Intended for healthcare professionals

Education And Debate

Achieving food security in vulnerable populations

BMJ 2005; 331 doi: (Published 29 September 2005) Cite this as: BMJ 2005;331:775
  1. Deborah Cohen, assistant editor1 (dcohen{at}
  1. 1 BMJ, London WC1H 9JR

    Communities who rely on raising livestock are most vulnerable to hunger when drought or other disaster strikes. How can aid organisations provide effective help?


    Hunger and malnutrition cause tremendous human suffering and cost developing countries billions of dollars in lost productivity and national income. The number of hungry people in the world rose to 852 million between 2000 and 2002, up by 18 million from the mid-1990s, and the total number of hungry people in sub-Saharan Africa is 203 million, a third of the population.1 The human and economic costs of hunger will increase if the trend is not reversed. I visited northwest Kenya to see how organisations work to try to improve food security in pastoralist communities.

    Food security

    The 2004 annual report from the Food and Agriculture Organization says that little is done globally to fight hunger, although the resources needed to combat it are small compared with the benefits.1 Every dollar invested in reducing hunger can give from five to over 20 times as much in benefits. The report recommends giving priority to actions to improve food security.1

    But food security is a complex issue. A country or region is food secure when: “All people, at all times, have both physical and economic access to sufficient food to meet their dietary needs for a healthy and productive life.”2 Food security depends principally on three variables: availability of food, access to food and a nutritious diet, and proper use of food to ensure maximal nutrition and hygiene.3 In turn, each of these variables is influenced by several factors, the most important of which is poverty; others include the national and international economic environment, population growth, infrastructure, the climate, the level of investment and donor commitment, access to appropriate training and job skills, asset base, conflict and access to pasture, and the quality of diet, health, and sanitation.

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    Kaeris reservoir was built by the community to store drinking water for animals


    Because of the number of influencing factors, a multilateral approach involving both the international community and national governments is needed. Some factors, such as economic conditions and infrastructure, are the responsibility of national governments and the international community as a whole. Others, such as climate, seem to be beyond control. But droughts are a predictable natural phenomenon and should not result in scenes such as those witnessed in Niger this year. About eight million people risked dying from starvation in one of the worst food crises to hit Africa. The food shortages followed severe drought and locust swarms in the area last year, devastating crops and livestock.4

    The US Agency for International Development, Famine Early Warning Systems Network, warned about an impending food crisis eight months before the television cameras focused on the wasted bodies of dying children. As Grainne Moloney, Oxfam's regional nutrition and food security coordinator for Horn, East, and Central Africa says: “Niger represents a failure of the international community to act.” But funds for long term development projects are much harder to attract.5

    Because the situation in Niger had become so critical, emergency food aid from donors was the best way of providing food for the community. Yet, emergency food aid is not a long term solution to food security. It's expensive, not reliable enough, and can adversely affect local food production through depressing market prices and discouraging local production. Another criticism is that it creates dependency—a contentious issue that non-governmental organisations have differing perspectives on.

    Need for a broader approach

    To have a sustained effect on food security, food aid should be part of a broader effort by non-governmental organisations and the recipient country.3 Programmes should aim to maintain food security after the non-governmental organisations leave.3 As the Food and Agriculture Organization report puts it, we have “Ample evidence that rapid progress can be made by applying a twin-track strategy that attacks both the causes and the consequences of extreme poverty and hunger. Track one includes interventions to improve food availability and incomes for the poor by enhancing their productive activities. Track two features targeted programmes that give the most needy families direct and immediate access to food.”1

    Some communities are more susceptible to food insecurity than others. By the nature of their lifestyle, pastoralists tend to be the most vulnerable to extreme weather conditions. Their main source of income and nutrition is their livestock, which depend on pasture and water and, thus, weather conditions. During the wet seasons, when pasture and water sources are abundant, the local markets are thriving and livestock prices are favourable. Once drought hits and pasture and water sources become depleted, people sell their livestock to raise money to buy food. The sudden glut of livestock on the market, coupled with leaner livestock, means prices fall and people have less money to buy food for the droughts.

    One method that non-governmental organisations use to overcome this problem is to purchase the livestock at high prices and sell the meat at subsidised prices. Although such interventions might ensure pastoralists can survive the drought, they too are emergency strategies. A recent editorial in the Economist suggests that projects offering cash or vouchers in return for work provide a solution for food security.5 These schemes, often funded by non-governmental organisations, pay local people to work on a project to generate cash and help them build up their assets.

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    Burning Prosopis bushes


    But these schemes need to be well thought out. The Turkana, a pastoralist tribe in Kenya, refer to foreign aid workers and their government as ngimoi (enemies or strangers) after being beneficiaries of poorly planned charitable projects.6 For example, the Australian government initiative funded planting of the drought resistant shrub Prosopis. Not only does the shrub kill livestock, it is a breeding ground for mosquitoes, the thorns cause severe wounds in people, and the bushiness adds to local insecurity by providing cover for bandits. Removal of this shrub now forms an aspect of an Oxfam cash for work scheme. As Akabwai points out, local recipients need to be involved from the outset, and agencies should tap into their knowledge and customs rather than deciding their fate for them.7

    One of the benefits of cash for work schemes is that they allow people to make decisions independently. Lopua Lokou, one of the beneficiaries of a tree planting project after losing livestock to bandits, says: “This is a better source of assistance. I want to earn money to start a small trade—selling sugar and salt—and also buy some goats.”

    Projects need to tap into the community too. In Turkana district, the non-governmental organisations approach vulnerable communities and ask them to prioritise their needs and to nominate the most vulnerable members of the community to work. These tend to be people with lots of dependants, single mothers, and those with no livestock. Projects vary according to need—for example, building a water pan to collect and store rainwater for the dry season or building fences to protect against bandit attacks and cattle rustling.

    Role of conflict

    The Turkana's proximity to the pasture lands of neigh-bouring ethnic groups, coupled with the increased competition for food and water through more frequent droughts, puts them at particular risk of conflict and cattle raids. This adds to food insecurity through loss of livestock and by putting richer pastures and fish abundant parts of Lake Turkana out of bounds. A local peace building group, Riam Riam—Turkana for coming together—initiates negotiations about access to land between neighbouring ethnic groups. Without such initiatives, non-governmental organisation projects are jeopardised—conflict is one of the main reasons for food insecurity.

    In turn, some projects help assuage the risk of hostilities. Akom Esekon, a committee member of the Kaeris water pan project, says: “Most of the community had moved away to find water. Now the community has moved back, and people are no longer forced to go on to Dassenach [Ethiopian ethnic group] territory. This means we're less at risk of conflict and cattle raids.”

    Getting the most from cash for work schemes

    Other schemes work to directly enhance the economic profile of the surrounding area, such as by creating a market place. Margaret Lokoel, one of the beneficiaries of such a scheme in Lokitaung, a larger settlement in northern Turkana, says that she hopes the sale yard will boost the local economy and reduce poverty. “It will attract traders from outside. People will be able to set up other businesses to cater for the needs of the traders,” she says. “The community will grow, and this might then encourage the government to invest in health and education.” Despite this optimism, poor roads continue to hamper economic activity by making it difficult to get goods to the market. The Turkana lack a political presence in government to lobby for better roads and infrastructure, although non-governmental organisations that work closely with the community, lobby on their behalf.

    Cash for work schemes have other pitfalls. The money is intended to be used to buy assets to support long term development and not to be a quick fix. However, if people don't receive food while they are working, they have to use their salaries to buy food rather than assets. For people to get the most out of these schemes, projects need to be coupled with food aid.

    They also need to be supplemented by education programmes. One concern is that land management is non-existent in pastoral districts, leading to accelerated land degradation and raising questions about the viability of pastoralism as a livelihood. Pastoralists may need to diversify, as dependence on a single enterprise has made them more vulnerable to food insecurity.8 If people have resources and other skills, they are better able to cope with adverse conditions.

    Several non-governmental organisations in Turkana support mobile schools to teach other skills, such as literacy. They also teach sanitation and hygiene, which improves nutritional status and influences food security by improving health. In Kenya, provision of primary education boosts food security and helps to prevent malnutrition because the government supplies primary schools with free food.

    But education should not just focus on children. If market places are developed, sellers need educating about marketing livestock, how to invest the money earned from cash for work schemes, and how to diversify trade and open up businesses. Organisations such as Merlin, Oxfam, and World Vision also provide education for influential members of the community, such as traditional birthing assistants, nurses, and patient attendants. With the right training, they can promote hygiene and sanitation in their communities, recognise outbreaks of disease, and learn when people need referral to medical services.

    Summary points

    Food aid is necessary to meet crises but is not the most effective way of providing long term support

    Programmes should aim to maintain food security after the non-governmental organisations leave

    Long term strategic planning and sustainability is crucial

    Non-governmental organisations, international donors, national governments, and local communities need to work together

    Cash for work schemes need to be coupled with food aid

    Healthcare also needs investment. The relation between health and food security is complex. Not only can medical services treat severely malnourished people, they can stop illnesses from becoming prolonged, which affects the ability to work. If people are unable to look after their livestock and crops or are unable to search for wild fruits, they become more vulnerable, further compromising food security and health.

    Sustainable solutions

    If food insecurity is going to be overcome, the focus needs to shift away from emergency measures and last minute appeals for money. What's more, investment in early warning systems will not work unless national governments and the international community respond to the information.

    Food security is a complex problem. Patching up the problem with goodwill isolated interventions without consulting the local community is prone to failure. A coordinated, multistranded approach is needed involving organisations from different sectors. Ultimately, improving food security will help governments achieve the millennium development goals. Not only will it help to eradicate hunger, it will help to reduce child mortality and improve maternal health. But, most importantly, it will help to break the cycle of poverty.


    • Competing interests DC's trip was organised, but not subsidised, by Oxfam.