Food Security and Nutrition Integration into WFP s Food and Nutrition Analysis in the Sahel

Transcription

1 Food Security and Nutrition Integration into WFP s Food and Nutrition Analysis in the Sahel November Technical Background Paper Prepared by: Friederike Bellin Sesay On behalf of: WFP ODD Dakar This document has been produced with the financial assistance of the Canadian International Development Agency (CIDA). The views expressed herein can in no way be taken to reflect the official opinion of CIDA.

2 Table of Contents Introduction Part 1: Some Conceptual Aspects Concept of Food Security and Nutrition Security Discussion of Malnutrition Prevalence Rates Part 2: Comparison of studies Objectives of the Studies under Review Sampling Methodology Data Collected Type of Analysis Conclusions and Recommendations Part 3: Concrete Proposals for Study Improvement General remarks Objectives Sampling Data Collection Type of Analysis Concluding Remarks Part 4: Food Security Monitoring Introduction Some Conceptual Remarks Continuous Food Security Monitoring: Basis for Project Action Ethical Considerations Chad - Food and Nutrition Security Monitoring Mauritania Food and Nutrition Security Monitoring - Vulnerability Monitoring Mali - Food Security Monitoring Further observations and recommendations Part 5: Proposal for a Standardized Food Security Monitoring 2

3 Strengthening the Integration of Food Security and Nutrition in WFP s Work in the Sahel Introduction According to the terms of reference the aim of this paper is to: 1. prepare a technical paper to review the data collected and analyzed on the nutritional situation in the context of WFP s food security analysis, food security monitoring, nutrition surveys and comprehensive Food Security and Vulnerability analysis (CFSVA), and identify critical conceptual and analytical issues, and propose concrete ways forward to solve them. 2. assist in the preparation of a workshop in which the findings of this review will be presented and discussed The aim of this paper is definitely not to criticize any of the studies done in recent years. It is well known how studies have to be squeezed in to the daily work how much resources they take, how little time, personnel and money one has in order to do them. We all wish for optimal conditions under which we could carry out our duties. How much time should be spent on big surveys, how much more time would we need to intervene and to monitor interventions? These are critical points to be addressed in this paper. As we can see from table 3 in the annex, a broad variety of data has been collected over the years in the countries concerned. The question one needs to ask at this point is, irrespective of whether this information is useful and interesting; does it really help in identifying the target group for our intervention? We have done hundreds of surveys worldwide more or less carefully done. We have weighed and measured millions of children, we have a wonderful causal model on malnutrition in children and the analysis could try to show the linkages in the model. Sometimes we succeed in showing significant differences between socio-economic groups, sometimes we can proof that dietary intake has an impact on the nutritional status sometimes we cannot. Sometimes there is confusion if we talk about an integrated nutrition and food security approach as people tend to have a different notion of nutrition (security) on the one side and food security on the other side. Therefore, this paper will be structured in the following way: The first part of this review will focus on some definitions and theoretical aspects of the topic strengthening the integration of food security and nutrition in WFP s work in the Sahel. The second part of this review will be based on the TOR outline and will provide a kind of summary on the - objectives - sampling methodology - data collected - type of analysis - conclusions & recommendations 3

4 It has to be pointed out that the summary, especially on the type of data collected, was extremely tedious and time consuming as they have been assessed and presented in different ways and were sometimes only cited in the context of explaining some of the findings. The order in which data have been presented varied from one to the next report. Therefore, it is possible that the table is incomplete to some extent; however, it is enough to serve the purpose of this comparison. The third part will then come up with some proposals, which should be discussed in the upcoming workshop beginning of October in Dakar. The proposals of this report should be seen as an inspiration for discussion they might be provocative to a certain extent but they will seek in any case practical solutions in order to improve data collection and more so the use of them in our daily work. The following surveys were considered in the present paper: 1. Burkina Faso (2004): La vulnérabilité structurelle a la sécurité alimentaire en milieu rural 2. Burkina Faso (): Enquête nutritionnelle de base (draft) 3. Mali (2005) : Analyse de la sécurité alimentaire et de la vulnérabilité (CFSVA) 4. Mauritanie (2005) : Analyse de la sécurité alimentaire et de la vulnérabilité (CFSVA) 5. (2006) : Enquête Démographique et de Sante et a Indicateurs Multiples (EDSN/ MICS III 6. () : Enquête conjointe sur la vulnérabilité a l`insécurité alimentaire des ménages (données de 2006) 7. Tchad (): Draft report The reports of Mali and Mauritania were both not available at the time of this review. These data could be included at a later stage. However, for the sake of the objectives of this review, these two reports will most likely not change the outcome and recommendations of this review. Finally part 4 will have a look at the Food Security Monitoring tools in place and propose concrete ways forward. 4

5 Part 1: Some Conceptual Aspects Concept of Food Security and Nutrition Security There seems to be common misunderstanding and disagreement between food security specialists and nutrition security experts. Food security specialists are emphasizing the fact that their concept entails availability of, access to and utilization of food in order to live an active and healthy life. They acknowledge the importance of health in order to be able to make best use to the available and accessible food. However, the concept ends with the acknowledgement of the importance of health. Interventions in the medical field, however, are rather scarce. Food security is at the same time highly dependent on healthy and well nourished people as an important precondition to take part in economic activities. The concept of nutrition security could be explained best using the famous and often cited UNICEF model, which will be presented here in another adapted version. Instead of using the negative model resulting in malnutrition and death, the model below is looking at positive impacts. Thus nutrition security (expressed by the nutritional status of the population) is positively influenced by adequate health and adequate food intake. The underlying conditions are food security, care and functioning health services and good environmental/ hygienic conditions. In this context the importance of food security in terms of achieving a good nutritional status is very obvious and we could as well extent the food security concept to the level of dietary intake which includes the utilization of food. The fact that dietary intake and health status are depending on each other is demonstrated by the overlapping circles. Nutrition Security Dietary Intake utilisation Health Situation Food Security Availability Access Care Services/ Hygiene Education 5

6 As to the understanding of nutritionists, the complete UNICEF model comprises the concept of Nutrition Security as expressed by the nutritional status, whereas Food Security is one but very important part in the overall concept and is marked with green letters (left side of the model). The UNICEF model, however, does not give us any idea on the impact of each of these underlying causes on malnutrition. In this context it is useful to cite the study on Overcoming Child Malnutrition in Developing Countries (IFPRI 2000) in which the authors were trying to identify the main reasons for improving nutrition between 1970 and Both, improved food availability and improved health environment contributed with 26.1% and 19.3 % respectively. However, the most important impact came from the education of women (43%) and their social status (11.6%). This fact helps us to explain, why we find sometimes very high rates of malnutrition in so called food secure areas or the food baskets of countries. There is a need to ask for the correct entry point. We can identify the status of food security and the nutritional status of people, we can try to find out the linkages and whether or not there is a significant relation between the two. We need this information from time to time in order to describe changes. But does it really matter to discuss, which one is more important? For example: if we find out that there is no access to safe drinking water but we cannot show a significant impact on the nutritional status. Does this mean the improvement of drinking water is not important? What does it really mean if we cannot prove the impact of drinking quality water on the nutritional status? It simply tells us, that the entire population is affected. 6

7 Discussion of Malnutrition Prevalence Rates It is sometimes useful to present data in using the bell shape normal distribution curve. The curve below was taken from the Guinea Bissau Baseline Survey If we plot the results of any of the countries under review, we will find out that the distribution of our study population is normal as well. However, it has shifted towards the left side which means an increasing number of children are falling below the 2SD of the reference population. If we look at the right side of this distribution, we find out, that even here there is a shift towards the left and even the children plotted on this side have not reached their potential. The insignificance of our findings could be thus interpreted in the following way: the entire population is affected by poor sanitary conditions and therefore we cannot find any significant impact on the so called malnourished children alone. The prevalence rate is providing information on how much the bell shaped curve has shifted; it describes the degree of malnutrition in the entire population. 7

8 Part 2: Comparison of Studies Objectives of the Studies under Review As can be seen from table 1 (Annex), the objectives of the studies under review were rather mixed. They range from very broad based aims providing information to characterize vulnerability towards food security or characterize and better understand malnutrition in children and women. Sometimes they focus on the nutritional status of children and women. The two nutrition studies done in Burkina Faso and Thad came up with similar specific objectives on nutrition, whereas the vulnerability studies in Burkina Faso (2004) Mali (2005) and Mauritania (2005) have similar specific objectives towards food security. This fact shows clearly, that nutrition baseline studies and vulnerability studies have quite a different focus. In the case of the CFSVA Mali a range of additional objectives have been mentioned which focus on better understanding of vulnerability and some of the underlying factors. It seems to be important to agree basically on why studies of this dimension take place and what should be there immediate benefit. It will be necessary as well to agree on the frequency at which these studies could be carried out. This again is depending on the main objective of the survey. And finally, looking at the objectives mentioned in these studies, one should as well investigate whether or not there would be alternative methods that would be less expensive and time consuming and would even provide more detailed answers. This is especially true for the question of vulnerability. If the aim is to better understand vulnerability, more qualitative approaches seem to be appropriate. Sampling Methodology Basically three different approaches have been described to define the sample: - Double stratification, starting from regional level down to villages from which households are chosen at random - 30 by 30 cluster approach - definition of sample size by the expected prevalence of malnutrition in the regions under survey As long as the sampling is done properly, survey results will be representative and thus comparable as long as the same indicators were used. The kind of sampling depends on administrative conditions, the availability of census data etc. Therefore, a harmonization in this context will not always be possible. However, there is another issue that should be discussed in the context of sampling which is the sample size. The range goes from more than 1800 households as far as households. This requires a huge number of enumerators, including their logistical requirements, transport and supervision. It takes a toll on data quality if the above-mentioned conditions are not sufficiently met. There is no need to discuss the adequacy of sampling, representation and comparability, if data quality cannot be assured. Standard deviations become meaningless if anthropometric measurements are not done correctly. In 1998 a baseline survey was conducted by an integrated food security project in Haiti and two different consultants did the data analysis. As they came up with conflicting data there was need to go back to the questionnaire. These questionnaires were the key to the whole problem. They were carelessly filled, data entry was partly false as well and it was obvious 8

9 that most of the problems could have been avoided if close and timely supervision would have been in place. It is frustrating to say, but if data quality cannot be assured, which need a lot more supervision and expertise, a survey maybe unethical due to useless data and thus waste of time, money and resources on all sides. So the question should be allowed as well, what could be a manageable and adequate sample size. Or do we need very exact quantitative data for all of these indicators. Can we replace them by more qualitative approaches? Robert Chambers was asking in the context of PRA, what kind of precision is really necessary to better understand a situation? He was appealing for appropriate imprecision. Where should we rely more on the assessment of qualitative data (PRA, focus group etc) from which we might even get a deeper insight not only of what is happening but even why. We might be closer to people s realities and could thus intervene with more precision. Again this needs to be discussed an agreed upon. Data Collected Since the objectives of studies are so different and sometimes unspecific, the data being collected in the various studies differ from each other as well (see table 3 in annex). Some of the differences in data collection are unavoidable others do need some harmonization. Last but not least, some of the questions seem to be interesting but may not be necessary in the context of the survey. Ethical considerations should be attached to the surveys. Each and every survey is not only demanding time and resources from the side of the project but more so from the respondents. If questionnaires are too long, they take a lot of productive time from the respondents for whom the purpose of our endless questions is not really clear. What is the expected information from a question and what are we going to do with it, once we have the answer? We should turn around each and every question in order to value the importance in the context of understanding food insecurity and malnutrition. If we have a look at the anthropometric data, most of the studies looked at children under 5 years of age except Burkina Faso (). This study limited the data to children up to 3 years of age. The anthropometric indices used are different as well. In three cases (Burkina 2004, Mauritania 2005, ) there was no analysis done for underweight (weight/age), even though the information was available and the existing software could provide this information easily. But more important is the fact that only one study (Burkina ) looked at the presence of edema, which is a marker of severe malnutrition and which will have an impact on the weight of children! Only one study looked at the MUAC of children (Burkina ). The nutritional status of women was assessed only in Burkina () and Chad (). Whereas the study in Burkina looked at BMI and MUAC of pregnant women and mothers, the study in Chad included only the BMI of mothers. There is still some need to discuss the indicators for malnutrition in pregnant women. It has been widely agreed that the use of BMI is not a valid indicator. WFP is using MUAC for targeting purposes. However, the study in Burkina Faso shows that there are completely different malnutrition prevalence rates between MUAC and BMI of women. The baseline survey done in Guinea Bissau on behalf of WFP showed as well, that MUAC does not seem to be a good indicator for the identification of malnutrition in women. Childcare indicators (breastfeeding, dietary diversity, weaning) varied substantially between the studies. In some cases, there was no information at all in other cases too many questions were asked. One has to ask for the added value if the question, how often mothers breastfed 9

10 their children during the last 24 hours, is asked (Burkina ). Knowing the breastfeeding on demand philosophy and even the fact that children might suck for 10 seconds and leave the breast, this information will not really help! The assessment of dietary diversity of the child s diet is difficult to compare as well, as different scores and different age groups have been considered. The composition of a weaning porridge was assessed only in Burkina (). Once the dietary diversity will be assessed at household level, it might be enough to do some qualitative assessment on child feeding behaviors as the information gathered from this could help in designing appropriate nutrition communication messages. In terms of childcare there are certain aspects that might be very relevant, especially the presence of a road to health card and the number of weigh measurements registered during the last 6 months. The Growth Monitoring and Promotion (GMP) system could play a very important role if it is functioning properly. This will be further elaborated in the recommendations. The completeness of child immunization is as well a very good proxy indicator of childcare. Looking at the immunization against measles alone could simplify the assessment. However, this has been assessed only in Burkina (), Mali (2005) and Mauritania (2005). There is a big variation in the assessment of morbidity data in children. Some studies used the last 7 days and some the last 2 weeks. That will make it impossible to compare the data between countries. The information gathered on women was very difficult to compare as the questions tend to be overlapping between mothers of children and/ or pregnant women and sometimes it concerned both sometimes not. Sometimes, questions should be related to the household level as such (e.g. use of health facilities) and sometimes the mere fact that women use health facilities or not would not explain their reasons for doing so. Even in this section a lot of questions might be replaced by focus group discussions, which help to understand much better some of the behavioral issues, attitudes and constraints. It is not in the scope of this paper to discuss each and every indicator used in detail and therefore there is still the appeal to check the necessity of each and every question in the context of what this information will be used for in the end. If we are running a malaria prevention and control program it is important to know the prevalence rate of preventive measures in the field. If we do not have any objectives to work in this field, what is then the use to collect this information? The last section of this comparison deals with village and household level. Whereas at the village level it might be useful to collect some of the information through focus group discussions and key informant interviews, the household level could still include some of the data, which have been assessed in the various studies. Some of the socio-demographic data collected in the surveys might not be necessary to explain household food security or nutritional status but they will definitely help to understand, whether the sampling was adequately done. As can be seen from the table there was not systematic assessment of this kind of information and there was no comparison as to whether there might have been a bias in sampling and why. Especially in this section it can happen that some of the information was cited in the report under a different section, therefore the completeness of the table is not 10

11 assured. In addition, not all questionnaires that have been used were under review but the information compiled in this report is deriving from the reports only. Looking at food security (availability of and access to) as one important precondition for a good nutritional status and looking at the aspect of integrating and combining the two concepts, the information on agriculture and livestock activities as well as income variables and market information should be of big importance. The more nutrition related surveys did not pay attention to these variables (Burkina, Chad, and 2006). Those studies looking at vulnerability towards food insecurity obviously considered this information as important! However, the indicators used to describe food insecurity and vulnerability varied. Some looked at access to credit, some at the adequacy of stores but only very few considered the coping strategies. What does it mean if cereal stores are adequate or not. What are people doing if they do not have cereals on stock? And obviously, people deriving their income from livestock or other economic activities do not rely on cereal stocks. Some studies have collected data on life conditions (water, housing, latrines) at household level. Again this is information that can hardly be compared. First of all, not all studies collected information, secondly one has to ask, whether they help in identifying the target group. The mere fact that households collect water from a tap or well would not explain whether water is stored properly in the house, whether hygienic conditions are adequate. In terms of improving living conditions this information might be useful at village level (kind of water source and distance) and the assessment within such a survey should be discussed. How are we able to capture all relevant aspects of vulnerability and food security to enable comparison and classification? Qualitative assessments, using the PRA methodology, have been very useful in the past to identify the poorest and most vulnerable households in communities. People have the chance to use their own notion of vulnerability and they do this with much deeper knowledge than outsiders. These criteria may be different within regions and countries but it helps to bring assistance to those in need and this should be one of the most important objectives of our efforts. The main finding concerning the data collection is that we need to harmonies and simplify our surveys. There should be a core set of indicators that should be used in all surveys. Section three will provide a concrete proposal that would need to be discussed during the workshop. This core set of indicators should be valid for all implementing partners and should be assessed maybe all 5 years in a concerted effort. In between, the different implementing partners would need some monitoring and process indicators, which will enable them to identify target groups, assess the quality and quantity of interventions etc. These could be achieved through for example existing Early Warning Systems, qualitative assessments at village level etc. 11

12 Type of Analysis In terms of statistical methods used, there is a big variation between the reports (see table 4 in annex). The range is from very basic descriptive statistics (frequencies and percentages without SD) to multivariate regression analysis and very special tests (Burkina ). It would have been tedious and partly impossible to compare these methods and in any case it would have needed an expert on statistics to validate some of the methods used in the analysis. Therefore it is not the aim of this paper to go into depth of all this statistical methods. However, at this point the question should be allowed: How complex should be statistical analysis be in order to serve the purpose? or How simple could it be so that it provides the necessary information and will be understood at the same time by practitioners in the field? One of the main aims of conducting big surveys is to have the possibility to compare to either previous studies or the situation in neighboring countries. Except in the case of the Chad report in which a comparison was made (stating that there was no change from 2005 to 2006 and finally in terms of the percentage of vulnerable food insecure households) none of the reports did. In case of Burkina Faso () there was only a draft version available. In this case it might be possible that this comparison will take place in the near future. In terms of food security analysis different data were used to describe availability, access and utilization of food. In Burkina () and (2006) due to the absence of food security data, there is not such kind of analysis. The utilization of food, which was measured using food frequencies, expressed in different food diversity scores, is subject of another paper. Therefore it should be stated at this point, that the scoring used in these studies differs from each other. The presentation of determinant analysis of malnutrition was done very differently as well. Malnutrition was analyzed in relation to either only health indicators sometimes health and dietary diversity, sometimes looking at education, or in other cases the food security classification. Some of the determinant analysis did not use statistical tests but just the summary of findings and observations. Conclusions and Recommendations As the conclusions of the studies were either a summary of findings or an integral part and mentioned during the discussion of findings, this report is not looking at the conclusions but the recommendations that should follow subsequently. Recommendations were still missing in the case of Burkina Faso () and (2006) due to the fact that these were still drafts. Despite the fact that the report for () was a final version, there were no recommendations at all. The other recommendations have been structured around the topics of food security, nutrition and markets. General recommendations were spelled out in the Mali report. However, they were not based on the findings of the study and could have been given without any tedious survey exercise. The recommendations listed under the food security section in the Mauritania report are very general and not very specific, too. The same is true for all the recommendations under the nutrition topic. 12

13 The Chad report tailored the food security recommendations to regions and special groups within the survey population e.g. displaced people. Burkina Faso (2004) structured the food security recommendations under the topics of availability, including stability, access to food and finally to social services. These recommendations are very general as well and most of them could have been spelled out without any survey. Finally the nutrition recommendations from the Mauritania report are hardly based on the findings of the survey. The call for another survey in urban areas or the demands for simplifying weaning recipes are just two of them. Once more, these findings are not pointed out in order to criticize the authors of the reports! One has to come back to the objectives of the surveys and maybe the 5 main questions from the VAM thematic guidelines on nutrition and health (2005). 1. Who are the foods insecure? 2. How many are they? 3. Where do they live? 4. Why are they food insecure? 5. Does Food aid have a role to play? We should ask whether the surveys under review are really tailored to answer these questions? In the light of integrating food security and nutrition, the questions to be answered should change as well. And if we can agree, that surveys should be compared to earlier ones the following questions would arise: 1. Was there any change in the numbers of food and nutrition insecure people? 2. Was there a shift from one to another region? 3. If there was a change can we identify certain events, interventions etc. that would enable us to explain the changes? But there are many more questions to be asked in the context of these surveys under review 1. Why does it happen so often, that one asks for a particular survey report and the answer given would be, but be careful with the data, we don t rely on them too much. 2. How often should we carry out big surveys with sample sizes exceeding 1800 households? 3. Do these representative surveys really help in identifying the target group in our daily work, and if yes, to which extent? 4. What kind of information is necessary in our daily work in order to better target the malnourished and food insecure people? Finally, one needs to look into the core indicators that should be used to describe the nutrition situation in a country and which would allow for comparison over the years and between countries. There may be many more questions, a lot of them have been addressed already in the workshop Linking food security and nutrition held in April this year and I fully agree with the statement that we have to simplify the surveys while at the same time integrate food security into the wider concept of nutrition security.47 13

14 Part 3: Concrete Proposals for Study Improvement General Remarks First of all it is good to know that WFP is seeking to do project work on the basis of well documented data and above all is trying to improve the work in relation to this. It is as well appreciated that WFP and UNICEF are seeking together with other partners to complement their activities in the countries under review. Moreover it is well recognized that WFP is seeking a more complex approach to food security trying to incorporate nutrition considerations. However, there is need to agree on one concept and a mutual understanding of what we mean by nutrition. Nutritionists are the most misunderstood species of experts in the field. People consider them as those weighing and measuring small children and maybe women and give advice on what and how to eat. The concept presented in this report is talking of nutrition security rather than nutrition and presents food security as a very important integral part of nutrition security. Therefore, the proposals, which will be presented in section three, are based on this understanding. Nutritionists become all over sudden managers of complex situations. They are not specialized in the field of agriculture, health or any other sector but they could take lead in directing all these activities towards the overall goal of reducing malnutrition and thus improving nutrition security. Objectives According to the VAM Nutrition guidelines, the main objectives of VAM studies should be to answer the following questions: 1. Who is the food insecure? 2. How many are they? 3. Where do they live? 4. Why are they food insecure? 5. Does food aid have a role to play? If the main aim is to follow a comprehensive food and nutrition security approach we should rather answer the following questions: 1. Who is the nutrition insecure? 2. How many are they? 3. Where do they live? 4. Was there any change as compared to an earlier assessment? 5. What are the main reasons for being nutrition insecure? 6. What can be done and by which organization to improve nutrition security? If studies and surveys were done as an inter-agency collaboration, the question of food aid would be incorporated into the more general question of what can be done, as other interventions need to be identified as well. 14

15 In fact, it is highly recommended, that in the near future studies of this importance would be carried out in collaboration and not one year WFP, next year UNICEF and one year later again another organization. The main objective would be to provide information in the nutrition security and to compare this information to earlier studies and neighboring countries. One last aspect would be the question: How often do we need to carry out these big surveys? If we take the anthropometrics measurements as the indicator of nutrition security we need to understand, that first of all a lot of interventions should take place aiming at the improvement of the underlying factors contributing to malnutrition. If we would like to measure changes that might be due to these interventions, we might repeat the survey after 5 years. We will have a new generation of under 5s who grew up under hopefully improved conditions. Therefore, it is strongly recommended to collect the data only after 5 years. In the mean time there are a number of monitoring data, which could be collected and would be definitely different from the one of the next organization. They will focus on the specific mandate and activities but will provide regular information on certain developments. In terms of nutritional outcome it is recommended to strengthen the existing Growth Monitoring and Promotion (GMP) programs. These programs have been repeatedly criticized as they were not carried out as expected. However, they do have a significant importance in many ways. First of all, the main aim of GMP is to prevent early child malnutrition. The program will help in identifying the malnourished children in the society. At the same time it can help to identify the main causes of weight stagnation or weight loss as health workers can document recent developments, like diarrheal episodes, fever or food deficits in the household. If the whole program is well documented it can contribute at the end of each month to an early warning system. The people carrying out GMP should only note down the number of children measured, the number of children loosing or stagnating in weight. If the percentage of children stagnating and loosing weight is increasing there could be need for some kind of intervention. A number of such monitoring indicators need to be identified for each of the immediate or underlying causes of malnutrition. This information does not need to be collected in the overall big survey exercises. In addition some qualitative research methods need to be applied as well to get a better understanding of certain findings. Sampling As has been stated in section two already, the sampling methodology depends a lot on the conditions under which a survey takes place. Therefore this paper will not give any advise on this topic. Data Collection The agreement on which data should be collected during a food and nutrition security survey will be the most difficult part to find consensus. As has been stated in the paper on the workshop linking food and nutrition (April, Rome), collecting too much information is as inefficient as collecting too little. It will be impossible to come up with the one and only list of indicators that should be used in all of the studies. There might be always a country specific reason to introduce some more questions or to modify. Therefore, the list presented 15

16 below should be considered as the basic minimum. In any case, it will be most useful if each and every question included in such a survey exercise should be questioned itself: Is it really necessary to ask this question? What is the use of having this information for programming purposes? Is there another way to get hold of this information? Which of these data should be part and parcel of a regular monitoring and thus be part of the monitoring system. These data do not need to be included in the big surveys. It might help to structure the necessary data assessment using again the UNICEF model. Apart from the information on household structure (size, composition, village) all the remaining core information should derive from the model. Nutrition Security/ nutritional status Children (stunting, wasting, underweight, MUAC, oedema) Women (BMI, MUAC) Micronutrient Malnutrition Dietary Intake Utilisation Dietary diversity scores Health Situation Morbidity Food Security Availability Agricultural Production Livestock Accessability Expenditure Profile Markets Care No of weight measurements Breastfeeding duration Introduction of weaning porridge (composition) Health Services/ Hygiene Road to Health Card Immunisation Toilets, Water Source Education mother, father As the results of the Burkina Faso Baseline Study () shows, MUAC is not a good predictor of malnutrition in pregnancy. It is recommended to exclude this information from the survey until a better indicator has been identified. If it is agreed upon that the survey should describe the situation and compare it to earlier studies, the nutritional status of nonpregnant women could be used to describe the situation of women in reproductive age. If there is an indication of micronutrient malnutrition it can be advisable to include relevant indicators. The easiest way to provide information in the adequacy of dietary intake is the dietary diversity score. The discussion on which score would be the most suitable is still ongoing. 16

17 The origin of food consumed could play a role here as well. However, there should be a discussion, if dietary diversity a good predictor for the need of food aid, as the food provided in such a packet may not have an effect on diversity. Case studies should be done in a much smaller sample to assess once in a while information on the quantity of the diet (e.g. 24 h- recall). The prevalence of diarrheal diseases, fever and ARI are the data mostly asked in surveys. However it is necessary to agree on the time span (one or two weeks). Data on agricultural and livestock production (availability) as well as expenditure profiles (access to food) are the most crucial indicators for food security. The regular assessment of the educational status of adults in the area requires as well some educational input for this target group. If the impact of the educational level of women is so evident, interventions should take place in this area. Education of girls will serve the purpose in the long run. If data presentation follows the UNICEF model in a similar order, the comparison of studies will be much easier. Secondly, there are a number of data that have been collected in recent surveys that do not appear in this list. As has been mentioned already, from the country context it could be important to include more data. However, some of the information could be collected instead in case studies or sub samples as they do not even require such numbers in order to be representative. Especially information on knowledge, attitudes and behavior (be it in terms of eating habits or sanitation) should not be part and parcel of a big survey exercise. Qualitative approaches seem to be more appropriate since they would even help to better understand the situation. The way to simplify a survey is as well not to have a part on pregnant mothers, on breastfeeding mothers and one on children. They all derive from one household and their situation in terms of morbidity, drinking water, latrines etc. is just similar. Thus it is proposed to structure a questionnaire along the big topics that derives from the UNICEF model. The comparison of data was so extremely difficult and time consuming, since information appeared in different sections of the report. Type of Analysis The analysis of data is calling for a twin track approach. On the one side, there is a great need to have a very simple and well-understood data analyses. Apart from simple frequencies and percentages, simple cross tabs could serve to better understand a given situation. Data presentation should be simplified even more if the results have to be presented at village level. Data presentation should allow the main actors in the field to understand and draw their own conclusions. In fact surveys are meaningful only, if data are taken to the field again to discuss their implications. This is of course not necessary in a PRA approach or any other qualitative methodology, as villagers are discussing their own fate in the PRA process. At the same time, there is need to present data using more complex statistical methods, in order to proof to stakeholders, politicians or decision makers the relevance of data. Data need to be crosschecked in many ways: for example looking at bias, inter observer errors, intra observer errors, normal distribution etc. This all would allow setting the data analysis on a 17

18 sound basis. This has to be done in the background and could be annexed to a report. In fact the need to even further explore the data calls for the cooperation with research institutions. The proposition in this context is to conduct future surveys in collaboration with universities and research institutions. This could as well be seen in the context of capacity building. The advantage of this approach is that the number of supervisors in the field could be augmented considerably, if MSc students from local and international Universities as well as junior staff from the organizations could be involved in the survey work. Data entry and analysis could be placed under the responsibility of universities. In a first step, a simple report with main finding could be produced for project purposes. MSc students who would be allowed to use the data to write up their thesis could do a more detailed analysis. Universities (local or international) would be allowed to further use data sets in terms of scientific research. This could help in the long run to e.g. find a better indicator of malnutrition in pregnancy. Students could as well be asked to clarify some of the topics in case studies, especially topics like knowledge, attitudes and practices that cannot be sufficiently covered by large-scale surveys. Concluding Remarks It has to be stated once more, that the findings presented in this paper are not meant to criticize any of the reports under review. The points raised should be discussed during the workshop and hopefully not only for the Sahel countries but worldwide. There is a tendency to do a lot of surveys and ask a lot of questions and one should always ask: do we ourselves would like to be asked all these questions? How much patience would we have if a researcher comes with a 20 pages questionnaire? What do we really want to find out with such a survey and in this context: what representativety is required in order to draw the necessary conclusions for our daily work? Instead of conducting big CFSVA surveys twice a year it is advisable to look at proper monitoring tools which would provide timely information on indicators that are likely to change and that could give a good insight on how the food security situation develops. 18

19 Part 4: Food Security Monitoring in the Sahel Introduction Based on the discussions during the workshop on food and nutrition security monitoring held from October 1 3, in Dakar the following section is meant to review the Food Security Monitoring questionnaires which are presently in use in the 5 Sahelian countries. Despite the fact that I was requesting the respective country officers to provide the most recent version of their monitoring questionnaire, it was only the country office in Chad that worked on a revised version of their monitoring tool. Of late I received through ODD the vulnerability monitoring questionnaire from. Basis of this review is as well the very detailed Food and Nutrition Monitoring questionnaire from Mauritania. Burkina Faso has attached the monitoring activities to the agricultural survey (l`enquête permanent agricole, EPA) since Since I do not have any questionnaire at hand, there will be no review in this case. However, I feel it s advisable to link activities to already existing tools, so that there is no doubling of efforts. Last but not least there is a report on the food security monitoring in Mali (2005: Suivi de la sécurité alimentaire a travers les sites sentinelles). In this case I will comment on Annex 1 of this report which entails a detailed list of monitoring indicators. Finally, some options for the way forward are proposed. It will reflect on the question whether to include nutrition into monitoring efforts and will come up with concrete proposals on which data to monitor, how often and the appropriate methods of data collection. Some Conceptual Remarks In the project cycle management there are different types of data needed. In the first place it is necessary to conduct a kind of baseline survey which serves to identify target groups, most vulnerable people, most affected regions and proper project interventions. Secondly, there is a need to install a Monitoring and Evaluation system. In general one should distinguish between two different types of food security monitoring: a) Continuous food security Monitoring: basis for project action These type of data should enable the project to monitor the food security situation in a given area and/ or for a specific target group in order to timely react to an upcoming food insecurity or food crises. A specific set of early warning indicators is necessary; this can be obtained on a regular basis and provides sufficient information on the food security situation. b) Process monitoring: input, process and output (e.g. food aid M&E). These data allow monitoring project activities in terms of the given input, certain processes and the expected output. Simple statistics on the number of food aid recipients, the amount of food aid, and the activities linked to these food aid interventions and the expected benefits are collected here. These systems are in place in all WFP projects. 19

20 Finally the project needs to have an impact evaluation which is due after a couple of years and this would hopefully provide the proof that project interventions that have been monitored before and were adequately in place, led to a positive impact. Continuous Food Security Monitoring: Basis for Project Action The continuous food security monitoring as an integral part of an early warning system is what is aimed at in this paper. In the first place it will be necessary to decide which data are needed; data that would serve the purpose of an early warning indicator. It is useful to characterize the various indicators of a baseline survey in terms of their likeliness to change rapidly or not. All indicators that do not change often are not necessary for the Food Security Monitoring. Such data comprise the distance to health facilities, drinking water quality, chronic malnutrition, etc. Secondly, there are indicators that would change according to seasonal conditions. The dietary diversity score would be one of them. One has to come back to the objectives of the food security monitoring surveys and maybe the 5 main questions from the VAM thematic guidelines on nutrition and health (2005). 1. Who are the food insecure? 2. How many are they? 3. Where do they live? 4. Why are they food insecure? 5. Does food aid have a role to play? Whilst the above mentioned questions should be clarified in a sort of baseline exercise, the questions for food security monitoring should rather be: 1. Is there any change in the numbers of food and nutrition insecure people? 2. Is there a shift from one to another region? 3. If there is a change can we identify certain events, interventions etc. which would enable us to explain the changes? 4. Do our interventions have any impact on the food security situation of our target group? For the design of a proper monitoring questionnaire two more issues are important: 1. It is essential to decide for each and every indicator the frequency at which these data need to be assessed in order to serve as a valid monitoring tool. 2. In consultation with statisticians it is necessary to reflect on the minimum sample size and sampling requirements. 20

21 Ethical Considerations Last but not least there are ethical considerations attached to all our studies and monitoring efforts. Even though FSM is no biomedical research, a look at the International Ethical Guidelines for Biomedical Research ( can help identifying some of the key issues. Guideline 4 talks about informed consent: Households that are repeatedly being involved in FSM activities must be informed about the reasons, the objectives and the outcomes. They do need to agree! Guideline 8 deals with the equitable distribution of burden and benefit: Doing interviews in households takes a lot of time. Is the burden we put on the households equitable to the expected benefit of their participation? Guideline 13 deals especially with vulnerable people: vulnerable persons are those who are relatively or absolutely incapable of protecting their own interest. More formally, they may have insufficient power, intelligence, education, resources, strength or other needed attributes to protect their own interest. Their interest could be to continue the day to day tedious work instead of answering to our questions. Therefore it is absolutely necessary to minimize our data collection in terms of sample size, frequency of data collection as well as the length of the questionnaires! Finally, in the process of looking at these questionnaires it became increasingly clear, that it would be appropriate to discuss with the people in charge of food security monitoring all the questions in detail to better understand the reasons why they feel it would be necessary to have this kind of information. Sometimes an outsider may not understand why questions are asked or why it may be necessary to monitor a certain indicator. Having said this, all the comments made in this paper should be seen as opening remarks for a future dialogue. Chad - Food and Nutrition Security Monitoring In the light of these aspects, I would like to comment on the Chad questionnaire, which has been revised after the workshop. In the first place it has to be clarified how often the Chad team would like to do this monitoring exercise and whether the households to be interviewed will keep on changing. In case they will go back to the same households, some of the demographic information in section 1 of the questionnaire could be left out for subsequent rounds. If surveyed households keep on changing in the different rounds the information will be necessary in order to have some comparison in-between the two different rounds. The same is true for section 2 of the questionnaire. If this is done in the same households this information does not need to be repeated. If households in the survey sample change, the information is relevant. The question about the adequacy of seeds is needed just once a year, it could be alternated by questions of growing conditions. In fact the question about seeds and 21