Part VI
Technical resources and sources for methodologies and practical tools

Technical briefs

Brief 1. Development and testing of checklists

Preparation for the needs assessment starts with identifying information needs based on the framework developed in Part I. A review of existing secondary data and information will help to refine and focus primary data collection needs to avoid duplicating effort. Checklists can be developed to help screen and review secondary data sources, support the preparation of structured questionnaires and/or guide semi-structured interviews, or provide the basis for focus group discussions and diagramming exercises.

Checklists need to be appropriate to the stage of assessment (secondary literature review, primary data collection, validation), the level of inquiry (community, household, individual) and the specific topic.

• Generally, information is first collected at the area level, through key informants, in order to understand the overall context and identify general patterns, differences, estimates of proportions of households affected, etc.

• Household-level information can help to verify area-level information and provides more detail as to what different types of households do in practice.

• Focus groups help to provide in-depth analysis of specific topics.

Interviews with key informants should clarify whether they are providing information about the area as a whole or about what they think/do themselves. When household-level information is being collected, each household should be characterized by livelihood group, socio-economic status, residence status and household head status as appropriate, so that the data can be analysed in a disaggregated manner.

Developing lists with assessment team members helps team building and the identification of priorities. The checklists should be developed in the local language/s to ensure that key concepts can be internalized and explained appropriately. Testing the checklist in the field helps to identify any ambiguity in the questions or in the interpretation of possible responses. Piloting a checklist can also help to improve and standardize interviewing techniques.

General background, political and policy context and security situation

Geographical, demographic and administrative information

• Geographic location and access conditions.

• Nature of crisis (type of shock event, acute/chronic) and immediate impact (high mortality, population movement); imminent risk of further event.

• Administrative and political structure; role of traditional leaders.

• Population estimates and breakdown: residents, IDPs, returnees (since when). Likelihood of continued population movement.

• Demographic characteristics: size and composition of each household (whole households, single-headed households, disabled-headed, child-headed, etc.). Are there many infants and pregnant women? Are there many unaccompanied or motherless infants? Are there people living outside family structures (e.g. elderly, marginalized through ethnicity, language or religion)?

• Socio-economic characteristics of typical/majority of households: cultivated area, holdings of small livestock, assets, income sources and levels. What are the differences between poorer and better off households?

• Settlement pattern: dispersed/concentrated. Where are the geographical administrative and social centres? Do socio-economic/ethnic/other factors affect the settlement pattern (e.g. poorer households live on the periphery)?

• Shelter/housing conditions: permanent, hosted by relatives/friends, temporary, public buildings, street/open spaces.

• Social organization: groups and leadership (religious, women, youth, recreation); examples of when people assist each other/work together; examples of when this is not possible.

Local-level information

• Daily activity pattern at time of assessment (places and times to find people).
• Water provision: distance, type, state of repair.
• Health infrastructure: type of facility, staffing, supplies and medicines available.
• Sanitation conditions: latrines, rubbish disposal.
• Education provision: early learning, primary, secondary, informal, teachers.

Information needed for planning activities

• Which local government bodies and NGOs (national, international, faith-based) provide food and nutrition-related assistance? What are they doing and what are their organizational capabilities? What has already been provided on departure/arrival?

• What supply and storage resources are available for activities (e.g. access infrastructure, warehouses)?

• What interventions have been planned by government, international, private and voluntary organizations, and what coordination structure is to be used?

• Are there reviews of previous programmes (i.e. lessons learned to avoid identified pitfalls)?

Additional types of information needed in areas of conflict

• Geographical delineation of conflict zones and known mined areas, etc.

• Level of violence and kind: armed groups, use of mines, banditry, involvement of civilian population, incidence of war crimes, and targeting of women (e.g. rape, kidnap).

• Freedom of movement/conditions of access to conflict zones for local people, market traders, humanitarian workers, and the transport of bulk commodities.

• Humanitarian activities of partisan organizations (i.e. government and rebel).

Political context

• National and local political commitment to disaster mitigation and emergency response and longer-term interventions.

• International relations: involvement in conflict resolution/peace negotiations.

• Relations with neighbouring countries: support to partisan groups, acceptance of refugees.

• Donor position: eligibility for development or humanitarian aid, International Montetary Fund (IMF)/World Bank grants/loans.

• Macro policy environment (economic policy fiscal policy land tenure, credit), and its enabling/disabling impact on livelihoods.

Sources: Secondary information, key informants from government departments, multilateral agencies (e.g. UNICEF, WFP, OCHA, UNHCR, FAO), NGO (e.g. Care International, SCF, Concern, ACF).

Livelihoods information: how different types of households normally achieve their food and nutrition security and how this has changed as a result of the crisis

Natural resource base

• Land type (upland, low-lying).
• Land utilization (arable, grazing, forestry), and access.
• Soils: types, and trends in fertility.
• Water resources: lakes, rivers, dams, coast, etc.
• Rainfall distribution.

Sources: Secondary data and documentation from government and non-governmental institutions (agricultural, environmental, water, natural resources, meteorological). Local-level mapping exercises and transects.

Local and household asset base

Social organization and assets (before and after the crisis)

• What mutual support activities and reciprocity are there at the household and local levels and with the State (e.g. food sharing, communal herding, support for funerals, care of orphans, social safety net programmes)?

• What local grassroots organizations are there (e.g. women's groups, cooperatives)?

• What are the local criteria and characterization for less well-off/better-off and food-insecure/food-secure households?

• Which are the most influential households in the community? Why? How can they be distinguished?

• What education facilities are there: schools, informal learning, early learning, skills acquisition, teachers (trained/untrained)?

• How have these mechanisms/institutions/facilities been affected by the crisis?

Sources: Focus group discussions, key informants, Venn diagramming, social mapping.

Physical and economic infrastructure available to affected populations

• Shelter and public spaces: What kinds of houses are there (roof, wall and floor types)? Are there any public spaces (faith-based, markets, recreational)?

• Transport and communication infrastructure.

• Market provision.

• Grinding mills and other food processing infrastructure.

• How do the facilities provided for the affected population compare with those of the host population? To what extent are facilities shared?

Sources: Observation, mapping, focus group discussions.

Financial and physical assets

• Savings in cash or kind: stock, savings, small livestock, jewellery.
• Productive and physical assets: agricultural equipment, tools required for income generation activities.
• Consumer assets: furniture, household utensils and processing equipment.
• How have these assets been affected by the crisis? What accumulation, savings, reinvestment mechanisms are still functioning?

Sources: Semi-structured household interviews, household survey data, and observation.

Human assets

• Labour availability: dependency ratio, seasonal availability.
• Health and nutritional status (see also Brief 2 on conducting anthropometric surveys).
• Skills and knowledge: practical (e.g. mechanics, electrical repair, construction), business, social and counselling skills.
• Are these assets under threat owing to the crisis (e.g. loss of knowledge transfer mechanisms for indigenous technical knowledge, child caring practices, etc.)?

Sources: Semi-structured household interviews, household survey data, demographic and health surveys, health facility data, observation, focus group discussions.

Livelihood strategies Agriculture

• What food and cash crops are grown (field crops, vegetables, and fruits)? Include main season/s and dry-season production, if applicable.

• What average areas of different crops are cultivated by different types of households (wealth, status)?

• Are there gender and age differences with respect to type of crops cultivated and land use?

• What are the average yield estimates for different crops?

• How does production this year compare with that for the previous year and a "normal" year?

• What are the main types of agricultural tools and equipment (e.g. hand, draught, mechanized)? Are these owned or borrowed? Which tools and equipment does the household have, and in what condition are they? Can tools/spare parts be manufactured/purchased locally?

• How do households obtain seed for the main food and cash crops (e.g. through retention, purchase, borrowing, exchange, government/NGO distribution)?

• What are the local seed conservation practices?

• Do households use fertilizers, pesticides etc? How are these obtained?

• What are the main crop pests and diseases?

Sources: Key informants, agricultural census, government and NGO reports, household survey data, transects, mapping, focus group discussions, semi-structured household interviews.

Livestock

• What livestock and poultry raising activities are practised? Are there any differences by type of household?
• Who herds animals? Do households jointly herd/kraal animals?
• Is there any transhumance or migration of herds at different times of year?
• What is the average off-take for different species? When do households sell?
• Who controls the use of animal products for consumption and sale: milk, meat, eggs and hides?
• Have there been changes in the availability of or access to dairy, meat and poultry products for different family members?
• What are the main diseases and constraints for livestock and poultry production?
• What are the main livestock and poultry diseases? What interventions are in place to prevent and control these?
• How has the crisis affected livestock practices and holdings?

Sources: Key informants, livestock census, household survey data, transects, mapping, focus group discussions, semi-structured household interviews.

Income sources

• Income sources: ranked for different socio-economic groups and by gender.

• Typical income for different activities, and seasonal pattern: casual labour, charcoal production, water collection, petty trading.

• What proportion of cash income comes from sales of own food and horticultural production?

• At what time of year is income from the sale of cash crops received? What is the average income from cash crops, and who controls it?

• What are the other sources of cash income (e.g. gifts, loans, remittances)?

Sources: Key informants, household survey data, transects, mapping, seasonal calendars, proportional piling, focus group discussions, semi-structured household interviews.

Other livelihood activities: seasonality, gender differentiation

• Formal employment: State, NGO, business, factory, transport.
• Casual employment: agricultural, transport, domestic. Are there seasonal patterns?
• Petty trading: What commodities are traded? Who is involved? What are the links with markets and wholesalers?
• Preparation and sale of local alcoholic and non-alcoholic drinks: palm wine, beer, spirits.
• Forest-based enterprises: timber, collection of wild fruits, nuts, honey, etc.
• Fishing.
• Hunting, gathering: fruits, nuts, honey. What proportions are consumed and sold?
• Charcoal production and fuelwood collection.
• Collection of materials for house construction: poles, thatching grass.
• Brick making, house construction.
• Carpentry, mechanics, metal working, radio/TV/fridge repairs.
• Preparation and sale of snacks/food items.
• Service industries: water collection, portering, domestic tasks.
• Artisan mining: stone, precious/semi-precious gems.

Sources: Key informants, household survey data, transects, mapping, seasonal calendars, proportional piling, focus group discussions, observation, semi-structured household interviews.

For different types of small businesses or livelihood enterprises

• Who is involved?
• Capital required.
• Inputs needed: nets, traps, beehives, oil extraction equipment.
• Market for commodity or skill.
• Average earnings per day/week.
• Seasonality of income.
• Stability/security of employment.
• Savings, credit and banking mechanisms.

Sources: Key informants, household survey data, business and enterprise survey data, seasonal calendars, proportional piling, focus group discussions, observation, semi-structured household interviews.

Household expenditures

• What proportions of cash expenditure/income are spent on staple foods and other foods? Are there seasonal differences?
• What are the other main household expenditures, and what proportion of income is spent on them (e.g. health, tools, shelter, education, social obligations)?

Sources: Household semi-structured interviews, proportional piling, seasonal calendars.

Market assessment and formal and informal trade and procurement mechanisms

• What markets/shops are there? How far away?

• What transportation facilities are there?

• How accessible and safe are market facilities for the elderly, disabled, children and women?

• Availability and quantities of different products: essential food and non-food items, tools, livelihood inputs (e.g. seeds, veterinary drugs, fishing equipment, spare parts).

• Prices of key products, and terms of trade between locally produced goods and manufactured items.

• Flow of products to and from market.

• Number of petty traders and distances travelled.

• Traffic density: number of lorries/day/week.

• Casual labour rate: Are there differences for IDPs and refugees, women? Are there different rates for different tasks? How do these compare with rates for cash-for-work programmes?

• Distance to next larger market, and linkages to large-scale traders and regional and global markets.

• Cost of transporting "product x" to next market.

• Are food and non-food relief commodities sold in the market? What are the impacts of this on the prices of locally produced commodities and on local agricultural production? Does local purchase of relief commodities increase local inflation?

Sources: Market information systems, observation, focus group discussions, semi-structured interviews with key informants.

Household utilization of food

• Sources of food: production/livestock/purchase/wild food, food aid, payment in food, gifts, loans, remittances, etc. Are there seasonal differences?

• How many months do staples (main and supplementary) last in a normal year? Current household food stocks.

• In which months of the year is staple food normally purchased?

• Are there seasonal differences in the availability of micronutrient-rich foods?

• Has the crisis affected the availability of micronutrient-rich foods?

• Sources of cooking fuel and cooking utensils.

• Processing and storage practices for different products: equipment, knowledge.

• Food hygiene practices: storage, processing, preparation, consumption.

• Food consumption habits and practices: definitions of "meal" (e.g. does it have to include a particular staple?) and "snack"; normal composition of typical meal by season.

• Meal frequencies for adults, youth and children.

• Frequencies of consumption of different foods.

• Who allocates food to different family members? Who is served first and last?

• What happens to leftover food?

Sources: Semi-structured interviews, seasonal calendars, observation, survey data.

Caring practices

• What were the breastfeeding practices before the crisis? Did many mothers feed artificially (especially in urban situations)? Are breastmilk substitutes and feeding bottles readily available?

• What complementary feeding practices were there before the crisis? At what age are semi-solid foods normally introduced? What are they? Are special foods used for young children?

• Who looks after small children and infants? Who feeds them?

• Are pregnant and lactating women, older people and people with disabilities recognized as having special needs? How are these met and are there any constraints as a result of the crisis?

• How are chronically sick members of the household cared for (nutrition, personal hygiene, socio-psychological support)? Are these practices still possible? What are the constraints?

• What happened to the community before, during and after the emergency?

• How did people deal with trauma, loss, grief and mental illness before the emergency?

• Is support available for the treatment of post-traumatic disorders?

• Is self-reliance being facilitated?

• Is there support for mothers to stimulate apathetic children?

• Is there learning and/or are there organized play activities for pre-school children?

• How are orphans and single-parent families supported by the community/external organizations?

Sources: Focus group discussion, semi-structured interviews, observation, key informants, KAPP surveys, government and agency reports.

Water and sanitation

• What are the main sources of water: e.g. open wells, boreholes, rivers?
• What are the distances from these (time)?
• Are there seasonal changes in quantity and quality?
• Are there different sources of water for drinking, food preparation, washing and agriculture?
• Are the locations of water sources secure for women and children?
• Do households pay for water? What is the cost?
• How is water stored in the household?
• What happens to waste water?
• How is water for drinking treated? Is this for all family members or only some?
• What are the practices regarding defecation?
• What is the sanitation provision? What are the proportions of households with latrines, and rubbish pits?
• Is grey water or night soil used in agricultural production?

Sources: Focus group discussion, semi-structured interviews, observation, key informants, mapping, government and agency reports.

Health and infection

• What are the most frequent illnesses by season for adults and children? Has this pattern changed as a result of the crisis? Have there been reported outbreaks of specific diseases (measles, cholera)?

• What are local perceptions regarding the causes of most common diseases (e.g. malaria, diarrhoea, malnutrition, scabies) and how are they treated?

• What health services are available: immunization, antenatal, child welfare, family planning, gynaecological, STD, TB, HIV/AIDS counselling and testing services, mental illness/trauma?

• What is the distance/time to medical assistance, and what are the costs?

• Are there community health workers, e.g. trained birth attendants, growth promoters, malaria agents?

• Where are basic drugs, medical supplies, contraceptives and condoms available (e.g. government clinics, NGOs, private pharmacies, markets)?

• What is the estimated measles immunization coverage in the affected population?

• Are there estimates for crude and under-five mortality rates?

• Are there estimates of HIV/AIDS prevalence?

• Have there been environmental changes that might increase the risks of malnutrition and infection (e.g. temperature, malarial zone, flooding)?

Sources: Demographic and health surveys, health facility records, key informants, seasonal calendars, government and agency reports.

Nutritional status

• Wasting and stunting rates of children under five.

• Adult nutritional status, including pregnant and lactating women and older people.

• Micronutrient deficiency diseases: scurvy, pellagra, vitamin A deficiency, anaemia, beriberi, riboflavin and iodine deficiency diseases.

• How has the situation changed as a result of the crisis? How does the situation compare with that of the host population?

Sources: Demographic and health surveys, health facility records (under-five clinics), surveillance system data, nutrition survey data, feeding programme data, key informants, observation.

People's own perceptions of their food and nutritional problems

• What are the local terms for food insecurity and hunger?

• Are there gradations that reflect severity?

• What are the local terms for and the perception of malnutrition and its causes?

• What are the local beliefs relating to foods (e.g. which foods are considered especially good, or to be avoided in certain circumstances)?

• Are there differences in these perceptions within the area (by socio-economic, gender, ethnicity, status, etc.)?

Sources: Key informants, focus group discussions, knowledge, attitudes, perceptions and practices (KAPP) surveys.

Coping and crisis strategies

• What do households do when they have no food or when it becomes normal to purchase food?

• How do households differentiate among livelihood, coping and crisis strategies?

• Within the household, who undertakes and/or is affected by different coping and crisis strategies?

• Do households undertake activities that are degrading, irreversible or threatening to an individual's well-being or the future sustainability of household production and income activities (e.g. commercial sex or sexual favours, begging, stealing, sale of productive assets, bondage/slavery, forced early marriage)?

• Are there community-level coping strategies? Have these been affected by the crisis?

Sources: Semi-structured interviews, focus group discussions, observation, government and agency reports.

Checklist for food quality and safety in flood-affected areas

The following checklist has been developed to assist the identification of food safety and quality issues in flood-affected areas.

Has the pattern of food-borne disease changed significantly in the aftermath of the flood (e.g. types of infection, geographical distribution)? If so, explore the causes. Interviews with health care officials and household members, as well as available hospital or clinic records, may be useful information sources.

Availability of potable water. What is the quality of the water available for use in households or other major food processing/preparation locations? This has important implications on food safety, and not only in terms of direct water consumption; water is used in many food preparation and processing operations. The use of contaminated water in agriculture can represent a risk when fruit or vegetables are eaten raw.

• Have public information services been adapted to deal with the emergency situation?

• What is the level of understanding about the dangers of using contaminated water and about the measures that should be taken to prevent disease (among local health professionals and in the general population)?

• What measures is government taking to ensure a safe water supply in the post-flood period?

• What constraints are there to treating water in the home or factory before use (e.g. availability of fuel for boiling the water before use, availability of suitable utensils)?

Is there adequate knowledge of and adherence to hygienic practice in the preparation of food?

• Have consumer education programmes been adequately adapted to minimize the risk of food contamination in the prevailing post-flood conditions?

• What plans are there in this regard?

• Do social factors impede the maintenance of acceptable hygienic practice?

Have food control resources and procedures been adapted to the current reality?

• Where does the food come from? Have there been major changes in organization of the food supply such as higher reliance on imports from unfamiliar sources?

• Are inspection, analytical and other resources being reallocated according to the perceived risks from the food supply that face the population? The Ministry of Health and the Department of Preventive Medicine could be sources of information.

• Are there problems/disruptions along the marketing/distribution chain that might introduce food safety risks (bacterial or mould growth)?

Have new food storage/processing problems emerged as a result of the post-flood conditions?

• Has increased environmental humidity created problems in food/grain storage? Are existing storage facilities adequate to maintain grain in a satisfactory condition (at the household, village and larger-scale levels)? Are mould growth and mycotoxin production significant hazards?

• Are there greater problems with storage pests, and how are these being dealt with? Are the use and control of pesticides adequate?

• Are extension staff and information programmes providing advice on adequate storage containers and practices under the prevailing conditions?

• Are flood-damaged but operational food processing facilities meeting acceptable codes of good hygienic practice?

Have there been changes in agricultural practices that might introduce hazards into the food chain?

• Have there been changes in the availability and distribution of agricultural inputs that might give rise to the adoption of unacceptable practices (e.g. the use of sewage as fertilizer, the incorrect use of pesticides)?

Figure 6 provides an example of a livelihoods model that can help in visualizing the relationships among different livelihood strategies and their outcomes.

Figure 6: Food Insecurity and Vulnerability Information and Mapping System (FIVIMS) framework on food security, livelihoods and nutrition

Source: www.fivims.org/index.jspx

Brief 2. Anthropometric surveys

Anthropometrics is the physical measurement of the human body. Anthropometrical surveys are commonly used in situations of food scarcity. They are useful for:

• assessing the overall severity of nutritional stress in a population; they can also help to predict how the problem will evolve if no action is taken, because anthropometrics provides strong predictors of mortality and morbidity;

• informing and prioritizing resource allocation and the urgency of the intervention;

• advocacy and documenting the overall effort of the humanitarian community using trend analysis;

• assessing the requirement for and design of feeding programmes;

• further investigation when surveillance or programme data have flagged a problem;

• (for surveys undertaken prior to an intervention) providing baseline data against which to measure future changes.

Choice of anthropometric indices

Data on weight, height, mid-upper-arm circumference (MUAC), the presence of bilateral oedema and age can be collected from population-based surveys or facility-based health information systems. Anthropometrical indices are derived from combinations of these measurements, and are compared with a reference group from a healthy, well-fed population to determine whether an individual deviates from the mean or median value for the reference population. Different indices show different forms of malnutrition, for example, wasting, stunting or underweight.

The choice of index to use depends on the purpose of the survey and on practical constraints. Weight for height (WFH) is the most appropriate index for assessing short-term changes in weight. Where age cannot be reported accurately (as is the case in most emergency situations), WFH and MUAC are the only options.

It is often assumed that the anthropometric status of children of six to 59 months can be used as an indicator of the nutritional status and/or food availability for the whole community. This assumption cannot always be fully justified as children can become malnourished for reasons other than lack of food per se, such as inadequate weaning practices. Knowledge of local patterns of disease and intra-household food consumption is needed. Furthermore, both dietary and anthropometric data show that parents usually try to protect young children from malnutrition, at a cost to their own health in times of food insecurity.

However, it is convenient to use this assumption in relief and rehabilitation settings, because the best method for assessing malnutrition in older children and adults is still not clear.^[8]

The following indices are those most often used in emergencies:

• Weight for height (WFH) is the most common index used in nutrition surveys of children under five because it reflects failure to gain weight, or loss of weight, and therefore recent adverse conditions leading to "wasting", or "acute malnutrition".

• Low height for age (HFA) ("stunting" or "chronic malnutrition") reflects a failure to gain height, and so represents an integrated record of all past experiences.

• Weight for age (WFA) cannot distinguish tall, thin children from those who are short and of adequate weight; however, it has been found to be a powerful indicator of mortality risk.

• Mid-upper-arm circumference (MUAC) reflects recent weight loss. It is most often used as an initial screening tool when time is limited and/or equipment (scales) are not available.^[9] The World Health Organization (WHO) recommends using reference values to transform arm circumference measurements into MUAC for age/height.

• The QUAC stick measures arm circumference and relates it to height. The height of a nutritionally healthy child should correspond to a minimum arm circumference. This procedure is only practical for children of at least two years of age, who can stand to be measured. ICRC uses the QUAC stick for nutrition surveys.

• For adults, the body mass index (BMI) is the equivalent of the weight for height indicator in children. It is calculated by dividing the individual's weight in kilograms by his or her squared height in metres. MUAC can also be used as an alternative, quicker method for screening adults.

Indicators and cut-offs

Observed measurements can be related to the reference in different ways:

• percentage of the median of the reference population;
• in relation to the centiles of the reference distribution;
• Z-score (standard deviation units).

A combination of the indice and a cut-off point becomes an indicator. A commonly used cutoff for WFH, WFA and HFA is "-2 Z scores", i.e. 2 standard deviation (SD) units below the reference mean. It is recommended (WHO, 1986) that malnutrition in individuals be classified using Z-scores for the analysis of survey data. Percentage of the median of the reference population represents different standard deviations depending on the age of the child. Z-scores are statistically more precise, and can be consistently applied for all indices. However survey data should also be presented as percentages of the median when they are to guide decisions about interventions. Percentage median reference WFH is better correlated with risk of mortality, and should be used as an entry criterion for feeding programmes.

To save time, some agencies recommend combining the two indices in a two-tier system for screening for referral to feeding programmes.

WFP

Table 1 illustrates indicators and cut-offs^[10] for malnutrition in children and adults.

Table 1: Indicators and cut-offs for adults and children under five years

Results from surveys that use different indices and/or cut-offs are not comparable, even though the same terms ("moderate", "severe") are used to classify malnutrition. When measured on the same children, MUAC gives the largest estimates for the percentage of children who are malnourished, followed by Z-score for WFH, while percentage of the median WFH gives the lowest estimates. It is therefore always important to specify which indicator has been used.

Levels of wasting in non-emergency conditions vary greatly across populations. There is therefore no single criterion for deciding the severity of prevalence of wasting at the population level. In Latin America, the usual prevalence of wasting (below -2 Z scores WFH) is about 2.5 percent, while among children in Africa it is 5 to 10 percent in non-drought situations. For guidance, a prevalence of 20 percent wasting indicates a serious situation, and more than 40 percent indicates a severe crisis.

Mean BMI in non-emergency conditions also varies greatly across populations. Cut-off points seem to imply different impacts for men and women in terms of risk of illness and death. It is also not clear whether the same cut-off points should be used for all age groups (e.g. adolescents and the elderly) and ethnic groups. Although for simplicity a cut-off point of 16 or 17 has now been accepted as indicating wasting in an individual, there is no guidance for the prevalence value that indicates the existence of a serious situation at the population level. BMI is thus mainly useful for assessing trends over time within the same group, and for identifying those individuals who are most vulnerable in a population group. This is also true for MUAC measurements in adults.

Design of anthropometric surveys

The planning of a formal survey requires knowledge and experience of survey design, sampling and statistics, and cannot be done without technical expertise. Implementation of the survey requires teams of people who are literate, numerate and accurate in their measurements. A nutrition survey should only be undertaken when these skills, and a period of at least two weeks, are available, as it is better to have no data than poor survey results that do not reflect the real situation.

In emergency situations, it is recommended that a random two-stage cluster sampling methodology is used, i.e. 30 clusters x 30 children. If support from a statistician is available, a different sample size could be calculated. All children in a household should be measured, and the presence of bilateral oedema should be checked. If mortality data are being collected, the sampling methodology should be 30 clusters x 30 households, and households without children under five years should be included for mortality and other data collection.

When conducting a nutrition survey, it is common practice to collect additional information by means of a short questionnaire. This can provide data on household demography, morbidity, access to clean water supply, sanitation provision and food access. These data allow the cross-tabulation of key variables in order to determine the possible determinants of malnutrition.

Interpretation of anthropometric data

Data collected from health centres cannot indicate the prevalence of malnutrition in the whole population, because the individuals who visit a health centre are self-selecting and the results may be biased, reflecting the situation of either the population with access to the health facility or those who visit the health facility because they are ill.

If different surveys have used the same methodology, sample size, indices and cut-off points, their results can be compared for trend analysis, or to study regional variations.

Interpretation of anthropometric data should take the following points into consideration:

• Standardized techniques should be used for sampling, measurements and the detection of oedema. Otherwise the findings cannot be considered reliable.

• Use of WFA and HFA indices should only be used in situations where it is possible to assess children's ages accurately.

• The weight measurements for children with oedema should not be included in the calculation of WFH and WFA indices. Instead, oedematous cases should be included in the category classified as severely malnourished.

• The timing of the survey should consider the agricultural cycle. There are often great seasonal differences in the prevalence of malnutrition depending on the stage of the agricultural cycle and the prevalence of disease.

• Out-migration of destitute families and excess mortality may distort figures and disguise deteriorating circumstances.

• When comparing different surveys, the samples included should cover similar proportions of individuals of different ages. If not, the results cannot be compared, because the prevalence of malnutrition varies among age groups (e.g. wasting is generally more common in children of 12 to 24 months than for other age groups, as this is the age of weaning).

• Survey results should be compared with normal rates of malnutrition in the population before the crisis. The significance of a particular prevalence rate of malnutrition in terms of illness and death will depend on what is considered normal in that particular context.

• Malnutrition rates may differ considerably, even among different ethnic groups living in the same environment.

• There do not appear to be guidelines on how to interpret anthropometric data for children under five years in populations/areas with high prevalence of HIV/AIDS.

• Nutritional survey data should be interpreted in the context of food security (access to food at the household level, and its distribution and use within the household), agro-economic, health and mortality data.

Anthropometric data as indicators of food stress

Anthropometry as a measure of nutritional status can indicate poor food security at the household level. However, nutritional status is affected by other factors, apart from access to food, and it is not always an indication of a household's food security status. An individual may be malnourished through disease or poor hygiene education.

In an emergency context, however, it is very likely that a malnourished individual comes from a food-insecure household if the crisis has affected livelihoods and the ability to grow or purchase food through the normal channels. In some communities - e.g. in Darfur, the Sudan before the 1984-1985 famine (de Waal, 1989) and Wollo, Ethiopia during the drought of 1987-1988 (Kelly, 1992) - early coping strategies were to preserve food stocks and go hungry in order to protect future livelihoods. Anthropometric status could therefore be used as an early indicator of food stress.

The anthropometric indices that are the most sensitive to change are the best indicators of food stress (WFH in children, BMI for adults and MUAC for both age groups.)

When assessing the severity of a nutritional problem, anthropometric data and rates of clinical deficiencies, mortality and morbidity should be considered. Some guidance for the interpretation of rates is given in the following subsection, but there are no universally applicable rates to define the severity of a situation; trends in these indicators are more useful.

Prevalence rates indicating serious nutrition and health problems

Levels of wasting

• Prevalence rates of 5 percent are usual in African populations in non-drought periods.
• Greater than 20 percent indicates a serious problem.
• Greater than 40 percent indicates a crisis that is out of control.

Levels of severe wasting

• Greater than 5 percent indicates a serious problem.

Crude mortality rate

• 0.3 to 0.5 per 10 000 per day is considered normal in developing countries.
• More than 1 per 10 000 per day indicates a very serious problem.
• More than 2 per 10 000 per day indicates an emergency that is out of control.
• More than 5 per 10 000 per day indicates a catastrophic situation.

Under-five mortality rate

• Fewer than 1 per 10 000 per day is considered normal in developing countries.
• More than 2 per 10 000 per day indicates a very serious problem.
• More than 4 per 10 000 per day indicates an emergency that is out of control.
• More than 10 per 10 000 per day indicates a catastrophic situation.

Case fatality rate

• Cholera: More than 2 percent indicates a very serious problem.
• Diarrhoeal disease: More than 1 percent indicates a very serious problem.
• Dysentery: More than 5 to 7 percent indicates a very serious problem.

Source: CDC. 1992. Famine-affected, refugee and displaced populations: recommendations for public health issues. MMWR, 41(RR-13).

Further reading and resources

Beaton, G., Kelly, A., Kevany, J., Martorell, R. & Mason, J. 1990. Appropriate uses of anthropometric indices in children. Nutrition Policy Discussion Paper No. 7. Geneva, UN ACC/SCN.

Bern, C. & Nathanail, L. 1995. Is mid-upper-arm circumference a useful tool for screening in emergency settings? The Lancet, 345: 631-633.

Cogill, B. 2001. Anthropometric indicators measurement guide. Washington, DC, Food and Nutrition Technical Assistance Project, Academy for Educational Development. de Waal, A. 1989. Famine that kills: Darfur, Sudan, 1984-1985. Oxford, UK, Clarendon Press.

FAO. 1990. Conducting small-scale nutrition surveys. A field manual. Nutrition in Agriculture No. 5. Rome, Policy and Nutrition Division.

Ferro-Luzzi, A. & James, W.P.T. 1996. Adult malnutrition: simple assessment techniques for use in emergencies. British Journal of Nutrition, 75: 3-10.

Field Exchange. 2002. Emergency Nutrition Network. Issue No. 15, April 2002.

Kelly, M. 1992. Anthropometry as an indicator of access to food in populations prone to famine. Food Policy, 17(6): 443454.

MSF. 2002. Nutrition Guidelines. Revised draft. Available at www.nutritionnet.net. SMART Web site: www.payson.tulane.edu/haresults/index.html.

Sphere Project. 2004. Sphere Handbook. Revised edition. Humanitarian Charter and Minimum Standards in Disaster Response. Geneva. Available at: www.sphereproject.org/handbook/index.htm.

WHO. 1983. Measuring change in nutritional status. Guidelines for assessing the nutritional impact of supplementary feeding programmes for vulnerable groups. Geneva.

WHO. 1986. Use and interpretation of anthropometric indicators of nutritional status. Bull. WHO, 64: 929-941.

Close-up of a mother with her child

FAO/18438/P. Cenini

Brief 3. Rapid appraisal techniques

In an emergency situation, information is needed rapidly, and so qualitative data collection techniques are a particularly useful tool for understanding the key issues and processes. A rapid appraisal can provide decision-makers with timely and relevant information. It adopts a systematic field-based approach and direct interaction with the local community. Rapid appraisal methods are an advantage when security considerations do not allow a team to remain in an area for long. However, the potential unreliability of informally gathered material must always be borne in mind - particularly if cross-checking is problematic (e.g. in southern Sudan; Young and Jaspars, 1995).

Principles of rapid appraisal methods

Triangulation: Accuracy is achieved through gathering diverse information from different kinds of sources. For example:

• data triangulation - the use of a variety of data sources in a study;
• investigator triangulation - the use of several investigators with different perspectives and from different disciplines;
• methodological triangulation - the use of multiple methods or techniques to study a single problem.

A multidisciplinary approach: Using a team with a mix of diverse skills, perspectives and gender should be followed.

Mixing tools and techniques: The sequencing and timing of these depends on the context.

Optimal ignorance and appropriate imprecision: Unnecessary detail or the collection of too many data should be avoided.

On-the-spot analysis: Analysis of the data and information gathered is an integral part of the fieldwork. The iterative process contributes to verifying the internal consistency of data, identifying data and information gaps, and narrowing the focus as the fieldwork progresses.

Descriptions of some rapid appraisal techniques and tools that are useful for food security and nutrition assessments are included in the following subsections. The choice of tool depends on the data or information required, and this brief should be read in conjunction with Brief 1, which provides guidance on developing checklists; for example, calendars can be used to collect data that require seasonal comparisons. A mix of techniques should be used to allow cross-checking and verification of information. These methods are designed to provide information quickly, and success relies to a large extent on the team members' interviewing and analytical skills and sensitivity. There is a literature that documents past experiences and provides advice. See the recommended further reading at the end of this Brief.

Introductory meetings protocol and ethical considerations

The objectives and purpose of the assessment should be explained in advance to key government officials and local leaders. The explanation should include the methodology that will be used, the time scale, and how the results of the assessment will be used. Care should be taken to avoid raising expectations, for example over food aid. If necessary, the translation and interpretation of key terms such as food security should be checked; for example, in conflict situations, "security" may be misinterpreted to mean military security. The right of confidentiality and the right not to participate in the assessment should also be explained.

Summaries of a selection of techniques and tools for gathering food and nutrition information

Examples of how these tools and techniques can be used in the emergency context are given in brackets.

Semi-structured interviews. Interviews are usually "semi-structured", meaning that they are informal, but guided. Only some of the questions are predetermined, and new questions or subjects that lead from earlier answers can arise during the interview. Informants with special knowledge or who hold positions of interest are identified and interviewed on a one-to-one basis about these topics. Key informants are usually asked to provide information about the area as a whole and differences within it. Semi-structured interviews with household heads aim to reach an understanding of the attitudes, perceptions and practices of that particular household.

(Ask NGO health staff about the main nutritional and medical problems of displaced populations.)

Examples of key informants: Village leader, head of women's cooperative, community health worker, agricultural extension officer, local NGO staff member.

Group interviews/focus group discussions. Local groups with particular characteristics (e.g. wealth, age, gender) or specific expertise or interest (fishers, petty traders, health service users) are invited to participate in an open-ended discussion on a stated topic. For example, a group of mothers at a clinic would be a good source of information about children's diets, while a group of farmers could discuss the constraints on food production. A facilitator is needed to stimulate and guide the discussion, and a note-taker to record the main points. For in-depth discussions the group should consist of fewer than ten people.

(Talk to women refugees about their use of food aid commodities.)

Examples of groups: Male farmers, female farmers, women heads of household, teachers, health workers, mothers' groups, fishers, informal groups at markets or health centres. (Depending on the culture, it may be advisable to meet men and women separately in order to avoid people feeling inhibited.)

Observations. These are any direct observations of objects, events, processes, relationships or people, and are recorded in note or diagrammatic form. Systematic observations of the situation, especially of individual, household and group behaviour, are a fundamental tool for cross-checking the information obtained from other sources.

(Observe what food aid commodities are sold in the market, and what people are buying with the proceeds. Observe rubbish pits to see what people have been eating, and what they throw away.)

Resources maps: These are schematic representations of the area, which are drawn by a group from the area with the objective of obtaining an overview of all types of resources, such as water sources, health facilities, markets, cropping patterns, roads, grazing areas and forests. A map can help to identify different livelihood systems, population concentrations and security risks. Discussions around the map can help to highlight the diversity and similarity in an area, and contribute to the purposive sampling of villages to visit.

(Obtain a map of refugee camps showing sources of water and fuelwood, security risks, etc.)

Transects: This tool builds directly on the resources map to learn more about the environmental, economic and social resources in a community. It is a one-dimensional map of a line cut through the area. Team members walk along the line with local people, recording their opinions and observations of differences in various features such as soils, crops, trees, wildlife, housing patterns, and livelihood and social activities.

(Obtain transects before and after a drought showing changes in land use and food sources.)

Seasonal calendars: These are single or composite diagrams that illustrate inter-seasonal changes in factors of interest, such as climate, crop sequences, pests and diseases, wild foods, labour demand, prices, human diseases, social events, income/expenditure, and food consumption. They can be prepared by different groups in the population, such as women heads of household, landless labourers or landowning farmers, and they help to clarify periods of the year when there is nutritional stress, and what can be done to relieve it.

(Find out from drought-affected populations what their problems are in the hungry season. Identify periods of the year in which time is an important constraint.)

Historical profile: This is a chart that summarizes events of great importance to the affected population. Often it is useful to do this with elderly people. The "origin" story of a group or area, can serve to underline power relations and tensions. In emergencies, the profile might cover a much shorter period and specific themes, because the situation can change so rapidly. Historical profiles can reveal successive displacements, epidemics, changes in food habits, etc.

(Ask refugees about major events that have affected their welfare, before arrival in the camp and since arrival. Historical profiles can show that droughts were recurrent events in the past, and further discussion can show how the population has been able to cope with these.)

Time charts or daily action clocks (24-hour clocks): These are diagrams that illustrate the proportions of the day spent performing different tasks. Different groups (form a separate focus group for each category) relating to occupation, age or gender place beans or stones in piles of different sizes corresponding to the proportion of their total working time spent on each task. Alternatively, a circular clock is drawn with different sized slices corresponding to the different proportions of time spent. Time charts help to identify the relative workloads between, for example, the elderly and the young, men and women, and the rich and the poor. This is also a useful tool at the beginning of an assessment to identify the best time to meet people in their homes, or where to find people at a particular time of day.

(Ask drought-affected farmers how they spend their day now and how they used to spend their day before the flood. Repeat the exercise with farmers' spouses. Alternatively, ask the women, men and/or elderly in refugee camps what their daily activities are and how much time they spend gathering fuelwood, queuing for water and food distributions, taking children to feeding centres, preparing food at home, caring for the young and elderly, etc.)

Venn diagrams: These help to clarify the importance of local groups and institutions, the links among institutions, how close the population is to the different institutions, and who makes decisions. They can also help to identify implementing partners and potential conflicts of interest. Key institutions and individuals responsible for decisions are represented by circles of different degrees of overlap and distance from the group being interviewed. This provides insight into local perceptions of institutional control and decision-making. It is useful to compare the diagrams produced by different groups and investigate the reasons for the differences.

(Identify who should/could be responsible for clean-up campaigns. Is there a community/social space where common issues can be discussed?)

Other diagrams: These can represent flows or decisions to demonstrate hypotheses or summarize interview information. They can be problem trees, which summarize the information gathered and help identify solutions.

Proportional piling

Preference or frequency rankings: Items are compared with each other; for example, problems are compared to see which are considered the most grave, or food types to see which are consumed most often or are most preferred. If there are more than two items, the results can be recorded on a matrix, and the number of times each item is preferred can be recorded in order to rank the different items. Alternatively, the ranking can be obtained directly, without pair-wise comparisons.

(Ask the beneficiaries of food aid distributions to rank food aid commodities in terms of taste preference, ease of cooking, and ease of sale.)

Wealth rankings: Informants' perceptions are used to rank the households within a village or portion of a village into groups according to overall wealth. (It is easier to classify individuals into groups than to rank each individual in comparison with every other one.) There can be four stages in this:

• discussing local concepts of wealth, and identifying a local phrase or word to reflect wealth;
• drawing up a list of households;
• asking three or four key informants separately to divide the households into categories (e.g. rich, medium and poor);
• discussing what factors make a household become richer or poorer.

Local-level workshops: These are open discussion sessions where research issues can be explored or results fed back to the community. Workshops can be managed as one single group, or the larger group can be broken up into smaller discussion groups with plenary feedback.

Analytical workshops: These are sessions that bring people together (both the field team and outsiders) to review, analyse and evaluate the information gathered. Both plenary sessions and group work can be used to arrive at a consensus of opinion about the causes of problems and priorities for action.

Further reading and resources

FAO. 1999. Conducting a PRA training and modifying PRA tools to your needs. An example from a participatory household food security and nutrition project in Ethiopia. Available at: www.fao.org/docrep/003/x5996e00.htm.

FAO. 2001. Socio-Economic and Gender Analysis Programme. Field handbook. Available at: www.fao.org/sd/seaga/4_en.htm.

IDS. 1999. Workshop on Participatory Approaches in Emergencies, Addis Ababa, 29 Nov. - 3 Dec. 1999. Sussex, UK. Available at: www.ids.ac.uk/ids/particip/research/emergencies.html.

SCF. (no date). Household food economy approach. Available at: www.savethechildren.org.uk/foodsecurity/other/uses.htm.

Brief 4. Developing a SWOT analysis

The strengths, weaknesses, opportunities and threats^[11] (SWOT) analysis is a tool that may help to summarize, structure and evaluate the information gathered from a situation assessment and analysis. SWOT analysis aims at organizing this information in terms of strengths and weaknesses within a population group (for each livelihood group), and opportunities and threats coming from outside the group. Strengths and opportunities help a group; weaknesses and threats hinder it in addressing the food and nutritional problems that have been identified. The advantage of a SWOT analysis is that it makes it possible to look at both the positive and the negative factors and situations. By carrying out a SWOT analysis for each livelihood group, common factors can be identified, which can lead to the development of a "win-win" intervention strategy. Alternatively, potential tensions can be identified where conflict management or consensus building is required.

1. What are the strengths present within the group that help to address the situation/issue being investigated? Strengths include the advantageous characteristics of a situation - the local potential, capacities, resources, experience, knowledge and successes.

2. What are the weaknesses present within the group that hinder efforts to address the issue being investigated? Weaknesses include the negative characteristics of a situation or issue, such as constraints, difficulties, problems, attitudes and shortcomings. What impact do these weaknesses have on the food security and nutrition situation?

3. What are the opportunities from outside the group that help it to address the issue being investigated? Opportunities include positive situations and factors that are out of the group's direct control. Although the group may sometimes seek to use opportunities to resolve problems, some opportunities are completely outside the control of the community, such as favourable prices or good weather. Why and how have these opportunities had an impact on the community's nutrition and food security situation?

4. What are the threats from outside the group that hinder its efforts to address the issue being investigated? Some threats are difficult or impossible for a population to deal with, such as environmental disaster or policies, but awareness about threats can lead to interventions that mitigate their impact when they do occur.

The following (Table 2) is an example of a SWOT analysis from Angola. This was used in conjunction with the problem tree in Brief 5 to develop a set of recommendations.

Table 2: Example of SWOT analysis from Libongos, Bengo, Angola

Brief 5. Developing and using a problem tree

Nutritional problems have multiple causes. Part III showed how important it is to develop a holistic analysis in order to understand the interrelationships among causes and their impacts on different groups. This makes it easier to design appropriate actions. The assessment team, together with local groups, NGO representatives and government officials, must be able to summarize, structure and evaluate the information gathered from the needs assessment in order to identify key problems and agree on priority actions.

A problem tree can be developed for each livelihood group, showing the cause and effect linkages and the interrelationships among problems. For each problem, it is necessary to specify who is most affected, for example, individuals within households^[12] (e.g. the elderly, orphans, the physically disabled, widows), households (e.g. single-headed households, households with small cultivated area) and population groups (e.g. returnees, IDPs). It is also necessary to consider how gender and age differences and relations influence the impact of these problems.

• The problem tree is constructed with the "trunk" showing the main problems, the "roots" showing the causes, and the "branches" showing the effects of the problems.

• A brainstorming process helps to identify the major problems to emerge from the situation assessment and analysis process. This normally generates many problems, which are not all of equal importance and therefore need to be ranked to identify the priorities. The problems are usually ranked by analysing the importance of each and considering which cause other problems.

• The problem statement should be formulated correctly in order to help identify the full range of causes. Problems should not be expressed as the absence of a solution (e.g. food is not available), but as an existing negative state (e.g. high levels of malnutrition in the population). It is therefore better to avoid the use of such phrases as: "lack of..." "insufficient..." "absence of..." and "no...".

• The main problem should be written in the centre of a flip chart (or cleared area on the ground). The causes of this problem can be written below as roots of the tree. Each of these causes may have its own set of sub-causes, which can also be written in. Above the main problem, the effects experienced as a consequence of it can be written in as branches. The effects should be expressed in a way that indicates who is affected and how they are affected.

• The completed tree will provide a visual representation of the main problem, its causes and effects, and the relationships among them.

• The next step is to identify the "focal problems" (causes of the main problem), which are sometimes called the "entry points". These are crucial problems whose solution can directly assist in eliminating the main problem.

• Often it is better to draw up separate trees for different livelihood systems or perspectives (age, gender, status).

• Focal problems or entry points can be prioritized and ranked through discussion, scoring and pair-wise exercises, and will involve trade-offs among the different perspectives of the various groups within the population

Figure 7: Bengo Province Angola, rapid assessment of food security and nutrition: problem tree

Source: WFP Angola, 2002.

Brief 6. Issues related to targeting in crisis situations

Targeting is a method of delivering goods and/or services to a select group of individuals or households, rather than to every individual or household in the population. The approach chosen for targeting must be consistent with:

• the objectives of the activity, and any technical constraints;
• the characteristics of the groups to be prioritized;
• the socio-economic and cultural characteristics of the population, and the political context;
• the available financial resources and local implementing capacity;
• location-specific experience and knowledge, including the different needs that men and women may have.

Targeting mechanisms can be divided into administratively targeted mechanisms, for which beneficiaries are selected by either an external agency or community-based structures, and self-targeted mechanisms, for which beneficiaries themselves decide whether or not to become involved in a programme activity. In practice, combined methods or a multi-stage process and multiple selection criteria are used, and may be more effective in overcoming the constraints raised in conflict situations.

Whatever approach or combination is selected, the objectives, rationale and criteria should be discussed with and publicized to the affected population.

Administrative targeting

Administrative targeting involves the selection of specific geographical areas, communities and/or households or individuals. Geographical targeting is normally done by programme planners and staff and can be based on a national or regional vulnerability mapping exercise. The selection of specific households or individuals can be done by programme staff and/or communities, on the basis of whether or not candidates meet defined criteria.

Self-targeting

In this approach, the benefits are accessible to all, but programme incentives are set in such a way that the non-needy elect not to participate. Self-targeting does not involve the selection of programme participants by an external entity. This approach may be appropriate in situations in which targeting can be considered a "solidarity-breaking mechanism".

The following are some examples of self-targeting:

• Public works projects, in which the wage (paid in food or cash) is less than the market rate. This maintains a spirit of "self-help", but not all vulnerable groups (e.g. female-headed households, the disabled, the elderly) may be able to take part.

• Market-based targeting, in which programme incentives are introduced through changes in market forces. This can include the supply of a nutritionally adequate but less preferred or low-status food (e.g. yellow maize rather than white maize in eastern and southern Africa, or bulgur wheat instead of rice in Sierra Leone).

The choice of location or distribution method is also a tool in self-targeting approaches. For example, if a distribution centre is located in a poor area, it is less likely to be attended by richer households, or if food is available through a soup kitchen, it might be less attractive than dry rations.

Ideally, self-targeting methods can work through and build on local traditional methods. Finding out what will work and what not can be reviewed with the population through consultation and cross-checking with various groups.

Targeting levels

Geographical. Only certain areas may have been affected by a disaster. Geographical targeting focuses on the poorest areas (using socio-economic criteria), or those identified as being at the highest nutritional and health risk. Vulnerability and poverty assessments and mapping using a range of information sources and indicators can be used to identify geographical areas that are vulnerable to food and nutrition insecurity.

Socio-economic/livelihood group. Not all population groups will necessarily have been affected by the disaster or civil conflict. Individuals and households can be selected using socio-economic criteria such as ownership of assets (land, animals, tools), access to an income or remittances, or livelihood group. Examples of socio-economic/livelihood groups are:

• unemployed, low-income households, or households that have lost the primary earner: e.g. female-headed households, households with a high proportion of small children;

• fishers who have no nets, or farmers with landholdings below a certain size;

• pastoralists with small herds.

Selection of households and individuals. This is normally done after a geographic area or livelihood grouping has been selected by an external organization. The selection of households and individuals is often part of a multi-stage targeting process. Choosing the most appropriate criteria is the key to minimizing inclusion and exclusion errors when potential beneficiaries are being screened. The identification of admission and exit criteria, and the selection of households or individuals can be decided by external organizations using, for example, needs assessment, survey data and registration points. Aid agencies may not be in a position to collect data on sensitive topics such as food production and deficits at the household level.

Community-based targeting. If local-level leadership structures are still intact, local representatives will have good knowledge of individual households' circumstances and can select the households to be covered by an activity. However, this method requires a mechanism that independently verifies the selected households, as payment is sometimes demanded before a household is included. Criteria are decided either by local decisionmaking structures alone or through negotiation and discussion between the implementing organization and the community. A community-based targeting approach is compatible with a participatory and capacity building philosophy, and benefits from the insider's perspective. However, it requires an assessment of local decision-making structures, an analysis of existing support mechanisms, and public participation and education, so it may only be fully feasible in situations of stability.

Disadvantages of this approach, which may be exacerbated in complex crises, include:

• the difficulty in determining who best represents the community;

• the difficulty in ensuring that disadvantaged groups, such as women or ethnic minorities, are given an equal voice in the decisions. There is often the danger that a programme does not reach the most needy adequately;

• reaching consensus between local leaders and members and between the local population and outside agencies regarding what constitutes a fair and equitable distribution of programme goods and/or services can be an arduous and time-consuming process;

• social pressures, or local political leaders' need to strengthen their power base may bias allocation decisions to the detriment of those who are relatively powerless and should benefit most from the programme goods and/or services;

• targeting criteria differ across location and population group, which makes programme management and administration more difficult at the central level, and there may be inconsistencies in the allocation of benefits;

• for many nutrition-related problems, the definition of need is technical, and reliance on community-based targeting methods alone may not always be appropriate;

• determinants of malnutrition vary by location and population/livelihood group, so the best indicators for predicting the risk of future malnutrition for screening purposes are also likely to vary.

Source: Adapted from: FAO, 2001c.

The choice of location or distribution method is also a tool in self-targeting approaches

WFP

Brief 7. Strategies for establishing home gardening activities, and lessons learned from Africa and Asia

Gardening, or "food production in small quantities close to the house", enhances food security in several ways, most importantly through:

• direct access to a diversity of nutritionally rich foods;
• increased purchasing power from savings on food bills and income from sales of garden products;
• fall-back food provision during seasonal lean periods.

Households can use several strategies for ensuring continuous access to a variety of nutritious foods. Appropriate garden technologies are available to extend garden production and enable households to process and store perishable staples, legumes, vegetables and fruits, in order to extend their availability and enhance their marketing potential.

Key strategies

Plan improvements with the active participation of the community, and build on indigenous knowledge. This means identifying and assessing such factors as:

• the soil, climate and water availability;
• the types of crops that grow well;
• the foods needed for good family nutrition;
• family food preferences;
• appropriate planting dates to ensure the best possible yields of different crops;
• drought-tolerant crops if water supply is not reliable;
• seed availability;
• plants that are suitable for wet areas;
• access to technical support from field workers.

Identify appropriate improvements of the current food system to enhance variety and year-round availability, for example:

• introducing wider diversity of nutritious plants into the existing garden space, along with more effective management practices (e.g. soil and water management);

• opening up new spaces for special types of garden, such as vegetable/kitchen gardens, spices, herbs and medicinal plants, as well as for small animal raising, fish farming and the cultivation of indigenous green leafy vegetables;

• staggering planting dates to ensure availability of fresh foods for most of the year;

• setting up a dry-season vegetable garden close to a water source (e.g. riverbank, swamp or wetland) for harvesting vegetables during the dry season;

• introducing tree crops, such as fruit trees, that bear fruit at different times of year, as well as those that bear all year round (e.g. banana), and that produce fruits quickly (e.g. banana, papaya, guava), as well as those that produce more slowly (e.g. citrus, mango, avocado);

• introducing indigenous and semi-cultivated plants into the garden, such as amaranth, bitter leaf, cat's whiskers and blackjack. The advantages of indigenous plants are that they are well adapted to the areas where they are cultivated, they add variety to the diet and their nutritional contribution is significant;

• introducing improved storage, processing and preservation techniques (drying, curing, etc.);

• providing information on the nutritional value of foods and best buys, and educating parents on food preparation, child feeding, good hygiene and sanitation practices in the home.

Key lessons learned from garden promotion projects in Africa and Asia

Seed/plant material provision. Promote local varieties of indigenous species for which gardeners have experience of vegetative or seed reproduction, use and exchange. Minimize the distribution of purchased seeds, unless low-cost, accessible supplies are available for direct purchase by gardeners. Avoid the promotion of imported seeds that are not suited to local climatic conditions. They are often of poor quality and unfamiliar to local people.

Water supply. Various techniques have been developed for effective gardening in areas with overabundant or scarce water supplies. Gardens in high rainfall areas use raised beds, drainage canals, water-loving plants and plastic coverings, while dry gardens make use of mulching, ground covers and other water-conserving horticultural practices, the planting of drought-tolerant plants, the use of household waste water for irrigation, and seasonal gardening. In areas where water is of such short supply that gardening competes directly with basic household water needs or water collection requires too much time, it may be unreasonable to pursue vegetable gardening. A few perennial plants could be maintained, however.

Soil fertility/landlessness. Poor soil fertility or a lack of cultivable soil are limitations faced by many gardeners. Fortunately, a lot of applied research has been carried out on low-cost methods for improving soil fertility, such as composting, planting leguminous trees and cover crops, and terracing. Container and trellis gardening are options for families with no access to homestead land, as are local-level and school gardens.

Fencing. Promotion projects need to address the common problem of animal interference with gardening. Depending on the costs of fencing and the relative importance of livestock compared with plants, as well as family preferences, it may be better to enclose the livestock (chickens, pigs, goats) rather than fence the garden. Live fencing of the garden is an option that keeps costs down and obtains benefits from the fence plants.

Labour and input supply. In general, home gardens are more likely to be continued in the long term if input and labour requirements are low and flexible. A few days to establish the garden, and an hour a day for its maintenance are reasonable. More time and money will be invested if the gardens produce a regular marketable surplus. Projects cannot assume abundant family labour nor a low opportunity cost for family labour. Assess the household value of potential competing activities.

Integrating nutrition. The promotion of home gardening cannot be exclusively agronomic or nutrition-oriented as both concerns are fundamental and interrelated. Nutrition education is essential for ensuring effective linkages between garden food availability and consumption, and between consumption and bio-availability or absorption by the body. However, effective communication of nutrition is a two-way process. An assessment of the traditional diet, seasonal food shortages, food storage and cooking practices, intra-household food distribution and food taboos will provide important information for planning an appropriate nutrition education strategy.

Training. Field workers and men and women farmers need to be trained in both gardening techniques and nutrition. This ensures that gardens are planned to provide a year-round supply of nutrient-rich foods that are compatible with local taste preferences. Recipe development and cooking demonstrations are helpful when introducing new foods, or when teaching harvest, storage and preparation practices that optimize the nutritional value of foods. In addition, families need to know what factors promote or inhibit the bio-availability of consumed nutrients (e.g. eating fruits that contain vitamin C to enhance iron absorption, including fat/oil crops in the diet to enhance vitamin utilization). Communicating these messages involves a creative process that evolves from participatory project design and implementation in each local context.

Recognizing the income generation and other economic benefits of gardening. It is counterproductive to impose the nutrition objective to the exclusion of the income generation objective, because both are linked and compatible in most gardening situations. Among the urban poor, gardening generates income during hard times, and income or purchasing power is an important element of food security where households cannot be self-sufficient in food needs.

The multiple economic benefits of home gardening, include:

• returns on land and labour that are often higher than those of field agriculture;

• the dual benefits of food provision and income generation, including savings from purchased foods;

• the provision of fodder for household animals and supplies for other household needs, such as handicrafts, fuelwood, furniture and baskets;

• household processing of garden fruits and vegetables increases their market value and ensures year-round supply;

• the marketing of garden produce and animals is often women's only source of independent income.

Understanding women's and children's roles in gardening. Women's role in gardening varies by region and culture. Gardening is typically a family activity, involving women, men, children and the elderly, with some tasks carried out separately and others jointly. Men generally participate in the most physical tasks - bed establishment, fence building, well digging and tree harvesting - while women manage the day-to-day maintenance tasks. Women and children typically care for small livestock. The elderly play a special role in passing down traditional gardening knowledge to following generations, especially their understanding of the care and use of indigenous plants.

It is therefore important to involve the whole family in gardening promotion projects, even though emphasizing women's participation may be fully justified. There is also a need for caution regarding the assumption that women have unlimited time for gardening. Women will invest more time in gardening if the garden generates income as well as food for the family. In Africa, there is evidence that men take over the management and marketing functions when gardens become more profitable. Projects need to be aware of this risk and assist women to preserve the gains they achieve from gardening.

There is evidence that when gardens are controlled by women, both women and children are more likely to consume a larger proportion of the garden harvests. This is especially true if women are educated about the nutritional and health benefits of eating vitamin-rich foods daily, and the special needs of young children. Children benefit directly from home gardens as a nearby food source when their parents are busy for long periods in the fields. Children may also gather and sell garden produce for money to buy food.

Working toward an integrated strategy for improving food security

The most successful household gardening efforts in terms of food security achievements and sustainability are those that involve both the nutrition/health and the agriculture sectors in an integrated approach. Equally important is the participation of both private non-profit organizations (NGOs) and government ministries, even when government is involved only in a facilitative role.

If small, isolated gardening projects are to be built up into effective regional and national efforts, governments must provide basic policy support (e.g. through public agricultural research and extension services, schools, health clinics and supportive land use regulations in rural and urban areas, including improved access to land by women).

A boy watering a vegetable garden

FAO/23054/R. Grossman

Brief 8. Estimating general ration needs per person, and calculating food aid requirements

Immediate food aid requirements (in particular for refugees and IDPs) are normally calculated on the basis of estimating the number of people affected and multiplying this by an individual daily ration. Calculations for estimating food aid requirements should also take into consideration the demographic profile and assumed level of activity among the affected population.^[13] If there are high levels of malnutrition but food insecurity does not appear to be the major causal factor, targeted supplementary programmes may be necessary, in combination with interventions to address the location-specific determinants of malnutrition.

In situations where households are still able to continue some productive activities, food deficits are estimated for different wealth groups, based on an understanding of how households obtain food. This method is based on the household food economy approach developed by SCF-UK. It assumes that households are able to compensate for some food shortfalls through expanding their alternative food and income sources, or adopting coping strategies. This can be used for more effective targeting, and for justifying earlier food aid interventions, so that households do not need to resort to coping strategies that may erode future productive capacity and/or household well-being.

The following are the WFP/UNHCR guidelines for estimating general ration needs per person:

• Energy: 2 100 kcal/day.

• Fat/oil: a minimum of 17 percent of energy provided by the ration should be from fat. This means typically that 25 g of edible oil is provided per person per day.

• Protein: a minimum of 10 to 12 percent of the energy should be in the form of protein.

• Vitamins and minerals: the daily requirements of all essential micronutrients should be assured from the diet. The following are ways of ensuring an adequate supply, in order of preference:

- promotion of vegetable and fruit production;
- provision of fresh food items;
- adding a food that is rich in a particular vitamin or mineral to the ration;
- provision of fortified food (blended food);
- provision of nutrient supplements.

The energy value of the ration should be changed in the following circumstances:

• The population has suffered severe food shortages and/or cases of widespread illness. (Supplementary and therapeutic feeding programmes should also be implemented in these situations.)

• Activity levels are high, for example during periods of heavy work.

• Environmental temperature is significantly below 20 °C.

• The age and gender composition of the population is unusual.

N.B. The Red Cross (1986) recommends a target ration of 2 400 kcal for an average population, in order to cover the nutritional needs of pregnant and lactating women, cold stress, physical activity, catch-up growth and losses during transport, storage and distribution.

Calculation of food aid requirements (per month)

Ration item (pppd) x Beneficiaries × Planning period × Transport loss adjustment

Further reading and resources

WFP/UNHCR. 1997. Guidelines for estimating food and nutritional needs in emergencies. Rome.

WFP. 2000. Food and nutrition handbook. Rome.

Seaman, J., Clarke, P., Boudreau, T. & Holt, J. 2000. The household economy approach. A resource manual for practitioners. Save the Children Development Manual No. 5. SCF-UK.

Household at mealtime

WFP

Brief 9. Issues to consider when choosing food relief commodities

· Can the food be prepared, i.e. are cooking fuel and utensils available and affordable?

· If whole grains are being given, are there facilities for milling them? Are these facilities accessible and affordable to all those to whom the grain will be given?

· Where is the food aid coming from? Is it the same type of food as is produced locally? If so, will the sale of food aid in local markets damage local livelihoods by reducing the demand for local farmers' produce?

· Is it possible to buy the food aid in the country in a way that encourages both local production and commercialization?

· Is it possible to provide a micronutrient-fortified food for infants?

· Are there opportunities for encouraging the home preparation of weaning foods using local/indigenous foods?

· What are the opportunities for obtaining food other than the ration, and where does this food come from? For example:

- local markets, refugee camp markets;
- small home gardens for vegetable production;
- wild foods, including wild animals;
- exchange with or stealing from the local population.

· Will the population have to sell a part of the ration to obtain cash for other essential needs? For which items is there a good market? What are the nutritional implications?

· What are the quantity, quality, variety and safety of the present diet and the prior diet of the population? Does the proposed food aid fit in with existing food habits?

· Are the foods of good quality and safe for consumption?

· Can systems be set up to monitor problems such as pest infestation, contaminants and product age, and to exchange information among agencies?

Fruit and vegetable market

FAO/19853/O. Argenti