Malnutrition rates continue to climb throughout the world, and food/nutritional security interventions, particularly those targeting children, are increasingly turning to foreign food aid donations, economic development interventions, and agricultural subsidy programs to address the problem of malnutrition. Donors and implementers alike are asking whether the solutions to these problems lie in interventions involving fortification (adding nutrients to food), nutritional supplementation (provision of vitamins), commercialization (growing food on large scale to be sold in the market), and provision of food aid and therapeutic food (free or subsidized provision of food); or in promoting the use of local resources and traditional knowledge in local gardening or subsistence farming.

Operating in an HIV/AIDS-affected context magnifies the urgency of resolving these questions. People living with HIV (PLWHIV) are often at risk for food and nutritional insecurity due to the disease’s negative effect on individual and family resources. In response to this risk, Project Concern International organized the Africa Forum 2009 to strengthen the collective efforts of organizations working on the African continent in the areas of HIV/AIDS and Food and Nutritional Security. At the Forum, practitioners engaged in a debate about whether local gardens or fortification/supplementation/commercialization provide the most effective ways to address food and nutritional security in the context of HIV/AIDS. As with similar dialogues within and among organizations around the world, the debate at the Africa Forum generated much discussion, but little consensus.

The debate addressed questions such as:

• Can small-scale household gardens really meet the nutritional demands of the world’s increasing population, or are outside interventions necessary?
• Are nutritional intervention programs necessary for children in urban communities that lack access to land for farming and gardening?
• How do these two different approaches to food and nutritional security fit into the larger picture of sustainable development?
• Don’t children with specific diseases, such as HIV, require addition nutritional supplementation that cannot be obtained from simple household gardening systems?
• Are there particular situations where food aid and supplementation are appropriate?
• With the current downturn in the global economy, don’t people need safety nets to ensure health and nutrition?

A particular sticking point for participants was whether dire short-term needs or the demand for long-term sustainability should underpin the decision on which food and nutritional security approach to employ.

Arguments for greater use of food aid, nutritional supplementation, fortification, direct food transfers and commercial agricultural systems concluded that in the short term and the long term they are simply a cheaper – and easier – way to get food and nutrition to thousands of people, especially children. Gardens are risky: they take a long time to grow, they cannot be easily implemented at scale, they require energy to maintain that PLWHIV do not have or need to direct to other income-generating activities, and they need resources such as water, fertile soil and good quality seeds and seedlings, which may be hard to access. Furthermore, specific diseases such as HIV/AIDS, or specific circumstances such as pregnancy, require additional nutritional supplementation and therapeutic food, which cannot be obtained from simple household gardening systems. These are also often essential as immediate forms of treatment when situations reach their most dire: when children could die if they do not receive the nutrition from therapeutic food that they need; when people have illnesses that require special nutritional needs; and in post-conflict or post-natural disaster situations where there has been large population displacement.

The argument for local gardens countered that thousands of local resources can be used for foods and natural medicines. Furthermore, when food needs become dependent on outside funding and food provision, communities are vulnerable to external economic fluctuations, which local gardens can help guard against. Participants brought up cases of poor practices in the provision of food aid, such as long-term provision of minimally nutritious food. In terms of concerns about inputs and resources associated with gardens, it was argued that gardens require less space than people assume: “functional landscaping,” which utilizes all available space to grow food and takes advantage of the fact that many kinds of produce can be grown with little soil, opens gardening up to those who have little access to land, including households in urban areas. In addition, gardening has the potential to be accessible through organizations such as hospitals, churches, and schools. Gardening that utilizes local resources that have adapted to growing conditions over thousands of years helps eliminate the need for purchased seed and agricultural inputs such as synthetic fertilizer, hybrid seeds, and other chemicals. Gardening also carries benefits such as diversifying food crops, which is beneficial to households nutritionally. With a 12-month growing season, gardeners in Africa have the potential to access fresh food year-round with minimal need for cash, and the potential to expand production to the point of being able to sell produce as well as consume it.

Participants did come to one point of agreement: the issue is not one of selecting one approach over another, but marrying household food production with supplementation, fortification, direct food transfers, therapeutic foods, and commercialization in a way that is sustainable and meets communities’ and children’s needs. Identifying the best paths to achieving this goal, however, continues to challenge practitioners.

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This post was written by Margie Brand and Jennine Carmichael. It draws on information presented during a debate at the Africa Forum 2009, led by Kristoff Nordin and Margie Brand.

• Margie Brand is Program Director for the USAID STRIVE program and Founder of EcoVentures International (EVI). She is an experienced trainer, author, speaker, and curriculum developer in the areas of innovative environmental and youth livelihood development.
• Kristoff Nordin has been living and working in Malawi, Africa in the areas of sustainable agriculture and health for more than a decade. Kristoff and his wife, Stacia, a registered dietician, have identified hundreds of local food plants that can be easily and freely utilized, but are often neglected due to stigma, outside influences, and an ever-growing loss of traditional knowledge.

This guest post comes from Chris Desmond and Linda Richter, contributors to the Joint Learning Initiative on Children and HIV/AIDS (JLICA). Among other conclusions, JLICA’s final report advocates that, in countries heavily affected by HIV, the most appropriate economic strengthening action to be taken in support of children is the establishment of a social protection plan to transfer resources to the poorest families. Given the range of activities pursued in the name of improving the economic security of children affected by HIV, CYES asked Chris and Linda to discuss their findings in more detail. To learn more about JLICA and to access the report in multiple languages, visit their website at www.jlica.org.

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Although there is a great deal of controversy about the relationship between poverty and the risk of becoming infected with HIV, it is not debatable that HIV and AIDS place a financial strain on affected individuals and families. Over time, and often repeated shocks, AIDS is impoverishing. Many of the impacts which occur as a result of the epidemic, particularly those which affect children, result from this financial strain. For families already facing serious economic constraints, the added burden of HIV/AIDS can push them into destitution. Budgets are further constrained, food consumption may fall, children may be withdrawn from school, and less is available to spend on the health care of children and adults who are not ill.

Economic strengthening for individuals and families is an obvious response to financial strain, and there are a range of programmes which seek to do just this. These include, in an approximate order of rising complexity in delivery: cash transfers, in-kind transfers (such as food), livelihood development, micro- credit and public works programmes, among others. Identifying the most appropriate program to protect children in the context of HIV/AIDS and poverty was a major focus of the Joint Learning Initiative on Children and AIDS (JLICA). The JLICA concluded that cash transfers for the poorest families is the optimum policy choice given need, flexibility and capacity constraints. There are two parts to the JLICA recommendation: firstly, the provision of cash transfers as opposed to other forms of economic strengthening and, secondly, the targeting of the poorest families as opposed to orphans or people living with HIV/AIDS.

There are a number of arguments in favour of cash transfers. Cash transfers are a proven means of improving the health and well-being of vulnerable families. They also require, relative to livelihoods or public works, less capacity to implement. Unlike in-kind transfers, cash provides some flexibility and avoids goods being sold by families so they can purchase what they feel they really need. Cash transfers respond to constraints in demand for services. While there is frequently a focus on the delivery of health and education services, the capacity of families to access these services has not been addressed. Perhaps most importantly, cash transfers recognise that the leading role in child care and protection is played by the family. Outside responses should support families rather than try to by-pass them.

A common objection to cash transfers is that they foster dependency. But the amounts of money involved are small and can only been seen as supportive of other forms of family income and livelihood. Even if there is dependency, it may well be legitimate. Cash transfers are typically intended to benefit children, the elderly or families affected by illness or disability with no one able to work – all of whom are legitimately dependent on their families and the state. It is curious that descriptions of old or very young caregivers of children affected by HIV/AIDS and poverty are accompanied by arguments in favour of livelihood or public works programmes, the very forms of economic strengthening of least benefit to these groups of caregivers.

The JLICA, as mentioned, recommends targeting the poorest families in HIV/AIDS affected communities. This is premised on the contention that, at the point of delivery, the only appropriate indicator of need is need itself. Families affected by HIV/AIDS may be more at risk of being pushed deeper into poverty, but this does not mean that they are all more at risk than all other families. The same applies to orphans. Needs arise because of poverty; therefore the targeting should be based on poverty. It so happens that targeting the poorest families has been shown to cover the majority of families affected by HIV/AIDS being covered.

The above summarises some of the main arguments behind the JLICA recommendations relating to cash transfers. There are, however, other important arguments in favour of cash transfers not directly related to HIV/AIDS. Key among these are the protection and promotion of human capital and their potential impact on economic growth. Far from fostering dependency, cash transfers have been shown to increase household productivity and labour force participation. Moreover, the injection of money directly into poor communities has the potential to increase economic activity which leads to benefits for others in the community, not only targeted families.