approaches that facilitate the integration and complementarity of DA and Title II-funded activities, e.g., secondary city strategy and economic service centers in Peru, and economic corridors in Mozambique.23 Integration of Title II programs into Missions’ Strategic Plans also helps strengthen capacity of CSs where Missions have actively sought to bring together different implementing agencies (both Title II and DA–funded) with Mission technical staff to develop common performance reporting systems and to share best practices and promising innovations. Sharing lessons learned among CSs working within a country has provided useful insights to priority setting and program management, as have meetings with Mission, CS, local government and private sector representatives. This has enhanced both Title II and DA-funded program outcomes. Missions have facilitated the regular exchange of technical information and experiences among different USAID funded projects by: · Promoting local networks among donors, national ministries and organizations (extension and research), CSs and other USAID contractors. · Allocating DA resources to build bridges between CSs and important sources of technical information such as international agricultural research centers and affiliated networks. 23 Several of the examples of integrated strategies, common indicators and innovative approaches come from the Latin American Missions. This may be due in part to the active involvement on the part of the Latin America and Caribbean (LAC) Bureau to encourage integration of the Title II program into Mission strategies, and to repeated requests for R4 reporting by Missions that highlights the contribution of the Title II program. The LAC Bureau had a food security advisor for several years after the Policy Paper was issued who was tasked with strengthening food security programming in the region. The LAC Bureau’s actions may also be due to the relative lower priority placed on the region under the Policy Paper. This may have motivated the Bureau and Missions to strengthen the design of the programs in order to strengthen arguments in favor of continued Title II support, especially since in many LAC countries Title II resources represent a substantial proportion of Mission resources. Finally, greater institutional capacity in Latin American countries, and relatively lower ratio of DAPs per Mission management staff in many LAC Missions–LAC Missions tend to have more direct hire and Foreign Service Nationals assigned to manage Title II programs–may also have facilitated Missions’ efforts to integrate and strengthen the Title II program. 34 · Encouraging CSs to take more advantage of opportunities to cooperate among themselves and capitalize on their complementary skills, through working groups, regular meetings, field exchanges and partnering on DAPs. A major component of FFP’s strategy to improve the management of the Title II development program and to strengthen its partners’ capabilities was the decision to decentralize management of the Title II development program from Washington to the field. The process of transferring management oversight responsibilities to USAID Missions, known as redelegation, included transfer of in-country coordination of CS review meetings for new program proposals and authority to approve annual allocations under approved DAPs. Delegations of authority were expected to encourage greater integration of CS and Mission programs. Missions were considered candidates for redelegation if they met a series of criteria that capture critical components of program and management capacity, many of which reflect the Policy Paper. The redelegated Missions (Ethiopia, Mozambique, Bangladesh, India, Haiti and Peru) have instituted a number of the strategies described above: country food security strategies and integrated Strategic Plans, geographic targeting, indicators with associated M&E plans and joint monetization. In addition, these Missions have taken on the additional responsibilities that come with redelegation, such as being responsible for program reviews and annual resource allocation for approved programs. Some Mission and regional Bureau staff believe that they have not received an equivalent degree of control over the programming of Title II resources in return. At the same time that the redelegation process was being implemented, however, USAID was downsizing its presence overseas. Missions targeted for redelegation, and some of the already redelegated Missions, have expressed concerns about their continued ability to provide the required Title II program management, in particular their ability to ensure that staff would continue to be available. Downsizing also entails tough staffing decisions–the combination of technical and administrative qualifications required to fulfill Missions’ Strategic Plans will likely enter into decisions concerning the placement of FFP field officers. During FY 2000 FFP decided to put further redelegation on hold. Results of a survey of Mission and CS staff in five Title II redelegated Missions indicated that, generally, Missions viewed the results of redelegation efforts positively. However, among CSs, responses varied. In general, the larger CSs viewed redelegation efforts positively and wanted to see the number of redelegated Missions increase, whereas smaller CSs viewed redelegation efforts as either mildly or substantially negative. FFP believes that smaller PVOs may prefer keeping authority more centrally focused (i.e., in Washington, DC) in order to participate most effectively in policy decisions that affect the Title II program. As the level of resources available through Section 202(e) and monetization has become more constrained, the pressure to cost-share and use Mission resources to support the local Title II program has intensified. Unfortunately, there are no sources of data that quantify this contribution across the Title II portfolio. The degree that Missions and PVOs have provided complementary resources directly to Title II programs also is not evident from review of the documents and discussion with Title II implementers, although examples such as the 35 Mozambique Mission, and Catholic Relief Services’ (CRS) Madagascar Credit with Education certainly exist. Key Recommendation: CSs should intensify efforts to integrate Title II activities with other complementary development efforts or partners. Missions should improve integration of the Title II program with a broader spectrum of strategic objectives, especially when a multi-sectoral Title II program is placed under one SO such as economic growth, and the sectoral expertise of members of another SO team such as health is also needed. Missions should encourage and strengthen lines of communication between CS and Mission staff with the appropriate technical expertise and increase field visits by Mission program and technical staff to Title II project sites. Additional Recommendations on Integration with Other USAID Programs and Resources · FFP should work with the Office of Economic Growth and Agriculture to expand the outreach activities and field presence of the international and national agricultural research networks and organizations. · Missions and FFP should increase efforts to facilitate networking and exchange of technical information relevant to Title II program integration (i.e., improving partnering, complementary resource inputs and inter- and intra-sectoral linkages). · FFP, Missions and CSs should define more clearly what is meant by integration, in terms of intervention strategies, partnership objectives, complementarity of skills and resources, and cost sharing of the funding of DAP activities. Integration strategies need to reflect the realities of the political, administrative and funding environments, and the skills and resources of the partner organizations. These factors should be taken into consideration in the design as well as review of DAPs. 4. Sustainability “USAID expects its food security programs to result in local capacity for continued progress, even after U.S. assistance programs end. Building this local capacity should be an important objective of all USAID activities, since it is essential both to improved food security and to sustainable development.” (Policy Paper, p. 7.) Discussions with CSs, review of DAP proposals and the field visits illustrate that CSs have increasingly embraced multi-sectoral community-based approaches grounded in the principles of community ownership, self-reliance and empowerment. These approaches are consistent with the Policy Paper’s emphasis on long-term, sustainable development, as opposed to the predominantly short-term relief objectives of a decade ago. Intervention designs that foster community participation and empowerment are more likely to lead to sustainable improvements in food security. Capacity-building of local partners is a high priority and major focus of all CSs. CSs aim to build capacity at the individual, community and district levels through training, education, extension and role modeling. CSs strongly believe that strengthening the technical, managerial, 36 organizational and financial skills and capacities of local partners is essential to achieving sustainable solutions to food insecurity. Capacity-building objectives included in DAP designs are, indeed, critical for sustainable results. Unfortunately, the time required in order to ensure sufficient capacity development often exceeds the 5-year time frame of DAPs. Programs that rely on the development of greater local capacity in order to effectively hand off activities to local counterparts or beneficiaries normally require significant investments in both community organizations and their individual members. In general, 5 years is a relatively short time frame for achieving results, particularly in the agricultural sector. Greater flexibility in the length of DAPs is needed. Rather than having a fixed, 5-year DAP cycle, DAP life of activity (LOA) should reflect the food security problem and the types of interventions proposed. In general, there is a need for greater emphasis on sustainability and in the design and follow￾through of timely exit strategies within the proposed LOA. Most DAPs lack a clearly defined and adhered to exit strategy. Many CSs seem to have expectations that they will be continually refunded to work within their current countries. Sustainable capacity in communities and households will not be achieved if CSs do not eventually leave. FFP should require CSs to submit exit strategies early in the program, but allow them to modify strategies at mid-term in order to reflect unanticipated factors and broader program changes devised in response to mid-term evaluations. FFP might consider a two-phased timeframe whereby proposals for more than 5 years are broken into two phases with the second phase funding based on findings of a thorough external evaluation. Key Recommendation: FFP should allow greater flexibility in DAP length in conjunction with stricter exit criteria. CSs should assist communities to find alternatives to CS services early in the program cycle, and work on linking beneficiaries to these services or agents over the LOA. Additional Recommendation on Sustainability · To ensure sustainability of community management of food security interventions, CSs should: reinforce and refine the focus on establishment of community health management committees, village food security committees or comparable community structures designed to manage the food security and coping capacity of community residents; and assist communities to develop and implement sustainable solutions for participation and work of community volunteers and encourage creative solutions to minimize turnover of community volunteers. 5. The Relief-to-development Continuum “While ‘relief’ food aid and ‘development’ food aid are often considered and managed as distinct entities, they are, in reality, part of a continuum. Long-term food security efforts constitute the best ‘preventive strategy’ for dealing with acute food needs; conversely, how emergency food needs are met can help influence longer-term food security.” (Policy Paper, p. 22.) 37 The Policy Paper states that development and relief interventions should be mutually reinforcing, and work toward maintaining productive capacity, preventing migration, reinforcing development efforts and enhancing disaster management capacity. There is a need to design interventions that can serve both disaster mitigation and long-term sustainable development ends. Furthermore, the Policy Paper says that Title II development programs, in conjunction with other USAID resources, should help “… vulnerable groups develop the means to cope with future periods of drought and even political conflict." (Policy Paper, p. 23.) One shortcoming of the Title II program’s post-emergency assistance is the lack of a clear framework from which to build program policy and envision appropriate program designs and sequencing. The post-conflict context is no longer viewed as a linear continuum beginning with relief, moving to transition and ultimately arriving at development. Post-conflict situations tend to oscillate for a period of time between conflict and peace, and the transition moves unevenly across regions within a country (e.g., Uganda and Angola). In fact, natural disasters can be recurrent and follow an intermittent pattern of rehabilitation as well. This type of situation calls for multiple strategies that address the unevenness of the transition, a long-term vision combined with a series of short-term staged interventions, and flexible programming and funding. Recovery from conflict also requires significant investments in reestablishing trust among different factions and capacity-building of all kinds. These are activities that FFP has been less willing to fund. There are numerous examples (e.g., Kenya, Ethiopia, Uganda, Mozambique, Chad and Mali) of Title II programs in Africa working with the DA-funded Famine Early Warning Systems, local national early warning systems, WFP’s Vulnerability Assessment and Mapping field offices and, in the case of Ethiopia, Save the Children Federation (SCF)/UK’s Nutrition Surveillance Program. CSs provide monitoring data on food production and supplies, nutritional status and changes in the incidence of certain coping strategies such as small livestock sales, consumption of certain wild foods, migration, etc. They also help identify the most vulnerable populations and participate in relief planning sessions and operations. CARE and World Vision Inc. (WV) make similar contributions to early warning, disaster prevention/mitigation and relief as it relates to recurrent flooding in Bangladesh. Africare/Uganda also delivers the National Early Warning System’s climate and market forecast information to its participants. Because many Title II programs work with direct distribution and/or through local counterparts like Catholic Relief Services (CRS), they are well placed for disaster response. There are numerous examples of CSs administering development Title II programs that have fulfilled this role at one time or another. Several CSs have included local disaster management in their program designs. Africare’s agency-wide approach works through creating and/or strengthening community-based food-security committees that, through assistance from Africare, develop community-based strategies for coping with local food insecurity. WV/Kenya and Africare/Chad have established community grain stocks, which function as a community-based social safety net. Key Recommendation: FFP should put priority on developing a relief-to-development strategy for Title II resources that recognizes the oscillatory and coincident nature of most relief and development transitions. 38 6. Strengthening the Food Aid Partnership: Guidance on Implementing the Title II Program “…USAID will provide implementation guidance on how food commodities will be allocated and utilized to meet food security objectives. This detailed implementation guidance will be developed in consultation with the PVOs and USAID’s field Missions.” (Policy Paper, p. 20.) The Policy Paper explained the new food security orientation of the Title II development program and provided general guidance to Missions and CSs that directly implement Title II programs. As the USAID Operating Unit with authority over the Title II development program, FFP was expected to collaboratively develop and issue annual guidance that reflects changes in policy and programmatic preferences. FFP has the ultimate responsibility for granting DAP approval, and insuring that statutory requirements are met. Over the past several years, FFP has implemented several steps to re-engineer and streamline the Title II development program approval process and lighten the workload of both CSs and FFP, for example by reducing the number of submissions required. The annual DAP Guidelines has been the primary tool used by FFP to convey to its CS partners program and Agency priorities and criteria that would be used to judge DAP proposals. The guidelines issued by FFP since the Policy Paper have been consistent in terms of the geographic and priority technical sector focus of the Title II program and in requiring that CSs pursue food￾security objectives. However, over time the guidelines have reflected changes, modifications, and/or retooling of program emphases, Agency directives and initiatives, program and results management approaches and challenges for FFP and its partners. Some of these changes were obvious and major, while others were more subtle and reflected internal dynamics or political and financial considerations at the time. A common concern expressed by CSs and USAID staff relates to the timeliness of the DAP guidelines. Although CSs receive drafts of the guidelines for comment and discussion, the final versions are often issued late in the process, shortly before the DAP proposal submission date. At times significant changes are introduced too late for CSs to adequately address these changes. Frequent changes in administrative procedures such as issuing new policies or tightening enforcement of policies in an attempt to balance the multiple objectives of the program and the legislation make it difficult and more costly for CSs to follow through on planned program designs and achieve expected results. In response to these concerns, FFP divided the guidelines into two components: the guideline on format and content of the DAP proposal (the DAP Guidelines) and a Policy Letter that addresses the policy and procedural issues, which have been the most contentious and introduced most of the delay in issuing the guidelines. While FFP plans to incorporate the DAP Guidelines in USAID's Automated Directive System (ADS), which will eliminate annual revisions, steps still need to be taken to issue the policy letter in a timely manner. One member of the FAFSA team participated in the FY 2002–FY 2006 DAP proposal reviews in Washington, DC. Additional input was obtained through interviews with USAID, FANTA and CSs staff in Washington, DC, and the field who participated in the current and/or previous reviews. Overall, informants expressed the opinion that while the DAP review process is 39 improving, it can be further strengthened. The two most common complaints concerned inconsistencies and a lack of transparency in the review process and too much emphasis on political or administrative issues at the expense of important technical concerns. Concerns were also expressed about the lack of a standard review process, an inadequate number of technical reviewers and unclear roles and lines of authority. The role of Missions with respect to the DAP review process, and to a lesser extent implementation, remains unclear partly because Missions are best able to articulate how Title II DAPs fit into Mission strategy, but FFP remains responsible for ensuring that Title II DAPs have food security objectives and collectively meet legislative mandates. Several other recurring themes emerged from the interviews and document review. The importance of transparency, consistency, flexibility and communication continually surfaced in the discussions. As is the case with most transactions and business dealings, these elements are important contributors to building confidence among partners, which, in turn, is critical to building the food aid partnership. The absence of any one of these elements tends to create tension between food aid partners as well as for FFP as it attempts to harmonize the real and apparent divergence of interests. Tension also arises from the difficult tradeoffs that confront nearly all food aid partners at one time or another as they attempt to carry out their roles and responsibilities with respect to the Title II program. Key Recommendation: FFP should intensify its consultation with its food aid partners in crafting policy, particularly when the policy addresses a controversial issue. Consultation should help USAID better balance the real and anticipated pressures from interest groups, Congress and constituents, and thereby reduce the frequency of changes in administrative procedures. Key Recommendation: FFP should establish clear, concise DAP guidelines and not rewrite them each year. CSs should be held accountable to the guidance that was in place at the time DAPs were approved. CSs should not be required to alter the design of an ongoing DAP in order to comply with subsequent changes in the guidance, except in exceptional circumstance. FFP should issue the annual DAP policy letter at least 3 to 4 months prior to the closing date for DAP proposal submissions so that CSs have ample time to develop sound program designs that also reflect the latest policies, directives and initiatives. If FFP is unable to issue the policy letter within this time period, to the greatest extent possible, planned policy or administrative changes should be incorporated in the subsequent guidance, and DAPs should be developed based on the previous year’s guidance. Key Recommendation: FFP should establish a clear line of authority and clarify for its Title II partners the roles of different management units within the Agency (FFP, Regional Bureaus and Missions) with respect to the administration of the Title II program. 40 Additional Recommendation on Strengthening the Food Aid Partnership · FFP should program DAP reviews to maximize participation and allow for broader technical review and discussion. FFP should adhere to a fixed schedule of DAP review meetings. Key decisions should reflect the input of the participants and the outcomes of the review meetings. USAID staff from other Bureaus should provide greater technical input in the review of proposed DAPs because the number and technical diversity of FFP staff is insufficient to deal with the number and complexity of DAP submissions. However, FFP should clearly define the role of reviewers and participants from USAID (DCHA, regional bureau and Mission staff), FFP’s Institutional Contractor and Cooperative Agreements such as FANTA. 41 IV. Agricultural Sector Assessment A. Introduction This chapter assesses the overall Title II agricultural portfolio. It aims to identify general patterns and issues, and does not necessarily reflect any one DAP or CS. Generalizations attempt to reflect the majority of programs, not the bulk of Title II resources. Small programs and larger programs are treated equally. References to individual DAPs are made for clarification or to highlight a good or promising practice. In general, promising practices refer to specific DAP components or management practices, rather than an overall DAP. None of the DAPs assessed is considered superior or commendable in every aspect. At least one DAP of each CS and DAPs to cover the range of countries, agroecologies and typical24 agricultural interventions represented in the Title II portfolio, were reviewed. Although the review covers the entire Title II portfolio, certain countries and programs carry greater weight. Emphasis is placed on DAPs that had been in operation for 3 or more years at the time of the assessment. Site visits naturally led to more in-depth understanding and as a result, programs located in these countries received more attention. 25 Other DAPs were included because key informants recommended them for review for specific reasons, e.g., good research practices, interesting use of M&E data, etc. Appendix 2 lists the DAPs reviewed. B. Overview of the Agricultural Productivity Sector The composition of the Title II agricultural portfolio has dramatically changed since the launching of the Policy Paper. In an effort to address the underlying causes of food insecurity (e.g., poverty and low agricultural productivity), the emphasis of the program shifted from short￾term to longer-term sustainable interventions. Prior to the Policy Paper, Title II supported activities with a predominantly indirect relationship to agriculture such as road rehabilitation and reforestation. Today, the portfolio is dramatically transformed with a heavy emphasis on agricultural production and more post-harvest, marketing and agriculture-based microenterprise components (see Table 2.) For most CSs, these changes constituted a dramatic shift in Title II programming and implementation, and the transition required considerable retooling. In general, CSs have made significant progress in all these areas. 24 Typical or common interventions are presented in Table 2. The list includes the range of interventions that are subsumed in the agricultural sector portfolio. 25 Field visits were made in Bolivia, Ghana and Mozambique. ADRA, Africare, CARE, PCI, FHI, OICI, SCF, TNS, and WV have DAPs in these countries. 42 Table 2: Range of Title II Agricultural Interventions by Objective (Intermediate Result) Objective Increase agricultural production Reduce seasonal food gap Increase market access Protect or restore resource base (NRM) Program intervention · Adaptive research · New seed varieties for local food crops · Improved cultural practices (planting in lines) · Application of organic matter (animal or green manure) · IPM/Low external inputs · Inventory credit · Increase market access as incentive to produce more · Increase production · Improve storage · Inventory credit · Support community grain storage · Diversify crops · Encourage agro￾processing · Support income generating activities · Build greenhouses · Support agriculture-based microenterprises · Build marketing associations · Attract input suppliers · Supply price information · Improve rural road work · Add value · Establish rotating credit fund for input purchase · Diversify crops (including tree crops) · Agroforestry · SWC measures (terraces, barriers, drainage) · Reforestation · Irrigation · Water harvesting · IPM/Low external inputs · Incorporation of organic matter · Controlled burning (no burning) NRM = Natural resource management, IPM = integrated pest management, SWC = soil and water conservation Note: Some interventions appear in more than one column because they address more than one objective. Increased production can be an objective in itself or contribute to reducing the seasonal food gap, just as increasing market access can increase income, increasing purchasing power and reduce the seasonal food gap. C. Program Achievements 1. Impact Results Table 3 summarizes the performance of the Title II agricultural programs based on an inexact qualitative assessment of the achievement of targets. The assessment was inexact because it was based on IPTTs that provided insufficient indicator and target descriptions and were often incomplete and irregularly submitted. Comparisons of the performance of different agricultural interventions could provide useful information on the relative effectiveness of each intervention. However, lack of comparable performance data, the variation in Title II program design–both choice of interventions and method of implementation–and in farmer capacity make it impossible to isolate specific characteristics and compare. 43 Table 3: Agricultural and Natural Resource Management Results Achieved–Generalized Performance1 Anticipated Result Results Achieved (FY 1996-FY 2001) Results mostly achieved Results mixed Results often unachieved IMPACT INDICATORS Yields increased2 X Reduced losses in storage3 X Household income increased X Diet diversity increased X Increased value of production4 X Food provisioning improved, close the food gap5 X Reduced soil erosion X PROCESS INDICATORS Number of farmers adopting any improved practice X Total production increased X Number of farmers selling produce increased X Number of farmers belonging to an association X Number of associations X Loans provided X Loans repaid, agriculture-based microenterprise X Participation of women, microfinance X Nursery produced trees X Developing strategic plans with communities or local agencies X Sales/income of associations X Increase market access w/ rural road rehabilitation (km)6 X Number of farmers using soil & water conservation X Trees planted X Number of farmers adopting a specific improved practice7 X Hectares in improved cultural practice X Use of improved storage3 X Increase volume/value of household sales X Loans repaid, agricultural input loans X Hectares with SWC practices X Increase group capacity (associations, micro￾irrigation, community-based microenterprises) X Training/capacity-building of partners X Participation of women, all but microfinance X 1This assessment is inexact and based on the general performance of DAPs as reported in the Results Reports, Previously Approved Activity Reports, Mid-terms and Finals extending over approximately 5 to 6 years. Not all of these reports were available and many reports contained only partial information. There was no assessment of targets – how they were set or whether they are reasonable to begin with. If a CS achieved 95 percent or better of their target in most years, or if it met its LOA target, results are considered achieved. 2Yields tend to vary considerably from year to year, but the assessment is over the LOA. 3 Most CSs measure the reduced losses of a technology or the number of users of a new technology (process indicator) but not both. 4Depending on the DAP, the indicator was measured at the household, association and program level. 5 Targeted effects or changes are often small, e.g., sometimes only a fraction of a month. 6CSs tend to either exceed road targets or fall very short. 7 There is wide variation in achievement among the different cultural practices introduced (see text for more detail). 44 As the impact indicator26 section of the table illustrates, CSs have identified good technologies and practices that, when applied in the field, increase yields (mostly basic grains and root crops) and reduce storage losses. IPTTs illustrate significant annual variability in yield results for nearly all DAPs, but very few performed poorly consistently over the LOA. As the table suggests, most DAPs generally succeed in improving yields, and many exceed their targets. Title II CSs have identified or designed a number of promising storage technologies for maize, groundnuts, soybeans, rice, cowpeas and potatoes (e.g., Africare/Uganda, Adventist Development and Relief Agency (ADRA) and Opportunities Industrial Centers International (OICI) in Ghana, WV/Kenya, CARE/Bolivia and Technoserve (TNS)/Ghana’s Inventory Credit Program). Results have shown that low-cost grain storage methods (e.g., mud silos, with and without chemical treatment of stored grain) reduce losses, maintain grain quality, and extend stocks over a longer period of time, which improves household access to food. For example, by reducing insect and pest damage with improved storage and post-harvest practices in Ghana, it is possible to extend the storage life of grain stocks from 3 to 6 months in the Northern Region, and from six to nine months in Brong Ahafo Region. Adequate local storage has also kept grain in the community and available for purchase or consumption later in the season (WV/Kenya). Unfortunately, throughout the Title II program, extension of these technologies to rural households has been less effective, which probably partly explains why CSs have been less successful in expanding household food provisioning. Although harder to measure within a short time frame, CSs have had some positive outcomes related to natural resource management. Few DAPs use “reduced erosion” as an impact indicator, and several CSs within this limited number measure expected rather than actual soil loss reduction. 27 Nevertheless, evidence from several DAPs in Ethiopia indicates that the increased vegetative ground cover resulting from newly adopted structural and vegetative conservation measures have contributed to increased recharging of groundwater, leading to greater availability of potable water for both human and livestock consumption. WV/Ethiopia also reports an increase in the quantity and quality of forage produced. 2. Intermediate Results In general, CSs have been consistently successful at achieving targets such as organizing large numbers of farmer groups and marketing associations, distributing improved inputs and providing training for many farmers and counterparts.28 In the limited cases where CSs attempted to measure capacity developed, performance was weak, but this may be more closely related to poor indicators and measurement than to actual performance. 26 At the time that most of the DAPs reviewed were designed, the guidance did not require agricultural programs to measure nutritional status outcomes, nor were CSs required to tie increases in productivity and production to household food consumption or improved coping strategies. Hence there are no generic nutrition indicators for agricultural programs. 27 The “universal soil loss equation” measures expected soil loss rather than actual soil loss. 28 While these types of indicators are generally considered output indicators, many M&E Plans and IPTTs use them to assess intermediate results. 45 Despite considerable success in identifying effective interventions (e.g., improved varieties, planting in rows, etc.), CSs have had more problems broadly extending these same innovations. This is implied by the lower rates of achievement for adoption-related process indicators such as number of specific practices adopted, number of improved storage facilities constructed, hectares with improved practices or soil and water conservation, and trees planted. The results could be signaling that while these innovations may be well suited for the agroecology, they are not the most appropriate from the perspective of the farmer. Alternatively, the extension approach or intensity of the approach could be insufficient given the DAP objectives. Mixed to poor performance in these areas explains, in part, the mixed performance in extending household food provisioning. a) Post-emergency Rehabilitation Funneled through FFW activities, Title II resources have significantly contributed to the rehabilitation of critical infrastructure destroyed by natural disasters or during complex emergencies. Results Reports, mid-term evaluations and interviews with CS partners suggest that CSs have also been able to rapidly disseminate improved seeds to farmers eager to rebuild seed stocks and expand their production. For example, the Title II program helped to rejuvenate maize production in post-war northern Mozambique. After the most recent floods in southern and central Mozambique, CSs, in collaboration with the National Institute for Agricultural Research and the Southern African Root Crops Research Network (SARRNET), distributed vitamin A-rich orange-flesh sweet potato planting material to replace the less nutritious traditional white-flesh varieties. Similarly, CRS/Rwanda restocks small livestock (goats and pigs mostly) in an effort to increase households’ coping capacity. The animals also provide manure as fertilizer and an additional source of protein in household diets. b) Marketing Included in agriculture-related food access interventions are promotion of improved post-harvest technologies (e.g., storage and processing) and handling, input and output markets, road rehabilitation and expansion of agriculture-based income-generating activities or microenterprises (largely small-scale trade and agriculture transformation). According to the FY 2002 Guidance, microenterprise development means non-farm enterprises, suggesting that activities such as shea nut collection and transformation or palm oil collection and processing lie outside agriculture; yet, CSs promoting these types of interventions classify them as agriculture. Only a few DAPs (e.g., TNS/Ghana) concentrate on non-farm microenterprise development. Promoting increased marketing of agricultural production is the most common access intervention. Therefore, the discussion in section IV.D.4 focuses on marketing and gives lighter treatment to storage, microenterprise development and rural road rehabilitation. Although there are exceptions, most Title II marketing interventions and monitoring tools are weak. As Table 2 illustrates, CSs are successful at increasing the number of marketing associations and members of those associations, but building the associations’ or individual farmer’s capacity to independently carry out various market-related functions is more problematic. Most mid-term evaluations remarked on significant weaknesses in both the design and implementation of Title II marketing components (see section IV.D.4 on food access). 46 c) Rural Roads Road construction and rehabilitation is viewed primarily as a means to move produce out of surplus areas and into deficit areas.29 The most common indicators associated with rural road rehabilitation measure kilometers of improved roads, and only in a few cases, road use or commodity flows. Very few DAPs look at changes in seasonal variability in commodity prices and transportation times and fees. As a consequence, CSs fail to report on important food-access impacts of rural roads. Fortunately, a few studies on the benefits of Title II roads components have been conducted and there were some opportunities to interview beneficiaries during the FAFSA field trips. Beneficiaries frequently cite significant savings in travel time: hours, sometimes days, of travel are saved (CARE/Bangladesh, CARE/Honduras, Bolivia). Savings are greatest during the rainy season since travel on unrehabilitated roads is most difficult and restricted during this season. In some cases, travel would have been impossible and many communities would have simply gone without during the rainy season. Beneficiaries of road rehabilitation noted that the time and costs of transport for both people and goods dropped sharply with improved roads, and the seasonal variation in fares declined sharply (Bolivia, CARE/Bangladesh, and WV/Mozambique). In some cases, new stores and markets cropped up along rehabilitated roads bringing food, basic household supplies and farm inputs closer to the community. Africare/Uganda reports that traders now regularly come to villages to source produce, which expands farmers’ marketing opportunities and reduces spoilage of produce that would otherwise remain in the village too long. A study conducted for CARE/Honduras revealed that roads help strengthen social capital and remittances flowing into and out of Title II communities. The study also noted that improved roads allowed for easier access to training and technical assistance. Representatives from assistance and governmental agencies visited more frequently, and residents could more easily seek out training and technical assistance in other communities or in town. CSs have significantly strengthened their capacity to do environmental analysis, as part of the successful effort to bring the Title II development program into compliance with Regulation 216. However, there have still been some negative impacts associated with rural roads. Several mid￾term and final evaluations noted road construction and rehabilitation led to increased soil erosion, and loss of land through either the physical laying of the road or increased competition for land that had become more desirable due to greater market access. Some communities also note increased competition for public goods (e.g., fuelwood) in their vicinity as areas become more accessible. d) Income Generation Income indicator results are mixed, but interviews with beneficiaries as well as Results Reports and evaluation documents note beneficiaries are consistently spending additional income generated through participation in Title II activities on food, fertilizer, improved seed, clothes, zinc for roofing, fees for their children’s education and hired labor. In some instances, women 29 Although there are many benefits to improved road access that are not agriculture related (e.g., greater access to health services, education and consumer goods), FFP groups all rural road rehabilitation activities under agriculture. 47 have gained status and access to resources such as land. Women working at tree nurseries in Muslim-dominated areas in the Northern Region of Ghana actually were able to acquire use of land for their own food production with the resources they generated from their work at the nurseries. Husbands began giving their wives land because they demonstrated that they could make money from the trees they planted as well as from expanded field crop production. D. Program Design and Implementation 1. Program Focus Title II CSs have developed good food-security assessment tools and technical training materials. CRS has a manual on participatory program evaluation (Aubel, 1999) and is drafting a manual on assessments, CARE developed a household livelihood approach (Ndung’u, Muhoro and Daniel Maxwell, 1999, and Drinkwater and Rusinow, 1999) and Africare has developed a field manual that includes a section on participatory assessment methods. Still, a review of the DAP proposals submitted after 1995 suggests that, with a few exceptions, the overall Title II agriculture program designs tend to be relatively general and generic in their approaches, and do not account for the true variability within populations. One explanation is that CSs rely too heavily on country- or province-level data in defining the food security problem and designing DAPs (a frequent observation during the DAP review process). This is true even when CSs are proposing follow-on DAPs in the same areas and should, therefore, have activity-level data collected during the previous DAP cycle that could provide a richer characterization of constraints and opportunities. Two contrasting but common Title II scenarios will help illustrate the point. Many of the farming communities are physically isolated and receive little or no government agricultural support services. Consequently, farmers rely on traditional crops and farming practices for both household nutrition and income generation. Small improvements to soil and water management, plant and animal genetics (breeds and varieties), pest control, soil fertility and animal health could significantly improve output and the productivity of land, labor, and capital. For these remote farm households with seriously restricted market access, improving agricultural productivity and expanding farm output primarily for home consumption is the principal avenue for income growth and improved food security, and Title II interventions should be geared toward solving basic agronomic problems associated with traditional crops that have limited dependence on markets or external input supplies. Other Title II farming communities experience low food crop yields despite accessible or reasonably accessible markets. Through provision of technical assistance and some complementary inputs, CSs may substantially increase average yields and exceed LOA yield targets for a variety of basic food crops. Yet, yields are not sustainable due largely to constraints in accessing basic inputs (improved varieties, chemical fertilizers, pesticides, etc.) and/or market outlets for their produce. For these farmers, market access ought to be a critical component of the strategy. One recent study found that Ethiopia’s success in increasing the adoption of improved varieties and achieving higher yields was due, in part, to the development of a fertilizer industry (Sanders et al., 2000). 48 Closing the Seasonal Food Gap. Although DAPs note that eliminating the hungry season is critical to achieving food security, few are designed to directly address and monitor the spectrum of important underlying factors. Nearly all agricultural DAPs focus on increasing yields and give too little consideration to other factors. For example, in the Northern Region in Ghana, farmers claimed that grain stocks were consumed or destroyed by insects within 3 to 4 months. Poor farmers can easily loose 20 to 40 percent of the grain they store. Without adequate storage and post-harvest handling, farmers are not able to retain stocks to either smooth consumption over the agricultural year or sell later in the season and smooth cash flows and capture a higher price (a standard marketing strategy promoted by the Title II program). But despite the near universal storage constraint, most DAPs reviewed concentrate on promoting improved varieties (most grain varieties) and cultural practices and convincing farmers to sell their produce later in the season without giving adequate attention to storage bottlenecks. Alternatives to Increasing Yields. DAPs tend to emphasize increasing the productivity of field crops. However, in many instances the greatest potential for economic and food-security benefits may be found in livestock, gardens, tree crops and agro-processing opportunities. The overall Title II program is weak in addressing critical links between increased availability and access and improved household food security (e.g., provision of food, closure of the seasonal food gap, etc.) or coping capacity. The focus is on yield. This overemphasis on yields likely stems from the Policy Paper and follow-on guidance that continued stress on agricultural productivity as the ultimate food-security impact of Title II agricultural programs. In addition, yield is an accepted FFP generic impact indicator that most agronomists and field staff are accustomed to. Reaching Women. Many DAPs claim to be gender sensitive and inclusive of women, if not primarily interested in working with women. However, a review of DAPs reveals that strategies for addressing gender issues and objectives are undefined. Most CSs acknowledge that progress toward achieving gender-specific targets has been slow and not completely successful. Results Reports, IPTTs and mid-term evaluations note that, with few exceptions, CSs have had problems overcoming obstacles to incorporating women as active economic agents and full participants of their programs. Mid-term evaluations as well as discussions with CS staff, suggest that this is largely because the agricultural DAPs are oriented toward men. DAPs give too little attention to women as producers and economic agents with their own unique constraints and opportunities. Most agricultural DAPs are implemented by men and there are too few female extension agents and other project staff. This lack of success in reaching women is particularly unfortunate in situations where households depend on seasonal or long-term migration for a significant portion of their livelihoods (especially true for Latin America), and in many instances it is the men who migrate so women are actually the key to the continuity of Title II activities30 . 30 Migration patterns are case specific. In Africa, men often migrate to cities in search of wage labor, but increasingly in Latin America women migrate to urban centers to work as domestics or in factories and to other rural areas to work as seasonal laborers. 49 Rural Liquidity. Finally, the Title II program has not given sufficient consideration to rural liquidity constraints and the capacity of households to make the purchases and investments that are necessary to increase short- and long-term food security. Many of the Title II food availability and access interventions have stalled or faltered because of households’ general lack of complementary financing–greater cash flow or credit. Key Recommendation: CSs and FFP should make sure that DAP proposals demonstrate knowledge of local farming systems and market opportunities, emphasize interventions that address the priority concerns and constraints of farm families and describe the information systems to be used to refine interventions during DAP implementation. DAP proposals must demonstrate, at a minimum, general knowledge of local farming systems and be specific about the process to be followed in identifying and overcoming current and newly identified constraints. These constraint analyses should feed into annual and semi-annual reports, especially in the first 2 years of the DAP when program modifications are most advantageous. Key Recommendation: CSs need to make sure that they adequately deal with three potential problem areas: 1) finding the right balance between food and cash crops, 2) dealing with household cash flow and liquidity constraints, and 3) closing the seasonal food gap through an increased focus on improved storage, small-scale post-harvest transformation, crop diversification and market opportunities. FFP should actively promote greater flexibility in DAP designs and encourage these types of interventions where most appropriate. Key Recommendation: CSs should build a gender strategy into DAPs and commit to being persistent and creative in finding workable solutions throughout the LOA. CSs should conduct a gender analysis to identify opportunities to improve the active participation of women as farmers and economic agents as part of DAP proposal preparation. Additional Recommendations on Program Focus · CSs should conduct disaggregated assessments that look at the household food economies and farming systems (including farm and non-farm enterprises and calendars of activity) of the target communities. · For remote households with seriously restricted market access, CSs should focus their Title II interventions on solving basic agronomic problems associated with traditional crops that have limited dependence on markets or external input supplies. Emphasis should be placed on improving productivity and expanding output for household consumption. · CSs should ensure that market access is a strong primary component of DAPs’ strategy for farmers with low yields in comparison to global or local yield potentials and whose yields beyond the LOA are not likely to be sustainable due largely to inaccessibility of basic such inputs as improved varieties, chemical fertilizers, pesticides, etc. 50 · Early in the DAP cycle, CSs should conduct a formal or informal survey and analysis of who within the community is benefiting or likely to benefit from interventions. This will help CSs determine if among target households there are some groups that are benefiting while others are not, and indicate to CSs how they can modify program designs to improve the distribution of benefits. 2. Programming With Direct Distribution Versus Cash (Monetization) Direct distribution in agricultural programs takes the form of Food for Work (FFW). There are primarily two applications of FFW in agricultural programs: payment for work on infrastructure building and rehabilitation mainly to increase food access, and incentives to adopt new technologies and practices that are usually associated with longer-term gestation periods (e.g., soil fertility management and tree crops) or significant start-up costs (e.g., installation of micro￾irrigation). FFW can be viewed as a subsidy for participating households, in that it provides an incentive for participation and expands the household’s resources just as a subsidy would do. Unfortunately, FFW cannot be used to compensate technical staff, a critical component of any agricultural DAP. In addition, there are some conflicting views concerning whether the influx of food through direct distribution creates disincentives for local farmers and commodity traders. Unfortunately, it was impossible to address this issue because generally there is no monitoring or analysis of the effects of direct distribution on local production and marketing incentives. a) Food for Work and Economic Rehabilitation Numerous Title II FFW programs have made important contributions to rehabilitating infrastructure destroyed by natural disasters or complex emergencies and rebuilding of local seed stocks. FFW programs have also created incentives for Internally Displaced Persons to return home and resettle in areas where there is a shortage of food, few basic tools, limited capital and savings and weak or nonexistent markets. Many Title II programs began as relief programs (e.g., Bangladesh, India, Rwanda, Uganda, Mozambique, etc.) and later evolved into transition or development programs that used FFW to varying extents. FFW has been used as a valuable resource for constructing and rehabilitating rural infrastructure (e.g., roads and irrigation) and restoring the natural resource base (e.g., reforestation and terracing). However, evaluation teams and CS field staff repeatedly note that effective utilization and sustainability of these types of interventions require more significant follow-on training in the use, maintenance and repair of infrastructure, as well as in organizational management and environmental awareness. This training requires cash resources to pay for technical staff time and often to cover participant expenses. To achieve sustainable results these types of activities need to be combined with complementary capacity-building funded from monetization or other cash resources, such as DA, other donors or cost-sharing. 51 b) Food for Work and Farmer Adoption Extension of new technologies and practices requires significant contact between promoters– extension agents, lead farmers or village promoters–and often workshops, field trips (farmer-to￾farmer exchanges) and training sessions. Unfortunately, CSs are not permitted to use food as a short-term incentive for lead farmers or village promoters, and in many cases they are not allowed to use it as an in-kind per diem for farmer participation at workshops or training sessions. Many DAPs provide inputs and other services for free or at greatly subsidized rates. These inputs are often provided in fixed packages, which constrains farmer experimentation. FFW is used as an enticement for participation in the program. The logic behind this approach is that beneficiaries need an injection of additional resources to adopt new technologies and practices, especially those with high start-up costs. Sometimes, the benefits from a new innovation are delayed by the intrinsic nature of the innovation (e.g., natural resource management practices) or simply because farmers require time to gain confidence in a new approach or learn to execute the practice correctly. Some CSs provide free or subsidized inputs for a short initial trial period, while others continue the practice over the entire DAP cycle. Unfortunately, using enticements makes assessing farmer acceptance and sustainability, or continued use, more difficult, as was noted by numerous mid-term evaluation teams. The use of a practice under these circumstances does not provide a clear indication that the beneficiaries have accepted a technology based on merit. Often beneficiaries will show interest and use an innovation only so long as they receive free or subsidized assistance. Consequently, CSs need to assess whether or not subsidies are even necessary, and if they are, they have to be careful when using subsidies and interpreting farmer acceptance. Subsidies are best applied for a clearly specified short period of time made known to the participants. CSs also need to continue working with and observing farmers after the subsidy has been removed in order to evaluate farmers’ continued interest in the innovation. While there are problems associated with subsidizing households, the alternative “self-help” approach can be problematic as well. Beneficiaries are expected to purchase all inputs, fully repay all loans, and pay market interest rates. The idea is that a beneficiary’s expressed commitment implies both greater buy-in and sustainability. While this is likely true, it is also true that the approach entails greater responsibility on the part of CSs to identify interventions with a minimum degree of risk. This is because risk is shifted to the beneficiary, who has extremely limited resources, high opportunity costs, and a low tolerance for risk. However, the team noted that CSs generally did not sufficiently analyze the expected costs and benefits of proposed farm and business undertakings over a range of potential outcomes. Understanding the social, economic and agronomic factors driving or constraining adoption of new technologies and practices is fundamental to any agricultural program. This requires substantial feedback and analysis. Whether adoption is assessed through frequent interaction with farmers, focused socio-economic analyses, or both, CSs need cash resources to execute these activities. 52 Recommendation on Programming with Direct Distribution versus Cash · When CSs determine that free or subsidized inputs, including FFW, are needed as incentives for the introduction of a new technology or practice, these inputs should be offered for a clearly specified short period of time. In these instances, CSs need to continue to work with farmers after the subsidy has been removed in order to evaluate farmers’ continued interest in the innovation. 3. Food Availability – Production and Natural Resource Management Observations and numerous discussions with beneficiaries and Title II partners in the field reveal that CSs are extremely competent at securing the confidence of farmers and other community members. They have been highly successful at pulling rural households together into groups to learn about new technologies and practices, sell produce and form new microenterprises. CSs are also well placed to aid and even bridge gaps within national agricultural research centers (NARCs) and the Consultative Group for International Agricultural Research (CGIAR) network in the dissemination of innovations and transmission of farmer feedback. Because of their positive relationship with the communities with which they work, CSs have been able to significantly extend the reach of NARCs or CGIAR centers, which in most cases do not have field staff engaged in outreach to farmers. Where CSs need strengthening is in the intensity of their interaction with their target populations and in continuously assessing and addressing farmer constraints to adoption of proposed technologies and practices. Numerous CSs have supplied national extension systems with up-to-date knowledge and additional resources to intensify or expand the coverage of their extension staff. Numerous DAPs work with basic food crops, including millet, sorghum, cassava and potatoes, which according to the Policy Paper are: “…basic food crops of the poor that … have not received sufficient attention in global agricultural research.” (Policy Paper, p. 16.) The FAFSA team was able to review many manuals and training materials developed by CS headquarters and field offices. In general, CSs have well-developed sets of extension and training materials for farmers and farmer trainers that reflect the most recent developments in the field. CS technical field agents are generally well trained, extremely enthusiastic and hardworking. A review of detailed staffing charts and work plans suggests that when there is insufficient technical capacity, it is most often related to an insufficient number of technical staff, or inadequate field staff supervision by program managers. An additional problem related to insufficient capacity is the tendency for CSs to offer too wide of a range of new technologies and practices. Given the limited number of agents’ and farmers’ capacities, there is generally too much diversity within DAPs. a) Addressing Complementary Factors The basic means by which Title II DAPs address drought-prone environments such as semi-arid tropics is through providing technical assistance on local dryland crops, e.g., millet and sorghum, and disseminating drought-resistant varieties. Africare/Chad managed to reduce the maturation period for millet and sorghum from 90 days to 40 and 60 days, respectively. Some CSs also provide extension in micro-irrigation and water-harvesting technology and practices (CRS in Guatemala, Agricultural Cooperative Department International/Volunteers in Overseas 53 Cooperative Assistance (ACDI/VOCA) in Cape Verde and several CSs in Ethiopia and Kenya). Managing soil moisture is an important aspect for any agricultural system; for dryland cultivation, it is especially critical. Studies have shown that while the yield gains attained from new cultivars is significant, the proportion of the gains attributable to fertilizer and water is even greater (Conway, 1997 and Sanders et al., 2000). Where CSs are weaker is in addressing the complementary factors to adoption of innovations: where will the inputs come from after their program ends, how will farmers be able to afford these inputs, where will they effectively store their produce, are there conflicting demands on labor and cash resources, are farmers willing and able to adopt the entire recommended technology package? Failure to address these issues results in lower rates of adoption and limited sustainability of results. b) Agroforestry and Soil Management Agroforestry and other soil fertility management practices take time before they demonstrate noticeable effects on yields and income derived from increased crop production. This is one of the major reasons why farmers tend to be resistant in adopting these practices. More technical assistance and time are required in order to sensitize and train farmers as compared to traditional field-crop technologies and cultural practices. Several CSs have had more success in capturing farmers’ interest in soil management practices where they have also highlighted the production of well-appreciated by-products in the short and medium run (e.g., ADRA/Ghana). Interviews with farmers and numerous mid-term evaluations support this observation. In general, CSs have expressed a growing recognition of the importance of these types of short- to medium-term products and how they fit into the broader farming system. These by-products include construction material, fuelwood, thatch for roofing, fodder, sauce ingredients and medical remedies. Even when the initial fruit or nut yields of young trees like cashew and oranges are small, income derived from sales at a strategic point within the agriculture season– when cash flow is most restricted but input and other purchases are most critical–can be a strong incentive for investment. c) Addressing Cash Constraints with Credit The discussion on credit is limited in this section because the Annex on microenterprise/ microfinance provides a much more detailed presentation of promising practices and issues. This section focuses on agricultural input credit and rotating funds because of their specific relevance to adoption of improved agricultural technologies and practices. The adoption of improved technologies and practices is often constrained by lack of cash resources and rural capital rather than physical inaccessibility to technology or input suppliers, although the latter are often problems as well. One strategy employed by CSs to overcome this barrier is to introduce low external input technologies. Another strategy is to increase access to credit. Input credit or rotating funds are usually conceived as a means to help beneficiaries adopt new technologies, e.g., purchased inputs. Various credit systems have been created to respond to this need. Unfortunately, most have been designed by CS field staff who do not have adequate expertise in developing and managing sustainable credit schemes. Often the primary objective of the credit is to convince farmers to adopt a new or improved technology or practice, which 54 results in an overemphasis on issuing input loans, rather than loan repayment. This is illustrated in Table 3, where CSs mostly achieve results in issuing loans, but often not in repayment of loans for inputs. The most popular credit program is the rotating fund, with or without counterpart contributions. Loans and repayments are sometimes denominated in cash, but more commonly in kind, for example, through seeds or produce. But, repayment in kind is problematic because farmers often use the poorest quality grain for repayment and reserve the best quality for seed, consumption or sale. Consequently, the value of the credit fund diminishes. Although participation rates might be high or as targeted, repayment rates are often low due to poor crop performance or negligent management of funds. Numerous mid-term evaluations note that field staff tolerates regular loan defaults, and this undermines the intent of the credit program. Under these circumstances, participation in the activity is not necessarily a good indication of the acceptance of a technology based on merit, or of the willingness of farmers to take on loans and the associated risk. Therefore, CSs cannot expect that these behaviors will continue after DAP inputs and subsidies are withdrawn. Drawing from the literature on credit, mid-term evaluations and discussions with CS field staff, the team was able to identify some characteristics that correlate with better performance of credit schemes. First, strong solidarity groups ensure repayment of loans. Second, the development of alternative income earning opportunities enables members to cross subsidize activities and pay off loans, even if the enterprise which received the loan suffers from a temporary shock (e.g., poor rainfall this season). Third, beneficiaries require more capacity-building in managing funds and individual loans than they are currently receiving under most Title II programs. In general, CSs need to establish clear indicators of group capacity achievement and criteria for graduation from Title II assistance. They should look toward programs inside and outside of the Title II program that have done so successfully. For example, FHI/Bolivia has devised a set of evaluation criteria for graduating credit groups from their program. After graduation, groups still receive some maintenance assistance, but they essentially operate on their own. Recommendations on Food Availability · CSs should strengthen specific technical skills of their field staff. CSs should establish formal and informal partnerships with international and national agricultural research and extension systems and other local and international development agents that have complementary strengths. · CSs should narrow the range of technologies and practices that they promote and intensify their efforts on fewer better established technologies and practices. In their efforts to increase production and yields, CSs should place more emphasis on extending the full technology packages developed by CGIAR and NARCs, which usually comprise improved seed and some key complementary cultural practices, particularly in difficult or marginal agroecologies–semiarid, high altitude, etc. · CSs should conduct or contract out studies on critical input and output markets associated with the interventions of DAPs even if DAPs are not designed to stimulate or strengthen markets. 55 · CSs and DAP reviewers should ensure that input credit schemes employ well-established design standards and better practices. FFP should request that other USAID staff with expertise in microfinance review and comment on credit components of DAPs. · CSs should make short-term by-products an integral part of any agroforestry or soil fertility management scheme. The by-products need to address the beneficiaries’ preferences and constraints. 4. Food Access – Storage, Marketing and Other Commercial Activities In general, marketing components of DAPs are weak. Mid-term evaluations and field observations indicate that CS field staff rarely has sufficient technical skills in marketing or economics. Usually an agronomist is responsible for the marketing component. At times, but not often, an agronomist has some training in market development or business, and frequently the agronomist/marketing specialist is wholly responsible for all commercial components of the DAP for the entire regional office. As a consequence, marketing tends to be viewed as an afterthought, or as an add-on after production issues are resolved. DAP designs mirror this perspective. CSs begin by encouraging production of a selected commodity and only after several seasons start to grapple with marketing issues such as establishing marketing associations, seeking a buyer, organizing transport and researching quality specifications. Seldom is marketing viewed as an incentive for production (i.e., if there is a market, farmers will produce more), a method of smoothing cash flows or household food access, and a means to acquire more resources in order to purchase the improved technologies being promoted by the project. The lack of marketing or economics expertise can explain why market analyses are limited, if executed at all, and designs of market interventions are often overly simplistic and often unsuccessful. It can also explain why Title II price reporting systems collect and report data too infrequently and for distant and less relevant markets. a) Enhancing Quality, Not Just Quantity There are some examples of Title II programs thinking beyond collective sales and more strategically about adding value to farmers’ commodities. TNS/Ghana sensitized farmers to several commodity handling practices that, if followed, would earn them more, even without expanding sales volumes. Farmers were taught to properly fill produce sacks and not overstuff them. This one small change earned farmers an additional 35 percent per sack. Participants of TNS’s Inventory Credit Program learned that by controlling the moisture content of maize, they could capture a higher price and earn more. TNS/Peru has worked with alpaca wool producers to improve the quality of wool by adopting improved shearing and sorting practices. Similarly, Title II farmers in Bolivia’s altiplano have taken advantage of their unique natural environment to secure a niche market for potato and other seed and capture a quality premium in regional markets. 56 b) Building Business Acumen Another common observation by mid-term evaluators is that field agents take too much responsibility for market transactions. CSs cover a significant share, if not all, of the transaction costs. Evaluators also note that CSs do not give adequate attention to building the capacity of farmers, tree nursery workers or associations. Few CSs work with farmers on demand analysis or supply and price speculation, important ingredients to decisions concerning what crops or tree species to grow, how to add value to primary production and where to sell products. Field discussions with farmers from more progressive marketing associations revealed that they were extremely animated about learning simple market research methods and they were keen to share ideas and strategies. They expressed a desire to learn to think strategically. Unfortunately these topics are generally not part, or only a minor part, of CSs’ marketing package, which are limited to assembling farmers’ produce, locating a buyer and finding a better price–at harvest, or more commonly, later in the season. The fact that so many farmers complain of too many others selling what they wanted to sell and of falling prices is an indication that better strategic planning and new product promotion is needed. c) Market Links There is a tendency within the Title II program to pay too much attention to creating links with large-scale buyers. Most Title II marketing activities are generally too dependent on one or two traders. Although building on economies of scale can be an efficient and lucrative approach, it can also be more volatile and risky. There are instances where private traders were contacted to purchase farmer output, but were unable to make timely purchases at reasonable prices. Such outcomes reduce farmer confidence and willingness to produce for the market the following season. A marketing agreement that fails can also mean considerable hardship for households that invested their scarce resources in it. In the process of establishing outlets for farmers’ products, CSs also assist the private sector. Although provision of sophisticated marketing services is limited within the Title II program, where it exists CS staff identify, organize and professionalize suppliers (farmers), convey demand preferences (information on output quality and packaging) and provide technical assistance. These are all valuable services to private-sector buyers as well as to farmers. But most CSs have not sought initial collaboration and support from the buyers and agro-processors. Such support signals buy-in and a greater likelihood that the private sector will take on more responsibility as the market matures. Private sector willingness to pay for services would imply greater sustainability. Lack of buy-in or proactive behavior might be a signal that private-sector agents are only interested in the short-term benefits derived from the presence of Title II activities. Linking farmers to bigger regional markets has also proved effective. In Bolivia, Food for the Hungry (FHI) has promoted greenhouse construction for horticultural production and sales in major markets of Oruro and Cochabamba Provinces. In collaboration with a local NGO with a specialization in marketing, CARE/Bolivia supports garlic growers’ cooperatives. The garlic grown is distinct and sought after in regional international markets of Argentina, Peru and Brazil. ADRA/Bolivia works with peach producers in the Camargo area who supply several large internal markets. TNS/Ghana works with numerous community-based microenterprises that 57 process products from local materials to satisfy in-country manufacturing and consumer demands–shea butter cosmetics, soy bean-fortified flour, yam stake production and cassava chip processing. d) Selection of Crops to Market Where possible, CSs can be more strategic in selecting a marketable crop to promote, and some are, but strategy is underutilized in the Title II program in general. Bananas in Manica, Mozambique, are sold throughout the year and thus provide an important source of cash income during a time when both cash from other sources and food are scarce. Income from cashew sales in Mozambique and Ghana coincides with a time of year when cash resources are limited but input purchases critical. Micro-irrigation, soil moisture management, greenhouses and crop diversification (e.g., sunflower in Mozambique, beans in India and horticulture in Kenya) all extend the agricultural season, allowing farmers to not only produce and earn more, but also smooth income over a greater portion of the year. These types of activities should be encouraged. Where DA-funded market projects exist, as in Bolivia, Ghana, Peru and Uganda, Missions have maximized effectiveness by encouraging the two programs to closely collaborate, with both parties, contractors and Title II CSs orienting each other through plenary and regular periodic meetings over the LOAs. The network of partners should be extended to include NARCs in order to coordinate research on production innovations with market opportunities. Key Recommendation: When a DAP includes a marketing component, it is absolutely necessary that the CS conduct a market study as part of the DAP proposal preparation and that it demonstrate adequate evidence of technical competency of the CS or a close collaborator. Additional Recommendations on Food Access · CSs should go beyond basic price information and support the collection and dissemination of important marketing information such as potential market outlets, demand preferences and suppliers of key inputs. Technical information should be broadly disseminated. CSs need to improve the quality of price and market reporting. CSs must hire qualified staff and/or develop ties with other agencies or USAID-funded programs with marketing expertise for continuing support throughout the LOA. Periodic narrowly defined studies could provide useful assessments of progress and recommend modifications. Monitoring indicators alone will not yield sufficient information for program management. · CSs should place more emphasis on teaching farmers to develop marketing opportunities themselves. Associations require more training on how to identify markets and create and capture local and even international demand. CSs should help farmers broaden their perspective on marketing beyond capturing a better price, and gain a greater appreciation for the factors that determine prices. Farmers need to learn how to account for buyer preferences in terms of the form, quality and timeliness of product to add value and take advantage of niche market opportunities, whether local, regional or international. 58 · CSs should ask the private-sector buyers to make both financial and other forms of contributions to support the market improvements encouraged through DAPs. This will leverage Title II resources and ensure greater private sector buy-in. 5. Sustainability A number of agricultural inventions or strategies appear to hold promise for sustainable results. Improved seed/planting material and cultural practices for maize, legumes, root crops and tubers have increased yields and incomes. Farmers everywhere said that planting in lines was a good practice. It reduced the amount of time spent weeding (largely a woman’s task) and improved yields. After a brief single-season period of experimentation, many farmers decided to apply the practice to their other fields. In areas where households cultivate on hillsides, contour planting has been widely accepted. Preparing fields using controlled burning techniques or improved plant spacing without burning are also more readily adopted than before. Sustainability is more questionable in the case of continued use of “external” inputs. Even when farmers were purchasing inputs from the project, they often relied on CSs to handle such transaction costs as search and transportation. When beneficiaries were questioned directly or indirectly about their willingness or ability to continue using the types of inputs that the CS had been supplying, some indicated that they would not continue to use them because of lack of interest or inaccessibility of inputs. In some cases, there are significant technological problems to overcome with disseminated technologies that are likely to require years of follow-on research and extension. This follow-on research was either not anticipated in DAPs’ designs or, if anticipated, the hand-off to another research entity was not incorporated in the designs. This generally applies to long-term natural resource management interventions, experimental tree crops, improved fallow or pasture systems and efforts to resolve agronomic problems that as yet have no well-established solution. The Policy Paper states that development programs should promote capacity-building, participation and sustainability. In fact, capacity-building is critical to the sustainability of Title II agricultural interventions because many are highly dependent on effective mobilization of community organizations such as agricultural production committees, rotating funds, women’s clubs, or roadwork committees, etc. Building the capacity of these organizations requires time and a significant amount of technical assistance from well-trained CS staff, which in turn requires cash (monetized) resources. Final evaluations and discussions in the field indicate that many farmer and community groups have not or will not achieve the requisite level of self reliance within the 5-year DAP cycle. In addition, CS documents suggest that as a rule they do not conduct follow-up studies to ascertain whether program outcomes continue once Title II resources are withdrawn. Factors that contribute to the lack of sustainability include the overall level of resources available for training and capacity-building, particularly too few cash resources from monetization, emphasis on quick results and weak DAP designs. In addition, throughout the Title II portfolio there is a lack of clearly defined or adhered-to exit strategies. Finally, many CSs initiate interventions within communities–sometimes completely new communities–late in the DAP cycle when it is clear that they will be unable to implement the full set of design components 59 within the LOA. While it is recognized that Title II program implementation takes place in difficult and unpredictable environments and consequently plans and schedules change, it did not appear to the team that CSs were attempting to minimize the incidence of unfinished activities. In fact, they appeared to take them for granted, as did Missions. This contradicts design justifications presented in DAP proposals (see Chapter III for further details). Recommendations on Sustainability Most of the recommendations for increasing sustainability were crosscutting and therefore were covered in Chapter III. In addition, improved design elements covered under the three previous sections (e.g., the earlier discussions on addressing constraints to adoption and capacity￾building), greatly contribute to the sustainability of results. The reader should refer to those sections for additional recommendations for sustainability. · When technologies and practices with long-term maturation are being promoted, CSs must identify and describe within DAPs’ proposals which agency will assume responsibility for continued research or extension. · FFP should recognize and support the critical need for cash resources in the implementation of agricultural interventions, especially where the primary aspect of the intervention is training and capacity-building. 6. Partnerships and Integration CS staff members have repeatedly said that sharing lessons learned has provided useful insights to program management. In countries where agricultural extension services are weak or non￾existent, sharing of knowledge concerning sources of technologies and technical assistance is particularly important. Some examples of country programs that have reported conducting regular CS technical meetings are Bolivia, Ghana, Guatemala, Ethiopia, Mozambique and Uganda. a) Supporting Missions’ Strategic Objectives Program and resource integration has grown significantly and become more clearly articulated and expressed over the past 6 years since the enactment of the Policy Paper. Given the marked decline in DA resources for agriculture over the previous decade, Title II agricultural activities have been fundamental to USAID’s rural-based strategies and to achieving results, particularly as they relate to poverty alleviation and food security. According to Mission and CS staff, Title II programs support Missions’ strategies and in many instances make an important contribution to the achievement of results. Most Title II agricultural programs fall under Missions’ economic growth SOs. While DA resources concentrate on policy reform, food aid resources support technology transfer and improving access to food. As such, Title II programs play a critical complementary role within the strategy of Missions and USAID (e.g., Bolivia, Ghana, Mozambique, Peru and Uganda). 60 b) Links to National Agricultural Research and Extension For Title II CSs working in agriculture, one of the most critical partnerships is that with the Ministry of Agriculture (MOA) and NARCs. Collaboration varies widely across the Title II countries, in part because local capacity varies dramatically, even across regions within countries.31 Where NARCs are still in the early stages of rehabilitation in a post-conflict situation, for example in Mozambique, CSs have used their years of experience and links to international organizations, particularly CGIAR, to perform many of the functions that NARC normally perform. The success of these higher-level research interventions hinges strongly on the vision and technical and managerial competence of CS head researchers and their support staffs. Active collaboration between CSs and research centers is more common with technical staff that has more experience and/or greater training (e.g., MS degree-level). The majority of research activities carried out with Title II funding, however, are limited to on-farm trials of off-the-shelf technologies, providing validation at local farm level. In general, this is the best research application for Title II resources. When necessary technologies or genetic materials have not been readily available, CSs have increasingly established research links to national, regional and international centers (CRS/Kenya, CARE/Bolivia, CRS/India, WV/Kenya, Africare and WV in Uganda, and all of the CSs in Mozambique). Perhaps the greatest contribution CSs have made to NARCs and CGIAR is in the broader diffusion of recommended technologies and practices. There are some problems with Title II CSs’ role in research and extension. Field discussions with key informants and mid-term evaluations give the impression that some CSs work too independently; at times they promote innovations that have not been sufficiently vetted or do not meet approval of the NARC, and their feedback to the NARCs is limited. There are also examples of field staff confusing on-farm trials with demonstrations. These problems seem to be the result of insufficient supervision. Numerous mid-term evaluations recommend that CSs collaborate with other agents that have marketing expertise. CSs have greatly expanded these partnerships. Mozambique is an excellent example. Together, DA and Title II resources can support broader development of key subsectors and support desired improved food security outcomes–in the case of Mozambique– maize, oilseeds, and some horticulture commodity subsectors. Recommendations on Partnerships and Integration · Missions, FFP and CSs should work toward integrating Title II and other USAID-supported programs with each other and with district and regional offices of NARCs and MOAs. · Missions should encourage CSs’ involvement in the planning of local research programs as well as in recording important field observations and providing feedback. 31 Bolivia has no extension service. Ghana has extension agents living in communities, even in remote areas of northern Ghana. 61 · Missions should invite staff from NARCs and MOAs to review and comment on DAPs’ proposals as well as participate in mid-term and final evaluations. E. Monitoring and Evaluation for Availability and Access Interventions 1. Analysis of M&E Output for Project Management One reason that CSs have had less success in meeting their adoption and access targets is their failure to analyze M&E output and additional basic information for management and planning purposes. Analyses provide critical input to the process of identifying sound innovations that households will be likely to adopt, as well as feedback on why they have not adopted recommended technologies and practices, and should be ongoing. As DAPs progress and more accurate information is obtained, assumptions are often refined suggesting that analyses should be redone and new results used as input to on-going DAP implementation. Discussions with CS staff across the Title II program reveal that there is a general lack of sound economic analysis of the technologies and practices being promoted. Sophisticated economic analysis is not required, nor is it possible given most field office realities, but a rough accounting for all key factors is important in determining the desirability of innovation from a farmer’s perspective. Simple descriptive statistics and sensitivity analyses can help gauge the robustness of results and account for some of the error in estimating values for key variables such as prices and labor time. Simple analyses can reveal important constraints as well as attributes of progressive farmers. CSs need to use their data more intensively to explain results and orient project implementation. These analyses can also be included in Results Reports in order to explain performance. Such analyses need to be applied as well to market opportunities and microenterprises such as oil presses, soap or commercial yam stake production. While there are examples of good marketing studies conducted as part of the Title II program, they are few. CARE/Mozambique produced a good oilseeds subsector study, and TNS/Ghana conducted several studies of potential export markets and palm oil processing. Recently, CSs in Bolivia contracted local firms to perform market analyses, which guided the development of new DAP proposals. All commercial interventions should be preceded by complete market analyses that consider future risks such as demand and price changes, and include some form of relevant sensitivity analysis based on these risks. 2. Missing Availability and Access Indicators An important constraint in evaluating the food-security impacts of food availability and access interventions is the lack of meaningful and informative indicators. Most indicators chosen are not sufficiently informative for evaluating food-security impacts. For example, increased yields do not guarantee higher levels of food consumption. Indicators for rural road rehabilitation and microfinance components tend to monitor outputs, such as number of kilometers rehabilitated or loans issued, but not household food security in the form of decreases in local food prices or greater food consumption at the household level resulting from increased access to microfinance. 62 The Generic Indicator that most closely corresponds to changes in the seasonal food gap or hungry season is the “months of adequate household food provisioning,” but it is not a commonly chosen indicator. (See Appendix 9 for a list of agriculture and natural resource management Generic Indicators.) Conceptually, this indicator provides a more accurate reflection of household food security, and it captures the combined effects of a wide variety of agricultural interventions and strategies–those that target production, storage and purchasing power. Combined with yield figures, months of provisions can signal when increases in productivity or food availability are and are not being translated into improved food access or consumption. In addition, to close this gap, given the seasonal character of food insecurity in most Title II contexts, it is crucial that CSs address households’ capacities. Another important attribute of production in the Title II context that is closely related to household food security but not well monitored is annual variation. Annual climatic conditions are a critical determinant of any agricultural system, but in the typical Title II context, the effects of climate tend to be more frequent, dramatic and life threatening. Poor farmers are generally risk adverse, preferring farming practices that perform well in bad years over practices that perform exceptionally well in good years, but poorly in bad years. Rather than concentrate on increasing average yields, more attention should be placed on stabilizing production. WV/Kenya monitors year-to-year fluctuations in yields and FHI/Bolivia monitors and compares the performance of participants and non-participants in both good and bad years. On-farm control plots can also be used. The Generic Indicator List includes the yield variability indicator, but CSs seldom select it. As mentioned in previous sections, Title II agricultural interventions often work through community groups, yet few CSs use measures (indicators) of the capacity developed or of how well organizations operate. The same argument can be made concerning capacity-building of partners who will be expected to take over some activities at the completion of the DAP. A few CSs have made an effort to capture capacity. ACDI/VOCA/Cape Verde has an indicator measuring whether the soil and water conservation group pays dues, fulfills contracts and earns a profit, as indication of capacity. CARE/Mozambique monitors whether a marketing association is able to independently negotiate a sales contract and whether at least 70 percent of the association’s contracts are fulfilled. Recommendations on M&E for Availability and Access Interventions · CSs must conduct market and economic analyses as part of DAP design process and for ongoing input to program implementation. · FFP and CSs need to define Generic Indicators for agriculture to: monitor and evaluate the relationship or link between DAP intermediate results and household food security or coping strategies; monitor and evaluate capacity-building; and substantiate the relationship between agricultural and microenterprise/microfinance interventions and household food security or coping strategies. 63 V. Household Nutrition: Maternal and Child Health and Nutrition Sector Assessment A. Introduction This chapter provides an in-depth review of Title II development MCHN programs implemented in support of the Policy Paper programmatic priority sector of Household Nutrition. First, it describes recent trends in the use of Title II resources for MCHN programming. Second, the chapter looks at the effectiveness of the program over the past half-decade in terms of both impacts and intermediate-level results, including improvements in nutritional status and food intake and nutrition and health practices in target households. Strengths and weaknesses of programs and constraints to achievements are analyzed. Recommendations pertinent to specific critiques are included throughout the chapter. For the MCHN assessment, in addition to the review of published and “gray” literature and interviews with stakeholders described in the methodology section, a total of 29 DAPs with health and nutrition components were reviewed (Appendix 3). These include all DAPs with at least one-third of resources devoted to MCHN and with results available for at least 2 years of program implementation. The Policy Paper states that priority in Title II will be given to programs that focus on improving household nutrition, especially in children and mothers. Effective food utilization is a necessary precondition for improving the nutrition status of children and mothers. Both food and health factors impact upon food utilization, which refers to food consumption practices as well as the body's readiness and ability to utilize food.32 As stated in the USAID Policy Determination #19, “Effective food utilization depends in large measure on knowledge within the household of food storage and processing techniques, basic principles of nutrition and proper child care.” It is significant that most of the key food utilization factors at the household level are behavioral in nature. 1. Trends in MCHN Programming in the Title II Portfolio Approximately half of Title II development programs had MCHN components before the Policy Paper was written. However, MCHN activities were predominantly center-based food distribution programs targeted to malnourished children and their mothers, combined with growth monitoring (McClelland, 1998). The Policy Paper emphasized that food transfer alone is not enough to achieve the goal of reducing malnutrition, and that various other complementary activities are essential to achieve household food security. Based on the 29 projects reviewed, the field visits and discussions with USAID and CS staff, it is clear that Title II MCHN programs have evolved from center-based efforts to integrated community-based development programs with long-term health and sustainability objectives. Activities now occur in communities, where the likelihood of sustainable improvements occurring is higher, rather than in centers. Greater attention has been given to improving the 32Anderson, M., et al. in: Austin, J. and M. Zeitlin, eds. (1981), UNICEF, 1990, 1998, 2001; ACC/SCN and IFPRI, 2000; WHO, 1998; Calloway, 1995; Engle et al., 1997; Payne and Lipton, 1994; Johnson-Welch, 1999; Huffman et al., 2001; Pacey and Payne, 1985; Beaton, 1987; Lipton in Gittinger et al., 1987; Soemardjan in Biswas and Pinstrup-Andersen, 1985. 64 quality of nutrition and health programming in order to achieve greater impact, reflecting major recommendations made in a 1990 report on maternal and child health supplementary feeding programs (Mora et al., 1990). CSs no longer view food supplementation as the core vehicle for achieving nutritional impact and in some programs have made strategic decisions to phase out this component. DAPs reflect an increasing use of multi-sectoral community approaches grounded in theories of community ownership, self-reliance and empowerment. Today’s Title II MCHN programs revolve around a select set of interventions essential to household food security that have been proven to reduce maternal and child death and disease and to combat malnutrition. DAPs aim to improve nutritional status through strategies designed to directly improve food consumption by the child/mother in the home, and/or improve biological utilization of food through provision of essential MCHN services. Some of the DAPs reviewed also seek to create linkages between health and nutrition activities and the agriculture sector so that improvements in agricultural productivity and income may translate into better nutrition in the home. The major intervention areas and approaches used, the objectives of the interventions, levels at which they are implemented and frequency of occurrence in DAPs are listed in Table 4. Intervention areas most frequently incorporated in the DAPs include: breastfeeding, control of diarrheal disease and acute respiratory illness (ARI), prenatal care, feeding during illness, and immunization. The most common intervention approaches include growth monitoring and promotion (GMP) and food distribution. Promotion of micronutrient consumption and appropriate complementary feeding are also significant, but less frequent, areas of intervention. In a small number of DAPs reviewed, intervention areas included promotion of personal and domestic hygiene behaviors, deworming and control of other childhood diseases, and family planning promotion, while approaches included rehabilitation of severely malnourished children and construction of water and sanitation infrastructure. Very recently, a small number of CSs have begun implementing malaria control and HIV/AIDS prevention strategies. Community￾level integrated management of childhood illnesses (IMCI), a recently developed child survival strategy, has been proposed in several DAPs beginning in FYs 2000 and 2001. One of the most significant changes in the Title II MCHN sector is the inclusion of anthropometric surveys to measure impact on nutritional status. CSs now routinely implement anthropometric surveys at the beginning and end of DAPs. However, as discussed in the Program Achievements section below, there are still significant limitations in the quality and comparability of the data. 65 Table 4. Major Title II MCHN Intervention Areas and Approaches Major Intervention Areas Key Objectives Key Level(s) Frequency in DAPs Breastfeeding Exclusive breastfeeding in first 6 months; continued breastfeeding for at least 2 years; initiation of breastfeeding within 1 hour of birth; avoidance of bottles. Mainly home. Initiation of breastfeeding may occur in clinic. +++ Complementary feeding Introduction of locally available, affordable, nutritionally appropriate weaning foods from 6 months; adequate feeding frequency, consistency according to age; adequate nutritional quality and diet diversity according to age; active feeding by caretaker. Home based. ++ Micronutrient consumption Consumption of foods rich in vitamin A; consumption of foods rich in iron and other essential nutrients; consumption of iodized salt; consumption of vitamin A by women postpartum and children 6-59 mos.; consumption of vitamin A for severe measles; consumption of iron/folate supplements during pregnancy. Home based for food consumption. Micronutrient supplementation usually clinic or health post based. ++ Hygiene promotion Improved personal and domestic hygiene practices, especially hand washing, use of latrines, use of adequate quantity and quality of water, use of garbage pits, proper food transformation, cooking and storage. Home based. + Control of diarrheal disease and ARI Use of ORT and continued feeding during diarrhea at home; hand washing, latrine use, water supply, domestic hygiene; health care seeking with severe signs. Home based for prevention practices and use of ORT. Clinic based for treatment of severe conditions. +++ Feeding during illness Continued feeding of breast milk, liquids, solid foods during illness. Home based. +++ Immunization Required series of child immunizations, DPT1-3 and measles emphasized. Clinic or community based. +++ Deworming, control of other childhood diseases Prevention and treatment through distribution of mebendazole (deworming) or other medicine, education. Clinic or community based. + Malaria control Use of insecticide-treated bednets for prevention; use of oral antimalarials for treatment. Home/community based for prevention. Clinic based for treatment. + Prenatal care Attendance at prenatal consultations for: weight gain monitoring; iron/folate supplementation; TT immunization; birthing IEC. Clinic based. +++ Family Planning Use of contraceptives, child spacing, Lactational Amenorrhea Method, education. Clinic or community based. + HIV/AIDS/STDs Knowledge of prevention and home/community support of people living with HIVAIDS. Community based. + 66 Table 4 (con’t). Major Title II MCHN Intervention Areas and Approaches Major Approaches Key Objectives Key Level(s) Frequency in DAPs Food distribution Improved food intake of mothers and children using Title II commodities or local food products. Community based. +++ Growth monitoring promotion Assessment of child growth through routine weighing; identification of malnourished children; improvement of mother's knowledge and child care behavior through counseling about weight gain or loss. Clinic or community based. +++ Nutrition rehabilitation Rehabilitation of severely malnourished children through feeding and education. Specialty clinic, center or facility based. + Mother-based support programs (e.g., Hearth Model) Nutrition rehabilitation through growth monitoring, mother-to-mother support, positive deviance assessment, behavior change (feeding) education. Home based. ++ Community IMCI Assessment, treatment and prevention of common, non-severe childhood illnesses through training of VHWs and caretakers. Community based. + Water and sanitation infrastructure Latrine installation; water supply installation; IEC. Community based. + +++ Very common intervention or approach in programs ++ Moderately common intervention or approach + Infrequently included as intervention or approach 67 B. Program Achievements 1. Overview of Program Effectiveness The Title II MCHN sector has made important advances in health and nutrition in the last 6 years. Improvements in nutritional status of children have been reported in Benin, Bolivia, Chad, Ethiopia, Gambia, Guatemala, Guinea, Haiti, India, Kenya, Madagascar, Mauritania, Mozambique and Nicaragua. Diarrheal disease has been reduced in Guinea, Guatemala, Ethiopia and Mozambique. Immunization rates have increased in Benin, Bolivia, Ethiopia, Guatemala, India, Kenya, Madagascar, Mozambique and Peru. Birth weights have improved in Peru and Nicaragua. In all of these countries, improvements in key household-level nutrition and health behaviors, and in the delivery of essential MCHN services, have contributed to positive impacts on child nutrition and health status. The following examples illustrate some programs that have been successful in improving health and nutrition: · In Benin, the CRS food-assisted child survival (FACS) program has improved the nutritional status of children in the Oueme-Plateau region. Stunting among children 18-36 months old was reduced from 41 to 35 percent between FY 1995 and FY 2000. There was an even greater reduction in stunting (16 percentage points) among children 24-30 months old who had participated in the program at least 18 months. · FHI’s MCHN program in Mozambique has been successful at reducing diarrheal rates among children 0-23 months old. In FY 2000, 28 percent of children had diarrhea in the last 2 weeks compared with 44 percent at baseline. Substantial improvements were reported in key household behaviors used to control diarrhea, namely feeding during diarrhea (22 to 91 percent), providing breastmilk (39 to 93 percent) or more liquids (29 to 97 percent) and giving children with diarrhea Oral Rehydration Therapy (ORT) (26 to 100 percent). The program also achieved improvements in exclusive breastfeeding (from 46 percent at baseline to 80 percent in FY 2000), in feeding of children 6-10 months old at least three times per day (24 to 92 percent), and in the percentage of children 6-23 months old receiving vitamin A￾rich foods (59 to 84 percent). · The Integrated Nutrition and Health Project (INHP) implemented by CARE/India, by far the largest Title II program in the world, reached over 7 million women and children in 100,000 villages of seven states. The final evaluation of May 2001 reported that the overall prevalence of underweight among children less than 2 years old had been reduced from 51 percent at baseline to 32 percent in FY 2001. The INHP also achieved marked successes in each of its priority intervention areas, including improvements in early initiation of breastfeeding (31 to 49 percent); exclusive breastfeeding (32 to 42 percent); dietary intake of pregnant women (38 to 67 percent), lactating women (33 to 58 percent), and children 6-24 months old (40 to 66 percent); immunization of children (16 to 39 percent) and pregnant women (64 to 74 percent); iron and folic acid (IFA) supplementation of pregnant women (14 to 26 percent); and antenatal care coverage (46 to 55 percent). The INHP worked closely with the Government of India to promote maternal and child health through community centers (anganwadi centers) through the Integrated Child Development Services (ICDS) program. 68 · In Bolivia, the rate of stunting among children 24-60 months participating in FHI’s Title II program decreased from over 50 percent at baseline in FY 1996 to 36 percent in FY 2000. The prevalence of underweight among children under 23 months decreased from 29 percent in FY 1997 to 16 percent in FY 2000, as weight gain velocity improved steadily among this group. Exclusive breastfeeding of infants under 6 months improved dramatically from 27 to 88 percent in FY 2000. FHI’s strategy included peer training, whereby mothers who exclusively breastfed trained new and expectant mothers. · The household nutrition program of Africare in Mozambique achieved a modest reduction in stunting of children under 5 years old from a baseline of 50 percent in FY 1997 to 48 percent at mid-term in FY 1999. More strikingly, underweight among children less than 5 years was reduced from 36 to 23 percent in the 2-year period. Among the household behaviors that contributed to these impacts were improvements in exclusive breastfeeding from 35 to 44 percent, a 12 percent increase in immediate initiation of breastfeeding after birth, a doubling of the percent of mothers who give supplemental foods and a 40 percent increase in the percent who give protein-rich foods to underweight children, a 30 percent increase in the number of households that consume vitamin A-rich foods and a 95 percent increase in the use of oral rehydration therapy (ORT) at home. Africare uses the Hearth Model methodology to mobilize community members, recruit and train model mothers and rehabilitate children in the community. 2. Impact and Intermediate Results The performance indicator data reported in IPTTs of the 29 DAPs were reviewed for evidence of positive achievements at both the impact and IR levels (see Table 5). Of these DAPs, 3 did not report on impact or IR effect indicators, and therefore only 26 projects were used in the analysis. Changes in indicators of knowledge, outputs or processes (e.g., trainings, formation of committees, number of children weighed, number of rations distributed, etc.) are not considered in this analysis. All 26 projects had results data available up to FY 1999, and several had FY 2000 results.33 Some projects had completed mid-term or final evaluations, which sometimes helped clarify IPTTs. Table 5: Availability of MCHN Performance Indicators in IPTTs Total # of DAPs reviewed 29 Total # of DAPs reporting impact/IR level indicators 26 Total # of child nutritional status impact indicators reported 61 Total # of maternal nutritional status impact indicators reported 2 Total # of household nutrition indicators reported 58 Total # of household health indicators reported 42 Total # of essential health care delivery indicators reported 60 33 Since the documents for this review were gathered, FY 2000 or FY 2001 results data have come in for some projects, but could not be incorporated into this analysis. 69 The results of this analysis can be summarized as follows (see Table 6): · Fifty-four percent of projects with impact/effect indicator data available reported some improvement in child nutritional status relative to baseline, according to at least one nutritional status indicator. (Improvement means any increase over baseline.) However, of the 16 projects that included multiple measures of nutritional status, only 38 percent could report improvement in all of the indicators used. Virtually no DAPs were able to demonstrate improvements that matched LOA target levels for nutritional impact (to the extent that these were available). · Only six projects included diarrhea prevalence as an indicator of impact, and of these, 83 percent reported improvements. · All of the 16 projects that included breastfeeding indicators reported improvements. Improvements were mostly in the practice of exclusive breastfeeding, or initiating breastfeeding soon after delivery. · Only nine projects included indicators of complementary feeding of infants and all of these reported improvements. · Only six projects included any indicators of maternal food consumption or dietary practice, but four (67 percent) of those that did reported improvements from baseline. · Twelve projects incorporated indicators related to child feeding practices during illness, including the increasing of foods or fluids during illness episodes and/or giving ORT during diarrhea. Of these, 92 percent reported improvements. · Only 15 percent of projects reported improvements in personal and domestic hygiene practices, such as the use of improved water sources. · Seventeen of the 26 projects incorporated indicators of child or maternal immunization. Of these, 88 percent reported improvements in immunization rates. However, immunization improvements often fell well short of LOA target levels. · Seven projects included indicators of maternal or child micronutrient supplementation, and five (71 percent) reported some improvements from baseline. · All of the twelve projects that incorporated indicators of frequency of antenatal care visits reported improvements from baseline. · Of the five projects that included indicators of birth attendance by trained traditional birth attendants or delivery at health facilities, only 40 percent reported improvements. 70 Table 6: MCHN Sector Results Based on IPTT Impact/IR Indicator Data Indicator Type # DAPs with indicators of this type in the IPTT # (%) of DAPs with indicators of this type reporting any improvement # (%) of all 26 DAPs showing improvement in indicator type IMPACT: Nutritional Status (single indicator) 10 7 (70) Nutritional Status (multiple indicators) 16 7 (44) * 14 (54) Diarrhea prevalence 6 5 (83) 5 (19) INTERMEDIATE RESULT: HOUSEHOLD NUTRITION BEHAVIORS Breastfeeding practices 16 16 (100) 16 (62) Complementary feeding practices 9 9 (100) 9 (35) Maternal food consumption behavior 6 4 (67) 4 (15) HOUSEHOLD HEALTH BEHAVIORS Child feeding during illness practices (including ORT use) 12 11 (92) 11 (42) Personal and domestic hygiene 4 4 (100) 4 (15) ESSENTIAL HEALTH SERVICES Maternal/child immunization 17 15 (88) 15 (58) Maternal/child micronutrient supplementation 7 5 (71) 5 (19) Frequency of antenatal care visits 12 12 (100) 12 (46) Deliveries by trained birth attendants 5 2 (40) 2 (8) * 6 projects (38 percent) reported improvements in all nutritional status indicators used. a) Implications of Findings from Impact and Intermediate Result Indicator Analysis The analysis of impact and IR indicator data is informative on two levels. First, it gives a picture of the relative degree of success of the different intervention areas chosen by CSs. Second, it provides information about which intervention areas are probably receiving the greatest attention in the sector based on the assumption that “if it isn’t measured, it isn’t done.” Overall, the DAPs reviewed achieved limited success with respect to impact on nutritional status. While slightly over half of the projects (54 percent) achieved some degree of improvement in nutritional status, more of the projects that used a single indicator of nutritional status reported nutritional status improvement compared with projects that used multiple indicators to measure their success (70 versus 44 percent). The reason for this difference is unclear. If FFP is to accurately ascertain the impact of MCHN sector activities on nutritional status, a standardized 71 approach for measuring and reporting on an indicator of nutritional status (or menu of indicators, such as the Title II Generic Indicators) needs to be developed and applied across DAPs. Without this, conclusions about overall impact of the Title II program on nutritional status will remain uncertain. Other than child nutritional status, the only impact indicator reported was diarrhea prevalence. Of the few DAPs that included it, most showed a positive impact. It is not clear if projects are having any impact on maternal nutritional status, since none reported indicators of change in this outcome. Of the 26 DAPs reviewed, the greatest emphasis (based on the assumption that indicator reporting is a good proxy for program emphasis) is being given to breastfeeding, child feeding during illness and use of ORT, immunization and antenatal care attendance. These areas are showing the greatest relative improvements. Limited or little attention is being given to complementary feeding, maternal food consumption, micronutrient supplementation and personal and domestic hygiene. The latter areas are showing relatively less improvement. Most reporting focuses on indicators of nutritional status impact at the strategic objective level. However, at the intermediate result (IR) level, most reporting is on indicators of essential health service delivery (60 indicators were included in the 26 DAP IPTTs reviewed), followed closely by household nutrition behaviors (59 indicators), and then household health behaviors (42 indicators). This reporting pattern suggests that essential health service delivery activities may be given at least the same, if not more, emphasis than household nutrition and health practices. Observations from the field, discussed in ensuing sections in this report, confirm that this is indeed the case. Lack of sufficient emphasis on household nutrition and health practices may explain why improvements in nutritional status are not greater. One of the conclusions of this report is that there is an overemphasis in many Title II programs on essential health service delivery at the expense of needed attention to household nutrition and health behavior change. CSs should revisit the mix of activities in DAPs and redress this imbalance, so that more effort is directed towards objectives that have the greatest likelihood of impact on nutritional status. This point is discussed in greater depth in section V.D.11. Most indicators reported by CSs in IPTTs show some improvements. However, many indicators don’t achieve LOA target levels, suggesting that CSs overestimate their abilities to achieve results. This finding is supported by analysis of the FFP SO indicator of percent of targets achieved by sector, for which data is available from CS FY 1999 and FY 2000 results reporting. Approximately 55 to 60 percent of the MCHN targets set by the CSs were achieved in FY 1999 and FY 2000. CSs need to improve their ability to set targets at achievable levels and to use results to modify program activities and out-year targets. b) Limitations of Analyses Based on IPTT Indicators While informative, the analysis of performance and conclusions about program effectiveness based on IPTT indicator data are inherently limited. CSs do not typically report on the population or beneficiary numbers used in their indicator data calculations. Therefore, some indicator results may pertain to only a few hundred individuals, while others may pertain to thousands of individuals. Indicators are often not well defined or are reported in confusing ways. 72 There is no standardization in the way indicator data are reported, and the variability between CSs in how indicators are defined is huge. The lack of standardization in the definition and reporting of impact and IR indicators makes it difficult to derive reliable estimates of performance. One can only hope that the limited analysis done for this assessment provides a reasonably good proxy for actual performance. C. Program Design and Implementation 1. Problem Assessment The need to adequately assess problems before deciding on the need for food aid was highlighted in the Mora et al. 1990 report as an important feature of effective supplementary feeding programs. This assessment also concludes that adequate identification of health and nutrition issues at the community and household levels, where programs are implemented, is necessary for effective programming. In DAPs reviewed, problem identification and description at the national level was excellent across the board, due largely to the strengthened ability of CSs to write good proposals and to the availability of good secondary data sources such as Demographic and Health Survey Program (DHS) reports and WFP Country Strategy Outline Papers. At the local level, CSs have applied a number of excellent diagnostic and research tools to identify problems. These include the Knowledge, Practice and Coverage (KPC) survey, used to collect baseline quantitative data on health and nutrition; anthropometric surveys to establish baseline estimates of malnutrition levels; and formative research such as Rapid Appraisal Procedures and Positive Deviance Inquiry to collect qualitative information. Anthropometric surveys, in particular, have provided the basis for assessments of program impact. While the breadth of diagnostic tools currently used represents major progress in Title II problem assessment, DAPs reviewed fell short of identifying many of the key community- and household￾level behaviors that directly impact food security and nutritional status. This includes information about complementary feeding practices, maternal nutrition, intra-household food sharing and distribution norms, food transformation and processing, food preparation and storage practices, personal and domestic hygiene, gender roles in household decision-making, community preservation and nutrition coping strategies and quality of available health services. DAPs would clearly be strengthened by greater use of participatory research tools. The KPC tool developed by the Bureau for Democracy, Crisis and Humanitarian Response (DCHA)/Office of Private and Voluntary Cooperation (PVC) for Child Survival projects might usefully be modified to better reflect Title II objectives and the food security conceptual framework, given its widespread use by CSs. Recommendation on Problem Assessment · CSs should design MCHN interventions based on better information about community- and household-level nutrition and health behaviors that affect nutrition and household food security. 73 2. Use of Community and Mother-based Approaches A significant accomplishment in the evolution of the MCHN sector is that virtually all of the programs are now community-based, compared with the mainly center-based programs prior to the Policy Paper. This means not only that programs are implemented in communities with some degree of participation of residents, but that community members may be actively involved in all stages of the program, from problem assessment to activity design, implementation and monitoring and evaluation. Greater devolution of design and decision-making is increasingly apparent in DAPs reviewed. In accordance with the shift to development through community empowerment, MCHN programs have reconfigured the key activities of growth monitoring, nutrition education and food supplementation from centers to communities. One of the best examples is CRS’ FACS program which, in all of CRS’s projects, is in the process of transitioning activities to communities. Within communities, Title II CSs have developed innovative program implementation approaches. Unlike the top-down approaches of the past, these are empowering designs that hold real promise for sustainability. In projects visited in Bolivia and Mozambique and others reviewed, a common approach is that CSs and implementing partners encourage communities to select representatives to serve as spokespersons and change agents, then train these change agents to work with families and counterparts. Change agents may be volunteer health workers, traditional birth attendants, model mothers or other community-level health workers (CHWs). CSs and/or implementing partners also assist communities to form decision-making bodies with responsibility for health, such as the Village Health Committee (VHC) or Village Food Security Committee (VFSC), or to strengthen existing health committee structures. Sometimes communities already have general development or governmental committees in place, and CSs facilitate development of a subcommittee for health. Many of the Title II MCHN programs have implemented mother-based programs (such as the Hearth Model, mother-to-mother approach or model mothers approach) that seek to engage mothers with well-nourished children in educating and helping mothers with poorly nourished children. The Hearth Model, for example, has been widely used and promoted by SCF, and a number of other CSs are now incorporating this strategy into DAPs (e.g., Africare, FHI, CARE, ADRA). Mother-based programs empower communities and are more likely to lead to sustainable improvements in nutrition than top-down programs relying on external assistance. While the transition to community-based approaches is an important advance of the Title II MCHN program, some limitations were observed, principally revolving around CS staff capacity. Field visits reveal that CSs often lack sufficient numbers of field technical staff, and the level of skill is in many cases inadequate. Possible reasons include insufficient training of regional staff, inadequacy of cash resources to conduct more frequent staff training, low staff salaries which limit CSs’ abilities to hire the best candidates, inadequate screening of candidates’ base knowledge in key intervention areas and little time available for study by technical staff. 74 Another observation is that supervision of CHWs by CS staff is too infrequent. Poor roads and infrastructure, inadequate transportation and heavy workloads are the common reasons for this. Some CSs have addressed this constraint by recruiting health/nutrition promoters directly from the communities, and in a number of new DAPs, CSs intend to place trained workers in the communities. Recommendation on Community- and Mother-based Approaches · CSs should strengthen the transition to community-based approaches that engage, educate, sensitize and foster ownership among community members. CSs should ensure that there are an adequate number and quality of technical and supervisory staff in place to support the community-based interventions. 3. Targeting the Vulnerable Groups Across the programs reviewed, CSs use situation analyses, rapid appraisals and other rapid techniques to select communities that meet criteria for intervention. The field visits confirmed that in most cases selected communities are truly in need and have the necessary potential for improvements in food security through the planned interventions. However, it was observed that CSs rely on implementing partners to identify communities, sometimes without adequate control to ensure that selection criteria will be applied consistently and objectively. Ineffective application of community selection criteria leads to inefficient use of resources and a reduction of resources available to other, more needy population groups. Programs generally target their interventions to children less than 5 years of age and their mothers, and pregnant women. Where food supplementation is part of the program, it is usually intended for children less than 2 or 3 years of age and pregnant or lactating women, depending on the role of the food supplements. The programs studied provide ample evidence that current programs are correctly targeting children and women. This was an important recommendation of Mora et al.’s 1990 report, which has been emphasized in recent DAP guidelines. Key Recommendation: CSs should establish country-specific criteria and verification methods to ensure that the neediest communities are selected and food resources are not used ineffectively. 4. The Role of Food Rations In the Title II program food is a key resource supporting achievement of MCHN program objectives. In consonance with goals set out by the Policy Paper and the evolution of MCHN activities into integrated community-based development programs, the use of food rations has moved away from a purely rehabilitative function. Food rations have been linked with other components of the program, and hence their role has expanded. In 1999 a FANTA-sponsored workshop on improving the use of food rations in Title II MCHN programs was held with CS and Mission representatives from Bolivia and Peru. That workshop concluded that there are three principal purposes of food distribution in Title II MCHN programs: nutritional recuperation, prevention of malnutrition, and as an incentive to program participation (FANTA, 1999). Clarifying these objectives helped CSs in Bolivia and Peru—and 75 ultimately CSs in other countries–define characteristics for their programs, including parameters for selection of beneficiaries, ration composition, ration size, and graduation and reentry criteria. The programs reviewed for this assessment use all three models of food rations or close adaptations of them. For example, CARE/India’s Integrated Nutrition and Health Project uses the prevention approach; CRS uses the prevention approach in some projects (Benin), and the recuperation in others (Haiti). In Bolivia, FHI, ADRA and CARE use the preventive approach, whereas Project Concern International (PCI) uses the incentive approach. CARE uses the recuperation model in Haiti. Although data are not yet available to say which model produces the best results, the models continue to assist CSs in program designs and evaluations and represent a good example of the partnership between FFP and CSs. However, food rations are not always being used effectively as leverage to improve outreach. For example, the final evaluation of the Haiti program recommended that CSs increase their efforts to use food rations to draw people from more remote locations to the MCHN program and related health services. The potential negative incentive effects of food rations, for example, the withholding of food from children or getting pregnant in order to qualify for rations (Kennedy and Knudsen, 1985; Bessenecker, 2000), may be leading some CSs to be cautious about the use of food as an incentive. However, as Mora et al. (1990) noted, “selective targeted feeding is most efficiently used as an incentive to bring those at greatest need to be exposed to MCH services and to raise their demand for them, when in the meantime service quality is improved.” Food used purely as an incentive should be considered and promoted as a short-term activity. Recommendation on Food Rations · FFP should support field research to compare the effectiveness of universally targeting all children under 2 (prevention approach) with targeting only malnourished children (recuperation approach). 5. Growth Monitoring and Promotion GMP is an integral part of almost all the Title II MCHN programs. In DAPs reviewed, the location of GMP in communities–rather than clinics–and participation of residents provides an empowering environment for communities in which transmission of information and knowledge can occur. In the best GMP programs, community members are involved in the operation and management of GMP activities as well as in identification of follow-up plans for malnourished children. As one evaluator noted in the final evaluation of the CARE and CRS Food Assisted MCHN program in Haiti, “(c)overage with growth monitoring/counseling has been achieved best in Haiti where there has been an effort to take services outside the four walls of clinics to posts near the homes of the clients." (Smucker and Schlossman, 2001.) Effective GMP programs include clearly established protocols for identification and referral of malnourished children to health facilities, specialized centers or more intensive community-based activities such as a nutrition education and recuperation programs, based on a pattern of faltering growth velocity over a defined period of time, such as 2 or 3 months, rather than weight at one point in time (i.e., at one growth monitoring session). 76 Although CSs have overcome many of the problems GMP can entail, quality control was an issue in many of programs visited. Accurate plotting of weights on growth cards and consistent and accurate counseling of mothers were the two main aspects that need to be reinforced. Improved training programs are needed that include: 1) the logistics of GMP, 2) techniques of weighing infants and children using different types of scales, 3) repair of scales, 4) plotting weights on growth charts, 5) interpreting the growth curve and growth velocity of children, 6) counseling the mother about the child’s weight in relation to the child’s age, growth pattern and growth velocity, and 7) checking for child health danger signs and making referrals if needed. The frequency and quality of supervision also needs improvement. Supervisory visits should be not less than monthly, and supervisors should be attentive to the accuracy of field workers’ weighing techniques, weight plotting skills and counseling skills used with mothers. Use of supervisory quality control checklists during observation of GMP sessions helps ensure appropriate feedback for field workers. In some of the MCHN programs visited, CSs were using GMP to screen children for eligibility to receive rations. While this practice is less common than it was in the 1980s, it is contrary to a large body of evidence that suggests that GMP should not be used for this purpose (Martorell, 1995; Ruel, 1995; Bessenecker, 2000). Key Recommendation: CSs should continue to use growth monitoring and promotion as a key strategy to improve the nutritional status of children under 3 years old and improve referral and follow-up of malnourished children. CSs should establish clear protocols for identification and referral of malnourished children to health facilities. Additional Recommendation on Growth Monitoring and Promotion · CSs should strengthen training for field staff and CHWs responsible for GMP, and intensify quality control of GMP activities. 6. Follow-up of Malnourished Children In most of GMP programs visited, children classified as malnourished were marked for follow￾up home visits, or special group sessions for recuperation and education of the mother. Severely malnourished children were, in a few cases, referred to specialized recuperation clinics. Follow-up of malnourished children in many of the observed programs was ineffective, due in large part to the infrequency of home visits, the lack of good home visit protocols, the low technical capacity of CS field staff and counterpart staff trained in the management of moderate or severe malnutrition and a paucity of well-equipped and staffed treatment (recuperation) centers. One CS’s final evaluation noted that overwork and lack of financial incentive to the health worker were partly to blame for the poor recuperation of malnourished children. The development of protocols for follow-up of malnourished children and the use of quality control checklists have been helpful in minimizing failures in some programs. Similarly, the use of checklists of positive/negative behaviors during home visits (such as those developed by FHI) has been helpful for field workers without extensive technical training. The most effective 77 protocols for home visits include guidelines for making observations and for advising mothers and other significant family members about age-specific child feeding, hygiene and health prevention practices. The use of visual materials and demonstrations (of weaning food preparation, ORT preparation, handwashing techniques, etc.) are components of effective home visit protocols. The low success in recuperation of severely malnourished children referred to specialty centers has been disappointing for a number of CSs. In some cases CSs have dropped recuperation centers from their projects (e.g., CARE/Peru, CRS/Benin) although some continue to provide training to Ministry of Health (MOH) staff on management of malnourished children. While the running of recuperation centers may not be practical for all Title II projects, in countries where MOH capacity to treat severely malnourished children is poor, a potentially appropriate and valuable role for Title II CSs is strengthening of MOH capacity in this area. The short- to medium-term goal of all CS support activities should be building capacity of MOH counterparts, and the long-term goal MOH sustainability of effective treatment and follow-up capability. CSs should have strong organizational and technical experience in this area prior to undertaking such interventions. Effective capacity strengthening programs aim to: · Establish or strengthen the referral/counter-referral systems between community-based growth monitoring programs and specialized centers or units of health facilities for the recuperation of severely malnourished children. · Provide technical and/or Title II resource support for training of MOH staff in treatment and management of malnutrition, in follow-up of recuperated children, and in the organization and management of recuperation centers/units, where such centers are supported under MOH policy. World Health Organization (WHO) protocols for treatment of malnourished children should be followed (Sanghvi, 1999).34 Recommendations on the Follow-up of Malnourished Children · CSs should develop protocols and quality-verification checklists for health promoter/CHW tasks and responsibilities during home visits. · CSs should focus on strengthening MOH capacity where capacity to treat malnourished children is weak. 7. Focused Nutrition Education and Behavior Change Promotion The goal of nutrition education in MCHN programs is to improve key health- and nutrition￾related behaviors that impact maternal and child nutritional status. Title II programs have been successful in moving away from didactic approaches to nutrition education to those that are participatory, empowering to communities and employ adult education principles. These approaches represent important advances in the way nutrition education has been delivered in Title II DAPs. Some CSs, for example, FHI, ADRA and Africare, have developed educational modules that group similar themes and messages, and facilitate training operations. 34 Dried skim milk is one ingredient in the WHO-recommended treatment formulas and should be made available for use by CSs and their partners within health facilities for training and actual recuperation activities. 78 The primary target audience for nutrition education is still women and young children, the most vulnerable groups, but the importance of other target groups made up of individuals who form the sphere of influence around the mother-child unit is tacitly recognized. Specific activities in many of DAPs–particularly educational activities–are tailored to husbands, other relatives, community leaders, teachers, traditional healers and health workers. However, observers noted during site visits that nutrition education curricula in many projects are too broad, incorporate topics or themes that are not associated with DAP interventions and lack specificity in terms of behavior change objectives. Quantity often comes at the expense of quality. One mid-term evaluation concluded that the quality of the nutrition education curriculum was “too luxurious for the communities and not practical.” Greater educational emphasis is needed across the Title II MCHN portfolio on household- and community-level behavior changes linked to improved food utilization and health prevention practices in the home.35 Experience in a broad range of adult education programs that aim to change behaviors has identified key characteristics for effective behavior change promotion: · Curricula are of good quality and reflect depth in a reduced set of themes directly related to the DAP interventions. · Educational sessions are oriented to behavior change promotion rather than to imparting theoretical knowledge. Curricula incorporate messages keyed to behavior change in the home. · Behavior change messages are consistent, simple and easy to adopt and incorporate locally appropriate images and symbols. · Models of the positive (desired) behaviors are contrasted with models of the negative (wrong) behaviors. · The number of behavior change messages promoted in a program cycle is limited to what is practical and feasible. · Multiple methods of dissemination are used (mass media, group discussions, individual counseling). · Strategies are diverse and extend to mothers as well as husbands, in-laws, other family residents, community leaders and other key audience segments that form the sphere of influence around the mother-child unit. Key Recommendation: CSs should put major emphasis on changing critical nutritional and health behaviors. CSs should include measurable behavior change objectives in all Title II MCHN programs if they are to impact positively on nutritional status. 35 Evaluations of Title II projects in Haiti (Smucker and Schlossman, 2001), India (CARE, 2001), Mozambique (Peters et al., 2000) and elsewhere highlight the need for increased focus on household nutrition and health behavior change. 79 Additional Recommendation on Nutrition Education and Behavior Change Promotion · CSs should design nutrition education curricula that focus on actions and practices in the home, community and public health sector that have the greatest potential impact on nutritional status of women and children. There should be a high degree of correlation between curriculum content and DAP nutrition and health promotion activities. 8. Women’s Nutrition While not given sufficient emphasis in USAID Policy Determination 19 or in the Policy Paper, women’s nutrition is both an important determinant and outcome of food security. Maternal nutritional status during pregnancy and lactation affects birth outcomes and the mother’s ability to breastfeed and provide adequate care for her children. In addition, women’s nutritional status affects their work productivity, which also affects household food security. Due at least in part to the lack of emphasis in the Policy Paper and program guidance, there is inadequate emphasis on women’s nutrition in the Title II DAPs reviewed, although many programs emphasize support of MOH efforts to increase antenatal care visits and tetanus toxoid immunization. While programs often acknowledge the importance of maternal nutrition through the educational component of GMP sessions, most programs have not defined specific maternal nutrition objectives. In a small proportion of the programs, MOH micronutrient supplementation activities as part of the antenatal care package may be supported. Increased emphasis is clearly needed on improving maternal nutrition before, during and after pregnancy, and during lactation. Activities to improve nutrition of women can be implemented in the community as well as in health facilities, but CSs should give priority to food-based interventions. Food is the primary Title II resource, which is the comparative advantage of CSs in MCHN programming. Given the close relationship between CSs and MOHs in many DAPs, opportunities exist to support MOH efforts to monitor maternal weight gain during pregnancy, counsel women on dietary changes, develop and disseminate educational messages, promote IFA and multiple micronutrient supplements, assess and prevent severe anemia, promote vitamin A supplementation for post-partum women and encourage birth spacing of 3 years or longer (Huffman et al, 2001). Activities may include technical support, financial/administrative support for operational costs, advocacy, or a combination of all of the above but should always be implemented together with a plan for phasing out the CS role and increasing the sustainable role and responsibility of the MOH. Key Recommendation: CSs should focus increased attention on strategies to improve women’s nutrition, and FFP should issue guidance that supports and encourages this emphasis. 9. Capacity-building of Local Partners Capacity-building of local partners through training, supervision and technical support is an implicit, if not explicit, objective of all of the MCHN programs reviewed. Reflecting the guidance of the Policy Paper, FFP and prior studies, programs have built capacity at the individual, community, facility and district levels, through education, training and role modeling. By working side by side with counterparts and implementing partners, CSs have strengthened organizations and institutions which can then provide capacity-building through their own 80 activities. In some of programs observed, the Title II program was the only source of capacity￾building for local governments and development organizations in poor regions. In Mozambique, Africare teaches local communities how to rehabilitate malnourished children using the community-based Hearth Model of nutrition recuperation, and combines this with extension activities to promote oil seed production. Africare’s West and Central Africa Regional food security initiative builds capacity in and across several countries, including Chad, Mali and Burkina Faso. CRS/Benin works with the Ministry of Social Protection and the Family through a semi-autonomous management unit, the Food and Nutrition Program Unit, to co-manage the MCHN/FACS program. CRS/India builds capacity through a Safe Motherhood/Child Survival program that works in partnership with Indian social service organizations. SCF builds capacity at the community level in all of its projects through positive deviance inquiries. Recommendation on Capacity-building of Local Partners · CSs should include clear plans for phasing out direct CS involvement and increasing the role and responsibility of MOHs. 10. Delivery of Essential MCHN Services Although MCHN activities have largely shifted from clinics to communities, a significant portion of activities continues to occur in and around the health facility. As the analysis of performance indicators in section V.C.2 suggested (see Table 6), many of the current programs provide significant support to essential maternal and child health services–and health interventions directly related to child survival. 36 The most common of these services are immunization, micronutrient supplementation, prenatal care, safe deliveries, and treatment of childhood illnesses–all among the most important health interventions needed for child survival (Sanghvi and Murray, 1999; Huffman et al., 2001; Gillespie et al., 1996; Tomkins and Watson, 1989). In Bolivia, Honduras, Ethiopia, Benin, Ghana, Madagascar and Kenya, CSs support MOHs in delivery of immunizations to women and children and promote the MOH’s efforts to have all pregnant women attend prenatal consultations. In the INHP in India, two out of CARE's four priority interventions are provision of IFA supplementation for pregnant women and immunization for infants and pregnant women. In Mozambique, WV and FHI provide support to the MOH in immunization, deworming of children through distribution of mebendazole, family planning, support of mobile health brigades, treatment of malaria, distribution of vitamin A and training of district health staff. While host governments in the countries studied have generally insisted that direct provision of essential services remain in the hands of the MOH, and that donors and NGOs not provide these services directly and not establish competing service delivery systems, the line between support and direct provision of service is often blurred. Lack of health infrastructure, of trained health staff and of political will, and the desire for more immediate tangible impacts, are among the reasons why many CSs inadvertently find themselves delivering services in place of MOHs. However, CSs need to look very closely at how they provide support for essential health care. 36 This trend became more prominent from about FY 1998, when greater emphasis was placed on mainstream child survival activities in the DAP Guidelines. See Table 4. 81 Direct provision of essential health services may create a disincentive for MOH partners to seek long-term solutions to the problems they face in delivering services. In many countries where CSs work, the lack of adequate health facilities and trained government health staff limits the impact programs can have on health and nutritional status. CSs in the field were often observed attempting to compensate for this by diverting resources to direct provision of health services. Yet, in many programs reviewed, CSs have developed innovative MOH capacity building efforts, which helps to overcome this problem. In a number of the programs, DAP support of essential health care delivery has the anticipated benefit of generating demand for health services. However, there is not enough evidence to know if or to what extent demand for services effectively results in provision of quality services over the long term. Obviously, this will be contingent upon factors such as the availability of materials and supplies; transport; financial resources; political will; and technical, managerial and organizational capacity of the local, district, provincial and/or central government. Concerted community demand may be able to increase government awareness of needs and political willingness but may not be effective in the face of inadequate infrastructure and insufficient country resources. Thus, generating demand for health services may be a more effective long-term strategy in countries where resources exist but the distribution of those resources is poorly organized or motivated, compared with countries where the resources simply are not available. Recommendation on Delivery of Essential MCHN Services · CSs should focus on MOH support strategies such as providing technical assistance and limited financial support for training, educational efforts, advocacy role modeling or mentoring. Any financial support should be provided with cost sharing, cost recovery or phase-out plans. 11. Integration of and Balance between Nutrition and Health Food insecurity is multidimensional and a number of CSs seek to follow an integrated strategy within the Title II program. Activities designed to improve the quality and availability of health services are important complements to activities designed to promote behavior change interventions that improve essential health and food utilization behaviors at the household and individual level. However, the challenge is for CSs to identify integration strategies that are multidimensional and manageable, and to determine their comparative advantages over other local or regional programs or organizations. The programs studied and field observations reveal that sometimes CSs are overly optimistic about what they can accomplish and about the level and quality of multidimensionality they can maintain. Strategic integration of health and nutrition activities at different levels (facility based and community based), sometimes funded by different types of resources (DA and Title II) and implemented by different partners with an appropriate mix of technical capacity and resources, may increase the likelihood of measurable impacts on health and nutrition. The extent of the impact will depend on the effectiveness of the integration and the combination of technical capacities and resources among the partners. In Mozambique, the integration of health service 82 delivery interventions with other activities under the Title II program ultimately proved to be problematic. By the middle of the last DAP cycle, Title II CS–and all PVO–health activities were consolidated under a single contract under the Missions’ health strategic objective team, which is not the strategic objective team that oversees Title II. The Mozambique case is an informative example of the fine line CSs sometimes walk between support and direct provision of essential health services, and the potential difficulty of integrating Title II resources with other resources in a Mission. Many of the Title II programs reviewed have contributed to improvements in immunization rates and utilization of antenatal care services. They have also helped women in poor countries deliver babies more safely and enabled women and children to access micronutrients in communities where the existing health infrastructure was unable to do so. CSs have often played a crucial role in health service delivery in times of crisis, during, for example, epidemics such as the cholera epidemics in Mozambique and Madagascar. Although many MCHN programs are designed with integrated health and nutrition strategies in mind, in practice some health interventions have absorbed a large bulk of CS staff time and resources, resulting in inadequate emphasis on complementary household level nutrition and health behavior changes. This observation is reflected in the recommendation of the final evaluation of CARE/India’s INHP project: “[CARE/India should] [i]nvest in building commitment … to achieving nutritional improvement through INHP, including a review of INHP-2 to balance nutrition and health interventions.” (CARE, 2001.) While it is true that the health focus areas of MCHN programs reviewed correctly address the major health needs and problems of poor women and children, the impact of these interventions on nutritional status depends on household food utilization behavior and preventive health practices in the home. That is, unless the target child consumes an adequate diet, sufficient in quantity and quality (i.e., sufficient in macro- and micronutrients) and provided with the appropriate frequency and density for age, nutritional status cannot improve. In food insecure homes, improving the delivery of health services without improvement in food consumption and key feeding and health prevention behaviors will have little or no impact on nutritional status. CSs need to be careful not to overemphasize essential health care at the expense of behavior change interventions that may be intrinsically more difficult to implement but ultimately are likely to have greater direct impact on nutritional status. An overall conclusion of this assessment is that the Title II program needs to improve the balance of health and nutrition. The assessment does not suggest that health sector support is not important or should be ignored. However, in programs that are heavily dominated by essential health care delivery, the mix of health and nutrition should be revisited with the goal of increasing the effort devoted to improvement of nutrition and health prevention behaviors in the home and community. Areas of essential health services appropriate for nutrition interventions are described in Nutrition Essentials Guide for Health Managers (Sanghvi, 1999). Key Recommendation: CSs should focus efforts with MOHs on the integration of nutrition into essential maternal and child health services. 83 Additional Recommendations on the Integration of and Balance Between Nutrition and Health · CSs should select health service areas that are strongly correlated with their organizational strengths, experience, objectives in other sectors and comparative advantages relative to other organizations working in the same geographical area. · CSs should avoid working in too many health service areas, but instead limit the number to a manageable few that can be done with a high degree of quality. D. Monitoring and Evaluation of MCHN Programs M&E plans developed by CSs in the MCHN sector have improved significantly over the past few years, as discussed in Chapter III.B.1, Managing for Results. However, many MCHN monitoring systems are designed almost exclusively for the collection and reporting of impact and output indicators. Information on outcomes that directly reflect CS efforts is sometimes not collected, or is collected but not used. In addition, M&E systems often contain performance indicators that are too numerous and unrelated to actual intervention efforts. Most M&E systems do not collect information on household nutrition behaviors that should be the key targets of change. In communities, monitoring systems are sometimes too complex for health workers with minimal education. CRS and WV have addressed this problem by using simple registers at the community level that can be filled in and tabulated by hand. Information collected in registers is simple enough to be interpreted by CHWs with low levels of education. Because the registers are kept by CHWs or health committee members, they have the added advantage of empowering communities. Recommendations on Monitoring and Evaluation of MCHN Programs · CSs should identify a few performance indicators that are directly related to the ultimate goal of household food utilization, and increase and refine the focus on indicators of household behaviors that reflect food utilization of vulnerable household members and that need to be key targets of change. · CSs should design monitoring systems for trained CHWs to collect individual, household and community level data using registers, or comparable notebooks. 84 VI. Food for Education Sector Assessment A. Introduction This chapter presents the results of an assessment of the eight food for education (FFE) programs funded in FY 2001 by the Office of Food for Peace using Title II resources.37 Various complementary activities have been used in combination with school meals and take-home rations to improve the quality of education. This chapter discusses only the components that may be programmed using Title II resources in different ways. It looks briefly at how Food for Work (FFW) can be used to improve school infrastructure, and at how the food itself can be used to leverage school reforms. B. Overview of the Food for Education Sector Within the USAID context, Food for Education programs (FFEs) refer to interventions in which food is integrated with other resources to enhance educational outcomes. FFEs share many features with School Feeding Programs (SFPs) but they differ in the emphasis on education: FFE is specifically designed to promote educational opportunity, educational progress and educational achievement (Bergeron and Del Rosso, 2001). This focus emphasizes the role that a nutritious, well-timed daily meal can play in helping students learn, and in helping countries meet their educational objectives. The Policy Paper emphasis on the use of Title II resources to sustainably increase the food security of recipients also drives the distinction. This is satisfied in FFE programs via the transfer of food to schoolchildren, their families and communities, which has an immediate impact on their access to food. Moreover, the increases in education that are expected from FFE programs can have a long-term impact on food security include enhanced productivity, an increase in incomes, a reduction in pregnancies and improved health and nutrition. Looking specifically at the role of food, the provision of meals or snacks to children at school has two primary objectives: improving enrollment and attendance and reducing short-term hunger among attending children. This should improve educational outcomes, since a well-fed student is more attentive, performs better in class and progresses further and more quickly. Schools thus become more effective as fewer children drop out or repeat grades. Using fortified foods will also add micronutrients to the meals, further improving children’s performance. The food is also a resource transfer to the family. The value of the meal the child receives at school can offset some of the costs of schooling such as fees, books, and supplies, or offset the opportunity cost of lost labor to the family. The meal served to the child at school also represents an economic benefit to the family when it substitutes for food normally served at home. Further benefits apply to the family when take-home rations are used, for instance, to encourage girls’ education where female schooling is low. FFE programs also transfer resources to communities via the school canteen committees that organize the preparation and distribution of meals at schools. Most FFE programs have extended this notion to work with Parent-Teacher Associations (PTAs) for mobilizing the community around other school activities. Community participation can improve school quality, for instance by increasing local supervision of teachers, 37 A list of FFE programs reviewed may be found in Appendix 4. 85 or making the school environment healthier. PTAs can also be a locally representative mechanism to channel requests for further assistance to other donors. Other school-based health and nutrition interventions can boost the value of FFE programs. Three key interventions that interact directly with the utilization of food are school-based deworming programs, micronutrient supplementation and nutrition, health and hygiene education. Title II does not, however, provide resources for these inputs, so CSs must integrate their FFE programs with other resources to provide for them and increase their impact on education and food security objectives. Food alone is not sufficient to improve educational achievement. CSs’ initial designs did include some components around the canteen activity to increase educational performance, but since little guidance or knowledge existed at the time to help CSs in that task, approaches varied widely. Since 1996-1997, however, several CSs have proactively adapted their programs based on the lessons they have learned from experimenting with the FFE model. Shifts were made from isolated food input provision to a broader range of complementary interventions, including early meal preparation, targeting of marginal groups, take-home rations, PTA mobilization and use of other donor and private resources to complement the food with activities such as the provision of Vitamin A and deworming medicine. These are positive steps and the various lessons learned from them are discussed in a later section. C. Program Achievements It is difficult to assess the overall performance of FFE programs on education. Due to a lack of guidance from USAID, annual monitoring indicators were not standardized across programs. Also, only one quantitative impact evaluation is available (Haiti). Still, all CSs did some annual reporting on enrollment, drop-out and promotion rates. Those are reviewed below. · Enrollment: Increasing school enrollment is the one area where FFE programs appear to be consistently progressing: most programs met their targets on this objective or came very close. Once disaggregated by gender, however, a distinct picture emerges: only two of the six programs that specifically aimed at increasing girls’ enrollment met their targets. This indicates how difficult it may be to change cultural perceptions about schooling for girls in traditional settings. Even the use of take-home rations in West Africa’s programs could not overcome cultural barriers in this respect (see further discussion of the gender issue in the next section). · Drop out: Reducing drop-out rates appears to be more difficult than initially thought: only one program in Latin America succeeded in lowering drop-out rates to the levels it had targeted. All other programs failed to reach their targets. Here again, gender bias was shown to be present, since the shortfall is always greatest among girls. · Promotion: Promotion rates are generally close to targets, but more than half the programs failed to reach 100 percent of their target. Promotion rates, on the other hand, are very similar across genders. The difficulty in attaining drop-out and promotion indicator targets could be expected, as no CS had prior knowledge on the amount of change it could expect in the educational area. More appropriate targets should be proposed in the future based on existing experience. 86 Recommendations on Improving Reporting of Program Achievements · FFP and CSs should agree on a limited number of common indicators to represent FFE results. · CSs should be more conservative in estimating their capacity to generate change. · CSs should try to gain a better understanding of the constraints and opportunities for increasing girls’ education. D. Program Design and Implementation This section covers aspects of program operation that appear determinative in ensuring success. It reviews the experience gained by CSs to date, and highlights promising approaches. 1. Facilitating the Schooling Process The first step in educating a child is to have him/her enroll in and regularly attend school. There may be a number of obstacles to this: difficulty of access for the child, parental attitude towards education, economic constraints, etc. The problems most often mentioned are briefly examined below. · Economic: Education, even when “free and universal,” is almost never without cost. Parents still must pay for school supplies, PTA fees, uniforms, and so on. Supporting more than one child at school, each for 6 years, can constitute an impossible burden to a poor rural family. In addition, the investment can be viewed as risky if the child, whose labor could contribute to family income, results in a schooling failure. The food transfer may thus not be sufficient to convince parents of the value of education, especially if the school is poorly managed. · Socio-cultural: Cultural perceptions may also affect parental attitudes towards schooling. In India, for instance, low education level is closely associated with caste-induced social barriers. Education can also be viewed as upsetting to traditional systems: in West Africa, some parents felt that education led children to “rebel against working in the fields and against the traditions of the village. The girls in particular refuse to accept early and forced marriages.” In particular settings, delaying marriage deprives the family of the labor of in￾laws. Thus, cultural and economic motives may at times work against education. Obviously, these are the very perceptions and conditions that FFEs seek to change; yet it is important to know what those perceptions are if any effort at changing them is to succeed. · Physical: Deficient infrastructure is often cited as an obstacle to education; crowded classrooms, shabby buildings and dirty spaces do not invite participation. Conversely, parents tend to value schools more when the building is adequate and when it is provided with amenities such as latrines and potable water. Thus, pride in the village school shapes people’s valuation of education and willingness to participate. Inadequate residential facilities (for boarding schools, for instance) may also affect the willingness of parents to send their children. Likewise the lack of housing for teachers has been noted in several instances to cause teacher absenteeism. Finally, distance, physical impediments such as a 87 dangerous river to cross or issues about safety of movement, particularly of girls, can make it more difficult for students to go to school. CSs have implemented a range of solutions to these problems, many of which have included “food as food.” FFW programs have been used in combination with FFEs to improve school infrastructure, or to build roads and bridges to schools. Take-home rations (THR) have also been used to offset the opportunity cost of sending a child to school. Information, Education and Communication (IEC) campaigns, for instance via radio or local animation, have been used successfully in combination with food to raise parental and student awareness of the benefits of education. Schools can also be made more attractive by improving the quality of education and making them more relevant to people’s lives, by training teachers and by improving the curricula. School authorities can examine the possibility of waiving school fees or using scholarships to entice most vulnerable groups. The first imperative, however, is to understand the main constraints before a program begins, so that the proper actions are built into its design. Recommendations on Facilitating the Schooling Process · CSs should consider a variety of means to reduce the economic cost of school attendance, in addition to the meals provided. · CSs should understand the reasons for negative perceptions, and then sensitize local populations to the value of education using IEC campaigns, local animation, social marketing, etc., which specifically address negative perceptions. Also, CSs should strive to make education more relevant to people’s lives by improving the curricula (e.g., including agricultural topics) to raise parental and student interest. 2. Food as an Input There is widespread agreement that “food as food” works well to increase attendance and enrollment. The reason for this is that food provides a broad array of mutually enforcing incentives to stakeholders (children, parents, teachers and communities). Some reports suggest that food in itself works better than school infrastructure or community mobilization to promote enrollment and attendance. However, these reports do not discuss the impact of food on other educational variables, such as promotion rates or test scores, although this may simply be due to the lack of data. Whatever the case, food programs must be designed with care if they are to have the desired effect on educational outcomes. Three elements in this respect are particularly important: the ration used, the timing of the meal and the meal delivery. Recommendations on Food as an Input · Ration: Issues about ration are covered in detail in FFP’s most recent Commodity Reference Guide (Part II, 2: Module 3) and need not be repeated here. However, it is important to note here that the type and quantity of commodities used in the ration should be determined by: how food is provided (on-site wet feeding, take-home dry ration); if on-site feeding, the meal it replaces (morning, snack, lunch, etc.); 3) the meal’s nutritional content (based on the specific needs of the student population); and the cultural and economic suitability of the commodities. 88 · Timing: Short-term hunger, common in children who are not fed before going to school, has an adverse effect on learning, since a hungry child has more difficulty concentrating and performing complex tasks, even if otherwise well nourished. School meals should be provided early in the school day to alleviate hunger before or while classes are in session. This will help children to be more attentive and to concentrate better. · Meal Delivery: Minimal ground rules should ensure that all children have equal access to the food, that ration sizes are even, that cooks receive nutrition and hygiene training and that the quality of the food is periodically monitored. To reduce the time spent on feeding, all children should have their own plates and utensils, and the school must ensure that meals are ready each day as planned. The canteen should never depend on one person, as this person could be absent. 3. Targeting and Girls’ Education Children who benefit from on-site feeding are not selected on the basis of their individual needs but on the characteristics of their school or community. Key criteria in selecting FFE schools should include the degree of food insecurity in the community, physical access to the school and number of students per school (so that CSs make the most efficient use of scarce resources) and the seriousness of the institutions and their willingness to undertake educational reforms in exchange for participation in the program, in conformity with FFE’s focus on improving educational performance. In practice, FFEs reviewed here have applied these selection criteria. Any time a targeting criterion is used, however, there is a potential for targeting error. In FFEs, basing beneficiary selection on school characteristics may provide benefits to a child from a better-off family who does not need them (inclusion error), or may fail to provide benefits to targeted, needy individuals (exclusion error). Inclusion error is reduced by the fact that participant schools in Title II FFE programs are generally selected from poor, food insecure villages, and by the fact that self-targeting is expected to be operating, since better-off families are likely to send their children to institutions with higher standards. Exclusion error is more troublesome, as it is likely to affect children from the poorest, most food insecure families. CSs may not even know how much of a problem this is unless a good census of the school-aged population is available. Correcting such a problem thus implies understanding its extent and its reasons. The discussion above of constraints to education could be used to initiate a formative study to determine what aspects are most important. A different set of criteria applies to THRs. Usually a THR, a direct food transfer to the student’s family, is used to target specific social groups thought to be educationally disadvantaged, such as school-age girls, or socially marginalized groups like disadvantaged castes in India. In such cases, THRs are used to motivate parents to enroll their children in school and to ensure they attend regularly; for the family to receive the monthly ration the child usually must have an 80 to 90 percent attendance record. THRs successfully raised enrollment and attendance of targeted groups in a number of settings while increasing parental awareness of the importance of regular attendance. The success of THRs varies from place to place, however. Cultural factors against education may be strong enough to deter parents from sending children to school, even when THRs are offered. Another factor affecting the success of THRs is the level of local food security–if enough food is available in the household, then THRs may not constitute a significant 89 incentive to increase target group attendance. Where this occurs, some NGOs have found that there is a particular value in including some commodity in the food basket that is seen as particularly valuable by families, such as salt or cooking oil. A judicious choice of commodities can increase effectiveness in reaching FFE goals. THRs have been particularly used in targeting girls. There are many good reasons to increase women’s education. First, educating women is one of the most effective ways to reduce gender disparities in skills, knowledge and income earning potential. This is not only an equity issue: it is by now well established that increasing women’s income has greater impact on household food security than increasing men’s. Hence FFEs should pay a special attention to girls’ education. Does this make the use of THRs appropriate in all situations? Maybe not; the key here is that there must always be a good basis for the preferential treatment of any particular group. When used to foster girls’ education, for instance, CSs must ensure first that education is truly gender biased. THRs should not be used if enrollment/attendance levels among girls are similar or superior to those of boys, lest the scheme induce social tensions that are counterproductive to the program goals. The issue is not always straightforward. An evaluation of a West African program pointed out that, although attendance was similar between boys and girls in lower grades, girls’ attendance rates declined faster than boys’ as they reached higher grades. In this case, THRs could be used to specifically target older girls, rather than all girls. These findings suggest the need for careful analysis before deciding to use THRs as a targeting device. There are many ways in which girls’ education can be supported besides providing them with THRs: IEC and awareness-raising programs can help make education more acceptable to communities and help ensure that girls enroll, attend and stay in schools. Other means include hiring of women as teachers, and training them to include linkage-building with mothers and women’s groups in the villages. This works particularly well when women teachers are local. Scholarships and fee concessions for girls have also been used with success, assuring admission of two girls on a concessional basis for every boy coming from the same village. Other means used by CSs include mapping the population to ensure unserved or underserved girls are actively targeted and recruited. Working through extensive family networks also helps, as the opposition to girls’ education often comes from extended family members. Still other measures include: offering residential summer camps and boarding schools for girls, highlighting the academic achievements of girls through awards and public recognition ceremonies to increase parental and community support; and extending program coverage up to higher grades in the primary cycle, in order to address the high drop-out rate of girls as they get older. In some places, it was also found that dividing classes by gender in coeducational settings made it easier for girls to attend. Recommendations on Targeting and Girls’ Education · CSs should conduct careful gender analysis of schooling patterns before deciding to promote girls’ education more intensely than boys’, and be aware that community sensitization is essential when such activities are promoted. 90 · CSs should always assess the real need for THRs, ensure proper sensitization of community members before beginning their use and be able to monitor diligently eligibility criteria such as school attendance. CSs should include in the ration commodities that are particularly desirable to the community and should involve parents directly with the school. 4. Infrastructure Good school infrastructure can help the cause of education considerably. Proper accommodations enhance students’ learning, and, in countries where classes are often held outside or in poorly maintained buildings, it is a source of community pride to have a good school. Parents will be more inclined to send their children if the school building is of higher quality. Communities are usually quite responsive and helpful in providing labor and other inputs to build classrooms, latrines, water points or teacher accommodations. FFW has been used in several situations to support this. However, the type of improvements should be carefully selected. There are documented cases where more classrooms were built than needed. Elsewhere, new classrooms were built that could not be properly equipped–it would have been more appropriate to improve existing classrooms or furnish them better. The type of building that will do most to improve school performance should also be considered. For instance, in some places it is the construction of teacher accommodations that is most urgent, as it will reduce teacher absence. In other situations, the provision of gender-segregated latrines will do more to increase enrollment of girls than the construction of a new classroom. Decisions on such issues should be made with the full participation of the community and school staff. Recommendation on Infrastructure · CSs should assess the degree to which infrastructure is a problem and assess the type of work that is most needed, and the potential of program to solve it. 5. School Reforms The term “school reforms” refers to improvements in school administration, such as bookkeeping, including attendance and enrollment; financial accounting, such as fee structure and collection and teacher salaries; sectoral policy compliance, such as days of operation and use of approved curricula; and quality of services, such as better control of teacher quality, and teacher compliance. Since quality of education is supposedly a keystone of FFE programs, several CSs have made it a precondition that schools undertake reforms in one or more of those aspects in order to continue receiving food. Food is thus used as leverage to improve the quality of educational services. Performance-based contracts are a promising approach to link the parties. An example of such a contract is a school agreement to maintain enrollment and attendance records in order to keep receiving the food. Such performance-based contracts are very flexible, as they can be drafted with individual schools on the basis of particular needs and capacities. As noted by Janke, however, “performance-based approaches to food assistance are still relatively untried” (Janke, 2001:13) and they will work only if food assistance is of value to beneficiaries, and the schools have the capacity to fulfill their obligations. These points are well taken, and support the idea that schools’ obligations must be realistic. An analysis of the areas for change is essential; some reforms such as the removal of school fees, the decentralization of resources and power to the 91 districts, or adapting the school calendar to the cultural and economic realities of communities, need to be implemented across the board for all schools. In this case it is better to negotiate with the Ministry of Education rather than the school itself. In the majority of cases, however, reforms can be negotiated with schools directly. An interesting model in this regard was proposed by FFE in Haiti. Recognizing that not all schools start from the same basis, CSs classified their institutions in tiers, each tier describing the relative quality of the services offered at that school. To maintain access to food, a school had to commit itself to graduate to the next tier within a specified period of time. Intermediate steps were identified to measure advances. The model, while flexible, ensures a progressive and sustained standardization and amelioration of the schools. Recommendation on School Reforms · Using food as a leverage, CSs can devise performance-based contracts tailored to the particular needs and capacity of each school, with the objective of progressively standardizing all schools. Performance-based contracts are still relatively untried, however, and are likely to work only if food assistance is of value to beneficiaries, and if they have the capacity to carry out their obligations. CSs must assess those issues before initiating programs. 6. Partnerships FFE programs typically cover large geographic areas and schools are often remote, making supervision demanding. To increase their capacity, CSs often rely on national NGOs to act as surrogates in the regional distribution and administration of the food. Such a delegation of responsibilities is both necessary and desirable for sustainability, yet it raises critical concerns over quality control issues: local partners have to be technically capable, administratively accountable, and sufficiently flexible to endorse CSs’ methods and approaches. The evidence from ongoing experience is mixed. There are many success stories of productive associations, but when national NGOs do not have enough staff to properly administer the program, local supervision may suffer from irregular meal preparation, non-standard ration size, dubious sanitary conditions in kitchens and poor commodity control. The monitoring of school performance can also suffer, with attendance records inadequately compiled, high rates of teacher absenteeism, etc. Although these problems may not arise, the point is that FFE programs are vulnerable to local capacity constraints. CSs can mitigate the likelihood of such problems by paying attention to three key aspects. First, clearly specify mutual performance obligations and define a clear sanctions policy in case of non-compliance. Second, devote the resources necessary for training local partners so they can perform their functions adequately. Third, monitor activities in the field closely in order to detect and correct emerging problems in a timely fashion. A related issue is commodity management. CSs have developed elaborate mechanisms for controlling food movements in their FFE programs, and under normal conditions the management of the commodities is straightforward. Problems do arise, however when commodities are not available, either because they were not delivered in time, were not sufficient in quantity to cover the full period, or because the actual number of recipients is different from the number predicted. Pest infestation or poor storage can also result in high losses. Such 92 logistical deficiencies can seriously affect the FFEs’ success, as they make provision of service uncertain. This can be countered at least in part by careful needs assessments, timely Annual Estimates of Requirements, and well-designed monitoring systems. Recommendation on Partnerships · CSs should specify mutual performance obligations carefully and define clearly their sanctions policy in case of noncompliance. CSs should ensure that the necessary resources are available for training and monitoring activities in the field in order for timely determination and correction of emerging problems. 7. Parent-Teacher Associations CSs have used school-based committees for a long time under school feeding programs (SFPs) to help locally in the operation of the school canteen. Under FFEs, the roles and responsibilities of those committees have been considerably extended. In addition to their role in managing canteen operation, school committees, or PTAs, are active in a variety of activities, from controlling teacher absences to serving as a local link to other community development initiatives. In this section, the managerial responsibilities of traditional canteen management committees are distinguished from the more development-oriented activities fulfilled by some PTAs. School canteen committees, which also exist under SFPs, are put in place by CSs to take responsibility for logistical issues such as preparing and maintaining kitchens and food storage areas. They also are responsible for providing the necessary cooking utensils and implements, identifying and supervising cooks and collecting canteen fees from parents to pay for firewood, water and condiments, and making up for eventual lapses in food availability. PTAs, by contrast, are often called upon under FFEs to support the quality of education. Their role can be supervisory–for instance, monitoring the effectiveness of teachers and discussing the quality of teaching with head teachers. It can also be entrepreneurial, including channeling requests for additional teachers, infrastructure, furniture and school supplies, or organizing the purchase of communal equipment such as a grinding mill to free the girls from domestic work. It can also be educational–for instance, conducting community awareness enrollment and attendance drives or mobilizing women’s groups, village education committees and youth groups around particular educational objectives. Thus, the roles of PTAs are varied and CSs have been very creative in exploring the possibilities. The experience of CSs in working with PTAs so far has, however, been mixed. Heartening stories are heard about the dedication of parents and teachers to quality education and their deep commitment to the community’s development. There are also stories of apathy, disaffection and lack of motivation on the part of PTA members. One often-cited issue is that PTAs are too “western” a structure for some situations–elder groups or the traditional structure of authority may at times be more effective, representative and sustainable. At the same time, effective PTAs may be easier to mobilize than the more traditional support structures. Among the attributes that appear to make for effective PTAs, the degree of management transparency plays a key role. It is thus important to educate community members about what accountability means, so they can support CSs in demanding it from school staff. 93 Recommendation on Parent-Teacher Associations (PTAs) · CSs should assess the roles local organizations are able to play, tailor their functions to those capacities and provide specific training in assigned roles. CSs must ensure that good communications exist among community leaders, parents, school officials and program officers. E. Conclusion The review of FFE programs was constrained in several ways. The discussion concentrated on food-supported activities only. Complementary activities that require resources other than food, although critically important to the success of FFE, were left out altogether. Phase-out issues and the sustainability of FFEs were not discussed either. Also important, the absence of common indicators impeded review of program performance in detail. To a large extent, the relative newness of FFE as a model, and the very recent introduction of principles and guidelines by FFP in the area of education, imposed those limitations. In other words, it was premature at this time to launch an evaluation of the FFE model because it is so new. As experience is gained in the use of the FFE model, however, new knowledge is being accumulated that will help to design, monitor and administer future FFEs. Already a few documents are available that may be consulted for guidance. To learn more about activities supported by resources other than food, the reader may consult the CRS document Food and Education: Background Considerations for Policy and Programming (2001a). FANTA is planning the publication of a comprehensive review of FFE’s best practices during 2002 that will examine how non-food resources may be combined with food to enhance FFE performance. On the issue of sustainability, the USAID Mission in Haiti, in collaboration with its Title II CSs and FANTA, is preparing a study of the effects of withdrawing food from beneficiary communities. This study will shed light on how community life is influenced by FFEs, and help design phase-out strategies that improve the long-term sustainability of education and food security in target populations. With respect to indicators, the situation should also improve in the future with the recent release of an FFE Indicator Guide, developed collaboratively by FANTA and the CSs. CSs are leading the way in innovation and experimentation with new approaches to improve on the quality of FFEs. Strategic alliances are being forged among communities, CSs, Missions and other donors to ensure that all the elements needed for quality education–quality schools, quality teaching and quality students–are brought together and managed effectively. It is critical that these experiments be documented and properly monitored so that appropriate lessons can be drawn. It is also crucial that FFP support CSs that seek out additional, complementary funding to improve the quality of education in schools receiving Title II support. 94 VII. Recommendations for the Title II Development Food Aid Program This chapter presents the key recommendations of the assessment. These recommendations identify actions that have the most potential for improving Title II programming and management. Further detail on the key recommendations and additional recommendations for program improvements may be found in the body of the report. Readers interested in a particular topic area should also refer to the related chapters.38 A. Implementation of the Policy Paper Programmatic and Management Priorities 1. FFP should adopt the following as the primary determinants of whether food aid is used in the form of food, local currency or a combination of both: the nature of the food security problem, the design of the appropriate solution, local market conditions, availability of complementary resources and CSs’ management and technical capacity. FFP should not assign quotas for levels of direct distribution and monetization for any given country or program (p. 30). 2. CSs should make greater efforts to find appropriate ways to use food to address food insecurity issues. In some instances, this could require identifying partners that can provide cash resources to complement their use of food resources (p. 30). 3. Congress should expand funds available through the current P.L. 480, Title II, section 202(e) mechanism, create a complementary source of cash funds for Title II programming and/or fund internal transport, shipping and handling costs directly, so that a larger share of the proceeds from monetization would be available for programming. Congress should re-evaluate the effectiveness of the value-added mandate (section 204b). To support a minimum level of production of blended cereal products, which are critical to emergency relief efforts, Congress should consider developing a new policy or set of policies to explicitly address this objective. This may make it possible to eliminate the value-added mandate, which is indirect and has compromised to some degree the food security objectives of the program and food aid partnership. At a minimum, a standard and transparent definition of what constitutes a value-added commodity should be established and consistently applied across all commodities (p. 30). 4. FFP should intensify its consultation with its food aid partners in crafting policy, particularly when the policy addresses a controversial issue. This consultation should help USAID better balance the real and anticipated pressures from interest groups, Congress and constituents and thereby reduce the frequency of changes in administrative procedures (p. 39). 38 Note that many, although clearly not all, of the implementation recommendations are consistent with items proposed by the Agri-PVO Working Group suggesting that there is likely to be a considerable degree of food aid partner buy-in for many of the recommended actions. The views of the Agri-PVO Food Aid Working Group are expressed in a letter addressed to Congressman Larry Combest, Chairman of the U.S. House of Representatives Committee on Agriculture. 95 5. FFP should put priority on developing a relief-to-development strategy for Title II resources that recognizes the oscillatory and coincident nature of most relief and development transitions (p. 37). 6. FFP should prepare guidance on improving food security for HIV/AIDS-affected households and for households in urban and peri-urban environments. FFP should support the CSs in their efforts to move beyond relief and direct distribution to building self-reliance for HIV/AIDS-affected populations. FFP should prepare guidance on the role of agriculture in promoting better food security in urban and peri-urban environments. The guidance should also encourage, where appropriate, the training of migrants for alternative employment (p. 19). 7. CSs should intensify efforts to integrate Title II activities with other complementary development efforts or partners. Missions should improve integration of the Title II program with a broader spectrum of strategic objectives, especially when a multi-sectoral Title II program is placed under one SO such as economic growth, and the sectoral expertise of members of another SO team such as health is also needed. Missions should encourage and strengthen lines of communication between CS and Mission staff with the appropriate technical expertise and increase field visits by Mission program and technical staff to Title II project sites (p. 35). 8. CSs should focus on institutionalizing their strengthened capacity and improving quality control in the field. FFP should focus the next round of ISAs on supporting the CSs to do this (p. 26). 9. CSs and FFP should standardize the methodology for results reporting and widen the dissemination and use of best practices across the Title II program. FFP should provide additional resources and CSs and Missions should program greater assistance in data collection and reporting methods to insure greater consistency and comparability of reports, especially reports of nutritional status indicators. FFP, Missions and the CSs should identify multiple strategies to improve the collection, dissemination and use of best practices and lessons learned within projects, within countries and across the Title II program (p. 22). 10. FFP should allow greater flexibility in DAP length in conjunction with stricter exit criteria. CSs should assist communities to find alternatives to CS services early in the program cycle, and work on linking beneficiaries to these services or agents over the LOA (p. 36). 96 11. FFP should establish clear, concise DAP guidelines and not rewrite them each year. CSs should be held accountable to the guidance that was in place at the time DAPs were approved. CSs should not be required to alter the design of an ongoing DAP in order to comply with subsequent changes in the guidance, except in exceptional circumstances. FFP should issue the annual DAP policy letter at least 3 to 4 months prior to the closing date for DAP proposal submissions so that CSs have ample time to develop sound program designs that also reflect the latest policies, directives and initiatives. If FFP is unable to issue the policy letter within this time period, to the greatest extent possible, planned policy or administrative changes should be incorporated in the subsequent guidance, and DAPs be developed based on the previous year’s guidance (p. 39). 12. FFP should establish a clear line of authority and clarify for its Title II partners the roles of different management units within USAID (FFP, Regional Bureaus and Missions) with respect to the administration of the Title II program (p. 39). B. Agricultural Productivity Sector 13. CSs and FFP should make sure that DAP proposals demonstrate knowledge of local farming systems and market opportunities, emphasize interventions that address the priority concerns and constraints of farm families and describe the information systems to be used to refine interventions during DAP implementation. DAP proposals must demonstrate, at a minimum, general knowledge of local farming systems and be specific about the process to be followed in identifying and overcoming current and newly identified constraints. These constraint analyses should feed into annual and semi-annual reports, especially in the first 2 years of the DAP when program modifications are most advantageous (p. 49). 14. CSs need to make sure that they adequately deal with three potential problem areas: 1) finding the right balance between food and cash crops, 2) dealing with household cash flow and liquidity constraints, and 3) closing the seasonal food gap through an increased focus on improved storage, small-scale post-harvest transformation, crop diversification and market opportunities. FFP should actively promote greater flexibility in DAP designs and encourage these types of interventions where most appropriate (p. 49). 15. When a DAP includes a marketing component, it is absolutely necessary that the CS conduct a market study as part of the DAP proposal preparation and that it demonstrate adequate evidence of technical competency of the CS or a close collaborator (p. 57). 16. CSs should build a gender strategy into DAPs and commit to being persistent and creative in finding workable solutions throughout the LOA. CSs should conduct a gender analysis to identify opportunities to improve the active participation of women as farmers and economic agents as part of DAP proposal preparation (p. 49). 97 C. Household Nutrition: Maternal Child Health and Nutrition Sector 17. CSs should put major emphasis on changing critical nutritional and health behaviors. CSs should include measurable behavior change objectives in all Title II MCHN programs if they are to impact positively on nutritional status (p. 78). 18. CSs should continue to use growth monitoring and promotion as key strategies to improve the nutritional status of children under 3 years old and improve referral and follow-up of malnourished children. CSs should establish clear protocols for identification and referral of malnourished children to health facilities (p. 76). 19. CSs should focus increased attention on strategies to improve women’s nutrition, and FFP should issue guidance that supports and encourages this emphasis (p. 79). 20. CSs should focus efforts with MOHs on the integration of nutrition into essential maternal and child health services (p. 82). 21. CSs should establish country-specific criteria and verification methods to ensure that the neediest communities are selected and food resources are not used ineffectively (p. 74). 98 Appendices 99 Appendix 1. Assessment Team The FAFSA team consists of co-team leaders Dr. Patricia Bonnard and Dr. Patricia Haggerty. Dr. Bonnard is an agricultural and natural resource economist, and Dr. Haggerty is a health and nutrition specialist. An agronomist, Dr. Noel Beninati participated in the field visits and contributed to the assessment of agriculture and agro-technology issues. Mr. James Dempsey, a microenterprise/microfinance specialist, drafted the Annex, “Microfinance and Small Business Development Services.” Dr. Gilles Bergeron, an anthropologist and food security specialist, drafted the Food for Education (FFE) section of the paper. Dr. Anne Swindale, FANTA Deputy Director, is the FAFSA technical manager. 100 Appendix 2. List of DAPs reviewed for the Agriculture Sector Assessment1 Country Cooperating Sponsor FY 2000 Program Value ($ 1,000) Percent of Resource Allocated to Agriculture AFRICA Cape Verde ACDI/VOCA 3,901 94 Chad Africare 1,132 65 Ethiopia CARE 3,890 70 FHI 3,209 75 WV 2,347 75 Gambia CRS 2,227 34 Ghana ADRA 4,037 99 OICI 889 100 TNS 3,648 100 Guinea Africare 684 33 OICI 1,402 46 Kenya WV 575 100 Madagascar ADRA 1,539 100 Mali Africare 788 40 Mozambique ADRA 1,368 100 Africare 1,020 50 CARE 2,338 100 FHI 1,483 70 SCF 1,426 90 WV 10,297 80 Rwanda CRS NA 100 Uganda ACDI/VOCA 5,325 89 Africare 974 77 ASIA Bangladesh CARE NA 100 India CRS 20,243 34 LATIN AMERICA / CARRIBEAN Bolivia ADRA 5,946 13 CARE 4,794 30 FHI 5,093 38 PCI 4,945 46 Guatemala CRS 7,441 57 Honduras CARE 5,127 62 Peru ADRA 9,851 48 CARE 12,332 57 TNS 1,265 100 TOTAL NUMBER OF PROJECTS = 34 1 Source: Appendix Table 1: FY 2000 Title II Non-Emergency Programs, 2002 R4. Title II data are not consistent across countries and individual DAPs with respect to what is included in agriculture. Agriculture can include agricultural production, post-harvest, natural resource management, rural roads and other FFW activities, some water and sanitation, and some microenterprise activities. 101 Appendix 3. List of DAPs Reviewed for the Household Nutrition: Maternal Child Health and Nutrition Sector Assessment1 Country Cooperating Sponsor FY 2000 Program Value ($ 1,000) Percent of Value in Health and Nutrition AFRICA Benin CRS 3,588 82 Chad Africare 1,132 35 Ethiopia CRS 6,510 18 SCF 1,341 65 Gambia CRS 2,227 66 Guinea Africare 684 67 Kenya CRS 1,929 100 FHI 964 37 Madagascar CRS 3,999 90 Mauritania Doulus 863 80 Mozambique Africare 1,020 50 FHI 1,483 30 SCF 1,426 10 WV 10,297 20 ASIA India CARE 53,088 98 CRS 20,243 26 LATIN AMERICA / CARRIBEAN Bolivia ADRA 5,946 36 FHI 5,093 18 PCI 4,945 10 Guatemala CARE 3,913 59 SHARE 3,247 69 Haiti CRS 10,900 25 Honduras CARE 5,127 38 Nicaragua ADRA 1,302 58 SCF 2,363 39 Peru ADRA 9,851 52 CARE 12,332 43 CARITAS 13,073 88 PRISMA 6,920 100 TOTAL NUMBER OF PROJECTS = 29 1 Source: Appendix Table 1: FY 2000 Title II Non-Emergency Programs, 2002 R4. 102 Appendix 4. List of DAPs Reviewed for the Food for Education Sector Assessment1 Country Cooperating Sponsor LOA Beneficiaries (# enrolled in school) Volume (metric tons) FY2000 FFE Value ($ 1,000) Burkina Faso CRS 1997-2001 180,000 22075 11,937 Ghana CRS 1997-2001 201,131 16,514 6,550 India CRS 1997-2001 266,474 3,669 1,527 PCI 1997-2001 75,000 2,485 1,163 FHI 1997-2001 66,000 2,450 1,175 Bolivia ADRA 1997-2001 39,291 636 302 Haiti CARE 1996-2001 170,000 28,171 8,100 CRS 1996-2001 177,987 33,579 9,198 TOTAL NUMBER OF PROJECTS = 8 1 Source: Appendix Table 1: FY 2000 Title II Non-Emergency Programs, 2002 R4. 103 Appendix 5. Bibliography of selected Cooperating Sponsor documents, DAP evaluations and cited references. A full list of FAFSA references is available upon request from fanta@aed.org. ACC/SCN and IFPRI. 2000. Fourth Report on the World Nutrition Situation. ACC/SCN, Geneva, Switzerland. ACDI/VOCA. Washington, DC. FY1997-2001 Development Activity Proposals: Cape Verde, Uganda FY1997-2001 Development Activity Proposal Amendments: Cape Verde FY2000-2004 Development Activity Proposals: Rwanda Results Reports (various years): Cape Verde, Uganda Previously Approved Activity Reports (various years): Cape Verde, Uganda Adelski, E., P. Bourdeau, J. B. Doamba, T. Lariez, and J. P. Ouedraogo. 2001. Final Impact Evaluation Report on Development Activity Proposal for 1997-2001. Catholic Relief Services, Ouagadougou, Burkina Faso. Adventist Development and Relief Agency (ADRA). Silver Spring, MD. FY1996-2000 Development Activity Proposals: Peru FY1997-2001 Development Activity Proposals: Bolivia, Ghana, Mozambique FY2000-2001 Development Activity Proposal Amendments: Peru FY2002-2006 Development Activity Proposals: Mozambique, Peru Results Reports (various years): Bolivia, Ghana, Mozambique, Previously Approved Activity Reports (various years): Bolivia,Ghana, Mozambique ______. 1995. Report on Community Needs Assessment/Baseline Study. Report prepared for FY 1997-2001 Development Activity Proposal. Adventist Development and Relief Agency, Accra, Ghana. ______. 1999. Mid-term Evaluation Andean Food Security Development Project, Peru. Adventist Development and Relief Agency, Silver Spring, MD. ______. 2000. Monitoring and Evaluation Implementation System. Title II Cashew Reforestation Project in Maganja da Costa. Adventist Development and Relief Agency, Maputo, Mozambique. Africare. Washington, DC. FY1996-2000 Development Activity Proposals: Guinea, FY1997-2001 Development Activity Proposals: Chad, Mali, Mozambique, Uganda FY2002-2006 Development Activity Proposals: Mozambique Results Reports (various years): Chad, Guinea, Mali, Mozambique, Uganda Previously Approved Activity Reports (various years): Chad, Mozambique, Uganda ______. 1997. The Dinguiraye Food Security Initiative Report on the Baseline Survey in Nutrition and Public Health. Africare, Guinea. ______. 1998. Goundam Food Security Initiative Baseline Survey Training Report. Africare, Goundam, Mali. ______. 1999. Africare Field Manual on the Design, Implementation, Monitoring and Evaluation of Food Security Activities. Africare, Washington, DC. ______. 1999. Ouaddai Food Security Initiative Monitoring and Evaluation Plan. Africare, N’Djamena, Chad. 104 ______. 1999. Goundam Food Security Initiative Report on the Baseline Survey. Africare, Goundam, Mali. ______. 2000. Africare/Mozambique Manica Oil Seed Food Security Initiative Fiscal Year 1999 Mid-Term Monitoring and Evaluation Report. Africare, Maputo, Mozambique. ______. 2000. Dinguiraye Food Food Security Initiative Final Evaluation. Africare, Washington, DC. Anderson, M., et al. 1981. Supplementary Feeding. In Nutrition Intervention in Developing Countries, eds. J. Austin, and M. Zeitlin. Cambridge: Oelgeschlager, Gunn and Hain. Arimond, M. 1999. CARE Mozambique Mid-Term Survey Report: Viable Initiatives for the Development of Agriculture (VIDA). CARE, Nampula, Mozambique. Associates for Global Change. 2001. Final Evaluation of the OICI Guinea-Mamou Profitable Agriculture and Village Extension (PAVE) Project. Opportunities Industrialization Centers International (OICI), Conakry, Guinea. Aubel, J. 1999. Participatory Program Evaluation Manual: Involving Program Stakeholders in the Evaluation Process. 2nd ed. Child Survival Technical Support Project, Catholic Relief Services, and Macro International, Calverton, MD. Beaton, G. H. 1987. Energy in Human Nutrition: A Reconsideration of the Relationship between Intake and Functional Consequences. In Food Policy: Integrating Supply, Distribution, and Consumption, eds. J.P. Gittinger, J. Leslie, and C. Hoisington. Baltimore: Johns Hopkins University Press. Belles, G., R. Pierce, and B. Riley. 2000. Joint Mid-Term Evaluation of Africare and ACDI/VOCA PL480 Title II Monetization Programs in Uganda. Africare and ACDI/VOCA, Kampala, Uganda. Beninati, N. and J. Pierre-Louis. 2000. Africare Goundam Food Security Initiative Mid-Term Evaluation. Africare, Washington, DC. Bergeron, G. and J. Miller Del Rosso. 2001. Food for Education Indicator Guide. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington D.C. Bessenecker, C. 2000. Addressing the Needs of the Food Insecure: A Position Paper on Food￾Based Maternal/Child Health and Nutrition Programs. Project Concern International, San Diego, CA. Bonnard, P. 1999. Increasing the Nutritional Impacts of Agricultural Interventions. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, DC. ______. 2000. Mid-Term Evaluation of the Ghanaian Rural Enterprise Development Project: 1997-2001. Technoserve, Accra, Ghana. ______. 2000. Applying Early Warning to Urban Settings in Africa. Prepared for The Future of Vulnerable People and Places Session, International Geographical Union 29th Congress in Seoul, Korea. Bonnard, P., L. Altobelli, C. Barrenchea, A. Campos Delgadillo, and V. T. Suarez Giga. 1999. Mid-Term Evaluation Andean Food Security Development Project USAID Title II ADRA/OFASA-Peru. ADRA/OFASA, Lima, Peru. Calloway, D. 1995. Human Nutrition, Food and Micronutrient Relationships. International Food Policy Research Institute, Washington, DC. CARE. Atlanta, Georgia. FY1996-2000 Development Activity Proposals: Bangladesh, Guatemala, India, Peru 105 FY1997-2001 Development Activity Proposals: Ethiopia, Honduras, Mozambique FY1997-2001 Development Activity Proposal Amendments: Mozambique FY1999-2001 Development Activity Proposal: Bolivia FY2000-2001 Development Activity Proposal Amendment: Peru FY2001-2005 Development Activity Proposals: Guatemala, Honduras, India FY2002-2006 Development Activity Proposals: Mozambique FY2002-2008 Development Activity Proposals: Peru Results Reports (various years): Bangladesh, Bolivia, Guatemala, India, Honduras, Peru Previously Approved Activity Reports (various years): Bolivia, Guatemala, India, Honduras, Peru Cooperating Sponsor Result Report and Resource Request (various years): Guatemala, Honduras ______. 1998. A survey of the market opportunities for the CARE farmer groups in Nampula Province. VIDA Project, CARE, Nampula, Mozambique. ______. 1999. CARE India INHP Mid-Term Review. CARE, Atlanta, GA. ______. 1999. Tecnicas basicas de producao de gergelim. Manual pratico para extensionistas. ______. 1999. Evalución de Medio Término del Programa de Seguridad Alimentaria, Titulo II, Zona 1: Informe Final. CARE, Tegucigalpa, Honduras. ______. 2000. Diagnostico Rural Participativo: Distrito Eustaquio Mendez. Title II Development Activity Program. CARE, La Paz, Bolivia. ______. 2000. Diagnostico Rural Participativo: Distrito Alto de Cajas. Title II Development Activity Program. CARE, La Paz, Bolivia. ______. 2000. Sistematización del Diagnostico Rural Participativeo del Municipio San Lorenzo, Tarija. Title II Development Activity Program. CARE, La Paz, Bolivia. ______. 2000. Diagnóstico de Línea de Base del Proyecto de Seguridad Alimentaria Título II Pn￾41: Informe Final. Title II Development Activity Program. CARE, La Paz, Bolivia. ______. 2001. CARE India Integrated Nutrition and Health Project Final Evaluation, Quantitative Survey. CARE, Atlanta, GA. ______. n.d. Manual de Funciones. Title II Development Activity Program. CARE, La Paz, Bolivia. ______. n.d. Analsis Cualitativo de Desempeño de Proyecto: Programa de Seguridad Alimentaria Titulo II. Proyecto Hogasa. CARE, Tegucigalpa, Honduras. CARITAS Peru with Catholic Relief Services/Peru. Lima, Peru. FY1996-2000 Development Activity Proposals: Peru FY2000-2001 Development Activity Proposal Amendment: Peru Results Reports (various years): Peru Catholic Relief Services (CRS). Baltimore, MD. FY1996-2000 Development Activity Proposals: Benin, Guatemala, Haiti, Kenya FY1997-2001 Development Activity Proposals: Ethiopia, India FY1998-2002 Development Activity Proposals: Gambia FY1990-2002 Development Activity Proposals: Madagascar FY2000-2004 Development Activity Proposals: Rwanda FY2000-2001 Development Activity Proposal Amendment: Haiti FY2001-2003 Development Activity Proposal Amendment: Madagascar FY2001-2005 Development Activity Proposals: Benin, Kenya FY2002-2006 Development Activity Proposals: India 106 Results Reports (various years): Benin, Ethiopia, Gambia, Guatemala, Haiti, India, Kenya Previously Approved Activity Reports (various years): Benin, Guatemala, India, Kenya Cooperating Sponsor Result Report and Resource Request (various years): Benin, Ethiopia, Kenya, Madagascar, Rwanda ______. 1997. CRS/Madagascar Food Assisted Child Survival/Focused Nutrition Program Baseline Knowledge Practices and Coverage Survey. Catholic Relief Services, Baltimore, MD. ______. 1997. Rapport de Base: Enquête anthropométrie sur l'état nutritionnel des enfants de 18 à 36 mois dans le Départment de l'Ouémé (Zone Rurale). Catholic Relief Services, Baltimore, MD. ______. 1998. CRS/Madagascar FACS/FNP Mid-Term Evaluation January 1998. Catholic Relief Services, Baltimore, MD. ______. 1999. Benin Development Activities Program (DAP 1996-2000) Final Evaluation. Catholic Relief Services, Baltimore, MD. ______. 1999. CRS/Ethiopia Mid-Term Evaluation, FY1997-2001 Development Activity Proposal. Catholic Relief Services, Baltimore, MD. ______. 1999. Agency Report Mid-Term Review of CRS/India P.L. 480 Title II Supported Program. Catholic Relief Services, Baltimore, MD. ______. 2000. The Gambia Final Impact Evaluation. Catholic Relief Services, Baltimore, MD. Conway, G. 1997. The Doubly Green Revolution: Food for All in the 21st Century. Ithaca: Cornell University Press. Curtis, R. V., G. Sharrock, S. Gannon, and K. S. Ndure. 2000. Food Assisted Child Survival Project and the Sesame Growers’ Associations Institutionalization and Strengthening Project, Part 1: Findings and Recommendations. Catholic Relief Services, Banjul, The Gambia. ______. 2000. Food Assisted Child Survival Project and the Sesame Growers’ Associations Institutionalization and Strengthening Project, Part 2: Companion Reports. Catholic Relief Services, Banjul, The Gambia. Development Alternatives, Inc. (DAI). 2001. Final Evaluation of USAID/Ghana’s PL 480 Title II Program: Fiscal Years 1997-2001. Development Alternatives, Inc., Bethesda, MD. Draft. DOULOS Community. 1995. DOULOS Community Title II MCH Program Mauritania Development Project Proposal FY 1996-2000. DOULOS Community. Freehold, NH. ______. (various). Results Reports: DOULOS Community Title II MCH Program Mauritania. Marlboro, NH. Drinkwater, M. and T. Rusinow. 1999. Application of CARE’s Livelihood Approach. Presentation for the NRAC 1999. CARE, Atlanta, GA. Engle, P., P. Menon, and L. Haddad. 1997. Care and Nutrition, Concepts and Measurement. International Food Policy Research Institute, Washington, DC. Food Aid Management (FAM). 1999. Proceedings of the Local Capacity Building Workshop. FAM Annual Meeting, 1999, Washington, D.C. Food and Agriculture Organization (FAO). 1999. Issues in Urban Agriculture. http://www.fao.org.ag/magazine/9901sp2.htm. Food and Nutrition Technical Assistance (FANTA) Project. 1999. Improving the Use of Food Rations in Title II Maternal/Child Health and Nutrition Programs. FANTA Project, Academy for Educational Development, Washington, DC. Draft. 107 ______. 2001. Improving the Nutrition Impacts of Agriculture Interventions: Strategy and Policy Brief. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, DC. Food for Hungry International (FHI). Washington, DC. FY1997-2001 Development Activity Proposals: Bolivia, Mozambique FY1998-2002 Development Activity Proposals: Kenya FY2002-2006 Development Activity Proposals: Mozambique Results Reports (various years): Bolivia, Kenya, Mozambique Previously Approved Activity Reports (various years): Bolivia, Kenya, Mozambique ______. 1996. Sofala Province Extension and Rehabilitation Project Research Unit. Summary Research Report, 1994-1996. ______. 2000. DAP Proposal Agriculture Mid-Term Survey. Food for the Hungry International, Maputo, Mozambique. ______. 2000. Post-Harvest Management Principles in Cereal Crops. Prepared for FHI Post￾harvest Management Training. Food for the Hungry International, Nhamatanda, Mozambique. ______. 2000. Programa de Salud Integral FHI/Regional Cochabamba. Title II Development Program. Food for the Hungry International, Cochabamba, Bolivia. ______. n.d. Procedimiento de Recolección de la Muestra, Sistema de Información del Programa Agricultura: Documento Final. 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Opportunities Industrialization Centers International /Guinea, Philadelphia, PA. Haque, T., S. Chandrashekhar; K. Bhattacharya; and C. Banerjee. 1999. Mid-Term Evaluation of CRS/Inida 1997-2001 DAP Agriculture Program. Catholic Relief Services, Baltimore, MD. Harinarayan, A., K. Flanigan, C. Reynolds, F. Feyissa, A. Hailu, A. Adem, N. Kumera, A. Issa, and A. Beyisa. 2001. Mid-Term Evaluation Ethiopia Development Activity Program FY1999-2003. Save the Children Federation, Washington, DC. House of Representatives. 1998. Conference Report on H.R. 4328, Making Omnibus Consolidated and Emergency Supplemental Appropriations for FY 1999. Huffman, S. et al. 2001. Essential Health Sector Actions to Improve Maternal Nutrition in Africa. LINKAGES Project, Academy for Educational Development, Washington, DC. 108 Janke, C. 2001 Food and Education: Background Considerations for Policy and Programming. Catholic Relief Services, Baltimore, MD. Johnson-Welch, C. 1999. 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ADRA PL480 Title II Project 1997-2001 Mid-Term Evaluation Report. Adventist Development and Relief Agency, Maputo, Mozambique. UNICEF. 1990. Strategy for Improved Nutrition of Children and Women in Developing Countries. UNICEF, New York, NY. _______. 1998. The State of the World’s Children 1998. UNICEF, New York, NY. _______. 2001. The State of the World’s Children 2001. UNICEF, New York, NY. United Nations Population Division (UNPD). 2000. World Urbanization Prospects: The 1996 Revision. UNPD, New York, NY. USAID. 1992. Policy Determination 19, Definition of Food Security, April 13, 1992. Washington, DC. ______. 1995. Food Aid and Food Security Policy Paper. Office of Food for Peace, Washington, DC. ______. 1996a. Strategic Plan: 1997-2001. USAID, Washington, DC. USDA. 1990. Agriculture, Conservation and Trade Act of 1990. (Also cited as the Agricultural Development and Trade Act of 1990.) USDA, Washington, DC. Van Straaten, L. 2000. Development Activity Proposal Agriculture Mid-Term Survey. Food for the Hungry International, Beira, Mozambique. Wenger, P. N. 1998. Food Aid Management Evaluation. Food Aid Manangement, Washington, DC. WHO. 1998. Complementary Feeding of Young Children in Developing Countries: A Review of Current Scientific Knowledge. World Health Organization, Geneva, Switzerland. World Resources Institute. 1999. 1998-1999 World Resources: A Guide to the Global Environmental. World Resources Institute, Washington, DC. World SHARE. Guatemala City, Guatemala. FY1996-2000 Development Activity Proposals: Guatemala FY2001-2005 Development Activity Proposals: Guatemala Results Reports (various years): Guatemala Previously Approved Activity Reports (various years): Guatemala ______. 2001. Final Evaluation Integrated Rural Development Program 1996-2000. World SHARE, Guatemala City, Guatemala. World Vision. Washington, DC. FY1997-2000 Development Activity Proposals: Kenya, Mozambique FY1997-2000 Development Activity Proposal Extension: Mozambique FY2002-2006 Development Activity Proposals: Mozambique Results Reports (various years): Kenya, Mozambique Previously Approved Activity Reports (various years): Mozambique ______. 2000. Mid-Term Evaluation of the World Vision Assistance Program Financed by USAID. World Vision, Maputo, Mozambique. ______. n.d. A Strategy for the Organization’s Role in the Development of the Mozambican Cashew Sub-Sector. World Vision, Maputo, Mozambique. Zarafonetis, J. 1998. Technoserve, Inc. Institutional Support Grant Final Evaluation. Technoserve, Washington, DC. 112 Appendix 6. List of People Contacted USAID/Washington Berger, Rene Chung, Eunyung Cummings, Ralph Estes, Nancy Fuller, Flynn (Bangladesh via email) Jansen, Anicca Graves, Sylvia Huggins-Williams, Nedra Labbok, Miriam Oliver, William T. Marchione, Tom Marcunas, Jeanne McClelland, Donald McKay, Nancy Meyer Capps, Jean Newberg, Rich Ralyea, Bridget Shepherd, Walter Sposato, Steve VanHaeften, Roberta Weller, Dennis USDA Levin, Andy Foreign Agricultural Service/U.S. Department of Agriculture Cooperating Sponsors Abdou, Irene Counterpart International Ameyaw, David ADRA Anaele, Sabinus TechnoServe Bell, Bob CARE Bessenecker, Chris Project Concern International Judy Bryson Africare Burpee, Gaye CRS Campbell, Ben World Vision Campbell, Ruth ACDI/VOCA Carter, Gail ACDI/VOCA Cederstrom, Thoric Save the Children Cekan, Jindra Red Cross Conway, James WFP/Peru Denizard, Carla OICI Endres, Kyung ACDI/VOCA Evans, Dave FHI Gardener, Tom ACDI/VOCA Gessel, Gwen ADRA Harinarayan, Anuradha Save the Children Kuennen, Lisa CRS Landis, Lauren Save the Children Levinson, Ellen Food Aid Coalition Lowther, Kevin Africare Majernik, Juli CRS 113 McCaston, Kathy CARE Namkam, Claude World Vision Perry, Allyson ACDI/VOCA Pinga, Victor OICI Remington, Tom CRS Russell, Mara Food Aid Management Scheffle, Dorothy World Vision Schmirler, Trisha Food Aid Management Silverthorne, Jessica CRS Tarver, Harold Africare Tiangbu, Ange Africare Truscott, Peter ADRA Volz, Amy ACDI/VOCA Other Alayon, Silvia Global Food and Nutrition, Inc. Caulfield, Laura Johns Hopkins University Clay, Ed Overseas Development Institute (ODI) Cogill, Bruce FANTA Harrigan, Paige FANTA Howard, Julie Michigan State University McGreevy, Tim Dry Pea and Lentil Council Rajabiun, Serena FANTA Rogers, Bea Tufts University Sanders, John Purdue University Schlossman, Nina Global Food and Nutrition, Inc. Schneider, Anton Academy for Educational Development Tschirley, Dave Michigan State University Willard, Alice FANTA Benin Aidi, Mourad CRS/Cotonou Bodjaenou, Augustin Cellule PAN/Cotonou Bokassa, Emmanuel Cellule PAN/Cotonou Claver, Pierre CRS/Cotonou Dehon, Luc CRS/Cotonou Hermanson, Jay CRS/Cotonou Keeys, Lynn USAID/Benin M'Bale, Amani CRS/Cotonou Pearson, Lori CRS/Cotonou Sero Yerima Aboubakar Sia N'Son/Parakou Zanou, Elisabeth CRS/Cotonou Zinsou, Pelagie USAID/Cotonou Bolivia Amiz Vila, Raúl A. Uníca Municipality, Bolivia Aramayo R, Carlos CYCAsur, Bolivia Ayalde, Liliana USAID/Bolivia Barrata, Eddy FHI/Bolivia Belding, Barbara USAID/Bolivia Blades, Alex CARE/Bolivia Blasquez, Juan Marcos ADRA/Bolivia Boren, Francesco CARE/Bolivia 114 Brems, Susan USAID/Bolivia Bullen, Victor USAID/Bolivia Calle, Irma ADRA/Bolivia Castro Gonzales, J. Alberto Project Concern Int’l/Bolivia Choque Conde, Porfirio Project Concern Int’l/Bolivia Cortez, Victor FHI/Bolivia De Leon, Darcy ADRA/Bolivia Deines, Buck FHI/Bolivia Delgado, David USAID/Bolivia Dick, E. Lew FHI/Bolivia Fernández, Alfredo FHI/Bolivia Guadelupe PCI/Bolivia Guardia, Waldo Ministry of Agriculture/Bolivia Guerra, Luisa, Dr. MOH, El Puente Hospital Henne, Kurt Project Concern Int’l/Bolivia Huanca Ch., Pablo ADRA/Bolivia Hunter, Brian J. Project Concern Int’l/Bolivia Imaña, Yovauna CARE/Bolivia Lenny, Dr. ADRA/Bolivia Luna, Oscar MOA /Bolivia Mareño Sánchez, Raúl ADRA/Bolivia Mendoza, Aldo ADRA/Bolivia Mendoza, Marcelo CYCAsur/Bolivia Mercado, Eduardo CYCAsur/Bolivia Murgrúa, José Project Concern Int’l/Bolivia Nilsestuen, W. USAID/Bolivia Noda, Luis FHI/Bolivia Oliver, Chip USAID/Bolivia Ortiz, Humberto SEDAG- Oruro Department/Bolivia Peredo, Ricardo Monetization Plan/Bolivia Peterson, Tricia FHI/Bolivia Pinto, Wilfredo ADRA/Bolivia Quintarrilla, Zenon SEDAG- Oruro Department/Bolivia Reyna, Adolfo FHI/Bolivia Rivera, Isabel CARE/Bolivia Romoro, Julian Magne SEDAG-Oruro Department/Bolivia Rubey, Lawrence USAID/Bolivia Sanchez Bustmante, Daniel USAID/Bolivia Schollaert, Yan CARE/Bolivia Sequeiros, Daniel Vargas SEDAG- Oruro Department/Bolivia Serrano, Vitor European Commission/Bolivia Torrez, Sergio World Food Program/Bolivia Van Milink-Paz, Willen World Food Program/Bolivia Varela, Felipe ADRA/Bolivia Vargas, Dr. FHI/Bolivia Vasquez, Angel USAID/Bolivia Velasco, Jorge USAID/Bolivia Wallauer, Gunther ADRA/Bolivia Yorrez Loayza, Miquel A. Project Concern Int’l/Bolivia Zaballos, Javier SEDAG- Oruro Department/Bolivia Ghana Abdul-Karim, Fuseini Government of Ghana (GOG) Aboagye, Richard ADRA/Techiman Abu-Bonsrah, Seth ADRA/Ghana 115 Aker, Jenny CRS/Ghana Alhassan, Yakubu OIC/Tamale Amevor, Paul OIC/Tamale Amezah, Kwame Ministry of Food and Agriculture (MOFA)/Ghana Arku-Kelly, Samuel OIC/Tamale Awuku, Issac ADRA/Ghana Azu, John Nene-Osom OICI/Ghana Baiden, George ADRA/Ghana Boandu, Kwame Octchere ADRA/Tamale Boateng, Appiah ADRA/Tamale Bruce, P.A. MOFA/Ghana Clottey,Victor A. Ministry of Environment, Science and Technology (SARI)/Ghana Cofie, Evelyn ADRA/Techiman Fuseini, Haruna (Prince) MOFA/Natural Resource Institute (NRI)/Ghana Gingong, Anthony Guinea Worm Eradication Program (GWEP)/MOH Tamale Gyamfi, Isaac OIC/Tamale Kanana, Seidu Centre for Agriculture Research and Development (CARD)/Tamale Kandoh, Emmanuel GWEP/Tamale Nornoo, Charles TechnoServe/Ghana Nsiah, James TNS/Techiman Nti, Abraham TNS/Techiman Opoku, Patrick OIC/Tamale Owusu, Issac ADRA/Techiman Panlibuton, Henry TechnoServe/Ghana Pinga, Victor OICI/Ghana Railston-Brown, Nicholas TechnoServe/Ghana Rose, Ian USAID/Ghana Samlafo, K.E. OIC/Tamale Sands, Fenton B. USAID/Ghana Shukla, Naresh CARD/Tamale Mozambique Aboagye, Isaac World Vision/Nampula Almeida, José Manuel A. Africare/Mozambique Almeida, Mario João de Africare/Mozambique Amuzu, Amin FHI/Mozambique Armando, Ismenio Pedro World Vision/Mozambique Asanzi, Chris World Vision/Mozambique Bameral, David World Vision/Mozambique Bayer, Gary World Vision/Mozambique Bias, Calisto Instituto Nacional De Investigacão Agronomica Bliss, Sidney USAID/Mozambique Born, Julie USAID/Mozambique Bowlin, John R. Excom Monetization Office Cofie, Evelyn World Vision/Nampula Correia, Maria Ana Africare/Manica Curado, Domíngos António Africare/Mozambique Dahlgren, Kirk USAID/Mozambique Damiral, David World Vision/Mozambique de Lamotte, Marc CARE/Mozambique De Sousa, Joao Paulo FHI/Biera Donovan, Cynthia Food Security Research Project dos Santos Coimbra, Lopes FHI/Mozambique Dussenberg, Bernard Excom Monetization Office Fitzcharles, Kevin CARE/Mozambique 116 Fraenkel, Richard M. USAID/Mozambique Gemo, Orlando Ministry of Agriculture and Fisheries (MOAF), Directorate of Agriculture Extension Guttschuss, Eric ADRA/Mozambique Hess, David USAID/Mozambique Hesse, Curtis ADRA/Mozambique Ismael, Carina Inter-Minsterial Group on Food Security and Nutrition (SETSAN)/MOH Kebede, Adugra FHI/Beira Khan, Sonya SETSAN/MOH Kolhoff, Veronique WVI/Maputo Knight, Melissa USAID/Mozambique Jamal, Abdul Chamber of Commerce/ Beira João, Manuel Gingo Ministry of Agriculture and Rural Development (MADR)/ Mozambique Jorge, Felipe Manuel FHI/Mozambique Lisboa, Sr. SETSAN/MOH Low, Jan W. Michigan State University Luis, Nicolau Martins Cashew Rehabilitation Project Mambosa, João António Mambocha Martin Luis, Nicolau Institute of Cashew (INCAJU)/ Mozambique McGarrity, Gayle Africare/Mozambique Madime, Joann SETSAN/MOH Malusalila, Percy M. Mozambique Seed Company (SEMOC) Matsola, Sabado SETSAN/MOH Mucavale, Sebastiao SCF/Nampula Melo, José Francelino de Mobeira Mussu, Joaquim Sociedade Mercantil de Sofala Muanacalaquenle, P. SCF/Nampula Narcí, Badrú P National Commerical Company of Mozambique (ENACOMO ) Nuvunga, Boaventura MADR/Mozambique Newsome, Martha World Vision/Mozambique O’Sullivan, Helen FHI/Mozambique Olupona, Omo WV/Maputo Owusu, Isaac World Vision/Nampula Patterson, Rob FHI/Beira Passades, Joaquim FHI/Mozambique Rosário, Paulo de FHI/Mozambique Souza, Marcia World Vision/Nampala Teclemariam, Solomon MOAF, Directorate of Agriculture Extension (DNER) Uaiene, Rafael Nemba Instituto Nacional De Investigacão Agronomica Vaz de Andrade, Maria I. International Institute for Tropical Agriculture Veruiz, José FHI/ Mozambique Vilanculos, Azarias Chamber of Commerce/Beira 117 Appendix 7. FAFSA Country Field Visit Selection Tables 7A. Title II Country Program Characterization Country Visit Selection Criteria Country Title II as Percent of Mission Program Value of Title II program1 ($ 1,000) # of T-II PVOs in country 1 # of current T-II PVO programs running 3+ yrs2 Percent of Title II program monetized3 (metric tons (MT)) Percent of Title II program monetized3 ($ value) Mission has both ag and health Title II programs (B, AG, HN)4 # PVOs with both ag and health T-II activities1 Angola 45 7,983 4 0 100 100 AG 0 Benin 12 3,588 1 1 36 19 HN 0 Burkina Faso n/a 13,932 2 1 32 33 B 1 Cape Verde n/a 3,901 1 1 100 100 AG 0 Chad n/a 1,133 1 1 100 100 B 1 Eritrea 5 495 1 1 100 100 AG 0 Ethiopia 50 29,201 8 5 55 56 B 4 Gambia n/a 2,227 1 1 40 61 B 1 Ghana 31 19,094 4 3 78 68 B 0 Guinea 13 2,087 3 2 100 100 B 2 Kenya 21 7,562 6 6 86 91 B 1 Liberia 37 1,350 1 0 0 Madagascar 28 7,249 3 3 58 69 B 1 Malawi n/a 4,726 1 0 0 Mali 3 3,432 2 0 100 100 B 1 Mauritania n/a 863 1 1 0 0 HN 0 Mozambique 29 17,933 6 6 100 100 B 4 Niger n/a 6,080 3 0 B 3 Rwanda 10 2,945 3 1 0 0 AG 0 Uganda 14 9,512 4 2 100 100 B 2 Bangladesh 31 15,327 2 1 100 100 B 1 India 74 73,331 2 2 3 6 B 1 Bolivia 30 20,779 4 3 61 61 B 4 Guatemala 26 18,438 4 3 83 64 B 1 Haiti 27 21,328 2 3 47 41 B 1 Honduras 37 7,345 2 1 65 43 B 1 Nicaragua 18 5,424 3 3 0 0 B 3 Peru 47 45,006 6 5 62 73 B 3 1 Source: Appendix Table 1: FY 2000 Title II Non-Emergency Programs, 2002 R4. Includes humanitarian assistance. 2 Programs initiated in FY98 or before (1998 activities had a planned start date of October 1997). 3 Calculated from the “worksheet” used for 2001 R4. Figures are FY 1999. All activities (health and nutrition, agriculture, education, microenterprise, water and sanitation, and humanitarian assistance) included. 4B=both agriculture and nutrition programs; AG=agriculture and not health and nutrition; HN=health and nutrition and not agriculture. Does not reflect education, microenterprise, water and sanitation, or humanitarian assistance activities. 118 7B. Cooperating Sponsor Program Characterization Country Visit Selection Criteria Country Activity size 1 L (>$5m) M ($1-5m) S (<$1m) Value of Title II program1 ($1,000) Title II program1 <2,000 MT (Y/N) LOA2 Percent of activity monetized3 (MT) Percent of activity monetized3 ($) Percent of health and nutrition activity monetized3 (MT) Percent of health and nutrition activity monetized3 ($) Percent of agricultural activity monetized (MT)3 Percent of agricultural activity monetized3 ($) Angola CARE M 2,086 N 99-03 100 100 100 100 CRS S 400 Y 99-03 100 100 100 100 SCF M 1,854 N 99-03 100 100 100 100 WV M 3,643 N 99-03 100 100 100 100 Benin CRS M 3,588 N 96-00 36 19 38 20 Burkina Faso AFRICARE S 701 N 99-03 100 100 100 100 100 100 CRS L 13,230 N 97-01 23 26 Cape Verde ACDI M 3,901 N 97-01 100 100 100 100 Chad AFRI M 1,132 N 97-01 100 100 100 100 100 100 Eritrea AFRI S 495 Y 95-97 100 100 100 100 Ethiopia AFRI S 933 Y 99-03 CARE M 3,890 N 97-01 70 73 69 72 68 71 CRS L 6,510 N 97-02 31 29 40 35 41 44 Ethiopian Orthodox Church (EOC) M 3,898 N 98-02 76 78 76 78 FHI M 3,209 N 96-98 67 68 100 100 57 59 REST L 7,074 N 99-03 44 48 44 48 SCF M 1,341 N 99-03 81 76 100 100 82 81 WVI M 2,347 N 95-97 35 39 100 100 31 35 Gambia CRS M 2,227 N 97-01 40 61 35 56 100 100 Ghana ADRA M 4,037 N 97-01 90 85 100 100 CRS L 10,520 N 97-01 53 42 86 75 100 100 OICI S 889 N 99-03 100 100 100 100 TNS M 3,648 N 97-01 100 100 100 100 Guinea ADRA S 684 Y AFRI 96-00 100 100 100 100 100 100 OICI M 1,402 Y 96-00 100 100 100 100 100 100 119 Country Visit Selection Criteria Country Activity size 1 L (>$5m) M ($1-5m) S (<$1m) Value of Title II program1 ($1,000) Title II program1 <2,000 MT (Y/N) LOA2 Percent of activity monetized3 (MT) Percent of activity monetized3 ($) Percent of health and nutrition activity monetized3 (MT) Percent of health and nutrition activity monetized3 ($) Percent of agricultural activity monetized (MT)3 Percent of agricultural activity monetized3 ($) Kenya ADRA S 874 Y 98-02 100 100 100 100 CARE M 1,539 N 98-02 100 100 100 100 CRS M 1,928 N 97-00 68 76 100 100 FHI S 964 N 98-02 100 100 100 100 100 100 TNS M 1,681 N 98-01 100 100 100 100 WVI S 575 Y 97-00 100 100 100 100 Liberia CRS M 1,350 N Madagascar ADRA M 1,539 N 98-02 100 100 100 100 CARE M 1,710 N 98-02 100 100 100 100 100 100 CRS M 3,999 N 95-98 28 39 Malawi CRS M 4,726 N Mali AFRI S 788 Y 99-03 100 100 100 100 WV/W inrock International M 2,644 N Mauritania Doulus S 863 Y 96-00 Mozambique ADRA M 1,368 N 97-01 100 100 100 100 AFRI M 1,020 N 97-01 100 100 100 100 100 100 CARE M 2,338 N 97-01 100 100 100 100 FHI M 1,483 N 97-01 100 100 100 100 100 100 SCF M 1,426 N 97-01 100 100 100 100 100 100 WVI L 10,297 N 97-01 100 100 100 100 100 100 Niger AFRI/CAR/ CRS L 6,080 N Rwanda ACDI M 1,600 Y CRS 98-00 WVI M 1,345 N Uganda ACDI L 5,325 N 97-01 100 100 100 100 AFRI S 974 Y 97-01 100 100 100 100 100 100 TNS M 2,007 N 99-03 100 100 100 100 WVI M 1,204 N 99-00 100 100 100 100 120 Country Visit Selection Criteria Country Activity size 1 L (>$5m) M ($1-5m) S (<$1m) Value of Title II program1 ($1,000) Title II program1 <2,000 MT (Y/N) LOA2 Percent of activity monetized3 (MT) Percent of activity monetized3 ($) Percent of health and nutrition activity monetized3 (MT) Percent of health and nutrition activity monetized3 ($) Percent of agricultural activity monetized (MT)3 Percent of agricultural activity monetized3 ($) Bangladesh CARE 94-99 100 100 100 100 WV L 15,327 N India CARE L 53,088 N 97-01 4 8 4 8 CRS L 20,243 N 97-01 Bolivia ADRA L 5,946 N 97-01 46 46 70 69 42 42 CARE M 4,794 N 99-01 84 84 79 78 100 100 FHI L 5,093 N 97-01 82 82 86 86 77 76 PCI M 4,945 N 97-01 57 57 66 65 41 41 Guatemala CARE M 3,913 N 96-00 68 44 16 7 100 100 CRS L 7,441 N 97-01 94 84 89 73 97 89 SCF M 3,837 N SHARE M 3,247 N 96-00 47 24 47 25 47 21 Haiti CARE L 10,427 N 96-00 47 41 64 53 55 49 CRS L 10,900 N 96-00 48 42 55 44 Honduras CARE L 5,127 N 96-00 65 43 60 39 67 45 CRS M 2,218 N Nicaragua ADRA M 1,302 N 96-00 PCI M 1,759 N 97-01 SCF M 2,363 N 96-00 Peru ADRA L 9,851 N 96-00 53 66 52 63 54 70 CARE L 12,332 N 96-00 64 73 100 100 52 61 CARITAS L 13,072 N 96-00 65 78 56 70 75 85 CRS M 1,565 N 99-01 100 100 PRISMA L 6,920 N 96-00 44 56 100 100 TNS M 1,265 Y 98-02 100 100 1 Source: Appendix Table 1: FY 2000 Title II Non-Emergency Programs, 2002 R4. Includes humanitarian assistance. 2 Life of activity. 3 Calculated from the “worksheet” used for 2001 R4. Figures are FY 1999. All activities (health and nutrition, agriculture, education, microenterprise, water and sanitation, and humanitarian assistance) included. 121 Appendix 8. FAFSA Advisory and Consultative Groups The Food Aid and Food Security Assessment (FAFSA) was conducted through a consultative process. Five consultative groups representing the range of Food Aid partners were identified and consulted throughout the assessment. They are as follows: FAFSA Core Advisory Group–The FAFSA team closely collaborated with a core Advisory Group from USAID that included representatives from Bureau for Humanitarian Response (BHR)/FFP, BHR/Office of Program and Policy Management (PPM), and G/PHN. This group worked with the team to refine the FAFSA scope of work (SOW), and provide feedback on the conceptual framework through meetings and email communiques. USAID Advisory Group–The USAID Advisory Group includes members of the FAFSA Core Advisory Group and representatives from USAID/Washington (BHR, PPC, global and regional bureaus) as well as from USAID/Field Missions who work closely with the Title II program or have had considerable experience with it in the past. CS Technical Advisory Group–The FANTA Project’s Technical Advisory Group (FANTA TAG) is composed of representatives from all of the Title II CSs. This group was identified as the appropriate advisory group of CS staff for FAFSA. External Expert Advisory Group–In addition to the USAID and CS stakeholder advisory groups, the FAFSA team identified a small group of academic technical experts with expertise in agriculture, nutrition and food security to serve in an external advisory capacity (i.e., the Expert Advisory Group (EAG)). This group provided high-level scientific and technical input from an academic/research perspective, guidance on the methods used for the desk and field analysis, literature and contact recommendations, critical review and comments on the assessment draft report and a contribution to the introduction of the report. The members of the Expert Advisory Group are: Dr. Beatrice Rogers, Dean for Academic Affairs and Professor of Economics and Food Policy, Tufts University; Dr. John Sanders, Professor of Agricultural Economics, Purdue University; and Dr. Laura Caulfield, Associate Professor of Nutrition, Johns Hopkins University. Food Aid Consultative Group (FACG)–FACG, comprised of representatives of Title II CSs, U.S. government, producer groups and congressional interests, is considered a key stakeholder group for the FAFSA. (Many of the members are also participants of FANTA TAG.) 122 Appendix 9. Title II Generic Indicator List Category Level Indicator Health, nutrition and Impact % stunted children 24-60 months (height/age z-score) MCH % underweight children (6-36 mo, 36-60 mos) (weight/age z-score) % infants breastfed w/in 8 hours of birth % infants under 6 months breastfed only % infants 6-10 months fed complementary foods % infants continuously fed during diarrhea % infants fed extra food for 2 weeks after diarrhea Annual % eligible children in growth monitoring/promotion monitoring % children immunized for measles at 12 months % of communities with community health organization % children in growth promotion program gaining weight in past 3 months by gender Water and sanitation Impact % infants with diarrhea in last 2 weeks liters of household water use per person % population with proper hand washing behavior % households with access to adequate sanitation (also annual monitoring) Annual % households with year-round access to safe water monitoring % water/sanitation facilities maintained by community Household food Impact % households consuming minimum daily food requirements consumption number of meals/snacks eaten per day number of different food/food groups eaten Agricultural Impact annual yield of targeted crops productivity yield gaps (actual vs. potential) yield variability under varying conditions value of agricultural production per vulnerable household months of household grain provisions % of crops lost to pests or environment Annual annual yield of targeted crops monitoring number of hectares in which improved practices adopted number of storage facilities built and used Natural resource Impact imputed soil erosion management imputed soil fertility yields or yield variability (also annual monitoring) Annual number of hectares in which NRM practices used monitoring seedling/sapling survival rate FFW/Cash for Work Impact agriculture input price margins between areas (CFW) roads availability of key agriculture inputs staple food transport costs by seasons volume of agriculture produce transported by households to markets volume of vehicle traffic by vehicle type Annual kilometers of farm to market roads rehabilitated monitoring selected annual measurements of the impact indicators 123 Annex. Microfinance and Small Business Development Services: High Impact Programs for Food Security I. Executive Summary and Conclusions A. High-Impact Programs for Food Security Microenterprise Development (MED) programs are highly effective in improving access to food by food-insecure poor households. The main impact of MED has been to increase access through increased household and individual incomes so that the poor and near-poor can acquire appropriate foods for a nutritious diet. The access impacts are found in both the microfinance and microbusiness development services programs, both of which improve food availability and utilization. Microfinance provides households with lump sums of cash that often are used to expand existing income sources or add new ones. Simply stated, loans can be divided into two types. The first is a microenterprise loan that expands a relatively large and important household business. This might be a retail store, carpentry business or transport operation for which major capital improvement is financed by the loan. The second type of loan goes into the household budget and can be used for a variety of things, including smaller investments for a business (including farming), household furnishings, consumption, school fees, funerals, weddings and the like. Microcredit and savings are important means to increase incomes and protect assets while helping to ensure that funds are available to meet daily needs such as food. Microfinance is an important tool to help the poor and near-poor increase access to food. The case for increased availability of food rests on the existence of urban/rural linkages. Microloans are fungible and most are made to households with lenders recognizing that actual use is tied to household needs at the time of the loan. In many developing countries, including most of Africa, households in urban and peri-urban areas and smaller cities and towns have family links to farms in the rural areas. Both farm income and expenses are part of the urban household budget. These households often use the micro loan funds to cover some of the farm costs, including crop production and remittances to the rural household. Many of the community-based lending methods use groups to guarantee loans, organize local management and empower local communities of borrowers. Once these groups are operating and good financial management and practices are established, then the group meetings are often used for related community needs, including health and nutrition guidance to improve food utilization. 124 B. Food for Peace and Microenterprise Programs The second part of this Annex paper reviews existing Title II microfinance (MF) and small business development services (BDS) programs. MED activities represent only 2 percent of the total Title II Non-Emergency Program. Total annual food aid support is in the neighborhood of $8 million out of a total annual budget of close to $400 million. The review found that individual MF programs show weaknesses in pricing (subsidized interest rates), bank failure, weak group formation, inadequate training of community bank staff, inappropriate products, lack of funding because of slow monetization, and targeted credit to poorly performing sub-sectors. Although these individual problems are significant, overall they pale in comparison to the lack of an institutional structure that draws from and builds on the strong body of knowledge of microfinance institutions’ (MFIs’) management and operations. Little can be achieved in correcting these other problems until appropriate and efficient MFI structures are established. The failure of the Title II MF programs to reach a significant number of clients in a sustainable way undermines the objectives of reaching the poor through increased access to credit, and of helping women in particular. This weakness in the programs stands out when compared to the potential that MF programs have to enhance food security through increased access, availability and even utilization of food. Given the overlap between BDS and agricultural development objectives and the need for continued learning in both BDS and small farmer agricultural business development, there appears to be much potential for collaboration and learning between the Office of Food for Peace (FFP) and the Office of Microenterprise Development (MDO). The paper’s recommendation is that the FFP and MDO begin planning to find the best ways to collaborate and learn to improve both BDS and agricultural development. The Office of Agriculture and Food Security’s participation would be desirable. The paper also presents significant recommendations in three other areas. Technical Strengthening ® FFP needs to encourage Cooperating Sponsors (CSs) in their new and existing programs to design and implement technically stronger MF activities. Special attention needs to be paid to ensuring that microfinance institutional structures are planned and established to direct and review community organizations and programs. ® Greater involvement of MDO staff in the FY 2002 DAP review process is a positive addition. FFP should seek to include technically strong evaluators in all future reviews. ® Because the MED field is evolving quickly, there is a need to have technically strong reviews of the implementation of MF components as well. MDO staff and their consultants may be a good source of expertise for the task. FANTA assistance to CSs in MED is another option. ® FFP should encourage CSs with existing or planned MF activities to strengthen their capacity. FFP should support this through new or amended Institutional Strengthening 125 Activity (ISA) grants. Some support may be available through MDO or Private and Voluntary Cooperation, USAID, (PVC) to improve FFP MED programs. ® Training of FFP Development Division staff in MF and BDS would be useful to those tracking results and adjusting program implementation. Microfinance Program Redesign and Redirection ® Since the MF field is evolving rapidly, FFP needs to provide flexibility and technical support to redesign and redirect programs as technical solutions develop and strengthen. ® Programs that do not follow successful practices will not show results and should be halted by CSs and FFP. A time limit should be provided to reform non-conforming existing programs. ® The timeframe to build and establish a MF program or institution is 7 years. DAP reviews and approvals need to take account of this. Partnerships with Leading MF Institutions and PVOs ® Constraints on monetization-based programs makes it difficult to add new CSs in MED. Yet there does seem to be a place to explore the possibility of participating in FFP Title II Development Programs with some of the leading local MFIs or U.S. private voluntary organizations (PVOs) that are leaders in MF. Partnerships between MFI/PVOs and FFP CSs working in MED should be encouraged by FFP as another way to add technical and operational (monetization) strength to microenterprise development. The overall objectives of the above recommendations are two. The first is to enable FFP to take full advantage of microfinance, one of the best development tools for poverty alleviation and food security. FFP needs to improve the technical quality and greatly expand MF. Its present MF programs are insignificant in size and woefully weak. The second is to encourage collaboration and joint learning in BDS and agricultural development in order to enhance the food security impact of successful rural businesses and on-farm processing. II. Microenterprise Activities in Existing Title II Development Programs A. FFP Programs and Funding for Microenterprise Development The Food Aid and Nutrition Technical Assistance Project (FANTA) staff has estimated funding for various types of FFP activities as part of its program reviews and assessments. These reviews for FY 1999 and FY 2000 show both a modest number of programs and a low level of funding for MED. This data set was then compared USAID’s annual Microenterprise Results Reports for a 5-year period through FY 1999, the most current year of published data. Additional FFP programs were identified with MED components. Altogether 17 programs were identified with MED components and 10 different CSs were implementing them. Total annual 126 funding coming from monetization (18-20,000 tons) is in the $8 million range. Program grants vary in length from 3 to 5 years and are routinely renewed for a second 3 to 5 years. FFP assesses program results and resource requests annually. The FFP Development Program has about 20 CSs altogether and an annual average food award (FY 1999 - FY 2001) of about one million tons with a value just short of $400 million. Of the 17 MED programs, 14 included a MF component while 7 had a substantial BDS component. Four had both financial and business services. A quick review of the Agricultural Development component found that there were a number that included income-generating, on￾farm business support or marketing assistance, all of which could be included in micro business development services. The seven identified for this review have significant BDS efforts, but this review recognizes the limits of the set and specifically addresses the identification and reporting issue in the recommendations section. This paper does not discuss agricultural production credit but recognizes that cash loans are fungible and that clearly there is an impact on household non-farming business activities, especially processing and marketing. FFP awards grants for Institutional Support Activities (ISAs) to CSs to help them with non-direct but supporting activities for FFP Title II Development Programs. Headquarters costs are covered under these programs. These awards were reviewed to see if they provided technical or other support for the MED activities. No significant direct support was identified and thus they are not discussed in the paper. A recommendation for their future use is, however, included. B. USAID Distinction between Microenterprises and Small Farm Producers USAID policy makes a distinction between small-scale farmers and microentrepreneurs. The Microenterprise Development Policy Paper39 defines microenterprises as “tiny, informally organized business activities other than crop production.” It also notes that “many farmers operate microenterprises as sidelines.” This distinction rests on a concern that funding set-asides for microenterprise business development could end up used for agricultural crop production. However, improvement of household food security and income are important outcomes found in both ME and agricultural objectives. USAID staff recognizes that small-scale farmers are often involved in agro-processing, cash crop production and marketing and non-agriculture household enterprises. The distinction in policy and funding does not exist in the lives of individuals in poor households. 39 Microenterprise Development Policy Paper. 1995. USAID, Washington, DC. 127 III. Microenterprise Development and Increased Food Security A. MED Programs for Improved Food Security USAID defines food security as the state when all people at all times have both the physical and economic access to sufficient food to meet their dietary needs for a productive and healthy life. USAID and the U.S. Government in general recognize three interlocking elements needed to achieve food security: Availability of sufficient quantities of appropriate quality food through agricultural production, imports and government programs and safety nets. Access to adequate means (primarily income) to obtain food from household production, local markets and other sources. Utilization of the food through the presence of adequate diet, safe water, sanitation, education and health care. Through World Food Summit agreements, these elements have also been endorsed by nearly all developing countries in which FFP programs operate. Programs in microenterprise development (MED), especially those following the successful practices of MF, are having a substantial positive impact on access, with lesser but important impacts on availability and utilization of food by food-insecure individuals. The field of MED has two approaches around which programs and successful practices have developed. The most important and successful is MF that focuses on credit to microenterprises and to poorer households. Savings and microinsurance are becoming increasingly important in MF. There is also a growing but still small set of programs and successful practices around non￾financial services that have become known as Business Development Services (BDS). The main impact of MED has been to increase access through increased incomes and assets by households and individuals so that the poor and near-poor can acquire appropriate food for a nutritious diet. The access impacts are found in both the MF and BDS programs. Microcredit programs are also providing finance for farm inputs and production. The fungible nature of credit enables households to use the money as members see fit. Urban and rural town residents have connections to family farms and use their non-farming-based microcredit loans for farm purposes, either cash crop or food production. Thus the food is made more available through the credit programs of the extended household. There are also some BDS programs that increase the availability of food through the introduction of new technology, primarily pumps and irrigation systems. Education programs have become integral parts of various group lending methods, and these extension programs often promote improved utilization of food through health and nutrition information. The best known of these is the Freedom from Hunger “Credit with Education” 128 program40. The success of these programs depends on a strong and sustainable credit program upon which education modules are grafted. MF works with those who are poor or near-poor, but is not an effective approach to help those who are the poorest of the poor, or destitute. If there is not an income stream to repay the loan, the repayment of microcredit just adds new burdens to the household. However, there are a few examples of MED programs that combine direct distribution with BDS and microcredit to benefit the poorest of the poor and the destitute. In Bangladesh, one of its largest NGOs, the Bangladesh Rural Advancement Committee (BRAC), runs Income Generation for Vulnerable Groups Development (IGVGD) that is targeted to destitute rural women. 41 It begins with an 18-month commitment of free World Food Program food for the women. The women receive skill training in income generation activities such as silk production and poultry rearing. The program helps participants establish microbusinesses and begin to use credit and save. Within 2 years of starting the process, approximately 80 percent of the women had made the transition to being microentrepreneurs with good business skills, and had accumulated savings. Many were in BRAC’s mainstream MF program. B. Microfinance 1. Access It is useful to look at various types of MF and their differing impacts to better understand MF and improved access to food. Microcredit provides a household with a lump sum of cash that often is used to expand an existing income source, add a new one or provide income smoothing. Although a bit oversimplified, loans can be divided into two types. The first is a microenterprise loan that expands a relatively large and important independent business. This might be a retail store, carpentry business, or transport operation for which major capital improvement is financed by the loan. The second type of loan goes into the household budget and is used for a variety of things, including small investments for a household business (including farming), household furnishings, consumption, school fees, funerals, weddings and the like. Both types of loans play an important role in improving household access to food. Again at the risk of oversimplifying, the business loan clearly seeks to improve profits and income while the household loan has more of an asset protection and income smoothing role as well as increased income. The business loan is taken as a means to improve business operations and sales to earn greater profits. Households’ income and access to food increase. These households are generally the near-poor who have reasonable assets yet can slip into poverty and destitution relatively quickly. 40 Christopher Dunford and Vicki Denman. 2001. Credit with Education: A Promising Title II Microfinance Strategy, Washington, DC, AED, FANTA Project. 41 Syed Hashemi. 2001. Including the Poorest: Linking Microfinance and Safety Net Programs: The Case of IGVGD in Bangladesh, Washington, DC, CGAP. 129 Sickness, economic slowdown or a family crisis could force a household into poverty. Access for food security is also supported by the fact that there may be one or more additional workers employed in the business as a result of expansion of operations. However, increased employment is not a common outcome. In fact in some cases, increased efficiency of a new machine or increased know-how means reduction in employment. Nonetheless, over the longer term positive employment impact exists. Turning to the second type of micro loan that is used more directly for and by the household, these loans must be understood in the context of the household rather than a particular micro business. For nearly all households, there are multiple income sources, including household micro businesses that are very small and usually require only part-time work. Their income streams are balanced by expenditures for household needs, particularly large ones such as school fees, weddings, funerals and health care. Then there are the day-to-day costs of food, transport, clothing and the like. The household management of its finances is enhanced by the microcredit. The actual lump sum of cash from the loan is fungible and is found to be used for a variety of needs, but justified to the lender based on the household’s income stream from retail trading, room rental, animal husbandry, salary, etc. The net effect of the loan varies by household, but at a minimum the loan protects the assets of the household. Quite often it builds assets and increases incomes. MF allows the household members to increase access to food through increased income and income smoothing. Savings are also an important financial tool for households. They provide lump sums that can be used as described above. Stuart Rutherford posits that savings are essentially the same as credit, but with the payments before rather than after the lump sum transfer.42 He goes on to point out that even the poor can save to improve their welfare. Thus, seen from the standpoint of the household, microcredit and savings are important means to increase incomes and protect assets while helping to ensure that funds are available to meet daily needs such as food. 43 Microfinance is an important tool to help the poor and near-poor increase access to food. There is a large body of literature that reviews the effect of increased income on household nutrition and food security. FANTA has completed a number of literature reviews and papers on the subject.44 The general conclusion of the work is that increased income does have a positive impact on nutrition at lower income levels; but there are numerous caveats. The characteristics of MED programs generally reinforce the positive correlation between increased income and improved nutrition. 42 Stuart Rutherford. 2000. The Poor and their Money, Oxford University Press, India. 43 USAID through its Assessing the Impact Microenterprise Services (AIMS), has completed a series of long term studies and reviews on the effects of MF on clients and their households. The publications are available on the MDO web site: www.mip.org. 44 Patricia Bonnard. October 1999. Increasing the Nutritional Impacts of Agricultural Interventions, Washington, DC, AED, FANTA Project. 130 ® FFP supported programs focus on the poor where incremental income most often does go for food. ® USAID MF program participants are 70 percent women. When the incremental income is earned or controlled by women, household nutrition improves. ® MF helps establish a frequent and regular flow of income to households from a new source. Such income helps insure that money is available for the regular purchase of food. Where there is a seasonal fluctuation in total income such as from farming, the steady income is especially helpful to purchase food in the “hungry time.” ® Some of the best and most common options to ensure steadier and more diverse income streams include: household-level production of local or export products and handicrafts, retailing, small-scale agro-processing, storage and inventory credit schemes. Microcredit and even savings often get such business activities started and help them to grow. ® Community based banking and small group lending methods offer opportunities to provide education on nutrition and health that are complementary and reenforcing to improved food security. There are additional products (microinsurance being the prime example) that are being developed in MF that are likely to have a positive impact on incomes and access to food. On balance they offer promise to poor households as tools to further protect assets. However, since these products are new and their use small, the focus of this paper is on credit and savings in MF. 2. Availability The case for increased availability of food rests on the existence of urban/rural linkages that are common in many developing countries. Micro loans are fungible and most are made to households with the lender recognizing that actual use is tied to household needs at the time of the loan. In fact, households in urban, peri￾urban areas and smaller cities and towns have family links to farms. Both farm income and expenses are part of the household budget. These households often use the micro loan funds to cover some of the farm costs, including crop production and remittances to the rural household. A study in Uganda45 looked at three programs, one in the capital of Kampala, a second in a secondary city and its hinterlands and a third in a rural district. First it found that farm residence is not a good indicator of which households use loan funds for farming. A main conclusion was that all three MF programs reach households with close ties to the agricultural sector. Approximately half of the clients use micro-loan funds for expenditures directly tied to the production or marketing of agriculture products. In the absence of the loan funds, three-fourths reported that they would not have made the investments. Other types of linkage with the agricultural sector are infusion of remittances and transfers to rural households. Slightly more than half of the clients provide cash or in-kind contributions to persons in rural areas. These remittances clearly have both an access and availability impact on food security. 45 Carolyn Barnes, Gayle Morris and Gary Gaile. September 1998. “Linkages Between Access to Microfinance Services and the Agricultural Sector: Baseline Findings From the Uganda Impact Study.” Washington, DC, USAID AIMS Project Brief No. 18A. 131 3. Utilization Many of the community-based lending methods use groups to guarantee loans, organize local management and empower local communities of borrowers. In the initial stages of a credit program, group meetings are used to build group solidarity, to educate about credit and savings and to provide some basic business training. Once these groups are operating and good financial management practices are established, group meetings are often used for related community needs including health and nutrition. A recent FANTA publication was Credit With Education: A Promising Title II Microfinance Strategy.46 The paper shows that credit and savings objectives can be blended with good quality education for health and nutrition improvements among the very poor. This education improves utilization and thus food security. The paper focuses on the approach of a particular MF PVO network, but the conclusions can be generalized to other credit organizations and group methods. C. Business Development Services A similar case to MF exists for non-financial services such as BDS that help individuals grow their businesses or establish new ones. Growing businesses, especially in rural settings, means more household income and better access to food. However, in contrast to MF best practices, there is much less experience and confidence in the ability of BDS programs to be successful. There is no doubt that business training, technical assistance and new technologies can and do have a very positive impact on micro and small business. However, the cost of these programs has been high, the number of beneficiaries/clients reached has been small, and the ability to sustain the programs without donor or government support remains a huge challenge. BDS programs are often used for agricultural development, and agricultural linked and rural￾based programs have been some of the most successful BDS programs. Their approaches are to develop a market for new crops, and apply and extend small farmer technologies and related essential services through private channels. For most successful rural examples of BDS, there is little program distinction between BDS and agricultural development programs. Recent work on BDS by the donor community has establish a set of Donor Guidelines47 that create what some are now calling the Market Development model for BDS. Its approach and principles are parallel to private sector-based agricultural development programs that have grown in number and importance over the last decade. Although the case for increased access resulting from BDS programs is strong, there is not a convincingly large body of research and successful programs to demonstrate positive and significant MED impact, much less the outcomes to improve food security. However there are 46 Christopher Dunford and Vicki Denman. 2000. Washington, DC, AED, FANTA Project. 47 Committee of Donor Agencies For Small Enterprise Development. February 2001. Business Development Services for Small Enterprises: Guiding Principles for Donor Intervention. Washington, DC, SME Department, World Bank. 132 examples of successful practices for most of the guidelines and a reasonable body of evidence to posit a new approach to BDS.48 The average annual value of FFP food aid for agricultural development during the period 1999- 2001 is approximately $154 million, or almost 40 percent of Title II Development Food Aid. The assistance covers a wide range of types of agricultural programs, but there are many rural and agricultural market development activities that would be considered BDS programs under the new market development model. The FFP Title II Development Program is USAID’s largest set of activities dealing with agricultural development, rural economies and small-scale farms and their households. As such it offers an excellent opportunity for collaboration and learning on the linkages between rural enterprise and agricultural development. Given the overlap between BDS and agricultural development and the need for continued learning in both BDS and small farmer agricultural business development, there appears to be much potential for collaboration and learning between FFP and MDO. IV. The Development of the Microfinance Sector and Best Practices A. The Success of Microfinance and USAID Support Microfinance is an economic development approach that has focused on providing benefits to low income women and men. It has been estimated that there are over 500 million economically active poor individuals in the world operating micro and small businesses. Most of them do not have access to credit and safe savings. Generally, access to financial services is limited in poor areas, especially in rural settings. Extending financial services, which in many developing countries reach only 5 percent of the population, is a positive force for economic development. Microfinance has proven to be a successful approach to reaching the poor and expanding the financial sector. The successful practices of MF activities include: ® Small loans, most often given for working capital for a household business. ® Non-collateral based loan programs. ® Collateral substitutes including group guarantees, compulsory savings and informal appraisal of businesses and individuals by community members. ® Access to repeat but larger loans based on a history of timely repayment. ® Short loan terms with extended periods possible with a good credit rating. ® Streamlined loan processing and disbursement. ® Easy access to safe savings. 48 Emerging Good Practices in Business Development Services. 2001. Turin, Italy, ILO International Training Centre Publication. 133 These practices have been shown to create or reestablish a positive credit culture, i.e., productive loans are made and paid back on time in a way that leads to development of a commercial MF industry. In following the above best practices, financial institutions have been able to achieve much success. . ® They reach and help the poor and near-poor. ® Their products are flexible and meet the needs of their clients. ® The benefits are self-sustaining. ® The institutions are locally owned and directed. ® The programs deepen the local banking and financial system. ® The programs reach millions of households. The Microcredit Summit estimated that at the end of 2000 there were close to 30 million microcredit clients, of which about 18 million were from poor households. ® The community-based approaches of many MFIs build grass-roots-level organizations, often of women. ® Through credit with education the participants learn about business, local empowerment and health and nutrition. Microfinance is provided through a variety of institutions: NGOs, savings and loan associations, credit unions, money lenders, government banks, commercial banks and non-bank financial institutions. Informal sources of MF such as rotating savings and credit associations are also important in many countries but are not generally supported and promoted by donors and governments. The number of MFIs that are commercially viable is growing sharply while commercial banks are becoming more active in MF as they recognize its success and potential for profit. USAID is an innovative leader in the field, providing both critical operational research for the identification of best practices and targeted institutional support to help local institutions reach a significant number of the poor. The most recent published data on USAID support to microenterprises49 show that USAID provided $153.5 million of funding. Of the total, more than two-thirds ($107 million) was for MF, while the balance ($46.5 million) was for BDS. Two million loan clients received services through 277 USAID-assisted institutions. The USAID-supported institutions had a total portfolio value of $667 million, with repayment rates reaching more than 95 percent. About 69 of the loans were to the poor or near-poor, while 70 percent of the clients were women. Savings services were provided to over three million individuals in USAID assisted institutions. The level of USAID funding for MF is growing in spite of declines in economic growth funds in general. 49 Reaching Down and Scaling Up: Focus on USAID’s Development Partners. 2000. Washington, DC, USAID Microenterprise Results Reporting for 1999. 134 USAID has also played a pivotal role in expanding other donor support to MF. Other donors are now financing a wide range of MF activities, including capacity building for MFIs to learn and apply best practices. USAID is giving priority to microenterprise development in African countries that are also the most food insecure. There is a clear complementarity between microenterprise development and FFP-assisted countries and objectives. The potential development impact is great for FFP funding for microenterprise development activities that foster food security in Africa. B. Some Other Microfinance Characteristics MFIs have largely developed and delivered credit rather than savings products. The majority of innovations have been in non-collateral-based lending, with less innovation on the savings side. Thus, MFIs are focused on loans. Donors want to support innovations in lending. Also donors are attracted to providing loan funds that can be disbursed quickly and measured easily. The most common measure is the number of loans below a poverty threshold level, often set at $300. One structural/organizational practice that is most often recommended is to have MFIs work on financial services alone. MFIs should not be involved in free services or grant programs to clients that could lead to clients believing that the credit is a grant rather than a loan. The discipline of loan repayment found in MF credit cultures could be undermined and lost. The exception to this finance-only recommendation is credit-with-education programs discussed previously. Finally, there is a concentration of successful MFIs in urban areas. There are far fewer rural than urban programs, but some successful rural programs exist in all regions. C. Microfinance Challenges Microfinance programs are not without failures and problems. Here are key challenges that lead to problems and failures. ® Capacity-building takes time and money for training, technical assistance and systems development. Donor and MFIs underestimate the need for investment in capacity-building. A 1995 USAID microenterprise credit policy paper states that MFIs should be able to achieve financial viability in 7 years. Many MFIs in urban settings or markets with strong credit cultures have reached financial self-sufficiency much sooner, but for rural areas and much of Africa financial self-sufficiency is taking longer than 7 years. Many of the food￾insecure countries and poorest regions within countries where CSs focus their programs are places where MF programs are likely to have the toughest times. ® Subsidized interest rates are used and make it impossible for MFIs to cover costs and be sustainable. Low interest rates attract large clients who have the power or position to divert low-cost funds from the poor. ® MFIs try to reach the destitute and poorest of the poor who have few or no economic opportunities. Microcredit is either of no use or a new burden on the poor if they have no new or expanded income opportunities. 135 ® Rural-based programs, especially in Africa, often lack basic infrastructure, have a less educated clientele, and have fewer local institutions upon which MF can build. Low population density makes the logistics of microcredit difficult and the related cost of travel high for both the clients and staff. Finally, the previous point of few or no economic opportunities is often found in poorer rural areas. ® MFI financial management is weak and loan defaults are high, with the result that MFIs become insolvent. ® MFIs are not business-like. Managers do not seek or never reach minimum scale and efficiency to cover costs. MFIs remain dependent on donor and other subsidies. ® Some programs establish MF programs at the community level using the non-collateral￾based lending approaches that have proven to be successful, but fail to establish the institutional structure (an MFI) that is equally important to MF success. Often multi-purpose NGOs try to take on the management and institutional roles without proper grounding in MFI best practices. ® MFIs often must modify successful practices and models to take into account local contexts. Failure to adjust to local needs can mean slow growth and increased loan defaults with the threat of insolvency. D. Cooperative Financial Institutions. Another institutional structure for MF is the cooperative financial institution, which is often identified as a credit and savings association/cooperative or a credit union. The special aspects of the structure are that the members (borrowers and savers) are the owners, and they generate their own capital through savings. They are not dependent on outside capital. Membership is often based on a common bond, e.g., members belong to a teacher’s union. Many have been formed over the last 40 years throughout the world, but most have had operational problems. They exist on paper but have had high loan default rates that have made them inactive. Reform and strengthening of systems is an approach to rejuvenate their operations. A leading US PVO institution to reform such programs is the World Council of Credit Unions (WOCCU). West Africa is the region where there are many cooperative financial institutions and they have done better than average. V. Microenterprise Development Programs in FFP Title II A. Best Practices and FFP Planning FFP has been striving to ensure that Cooperating Sponsors’ Development Activity Programs (DAPs) that are food aid proposals plan and use the most technically sound practices in implementing their programs. FFP with the help of FANTA has encouraged the strongest technical food aid development programs in agriculture, nutrition and health. Given the relatively small size of microenterprise development, there has been less of an effort to ensure MED best practices in FFP. During the recent review of the FY 2002 DAPs, MDO staff was asked to technically appraise a dozen or so DAPs with significant MED components. This is a positive first step to help FFP programs introduce and use technically strong and successful 136 MED practices. However, further cooperation and additional technical support in both planning and implementation is a critical need. B. The Importance of Monetization to MED A key aspect of all FFP microenterprise development (MED) programs is that they depend on the sale of food (monetization) to generate local currency for program activities. Direct distribution is not a significant part of any FFP MED activity. Monetization is an important issue for FFP. While a full discussion here is not needed, there are three aspects of monetization that are relevant for PVOs that want to apply for food aid for MED. 1) In addition to technical MED capacity, PVOs need strong operational and management skills to ship and sell food. None of the US PVOs focused on MF have food aid skills now. Only multi-sector and humanitarian relief organizations such as CARE, CRS, WV, SAVE, ADRA, etc., have both commodity and monetization management skills and MF programs. 2) For technical, budgetary and trade reasons, FFP is seeking to limit the amount of Title II monetization. Over the last 5 years monetization has risen from about 20 percent to 65 percent of the total value of Title II. Additional MED programs would require either yet more monetization, or a shift of funds from other monetization uses to MED. 3) Sale of FFP-supplied commodities in local markets must be done in a way that does not discourage local production and marketing. C. Microfinance 1. Some Common Characteristics and Features Programs selected for review were those that had a track record of results. Thus, they generally started at least 2 years ago and in most cases had 3 to 5 years of implementation. Many were drawing to a close. Newer programs that have not had time to show results were excluded. The 14 MF programs reviewed had a range of different types of activities and characteristics, but there were some common elements. ® Programs were operating in local areas or regions that were identified as poor. CSs’ focus on food insecurity led to a concentration of program activities in poor regions. ® Access to credit was identified as the key problem and thus was the main justification for the programs. ® Sustainability of the credit program was not a principal concern of most programs. ® All emphasized credit over savings, although savings were an important element of at least one. ® Microfinance was a relatively small component in multi-objective programs. ® For all programs, CSs or local NGOs coordinated and managed the MF component. In only two cases were MFIs involved as CSs’ partners. 137 ® Local NGO partners had little or no experience in MF, or at least no experience was identified in the DAP or follow-on documents. ® Loan methodologies used were generally based on a Grameen Bank group lending approach or a variation of the community/village bank model. Individual loan programs were less common. ® Although there were a couple of cases of subsidized interest rates, there was generally a commitment to commercial rates. However, it was not possible to determine if commercial rates were actually identified and applied correctly. Determining market interest when the market is thin or non-existent is a difficult task. 2. The Problem: The Missing MFI Management and Structure The overwhelming weakness in FFP MF programs reviewed was a lack of understanding or weak commitment to the successful and needed institutional structure to manage MF activities. Essentially, what is missing is the overall management unit or structure that is needed to review, check, manage and direct community based organizations or community banks that provide grass roots interaction and direction. Contract officers (COs) and country backstop officers (CBOs) need an umbrella management structure that provides management information systems, standard performance measures, checks on reported accomplishments, regular audits, and training and learning across local units. The body of knowledge and practices on successful MFIs that do these things and have the systems is now deep and robust. Yet, there is scarcely any discussion or action taken to use this knowledge to establish the right types of MFIs to manage FFP programs. Applying successful local lending methodologies for group and village banking without also establishing over-arching MFIs has meant that that FFP MF programs are weak. They are not able to reach a significant number of the poor and are not sustainable because of high loan defaults and/or inefficient operations. MF activities are dependent on continued FFP or other donor support. The failure of MF programs to reach a significant number of clients in a sustainable way undermines the objectives of reaching the poor through increased access to credit and helping women in particular. This weakness in FFP MF programs stands out when compared to the potential that MF programs have to enhance food security through increased access, availability and utilization of food. Individual programs show weaknesses in pricing (subsidized interest rates), bank failure, weak group formation, inadequate training of community bank staff, inappropriate products, lack of funding because of slow monetization, and targeted credit to poor performing sub-sectors. Although these individual problems are significant, overall they pale in comparison to the lack of an institutional structure that draws from and builds on the strong body of knowledge on MFIs management and operations. Little can be achieved in correcting these other problems until appropriate and efficient MFI structures are established. An exception to the norm that in fact supports the finding is the PRISMA loan program in Peru. It started in 1996 with a local credit program using a community bank approach. The PRISMA 138 program was typical of the FFP MF programs in that it lacked an MFI framework. However, PRISMA adopted MFI best practices and committed to their implementation. Thus, it adjusted the program and kept the community based partners operating their programs at a high level of efficiency with low defaults. In fact, PRISMA created a separate unit that acted as an MFI. It has also sought and used effectively help from COPEME, the local association of MFIs. The USAID Mission in Peru also added a complementary Alternative Development Program with PRISMA for microcredit. PRISMA has done well and expanded its operations. The February 2001 Results Report for FFP stated that the PRISMA loan portfolio size stood at almost $3.5 million, with 20,000 clients, delinquencies at 4.29 percent and an operational sustainability of 108 percent for the Microcredit Unit. PRISMA’s 2002 DAP proposes to transform its internal microcredit unit into some form of formal MFI. PRISMA was the only FFP MF program that started without a plan for an umbrella institutional structure and established a successful program. That PRISMA has come full circle and is now moving forward with an MFI structure reinforces the critical need for institutional structures above the community level. One important caveat to the institutional weaknesses identified above is that many of the programs reviewed started in the 1995/6 when the MF lending methodologies, e.g., group lending or village banking, were well understood, but good MFI performance standards and systems were still being developed. Thus, the original DAP plans focused on methods rather than on the institutional structures. However, then the question arises as to why no changes were made as the technical and management aspects of MF evolved rapidly. That nearly all CSs failed to change suggests that the problem may lie with the inflexibility of FFP. This review did not gather data on program flexibility, so no finding on this issue is provided, but certainly FFP should determine whether its systems are flexible enough to remain current in rapidly evolving fields such as MF. Related to the institutional problem is the inherent weakness of a multi-sector program where NGOs provide welfare assistance on a grant basis as well as loan funds that are commercial. The poor performance of microcredit may in fact rest on weak credit cultures where clients believe loans are subsidized or free, like other NGO services. D. Business Development Services Of the seven BDS programs reviewed, all but one could be described as following the traditional model of small business development services. Generally, services offered were training in business or technical areas of production. The services were delivered directly by CSs or local NGO partners on a subsidized or free basis. The inputs were provided reasonably well, i.e., training and technical assistance to help generate income. Whether these inputs lead to more income remains an unanswered question in most cases. BDS providers are not sustainable and the numbers of small farmers or entrepreneurs that benefit are relatively few. At least one program appeared to be following the new market development approach where the main intervention is to improve the functioning of the BDS market. In the market development model, the CS or partner does not provide services directly but acts as a facilitator working with all, or as many as possible, BDS providers in a way that least disrupts the market. 139 As mentioned previously, the market development model is still evolving. It has been built on solutions to the failed experiences of the traditional approach. Fundamentally it is a new approach and its application in the field is just starting to catch on. Thus, it is no surprise to find that FFP programs do follow traditional BDS models. The results and impact are also typical for the approach. As the market development model or some variation of it becomes more common and it proves itself to work well in areas of high poverty, more DAPs will include the approach. What is most interesting regarding BDS is its overlap with agricultural development components. Much present FFP assistance for agricultural development uses private sector and market development approaches that are accepted practices in the agricultural sector. The evolving BDS market development model and certainly the BDS donor guidelines are in line with this private sector approach to agricultural development. However, much FFP assistance deals with cooperatives and associations rather than micro and small businesses. Nonetheless, there are a number of good programs that are established to help the businesses of small-scale farmers and rural entrepreneurs. An example of where programs fit both into BDS and agricultural development is the FFP Technoserve program in Ghana. It is developing the markets and supporting services for a number of new cash crops for the small-scale farmer. The supporting services to market and process the crops are BDS activities. These services and actual crop production certainly fit in agricultural development. Trying to identify or set a line between BDS and agricultural development is less important than encouraging cooperation on the two. There is much potential for MDO and FFP to work together on joint learning agendas to move forward both BDS and Agricultural Development. The average FFP annual funding for agricultural development is in the $150 million range. VI. Recommendations The recommendations listed below are to help FFP strengthen its program and improve its results. The recommendations are grouped into five areas: Technical Strengthening, Microfinance Program Redesign and Redirection, Business Development Services and Agricultural Development, Partnerships with Leading MFIs and PVOs, and Program and Results Reporting. A. Technical Strengthening ® FFP needs to encourage CSs to design and implement technically stronger MF activities in new and existing programs. Special attention needs to be paid to ensuring that MF institutional structures are planned and established to direct and review community organizations and programs. ® Greater involvement of MDO staff in the FY 2002 DAP review process is a positive addition. FFP should include technically strong evaluators in all future reviews. ® Because the MED field is evolving quickly, there is a need to have technically strong reviews of the implementation of MF components as well. MDO staff and their consultants may be a good source of expertise for the task. FANTA assistance to CSs in MED is another option. 140 ® FFP should encourage CSs with existing or planned MF activities to strengthen their capacity. FFP should support this through new or amended Institutional Strengthening Activity (ISA) grants. Some support may be available through MDO or PVC to improve FFP MED programs. ® Training of FFP Development Division staff in MF and BDS would be useful to those tracking results and adjusting program implementation. B. Microfinance Program Redesign and Redirection ® Since the MF field is evolving rapidly, FFP needs to provide flexibility and technical support to redesign and redirect programs as technical solutions develop and strengthen. ® Programs that do not follow successful practices will not show results and should be halted by CSs and FFP. A time limit should be provided to reform non-conforming existing programs. ® The timeframe to build and establish a MF program or institution in a food insecure area is 7 years. The DAP reviews and approvals need to take account of this. C. Business Development Services and Agricultural Development ® Given the overlap between BDS and agricultural development programs and objectives and the need for continued learning in both BDS and small farmer agricultural business development, there appears to be much potential for collaboration and learning between FFP and MDO. Planning should begin immediately between the two to find the best ways to collaborate and learn in order to improve both BDS and agricultural development. The Agriculture and Food Security Office’s participation would be desirable. D. Partnerships with Leading MF Institutions and PVOs ® Constraints on monetization-based programs makes it difficult to add new CSs in MED. Yet there does seem to be a place to explore the possibility of participating in FFP Title II Development Programs with some of the leading local MFIs or US PVOs that are leaders in MF. Partnerships between MFI/PVOs and FFP CSs working in MED should be encouraged by FFP as another way to add technical and operational (monetization) strength to MED. E. Program and Results Reporting ® FFP needs to establish a better reporting system to measure both its actual support to MF programs and their impacts through the use of standard MF indicators and targets. FFP may be able to build on the Microenterprise Results Reporting (MRR) system and use the MDO “Table 1” report. This report contains standard MF indicators and industry targets. ® Similarly, FFP should identify and track various types of BDS that are now generally lumped together and reported under agricultural development. A better understanding of the types of programs supported and their impact will help guide future programming ® The MED Office needs to gather data on FFP programs under its agency-wide Microenterprise Results Report. Presently FFP programs are included in MRR but are lumped together with other programs that are funded with local currency. 141 In summary, the overall objectives of the above set of recommendations are two. The first is to enable FFP to take full advantage of microfinance, one of the best development tools for poverty alleviation and food security. FFP needs to improve the technical quality and greatly expand MF. Its present MF programs are insignificant in size and woefully weak. The second is to encourage collaboration and joint learning in BDS and agricultural development in order to enhance the food security impact of successful rural businesses and on-farm processing. Annex Table:Microfinance and Small Business Development Services: High Impact Programs for Food Security List of Cooperating Sponsors and Countries with Microenterprise Development Programs Country Cooperating Sponsor Burkina Faso CRS Ethiopia CARE Ethiopia CRS Guinea ADRA Ghana Technoserve Madagascar CARE Mozambique World Vision Mozambique Africare Uganda ACDI/VOCA Bangladesh CARE Guatemala CRS Guatemala Save the Children Guatemala World Share Haiti CRS Peru CARE Peru. CRS Peru PRISMA