Food aid in action / interview with Peter L. Pellet

Interview with Peter L. Pellet ][) r Pellet, you have just come back from a mission to Africa to look at food aid Can you tell us how it works? The country I visited is in a paradox- ical situation. It is well organized with a very good primary health care system available to 80% of the population and yet, at the same time, there is extreme poverty and desperate malnutrition. I saw food aid functioning in the village health centres: I saw undernourished mothers holding emaciated infants being examined by health staff and then being given food. Their children were specially vulnerable and probably would not survive without help. That is food aid at its simplest, working effi- ciently to reach those in greatest need. One of the criticisms of food aid is that it introduces food that changes eating habits and makes people dependent on imported foods. It is true that, on some occasions in the past, food that was brought in from abroad was not in line with traditional diets. But I think that the organizers of food aid are now sensitive to this problem. In the country I visited maize meal was distributed to adults. And that is the traditional food? Yes, that is the local staple food. A weaning food for babies has also been developed in that country, based on WORLD HEALTH. July-August 1991 maize meal. The sort of food aid that hits the media headlines is that distributed by the truckload to refugees or popu- lations struck by famine. Did you see any of this emergency aid? The country I just visited has a very humane way of dealing with this sort of situation. There are refugees settled in camps and others in villages along the border. When you come to a health post in this region you will find that they are caring for both locals and refugees and that food is available to all. Similarly, local people going to a refugee health centre would receive treatment and possibly, if they had a malnourished child, food as well. Ut71at about longer-term prospects for refugees? Increasing emphasis is being put on developmental assistance. Of course, at the onset of a crisis resulting in an influx of refugees, the priority is getting the food to them. However, where the situation is protracted, food aid and other types of assistance are used to promote the refugees' self-reliance, mainly by training for a lucrative activity or by giving them access to land to cultivate. As a long-term solution, is it better to give people food to eat or to help them to produce their own? Aid for development is the real answer, using food aid to help people produce more and better food themselves-helping them to improve food production by forming coopera- tives and digging wells, for example. There has been a dramatic change over the last 10-20 years in the way nutritionists look at the world. We know now that malnutrition exists not only because there is not enough food to eat; it is also related to eating habits, to the way food is prepared in the homes, and to diseases such as diar- rhoea, intestinal worms and malaria. But the root causes have to do with how society functions. In the country I visited in Africa the small farmers are in the "poverty trap" and they cannot get out of it because they have no capital, so no access to loans to buy seeds and fertilizer or to dig wells. They are doomed to continue producing the cheapest products in small quantities. Food aid might enable them to work on their own fields rather than to go and work on the big sugar, tobacco or coffee plantations in order to emn money to meet their essential needs including food. Thus food aid has to be combined with, for example, the provision of quality seeds or cheap loans. Such combined programmes could help small farmers get out of the poverty trap if the underlying problems Food aid has to respect the cultural preferences of the receiving countries. 11 Food aid in action of land distribution and agricultural policies promoting the production of cash crops for export were solved. How can those responsible for health have any influence on agricul- tural polices? Ministries of health do their best to keep their populations healthy by running campaigns against tobacco or in favour of healthy eating, but it is true that, at the same time, other ministries have sometimes promoted policies that are positively harmful! In the past, ministries of health have had little influence on overall socioeconomic policies. Fortunately, there is now generally a much better understanding among politicians and senior administrators in all sectors that policies relating to agriculture, prices, etc., influence health profoundly---for better or for worse. Serious consideration must be given to this fact before new policies are decided upon. In a nutshell, health promotion through healthy public poli- cies involves different sectors. Food aid can provide important support to the implementation of coordinated policies especially in areas characterized by widespread poverty. In the meantime, feeding programmes for vulnerable groups like pregnant women make it possible to give birth to babies who are not underweight and will have a good start in life. What is the role of the health sector in other types of food aid projects such as rural development and settlement projects? For example, smaller water impoundment schemes which aim at increased productivity through irri- gation may contribute to the dissemi- nation of malaria vectors or schistosomiasis. In larger schemes involving resettlement, in addition to the health risks I just mentioned, there are other problems such as people moving to areas where there are endemic diseases to which they are not immune or settlers bringing in new diseases. The spreading of schistoso- Children in a refugee camp enjoy a hot meal; good food is an absolute necessity in such circumstances. j I Local produce makes a nourishing meal for a young African child. Food aid should start by encouraging people to become self-sufficient in food. miasis is a typical example. Some of these projects are indeed supported by food aid. Settlers would receive food assistance for, say, two or three years to ensure that sufficient food is avail- able to them until they are able to meet their basic needs from farm income. I would like to repeat again, any kind of a project whether sup- ported by cash or food needs proper planning, assessment, analysis and continuous monitoring of positive and negative aspects. If these steps are not taken the use of food aid as well as of any other developmental resource is not justified. Could it happen that the food aid prevents real changes for the better? It might be that food aid could lull governments into a false sense of security because the immediate prob- lem was being solved. They could be tempted to pay less attention to social issues such as land distribution which we mentioned earlier. Crucial deci- sions for their solution may be difficult to take for political reasons, but must be taken if the problems are to be solved. On the other hand, the targets for food aid are people who have suffered from the deteriorating economic situation and from the change in economic and social policies called "structural adjustment". It would be unwise to withdraw food aid, because those "structural adjustment" programmes also aim at reducing social expenditure, particularly on edu- cation and health programmes. WORLD HEALTH, July-August 1991 Can food aid help to alleviate the negative effects of these new policies? Yes, because food aid is not only aimed at giving food to the hungry, but at helping them to improve both their health and their family economy. Food aid for agricultural and rural develop- ment is one example among many others. Another, lesser known example is selling food from food aid in small quantities at cheap prices directly to the beneficiaries, or in shops and markets. This has to be done in such a way that it does not restrict local food production by reducing the price of local produce to a point where farmers are discouraged. The money collected is then used to provide cash support to development projects in the poorest areas of the country. Food aid can provide the momentum for local development, both increasing food production and income and improving living condi- tions in general. So we could sum up by saying that food aid, if it is carefully planned to reach vulnerable groups, taking local food habits into consideration, and is aimed at promoting local agricultural production and development in gen- eral, is an excellent means of both combating malnutrition and helping countries to improve their socioecono- mic situation. • •;; Professor Peter L . Pellett 1" is with the Department of Nutrition. Un"iversity .;;of Massachusetts. Amherst. Massachusetts 01003, USA " w T' he World Food Programme (WFP), the United Nations Food Aid Organi" zation, started operations in 1963. WFP is now the second largest funding agency in the UN system.Jt is responsible for about 20% of all foOd aid, which it provides in two ways: ~' emergency food aid in acute hunger situations or following natural disasters or war, valued at US$ 246 million in 1990; - support to socioeconomic devel- opment, particularly in programmes for health, education, agriculture and rural development. In 1990 food worth US$ 436 million was provided for such projects. The'World Food Programme in the community ..• WFP<aims at assisting the poorest popu- lations. Women constitute an important percentage of beneficiaries, either indirectly when they or their husbands receive food as part paymel)~ for"working on a develop- ment project, " or directly when tood is distributed through health centres and hos- pitals. Much food aid is' channelled through feeding programmes as an incentive to pregnant women and," breastfeeding mothers to attend regular health care ses- sions at their local health centre. lt is also used to encourage an increased attendance of female students in" nursing schools and to support professional training program- mes for women. Food aid also provides· food to disabled people and those with chronic diseases such as tuberculosis or AIDS. How people live is important for their health. Support is therefore also given to providing clean' water supplies: and toilet fac:ilities, improving homes, and cleaning up' market-places. In Latin America, a house-improvement scheme is reducing the number of disease~carrying .insects. ..• in schools ... "People who can read and write find it easier to understand health education and information programmes and thus to adopt healthier life-styles and to cope with disease. In areas where many people are illiterate, the infant death rate is higher. If food is served at school, parents are eager fot their children to attend. Food aid used for school meals results .irt healthier chil- dren, and when they are not hungry they leam more easily. WF,P also f inances pro- grammes in schools "to promote · personal hygiene (su~h as washing hands before eating), immunization against childhood diseases, and treatment of intestinal worms. ... and in hospitals WFP makes more than US$ 42 million worth of foOd available to hospitals in 14 countries. This ensures not only better food . for the patients but also savings in the hospital budgets that can be used to treat more patients and provide better care. WFP helps finance the purchase of medical supplies and equipment, the maintenance of existing equipment. and part of staff salaries. Correctly used, food aid can do much to improve health. In order to get the best health effects from its activities, WFP works i~ close collaboration with WHO.