Unit 8 Policies and Programmes for improved Access and Utilisation

Question 1

Sen’s entitlement framework and loss of access

Answer 1

Loss of
o	 direct entitlement
o	endowments 
o	exchange entitlements
o	resource transfers

8.1

Question 2

Types of loss of access

Answer 2

Idiosyncratic

Seasonal

Widespread due to covariate factors
8.1

Question 3

Challenges facing governments when designing SP as response for seasonal hunger and poverty;
Most common solution?

Answer 3

Targeting:
- Unpredictability of seasons (timing, severity)
- Which household?
- How much is required?
Most common solution: PUBLIC WORKS
- self-targeting if low wage
- families can plan ahead if right to work built in, e.g. NREGA
- requires good design and management to avoid unsustainable overheads
- most do NOT guarantee employment during hungriest period
- only for able-bodied ppl
Year-round SP is needed to allow build-up of reserve

8.1

Question 4

Issues regarding high food prices - 2007-2009

Answer 4

2007-2009 period of high food prices;
immediate economic and political crisis in low- and middle-income countries due to widespread loss of access; political pressure;

controversy: temporary spike or long-term?

Question 5

Policy responses to high food prices (Preventing and mitigating temporary loss of access to food)

Answer 5

1. Targeted social transfers – FOOD
2. Targeted social transfers – CASH
3. Food price management / stabilization – INTERNAL
4. Food price management / stabilization – EXTERNAL
5. Support to food production and agriculture – INPUT / PRODUCTION COSTS
6. Support to food production and agriculture – OUTPUT TERMS

8.1

Question 6

Targeted social transfers

Answer 6

FOOD
1.1. Emergency and targeted food aid rations *
1.2. Food for work
1.3. School / Hospital feeding
1.4. Food vouchers / stamps
1.5. Direct sales to targeted groups at low price **
1.6. Nutrition / supplementary feeding programs
CASH
2.1. Direct targeted cash transfer
2.2. Cash for work
2.3. Civil Service (lower paid) wage increases*
2.4. Other payments / subsidies to poor groups (tax relief, fuel subsidy)

8.1

Question 7

Food price management / stabilization

Answer 7

INTERNAL
3.1. Untargeted food price subsidies**
3.2. Release stock (public or imported) at low price
3.3. Administrative food price control, with private trade restriction, action against hoarders **
3.4. Price agreements with key traders
3.5. Reduction of consumer taxes on food, including VAT *
3.6. Untargeted fuel subsidies
EXTERNAL
4.1. Food exports banned, restricted, export quotas**
4.2. Food export taxes raised or minimum export prices
4.3. Reduction or elimination of import tariffs, quotas, and customs fees ***
4.4. Monetary and exchange rate policies

Question 8

Support to food production and agriculture

Answer 8

INPUT / PRODUCTION COSTS
5.1. Provide free inputs (fertilizer, seeds); productive safety nets
5.2. Subsidised fuel/electricity for farmers*
5.3. Untargeted production and input subsidies (i.e. fertilizers) / improved access to credit
5.4. Targeted free inputs or input subsidies for own food production*
5.5. Short-term area-based emergency production projects (often incl inputs and technical assistance) *
5.6. Untargeted fuel subsidies**
OUTPUT TERMS
6.1. Raising producer support price
6.2. Reduction in producer taxes*
8.1

Question 9

Most common measures for preventing and mitigating temporary loss of access to food by low vs. high income countries (reasons?)

saq 3: List the main types of food and cash transfer programmes that were adopted by national
governments when world food prices shot up in 2007–2008

Answer 9

• Targeted food distribution incl. food for work (1.1)
• Targeted food sales (1.5) LOW INCOME COUNTRIES – international aid dependence – comes as food aid
• Targeted cash transfers (2.1) HIGHER INCOME COUNTRIES – scaling up requires infrastructure already in place
• Import tariff /fees reduced (4.3) LOW INCOME COUNTRIES (Price stabilization: border measures) – quick, low cost
• Export banned/restricted/taxed (4.1) LOW INCOME COUNTRIES (Price stabilization: border measures) – quick, low cost
• Admin price control (3.3)
• General food subsidy (3.1)
• Production subsidies and inputs (5.2, 5.4, 5.6) HIGHER INCOME COUNTRIES (Support to agricultural production cost) – international aid reluctant to give untargeted subsidies for inputs – more in high income, not dependent on aid.
8.1.2

saq 3: These were some of the most commonly reported. (Note that you are not expected to memorise
long lists of interventions, but should have a general understanding of the types and range of policy
options available.)
mentions TARGETED SOCIAL TRANSFERS - food transfers and cash transfers subgroups and other payments/subsidies to poor groups (eg tax relief, fuel subsidy)

Question 10

2 determinants of policy choice for preventing and mitigating loss of food access;
7 key considerations

Answer 10

Country history and experience shapes policy choice:
•	Public works experience – CFW /FFW
•	Trader distrust – anti-hoarding and price policy
Key considerations:
•	Speed
•	Ease
•	Cost
•	Coverage
•	Political acceptability
•	Affordability
•	Reversibility
8.1

Question 11

Policy implementation and unintended consequences

Answer 11

Kenya food price rises 2008: policy responses
- Government: different maize price for poor and middle class;
o Consumers could still not afford, according to opposition; entrepreneurs re-sell at huge profits
- Government forces farmers to sell cheap maize to NCPB
o Opposition blamed gvt for market distortion
- Confusion about official policies: subsidized resale to millers, but no budget for these subsidies
- Consequences: sales cross border before export ban; rumour of corruption by politicians: buy cheap from NCPB, resell expensively to millers

Question 12

Social effect of interventions - Academic researchers and donors less aware of social effects than local politicians.

Answer 12

• Tensions of cash transfers
• Witchcraft accusations
• Food transfers shared, cash transfers kept by individuals
• Possibly undermines complex web of local reciprocal support

8-1

Question 13

Approaches to improving and stabilizing food access - general measures

Answer 13

1) Targeted food aid
2) Improved livelihoods
3) Macroeconomic environment
• Access to food influenced by economic factors: 1- economic growth and distribution, 2- exchange rates and inflation, 3- infrastructure, 4- trade and finance integration with world economy, 5- international prices of inputs, 6- urbanization
• Wide range of programmes, e.g. pro-poor growth – not all discussed in module

Protection, prevention, promotion, transformation to improve access to food
8.1.1

Question 14

Approaches to improving and stabilizing food access - concrete measures and categories

Answer 14

Approaches: (advantages, disadvantages for access and other goals?)

1. Cash and near cash transfers (Grosh 7.1) (Unconditional cash transfers 8.1.1.2 c)
2. 1. Family allowance programme: one-off grants (e.g. maternity)
3. 2. Family allowance programme: Regular child support grant, noncontributory pension (e.g. widow’s); UCT (c)
4. 3. Food vouchers /stamps/coupons programme (c)
5. In-kind food transfers and other food-based programmes (Grosh 7.2) / targeted food transfer (8.1.1.2b)
6. 1. Direct food aid (food rations and transfers for vulnerable groups at free/reduced price) (b)
7. 2. Direct food aid (emergency food distribution to save lives (b)
8. 3. Supplementary feeding of infants, mothers (b)
9. 4. School meals (free or cheap) (b)
10. General subsidies: universal, untargeted; price control (Grosh 7.3) (8.1.1.2a)
11. 1. Universal, indirect price support for food (a)
12. 2. Subsidised untargeted sales
13. 3. Subsidised energy, utilities (8.1.1.2)
14. Work fare (Grosh 7.4) / public works programmes, temporary access to work / Employment Schemes (8.1.1.2)
15. 1. Roads, buildings
16. 2. Environmental (e.g. soil) conservation
17. 3. Service provision:e.g. child care
18. Conditional Cash Transfers CCT (Grosh 7.5) (d)
19. Free inputs (seeds, tools, fertilizer) (8.1)
20. Asset transfer (8.1.1.2)
21. Non-contributory health insurance (8.1.1.2)
22. Subsidised crop insurance (8.1.1.2)
23. Availability related (8.1.1.2)
24. 1. Subsidised inputs (fertilizer)
25. 2. Infrastructure (prevention: agric infrastructure e.g. irrigation to reduce risk)
26. Complementary social and business support (8.1.1.2)
27. 1. (Micro) credit (D&SW p.118)
28. 2. Training for unemployed
29. 3. Youth employment and training schemes
30. 4. Training for women –reinsertion into labour force
31. 5. Complementary social and business support

8.1.1

Question 15

What factors determine choice of intervention?

Answer 15

1. Target group to be reached
2. Strategies for accessing food and challenges faced (short-term crisis or chronic lack of access?)
3. Organizations that can provide assistance, capacities
4. Local economic context: market functioning, infrastructure
5. Political and social acceptability
6. Relative costs and benefits of different options
7. 1.1

Question 16

Factors affecting costs and benefits of different interventions to improve access to food?

Answer 16

(also see unit 4: Design features influences value for money – how to improve cost-effectiveness?)

1. Value of transfer
2. Coverage (number, types, location)
3. Targeting efficiency
4. Administrative costs
5. Beneficiaries’ private costs of accessing benefits
6. Dispersed benefits (e.g. from public works)
7. Impact on incentives to attend school, to quit work
8. 1.1

Question 17

Grosh: Food price rise context, country examples

Answer 17

Grosh (2008) p. 444: Food prices doubling since Jan 06, few parallels; structural factors: biofuel use increase, weak USD, diet shifts; policy: export restrictions on rice exports, thin market. Prices expected high through 2015; IMPACT: human development: poverty, nutrition, health, productive asset depletion – long-term effect. Very poorest, rural landless, lack labour – most severely affected. COUNTRIES’ CAPACITY essential.
3 Roles of safety nets: mitigate poverty and inequality; help maintain food access, health, education -HC; maintain social equilibrium.
General subsidies common but amongst worst option. Chile: good preexisting SP system; gvt issues a one-off USD 45 payment to 1.4MM poor households or 5.6MM people (beneficiaries of other programmes). Ethiopia quick response: suspends VAT; reliance on PSNP (rural) with rate increase; subsidized wheat to urban hh, meant to stabilize wheat prices in urban and rural areas. Haiti: protest growing violent, prime minister voted out of office, public demanding more visible, immediate action – got temporary food (rice) price subsidy (inclusion errors: all consume, but less exclusion errors than employment generation, food assistance – poorest not reached).

Question 18

Grosh: core message re. safety nets, and final lesson

Answer 18

Grosh p.451
Core message: no single recipe for safety net; context specific product mix; context determines how programs are implemented; e.g. PSNP community targeting for seasonal (heavy manual) work, long run focused, district-level planning; Jefes de Hogar (Ar): self-targeting, heavy and lighter work; Honduras responds to Hurricane Mitch with public works for cleanup and reconstruction, self-targeted, rationed participation; INSTITUTIONS: Ministry of Labor (Ar), FS Bureau (Ethiopia) Social Fund (Honduras);
Most SOPHISTICATED programs and systems: stable, middle income or transition countries, longer-standing systems; low-income settings: simpler systems
Final lesson: safety net systems and programs should be dynamic, respond as needs change, constant search for improvements (e.g. PSNP, Egypt’s food subsidies have become more effective. RESPONSES TO CRISES, NATURAL DISASTERS, POLICY REFORMS ARE INHERENTLY DYNAMIC.

Question 19

Evolving policy debate: SP and access to food;
5 Recent positive developments;
Challenges:

Answer 19

Evolving policy debate: SP and access to food
07/08 food price rises have influenced development of policies & programs for food access; Countries with systems in place were better off than those without (poorest), who were scrambling for international aid or implemented expensive policies (subsidies) to avoid catastrophic loss of access. LESSON: minimum systems that can be scalable to be in place
Recent positive developments:
- Broad gvt agreement of importance of food access
- SP floor: minimum level
- Right to food has increasing support
- Scaling up of programmes, e.g. Asia
- Alternatives to food aid from wealthy country surplus sought

Challenges: fiscal pressures to reduce SP expenditures; Reforms politically difficult but cost effective (switch food to cash tf, universal subsidies to targeted SP. Examples: Grosh 441-442 BFP: switch from fuel subsidy to CCT. Indonesia: from regressive subsidies to CCT.

8.1.2

Question 20

SAQ1: In what way do the ‘normative underpinnings’ of Conditional Cash Transfers (CCTs) differ from the beliefs underpinning food transfers and (non-contributory) Unconditional Cash Transfers (UCTs) as a way of tackling lack of access to food? How might this affect the political acceptability of these alternatives?

Answer 20

Choice of policies often reflects underlying NORMATIVE thinking (morals and beliefs) as well as EVIDENCE. The provision of UCTs usually reflects a view that recipients have a right to a minimum standard of living, as well as the freedom to make decisions for themselves. Provision of food
transfers and CCTs may reflect the view that certain behaviours of poor people are having a negative effect on their (or their children’s) well-being, and that they cannot be trusted with complete freedom over their money. This may, in turn, reflect complex underlying beliefs about the ‘deserving’ and ‘undeserving’ poor, for example, a belief that ‘innocent children should not be punished for the fecklessness of their parents’. Gender issues – for example, the idea that men might spend money on drinking and gambling – may also encourage a preference for less openended financial support. For these reasons, food transfers and CCTs are often more popular with the
taxpaying public than UCTs as a means of tackling lack of access to food. UCTs are often more politically acceptable when given to clearly-identifiable vulnerable groups such as the elderly.

Question 21

SAQ2 What are inferior commodities? What are the advantages and risks of subsidising inferior food
commodities as an approach to increasing access to food?

Answer 21

Inferior commodities (or goods) in economics parlance are those for which demand is less when incomes are higher (they have a ‘negative income elasticity’). It does not mean that the commodities are actually ‘inferior’ in taste or nutritional value. Examples might be locally milled
flour in relation to refined white flour or traditional bread in relation to factory-produced bread. The potential ADVANTAGE of subsidising such inferior goods is that they are ‘SELF-TARGETING’ – that is, to
some extent wealthier people will not want to buy them and so will not benefit from the subsidy. The main potential DISADVANTAGE is that if the subsidised commodity is not carefully chosen, richer people may still eat it or find a use for it (for example, as animal feed) and targeting will be relatively ineffective.

Question 22

Strategies to combat undernutrition (WB 06)

Answer 22

LONG ROUTES
• Supply-side incentives:
o WASH: primary health care services (family planning); infectious disease control; safe water, sanitation
o Food industry: policies against marketing breast milk substitutes; policies to increase supply of safe and healthy foods; market incentives for developing healthy / disincentives for unhealthy food;
o Production: fruit, vegetable
o Exercise: parks, bike paths, recreation centres
• Demand-side incentives
o Income: Economic development, employment creation
o Purchasing power: fiscal / food price policies to increase pp for right kinds of foods (exchange condition)
o Participatory program / policy development
o Marketing regulation of unhealthy foods
• Demand-side behavior change
o Improve women’s status
o Reduce women’s workload, especially in pregnancy
o Increase women’s education

SHORT ROUTES
•	Supply-side incentives
o	Nutrition and health services: Community- (growth promotion, C-IMCI) or facility- (antenatal care...) based
o	Micronutrient supplements, fortification (popular: requires no behavioural change, can eat foods they like – p.32)
o	Targeted food aid
o	Biofortification
•	Demand-side incentives
o	CCT 
o	Food stamps
o	Targeted food aid
o	Microcredit & nutrition education
o	Supplementation: food, micronutrient
•	Demand-side behavior change
o	Maternal nutrition, knowledge, care-seeking
o	Infant feeding
o	Education: weight control, hygiene, healthy life style (physical activity, balanced diet, cut salt, sugar, fat...)

Challenge: finding most cost-effective programme in improving nutrition;
8.2

Question 23

List of 13 actions

Answer 23

Research results in list of 13 actions, adopted as BASIS FOR ACTION by international Scaling-up nutrition (SUN) movement:
1. Promoting good nutritional practices (3): breastfeeding, complementary feeding after 6mths, improved hygiene practices

2. Increase intake of vitamins and minerals
   • Provision of micronutrients for young children and mothers (6): Vitamin A, Zinc, multi-micronutrient powder, de-worming drugs, iron-folic-acid to pregnant women, iodised oil capsules in absence of iodised salt
   • Provision of micronutrients through fortification for all (2): salt iodisation, iron fortification of staple foods
   • Therapeutic feeding for malnourished children with special foods (2): treatment for moderate and severe (SAM) malnutrition with RUTF- ready-to-use therapeutic foods

8.2

Question 24

Absence of interventions addressing long route factors because…

Answer 24

1) Long-routes complex, situation specific; scalable interventions review doesn’t include these
2) Mixed or thin evidence of complex intervention (agriculture, CT) on nutrition; evaluations costly, results difficult to understand
3) Quick fixes more appealing to politicians, implementing agencies, funders
4) Fixing immediate needs can help address long-term problems by breaking malnutrition lifecycle: well-nourished girls, high school performance, earning opportunities, later child bearing…
List of 13 will be prioritized for funding: solid evidence, quick results; creative solutions encouraged

8.2

Question 25

Challenges of improving utilization of food

Answer 25

1. Consumer demand and nutrition transition: “consumers don’t want to spend limited resources on most nutritious food”; e.g. poor in Greate Depression want to eat tasty (fat, sugar), not healthy wholesome, food to compensate for misery.
   No economic demand for better nutrition – reduced private sector /gvt incentive to focus on nutrition.
   Consequence: widespread fortification promoted: requires little behavioural change from consumers. Controversy: secret medicine forced by state; risk of micronutrient overdose. Examples: iodised salt, wheat with iron, o juice with calcium, juices with vitamin C.
   Nutrition transition and policy side effects: cash transfers, food subsidies and vouchers increases consumption of meat, fat, sugar, salt. -> obesity, NCDs; (e.g. US, Egypt; Thailand: massive decreases in child undernutrition, but nut trans issues few yrs later)
2. Institutions: Poor intra-sectoral coordination to achieve common nutritional goal due to different motivations and incentives; e.g. agriculture rarely prioritizes nutritional goals (lack of economic / political demand); Consequence: policy focus on simple, streamlined interventions (SUN 13) involving private sector; (see 8.2.2.2: UNICEF framework / food, caring, health, access, availability influenced by actions of health, environmental services, market, households; prices, hh income and production…)
3. The nutrition agenda is medicalised: streamlining, fortification contributes to homogenous world dominated y TNC.
   Global Health Watch 2011: mystification of malnutrition to create profit; Chronic Hunger defined as “deficiencies of small quantities of micronutrients” -> “NEED SUPPLEMENTS, FOOD FORTIFICATION”, but could be solved with breastfeeding and use of diverse locally available food (ensuring access: promote fair employment, kitchen gardens, small domestic animals); Consequences: less local control and autonomy over diets; local livelihoods displaced (e.g. milling); dependency, unsustainable solution; GAIN, Unilever lobby governments for introduction of micronutrient distribution.
   8.2

Question 26

3 legitimate reasons for promoting “quick solutions”

Answer 26

(also see absence of interventions addressing long route factors, above)

1. Low cost, evidence of efficacy; theory that quick fixes might drive structural change in next generation
2. Simplicity: no sectoral coordination needed
3. Profit motive as force to involve private sector, achieving increased coverage (e.g. some TNCs reach remote villages, public health interventions don’t)
4. 2
5. 2

Question 27

Policy choices on undernutrition: an example of reducing iron deficiency.

Advantages/ disadvantages?

Answer 27

1. Fortification of staple food – Cheap, effective, simple; may not reach remote, poor; local millers crowded out
2. Supplements: iron pills – effective for pregnant women; distribution is expensive in rural areas; not popular
3. Educational campaigns for iron-rich diet – expensive, does not tackle main problem of poverty
4. Biofortification (introduce iron into the seed of staples) – long-term research, long-term solution; depends on farmer and consumer acceptance
5. Reduce diarrhea, improve health to enhance absorption – might not sufficiently solve iron deficiency, e.g. in women
6. Price policies, e.g. taxes, subsidies, to create consumer incentives to change diet – iron-rich foods favoured by richer
7. Increase incomes, e.g. cash transfers – increase of iron amount but may still be insufficient
8. 2

Question 28

Specifities of addressing “Utilization” (Conclusion)

Answer 28

• Utilization depends on multiple sectors;
• Non-food causes in target groups has refocused international debate: breastfeeding, fortification – increasing distance between utilization policies (short route – 6 preferred of 13) and wider policies to increase access
• Nutrition transition: more and cheaper food not only goal: complex struggles for healthy diet and exercise
• Little economic, political demand for better nutrition – low incentives for private and public sectors; international aid can enhance these incentives = objective of SUN movement.

8.2

Question 29

Q5 Food subsidies promote good health when they are targeted to healthy foods, such as whole grain flour, which are traditionally consumed.
T / F?

Answer 29

It depends! Food subsidies may possibly increase the
consumption of the food being subsidised. However, another possibility is that the household buys the same quantity as before of the healthy flour and uses the money saved to buy other foods, some of which may be less healthy (for example, soda drinks)]

Question 30

SA - Q 1
What kinds of policies were adopted by national governments when world food prices shot up in
2007–2008? What factors affected the choice and effectiveness of these policies?

Answer 30

Most countries adopted a variety of policies. Some of the most common were:

• Targeted social transfers:

• Food for Work
• Targeted food sales
• Targeted cash transfers

• Food price management:

• Reduced import tariffs or fees for imported food
• Banned or restricted exports - Administrative price controls (ie price fixing by government order)
• General food subsidies

• Production or input subsidies to try to increase food production.

Some of the factors which affected policy choice were: political pressures for a rapid and visible response, especially in urban areas;
availability of finance (from national coffers or international
aid);
administrative ability to implement (for example, if programmes were already in place that could be scaled up);
history and experience;
potential policy reversibility;
and to some degree costs
and benefits.

Coverage and effectiveness were affected inter alia by: lack of finance; low coverage of existing system (for example, for social protection); weak administrative systems and poor management capacity; political incompetence and corruption in some cases.

Question 31

SA Q2
The list of 13 interventions in the internationally-promoted Framework for Scaling Up Nutrition does not include a single intervention to promote access to food. What might be the main reasons for
this?

Answer 31

In brief:
• increasing focus on specific target groups (under twos and pregnant and nursing mothers)
where other causes of undernutrition – such as lack of micronutrients or disease – may be more significant in many cases than access to food
• evidence is thin or mixed for the nutritional impact of many interventions that increase access to food
• the nutrition transition in many countries means that ‘cheap food for all’ is being superseded as a national political goal by ‘better health and nutrition’
• focus on relatively simple interventions that can be scaled up rapidly without complicated intersectoral co-ordination
• influence of large corporations on some policy choices is claimed by some critics (for example,
industrial food fortification)