3. What to do: Response options

• Food distribution provides free food assistance directly to households and is of great importance to ensure food security in the short term. Food distribution can be targeted or cover all the families of a given region (blanket distribution).
• Supplementary feeding to reduce the prevalence of mild and moderate malnutrition. Fortified Blended Foods (the main one being CSB = Corn Soya Blend) provide proteins supplements and compact food such as the BP5 that are targeted at children with mild and moderate malnutrition and pregnant and lactating women as take home rations or on site-feeding. Basic medical care is sometimes provided (e.g. de-worming, immunisation, vitamin A supplementation). Note that BP5 is usually available in the CARE stock in Dubai. See description and use of the product here: http://documents.wfp.org/stellent/groups/public/documents/manual_guide_proced/wfp260004.pdf
• Therapeutic care to treat and reduce the prevalence of severe acute malnutrition and prevent mortality. Therapeutic foods such as F75, F100 (both therapeutic milks) and Ready-to-Use Therapeutic Food (RUTF – example: Plumpy Nut) are provided to the severely malnourished. Those without medical complications treated in the community while those with medical complications receive specialised medical care at health care units or stabilisation centres (see Chapter Health)
• Infant and young child feeding support to promote exclusive breastfeeding for the first six months of life and promote timely and appropriate complementary feeding from 6 months and continued until 12 months of age and beyond.
• Check this link to have an overview of nutritious foods available: https://www.wfp.org/nutrition/special-nutritional-products and http://documents.wfp.org/stellent/groups/public/documents/communications/wfp255508.pdf?_ga=1.252003405.576055569.1485350970

• Distribution of seeds, tools and fertiliser can encourage agricultural production, as starter packs to returnees or to diversify crops.
• A seed security assessment must be performed before any seed intervention: http://www.fao.org/3/a-i5548e.pdf
• Seed vouchers and fairs are an alternative to direct distribution of seeds. Seed vouchers are provided to potential buyers. A seed fair is organised to bring together potential sellers, and creates a market for the vouchers to be used to buy seed (see FAO link: http://www.fao.org/docrep/018/aq418e/aq418e.pdf ) . This approach stimulates local seed procurement systems while increasing buyer access to a wide range of seeds.
• Livestock interventions can include animal health measures, emergency destocking, restocking of livestock, distribution of livestock fodder and nutritional supplementation; livestock refuges, and provision of alternative water sources. The Livestock Emergency Guidelines and Standards – LEGS – provide detailed and phased guidelines: http://www.livestock-emergency.net/
• Distribution of fish nets and gear or hunting implements can help restore people’s ability to catch food where these tools have been lost in a disaster.
• Promotion of food processing can be supported by humanitarian agencies to help the community be able to utilise available food, either with direct cash or in-kind support to the millers etc., , or with vouchers to beneficiairies
• Local and agricultural extension services can help improve food production.
• Training and education in relevant skills can strengthen food security.

• Unconditional cash transfers are the default response in many food insecure environments.
• Cash-for-work (CFW) provides food-insecure households with opportunities for paid work.
• Food-for-work (FFW) provides food-insecure households with opportunities for paid work which, at the same time, produce outputs of benefit to themselves and the community.
• Food-for-recovery (FFR) is a less structured form of food for work. Activities can contribute to initial recovery and should not require outside technical supervision.
• Income-generating schemes allow people to diversify their sources of income in small-scale, self-employment business schemes. These include support of people in the management, supervision and implementation of businesses.

Food and nutrition security is often characterised by slow onset. In theory, this could give time to prepare and respond early to mitigate the worst effects. In reality, the slow-onset nature of food security crises often results in a prolonged debate about just how serious the issue is or will become. Responses are delayed and often only triggered by deteriorating malnutrition levels. A delayed response limits opportunities to support people’s livelihoods and forces a response that focuses on meeting people’s immediate basic needs.

To improve the timeliness of decision-making, food security scenarios within EPPs should focus on determining triggers, pre-crisis mitigation activities and, where possible, building contingency funds into ongoing projects that enable an early livelihoods-based response (crisis modifiers). The coping strategies index (Annex 23.11) offers a potential set of indicators that could be used as a trigger. Possible triggers are rainfall data, dates of migration of livestock and people and market prices.

A timely response to food and nutrition security needs requires  well-coordinated early warning systems to inform decision making. A coherent approach to situation analysis between humanitarian agencies can help to raise timely awareness and response to emerging food and nutrition security issues. The Integrated Food Security Phase Classification (IPC) is a technical tool that enables agencies to co-operate , ensuring early  and appropriate responses. In support of the coherent inter-agency approach, CARE’s EPP and Contingency Planning Guidelines use the IPC’s analysis templates. Where national food security coordination mechanisms already use the IPC, CARE should participate in the IPC analysis. In countries where the IPC has not been adopted, CARE should support coordination mechanisms and consider which analytical tools are most appropriate to enable in-depth understanding and collaboration with other agencies. A willingness to use tools supported by other agencies and dedicating the time needed to co-ordinate analysis is vital to closing the gap between early warning and response.

Further information on the IPC can be found a www.ipcinfo.org and in Annex 23.17.

The HPN report Missing the point (Annex 23.12) highlighted three standard sets of responses that are commonly repeated without adequate consideration of needs assessment and context-specific design issues. 

Providing seeds and tools is a standard response that is assumed to help communities recover from acute food insecurity. However, seeds needs are seldom assessed. The need for seed is often assumed if needs assessments have shown a need for food. If designing a seeds and tools intervention, consider the following key points:

• There is increasing evidence that seeds systems are distinct from food systems. This means that food insecurity does not automatically translate into seed insecurity.

• CARE should conduct specific seed assessments before implementing major distributions

• Seed assessments can be incorporated into EPPs as a preparedness measure.
• The Office of US Foreign Disaster Assistance (OFDA) regularly provides funding for seeds assessments.
• CARE should also include the possibility of cash or vouchers as an alternative to direct seed distribution in any response analysis.

See also Annex 23.13 CRS seed vouchers & fairs 2004: Using markets in disaster response.

Free food distribution versus cash and vouchers

Food is a key response option to address food insecurity, so its relevance should not be underestimated. However, food distribution can be a standard response that is implemented with little regard for needs. Consider the following:

• Food is most appropriate where needs assessments show that the key driver of food insecurity is food availability.
• Where food access is the dominant issue, cash or vouchers are often more appropriate. Most emergency donors now require that the INGO justifies why it does not use the cash option.
• There are also potential risks associated with the use of cash.
• Markets unable to cope with increased demand and rising food prices make food increasingly inaccessible, which draws more people into the crisis. A market assessment and continuous monitoring of markets is therefore vital in any cash-based response.
• Cash and food should not be seen as mutually exclusive responses. The possibility of combining cash and food should be given serious consideration in any response.
• A small cash grant to accompany food distribution could serve to ‘protect’ the food and avoid the sale of relief food to fund other essential household needs. A larger cash grant could serve to supplement a basic ration and help to ensure that micronutrient and protein needs are met.
• Tools that can assist with the analysis of when and where cash is an appropriate response include Annex 23.15 CARE USA’s Food Resource and Commodity Team decision-tree tool, Annex 23.16 Oxfam’s emergency market assessment tool, Annex 23.17 CARE International Cash Based Interventions decision tree, and Annex 23.18 Markets Information for food insecurity Response Analysis (MIFIRA) decision tree. These can be used in EPP processes and for longer-term food security programming.

Supplementary feeding

One area of mounting concern is around traditional responses to moderate malnutrition in emergencies. For the past 50 years, supplementary feeding programs (ESFPs) have been a standard component of emergency nutrition response in large emergencies. ESFP protocols aim to prevent mild and moderate individuals from becoming severely malnourished and treating those with moderate malnutrition hasn’t changed much over the years (Nutrition Cluster Toolkit, 2008). Evidence of the efficacy of ESFPs is limited and a study has brought its shortcomings to the forefront (Navarro-Colando, 2007). Consider the following:

• SFP interventions need to be grounded in sound situation assessments that determine that SFPs are appropriate given the situation. Assessments should consider the likelihood and magnitude of default, non-response, and coverage. If implementation takes priority over assessment, SFPs should be re-evaluated at the first chance.
• Intervention needs to be supported by staff with expertise in nutrition in emergencies.
• Overall design: clarify roles and objectives of the emergency SFP ( two to consider: firstly, the treatment of individuals with moderate malnutrition and preventing the development of severe acute malnutrition in such individuals; and secondly, reducing the high levels of GAM at population level).
• Project reporting should include: clear and common definitions of outcome categories, clear and common statistical treatment of age groups and special groups, standard presentation of outcome statistics, and reporting on outcomes of patients that have not recovered.
• Defaulters: Reasons for defaulting should be examined and the program adjusted as necessary. The final outcomes of defaulters should (through surveys or defaulter tracing) be determined to actual mortality and recovery rates of programs.
• Outcomes of patients classified as non-respondents should be evaluated and program design adapted to reduce non-response.
• Coverage surveys need to be undertaken to assess the quality of screening and evaluate the potential impact of the program at the population level.

See this glossary on the terminology related to nutrition:  http://blog.actioncontrelafaim.org/wp-content/uploads/2013/06/2011-ACF-Nut-glossary-ENG.pdf

See Annex 23.17 UNICEF framework for causes of malnutrition, and Annex 23.18 Navarro-Colorado C.  A Retrospective Study of Emergency Supplementary Feeding Programmes. ENN/SC UK. June 2007.

Gender issues need to be mainstreamed into food security. Men, women, girls and boys  are affected differently by emergencies, and have different access to markets, finances and resources, including food and livelihood resources. Not having a comprehensive understanding of the target group’s gender roles around household food security may cause interventions to fail. For guidelines on mainstreaming gender considerations in food security projects, refer to Annex 23.19 Women, girls, boys & men: Different needs-equal opportunities. See also Gender.

Access to food in a food-insecure environment is a key source of power, and always carries a risk of power being abused. All food security programmes must put in place strategies to prevent and respond to sexual exploitations and abuse. For example, ensuring a gender balance among field staff and food distribution teams should be an initial priority to reduce this risk. There should also be a strong focus to ensure functional accountability mechanisms are established. For more guidance, see Chapter 33 Prevention and response to sexual exploitation and abuse.

Food and nutrition insecurity is an outcome of a range of factors that must be considered to address any immediate crisis and long-term causes. Food security crises are many times the acute manifestation of chronic underlying processes. In the short term, these symptoms might have to be addressed with a transitory response. A response to a food crisis should be one component of a broader, comprehensive approach by linking relief with development work and not waiting for an emergency before addressing chronic poverty. Chronic needs should be addressed directly through social protection, not through relief. See Annex 23.20 Agricultural rehabilitation: Mapping the linkages between humanitarian relief, social protection and development.
When considering the links between long-term and emergency food security interventions, it is vital to start with a thorough understanding of people’s livelihoods (for instance through an HEA study or review). A livelihoods-based response offers greater potential to link and support longer-term interventions. The importance of in-depth local knowledge of people’s livelihoods from a long-term presence in a specific area should not be underestimated.
The EPP process is a key mechanism to bridge emergency and long-term food security interventions. The EPP should integrate both a longer-term perspective into emergency food & nutrition security interventions and a disaster risk reduction approach into ongoing long-term programming. A draft set of food & nutrition security specific EPP guidelines is available by contacting the Emergency and Humanitarian Assistance Unit (EHAU) (emergencyfoodsecurity@careinternational.org).

In addition, recent research and analysis clearly demonstrates the solid returns on investment in risk reduction and the value of pursuing a twin track approach to food security that links emergency responses with longer-term resilience-building. As a result, emphasis should be given to dynamic risk management approaches that recognize the complexity of food systems, the benefits of responding to shocks in ways that better link relief and development and the importance of contributing to stability and building lasting resilience.

Food and Nutrition security programmes should ensure that effective monitoring and evaluation systems are in place. The monitoring shall align with the indicators specified in the Emergency Food Security Sub- strategy. Additionally the monitoring and evaluation should embrace the broad agreed upon humanitarian measurements like the Sphere minimum standard for food security. See more in Monitoring and evaluation.