FMD Trip Report – March 2011

As PM2A is being tested in the pilot projects of Burundi and Guatemala, it is apparent that the objective of targeting all under 2 children as a preventative approach to under-nutrition could become a significant part of most food security plans using Title II.  Since NAMA’s blended and fortified foods are the highest nutrition foods in the US food aid basket, we expect that this will lead to more CSB  and other such foods being programmed in the future.  With the Tuft’s University study advocating formulation changes in blended/fortified foods and inclusion of animal protein ingredients in such foods, the team also wishes to examine the justification for this effort.

NAMA’s ITC and staff will remain active in the Food Aid Consultative Group Food Safety Task Force with the goal of clarifying for our food aid cooperating sponsor partners the necessity of realistic expectations for food safety testing.  PVOs and World Food Program have confidence in the US food system’s quality control and we need to reinforce that with clear understanding of process controls based on the HACCP model.  It is important that FDA be engaged to assist in advising realistic expectations for food safety risks and putting Codex Alimentarius levels into context.

NAMA staff and ITC members will continue to engage USAID and Tufts University in dialogue regarding the field testing of formulations recommended by the FAQR for use with children under 2.  We should reinforce WFP’s clear recommendation that the new formulation including animal protein should not stop the production and availability of blended-fortified foods with the current formulation. (It might be possible to harmonize the premix for the current CSB with WFP specs).

Paul will engage FFP to discuss the forced destruction of CSB bags during distributions.  It is appropriate to weigh the environmental impacts, sanitation issues and lack of beneficial reuse forfeited by burning of bags.

Paul will obtain the WFP estimates of packaging and handling cost differences between smaller packs (single use plastic bags) of 3-10 lb each vs. current packaging.  WFP told the team that unitizing these packages (in bigger bags, or shrink wrapped, or in cartons) cost about $160 per ton more than the current packing.

PM2A
The travelers achieved a good working understanding of the objectives of the CRS (Catholic Relief Program) managed PM2A program in Northern Burundi, using CSB and vitamin A enriched vegetable oil as the ration for a ‘blanket feeding’ program targeting all children in two provinces from the time of conception to their 2nd birthday.  We observed the PM2A operations from regional warehousing to remote site warehouses and ration distribution in a remote hospital setting.  Large quantities of US CSB are used in such blanket feedings and if the results of this trial (and the Mercy Corps trial in Guatemala) are positive, NAMA should remain very closely involved with this substantial use of blended and fortified foods.

The PM2A approach is designed to prevent all children in a specific geographic location from falling into malnutrition during their first 1000 days, when the brain growth is critical to future life outcomes.  It’s a very expensive and labor intensive endeavor that will be evaluated after about 5 years.  The Burundi project began about 1 year ago. It currently has 34,000 enrollees and will hit its peak of 46,000 beneficiaries later this year.  It will begin to decline at that point as new women will not be enrolled and children will leave the program at the time of their 2nd birthday.  With each distribution, partner organization Feed the Hungry (FH) undertakes transition education and training of mothers in nutrition and hygiene with the intention that when the child reaches the age of 2, the local food sources can substitute and maintain the child’s nutritional status (and that of the entire household).

Beneficiaries at the PM2A distribution were primarily young women who appeared healthy and proved to be very strong, as the rations they received were a struggle for even able bodied individuals. They received 18 kg (about 40 pounds of CSB and a liter of oil for that month for children over 18 mo. and 15 kg for younger ones.  Each mother was given a yellow bucket for carrying their CSB ration at the beginning of their pregnancy and they return with it each month for their ration.  The bucket was not the right size, however, since they ordered the buckets using wheat flour as a substitute for CSB and found after the fact that flour has a different density.  Therefore, the buckets wouldn’t hold the full ration of 18 kg. and had to be mounded up.  The common method of carrying their ration was to wrap the mounded bucket with the top pressed down as firmly as possible in the large cloth that most women wore as national dress.  The bucket was then placed on the woman’s head.  The sight of a woman with a 40 pound bucket on her head, a 20+pound baby on her back and carrying a 1.5 liter oil bottle for a 1-2 mile trip home in very steep hilly country was daunting.

Burundi is a puzzling place for chronic malnutrition.  First impressions are of a lush, productive, diverse agricultural sector, where any seed planted would surely grow.  However, after observation it becomes clear that the small holdings of individual farmers and a very high birthrate has created a carrying capacity crisis for agricultural production in Burundi.  With no other obvious alternatives for labor, too many people are forced to draw their livelihood from the a given, smallholding farm.

The heavy starch-based nature of local crops (cassava, corn, banana, rice, sorghum etc.) and the scarcity of animal husbandry provided our team with clarity on the justification for inclusion of animal protein in the Tufts University Food Aid Quality Review (FAQR).  The under-2 population is clearly consuming a primarily starch based diet as they come off the breast and without the animal protein and micronutrients of other vegetable foods, they will not have a well-rounded diet.

It is also surprising that all farm labor appears to be done by human labor, rather than by animals, making the steep hillside farming a very difficult task.  Even transportation was primarily walking and bicycling.  Field work appeared to primarily be done by women and the bicycles were predominantly occupied by men, while women nearly always walked.

While not discussed during the Burundi visit, later in the trip, the travelers heard development experts asking whether the blanket-feeding model of PM2A might have perverse incentives that could undermine its admirable objectives.  Namely, they cite that there have been some instances of women buying pregnant women’s urine to falsely claim they were pregnant in order to get food.  This led to speculation that women might have the incentive to get pregnant in order to obtain 3 years of food.  While by no means certain, this perverse incentive needs to be examined by the program evaluators, prior to expansion of PM2A into widespread use. 

MYAP (Multi Year Assistance Programs
CRS Burundi is also operating a MYAP food distribution targeting moderately and chronically malnourished persons in a different province than the PM2A projects.  This program makes bi-weekly distributions and the travelers did observe one distribution for the MYAP, as well.  The distribution was orderly and seemed well organized.  The storage and handling was hygienic and neat, as well.

The distribution site required each beneficiary to bring their own container for transport of their food distribution.  This resulted in many types of containers, varying levels of hygiene and some questions of health and food safety.  We asked why recipients couldn’t use the packages that the products were in originally and were told that to keep the products from being resold in the commercial market, the bags for CSB were ordered burned at the site.  There was  smell of burning plastic that we’d noted and that was due to the inner liner of the paper bags being burned.

The GOK has established a new Biosafety Authority and though it is staffed by only 2 persons, they appear to be taking a ‘precautionary’ approach to GM products imported through Kenyan ports, even for reexport.  The KPHIS, which has been managing import issues for the GOK had made a distinction between bulk commodities that could propogate and processed products that couldn’t, but the KBA isn’t making such distinctions.  They have proposed regulations that are not implemented yet, but would require preclearance of all shipments of food products, to assure that each shipment did not contain a biotech event that wasn’t yet authorized for import.  This will be an unwieldy process and both the US Embassy and WFP have been working to assure the KBA implements their new authority in a trade facilitating manner.

WFP feels that the press is warming the population up for a more welcoming atmosphere to biotech food products, but it’s still going to be a long process.
Clearance of biotech food products in Mombasa warrants NAMA monitoring.

WFP is concerned about shipments of bagged commodities with different BUBD that can cause issues regarding product implementation.  When products are being distributed, it’s too late to discover that some of the bags are already past the date.  The travelers had a long conversation regarding the safety and shelf-life of the products even after the BUBD, but the bureaucrats want the products eaten before what they consider the expiration date.

School Lunch
WFP and their implementing partner, Feed the Children (FTC) permitted the travelers to view a school feeding at the Nazarene School in the Kibera slum of Nairobi.  The school is quite basic and the teachers are very dedicated to give these children instruction under such conditions.  Once again, we are shown that school food incentivizes parents to send their children to school, particularly girls.

Our visit to FTC was the first time NAMA has engaged this PVO, which is very active in School feeding globally, particularly as implementing partners for WFP.  This PVO is an important contact for NAMA and is in accordance with NAMA’s UES Management Objective to make contact with a potential user of NAMA products for food aid each year.    During a visit to the FTC HQ in Nairobi, we saw their warehousing and distribution facilities.  This Oklahoma based NGO feeds over 87,000 children daily in WFP sponsored schools and another 50,000/ day on their own funding.  Their own funds are used to buy local corn, beans and oil for the school meals.  Paul will follow up with the FTC  headquarters in Oklahoma City to expand the NAMA engagement.

Regional Food For Peace
Robert Drapcho, East African Regional Food for Peace officer is nearing departure for Afghanistan, but was willing to meet with us to debrief on many issues in the region.  Robert was outspoken on the PM2A as being a difficult concept to implement.  He noted that vegoil that is distributed to recipients is often sold in the market for other goods, while mixing the oil with grains shortens the shelf life considerably.  He was particularly critical of the use of CSB and other grains in situations where the populations were already starch heavy in their diets.  He suggested that Burundi may not be the best place to test PM2A, but it was too late to change locations at this point.

He also pointed out the potential moral hazard of PM2A in promoting women to have additional children in order to get the food.  This is an unintended consequence of food distributions that needs to be considered.

CRS East Africa
Most of the discussion with CRS’s regional office centered on the South Sudan and Darfur issues.  CRS has applied for a S. Sudan MYAP and is hoping to expand their programs there.  They encouraged NAMA engagement in S. Sudan on nutrition issues.

They point out that CSB++ is a real meal, vs. plumpy nut or other lipid based foods that aren’t.  They said that Mark Manery (sp) will be publishing a comparison of the food formulations soon and that should advise our future use.  WFP says they intend to continue to use CSB and CSB ++ in addition to plumpy nut for preventing moderate malnutrition.  They want all those tools available for their interventions.

Our discussion of food safety issues, particularly related to LRP was very interesting.  They acknowledged that Aflatoxin in grains and nut products they procured in Africa is consistently a problem.  They also acknowledged that testing for it in harvested products is too late, since the farmer is relying on that product for a year’s livelihood at that point.  WFP reps referred us to the Gates Foundation activity PAC (Partnership for Aflatoxin Control) that is hoping to lessen the amount of Aflatoxin in the soils in small holder farmer’s fields.

On the minds of all the procurement officials was the overriding concern over skyrocketing food prices.  With all budgets denominated in dollars, the tonnages have already shrunk and are continuing to cause hardship for WFP and it’s beneficiaries.  NAMA reiterated that there is no answer for the high prices other than high prices, which hopefully incentivizes higher production and more food security in the long-run.  This long-term solution is not of much consolation to the WFP practitioners who are wanting to relief humanitarian circumstances in the much shorter term.