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Nutrition Module: 8. Household Food Security

Study Session 8  Household Food Security

Introduction

In the previous study session you learned about the micronutrient deficiencies that are of greatest public health importance in Ethiopia. In this session you will be introduced to the issue of the overall shortage of food at the household level (household food insecurity). You will learn about its causes, consequences and prevention as well as nutrition emergency interventions. Coping strategies that may be adopted by households in response to constrained food supplies will be described, using local examples.

Learning Outcomes for Study Session 8

When you have studied this session, you should be able to:

8.1  Define and use correctly all of the key words in bold. (SAQs 8.1 and 8.2)

8.2  Define household food security. (SAQs 8.1 and 8.2)

8.3  Describe the causes of household food insecurity. (SAQs 8.1, 8.2 and 8.3)

8.4  Describe various stages of coping strategies of food insecurity. (SAQ 8.4)

8.5  Describe food security situations in Ethiopia. (SAQs 8.3 and 8.5)

8.6  Explain some of the food security strategies of Ethiopia. (SAQs 8.4 and 8.6)

8.7  List methods of preventing food insecurity. (SAQs 8.4 and 8.6)

8.8  Identify nutrition interventions during a nutrition emergency. (SAQs 8.5, 8.6 and 8.7)

8.9  Describe the consequences of household food insecurity. (SAQs 8.5 and 8.6)

8.1  Household food security

Household food security exists when all the people living in the household have physical, social and economic access to sufficient, safe and nutritious food at all times that meets their dietary needs and food preferences for an active and healthy life (World Food Summit Declaration, 1996). This definition is based on three core concepts of food security:

  • Availability (physical supply of food)
  • Access (the ability to acquire food)
  • Utilisation (the capacity to transform food into the desired nutritional outcome).

If these conditions are not fulfilled then the household is said to be in the state of food insecurity.

8.2  Chronic and acute food insecurity

In your own community you might have become aware of households with food insecurity. There are two forms of food insecurity; chronic and acute. Chronic food insecurity is commonly described as the result of overwhelming poverty indicated by a lack of assets (means of living). Acute food insecurity is usually considered to be more of a short-term phenomenon related either to manmade or unusual natural shocks, such as drought. While the chronically food insecure population may experience food deficits relative to need in any given year, irrespective of the impact of shocks, the acutely food insecure require short term assistance to help them cope with unusual circumstances that impact temporarily on their lives and livelihoods. Both chronic and acute problems of food insecurity are widespread and severe in Ethiopia.

Table 8.1 depicts the types of households that are vulnerable to chronic and acute food insecurity in rural and urban settings within Ethiopia.

Table 8.1. Households that are vulnerable to acute and chronic food insecurity.

RuralUrbanOthers

Chronic

Resource poor households

Landless or land-scarce households

Poor pastoralists

Female-headed households

Elderly, disabled and sick

Poor non-agricultural households

Newly established settlers

Low income households employed in informal sector

Those outside the labour market

Elderly, disabled and sick

Some female-headed households

Street children

Refugees

Displaced people

Acute

Resource poor households vulnerable to shocks, especially drought

Farmers and others in drought prone areas

Pastoralists

Others vulnerable to economic shocks (eg. in low potential areas)

Urban poor vulnerable to economic shocks, especially those causing food price rises

Groups affected by temporary civil unrest

  • What segments of the population are vulnerable to chronic food insecurity?

  • You may have thought of a number of people who are particularly vulnerable to chronic food insecurity, such as those who are not in work, the elderly, sick and disabled, female-headed households, and street children. People living in low income households, with informal employment are also very vulnerable.

8.3  Causes of household food insecurity

If you think of food insecurity within your own community you might have become aware of a number of different causes. In Ethiopia natural and man-made disasters are the commonest causes of household food insecurity.

Drought and conflict are the main factors that increase problems of food production, distribution and access. High rates of population growth and poverty also play a part, within an already difficult environment of fragile ecosystems where it might be difficult to produce sufficient food. The fact that almost 80% of the population in Ethiopia depends almost exclusively on agriculture for its consumption and income needs means that measures to address the problems of poverty and food insecurity must mainly be found within the agricultural sector.

Other natural disasters such as pest infestations destroy area-specific production levels and the threat of locust swarms is often present. Currently there is an ineffective weather and pest early warning system in the country.

Depending only on rainwater for farming when there is variable rainfall in some of the arid areas is not reliable for producing sufficient food supply. Initiatives in Ethiopia, such as using irrigation systems, water harvest technology and drip irrigation, are encouraging steps that need to be strengthened further. Figures 8.1 and 8.2 illustrate the importance of adequate drinking water and grazing land for farming animals. Table 8.2 summarises the different causes of household insecurity.

Animals need an adequate source of drinking water
Figure 8.1  Animals need an adequate source of drinking water. (Photo: Dr Basiro Davey)
Animals need adequate grazing land
Figure 8.2  Animals need adequate grazing land. (Photo: Dr Basiro Davey)

Table 8.2  Causes of food insecurity.

Causes of food insecurity Mechanism (how it leads to food insecurity)
Rapid population growth

A high rate of population growth calls for more food production and the need for ploughing more land. This leads to deforestation. Population may exceed the carrying capacity of the fragile environment in some areas

At the household level the food produced from the same plot of land that the household has may not be sufficient. It is also very difficult to purchase food for large numbers of family members

Conflict/civil war/ trans-border war

Interferes with production, marketing and distribution

Shunts the gross domestic product (GDP) towards purchase of war weapons

Extreme production fluctuationDecreases food supplies available for consumption
Limited employment other than farmingLeads to poor purchasing power of households
Lower level of savingLeads to poor purchasing power of households
High rate of natural erosionPoor soil fertility and decreased productivity leading to food supply shortages
High rate of illiteracy and school attendancePoor income earning power and hence purchasing power due unemployment
Poor health and sanitation Morbidity, mortality and reduced productivity due to illness
Deforestation Leads to high top soil erosion and poor soil fertility. It will lead to decreased rainfall and dryness
HIV/AIDS

HIV/AIDS leads to ‘green famine’ which has far-reaching adverse implications. There are four ways in which HIV/AIDS is linked to famine:

  • Changes in dependency patterns (children are dependent on children OR on the elderly due to death or frequent sickness of an adult)
  • Loss of assets and skills associated with adult mortality
  • The burden of care for sick adults and orphaned children
  • The vicious interaction between malnutrition and HIV infection
Poor governance

Corruption and diversion of public resources to personal use

Poor distribution of resources

High rates of chronic malnutritionDecreased wellbeing leading to decreased intellectual and physical productivity of people
Natural resource constraintsThe limitations of rainfall in the country place certain constraints on improving food security. The chances of drought occurring in parts of Ethiopia have increased the probability of food insecurity, especially in the arid and pastoralist areas (northern and eastern parts of Ethiopia)
Traditional rain-dependent farming systemsLack of agricultural intensification and low agricultural productivity means that many of those in rural areas remain subsistence producers. Therefore, the large quantity of food at low prices which is essential for economic growth in urban areas is not available

Stop reading for a while and think of the causes of food insecurity in your area. Are any of the above causes common in your community?

8.4  Indicators of household food insecurity

Food insecurity can be measured using two direct indicators:

  • Use of coping strategies
  • Dietary diversity score.

Indirect indicators can also give clues to the presence of household food insecurity. These include measuring the percentage of children under five years old who are malnourished and other early warning signs of vulnerability such as low rainfall or the presence of other disasters.

8.4.1  Use of coping strategies as indictors of food insecurity

Food insecurity is a matter of global concern, although it is most frequently observed in Sub-Saharan Africa. One of the most common methods for identifying food-insecure households or regions is to look at the frequency and types of coping strategies.

Coping strategies are social responses used to offset threats to a household’s food and economic resources in times of hardship. The different types of coping strategies are markers of the severity of conditions, often categorised into four distinct stages of food insecurity.

Stage 1: Insurance strategies

The first stage of household food insecurity is marked by the initial shortage of food, or inability to provide sufficient quantities of food to all members of the household.

Households may have prepared for a food quantity shortfall, as in the case of seasonal production, by storing quantities of grain or owning livestock that can be quickly sold, traded, or used for food (in the case of agricultural societies). These are often referred to as insurance (reserve food crisis), and are not intended to be a main source of income or an integral part of income generation, simply crisis insurance. But, before any assets are sold, changes in diet and frequency of meals per day are the first adaptations undertaken. Rationing of food consumption is a very common response, and is started and planned generally far in advance of selling any assets. The frequency and severity of coping strategies practiced will vary according to the causes of the food shortage (chronic vs. crisis), kinds of households affected (agricultural vs. pastoral), local market conditions, and the absence or presence of relief programmes.

Box 8.1 sets out the most common stage 1 food security indicators.

Box 8.1  Stage 1 food insecurity indicators
  • Diet change (consuming less preferred foods such as corn instead of rice)
  • Meal frequency (decreasing the number of meals per day)
  • Gathering wild foods
  • Inter-household transfers and loans
  • Increased petty commodity production (firewood, charcoal, etc.)
  • Seeking daily labour
  • Diversifying activities and working for long hours.
Stage 2: Crisis strategies I

The second stage of food insecurity is marked by the sale of assets, specifically non-productive assets.

At this point, in the food security crisis, food consumption becomes more important than holding onto assets. Jewellery, goats, chickens, other livestock and any other asset that serves as crisis insurance would be sold. Generally, the assets that are preserved are those related to income generation, such as land, farming equipment, oxen and cattle. In addition to non-productive asset sales, the second stage also sees the onset of loans or credit from merchants (as opposed to family), which also has serious implications for the future security of the household and recovery to their original livelihood systems. Typical second stage indicators include those set out in Box 8.2 overleaf.

Box 8.2  Stage 2 food insecurity indicators
  • Sales of non-productive livestock
  • Sales of jewellery, insurance assets
  • Credit or loans from merchants
  • Temporary migration for work or land (days/week, days/month)
  • Skipping meals for entire days
  • Withdrawing children from school (school drop out).
Stage 3: Crisis strategies II

Stage 3 includes the sale of productive assets and the shift of the number one priority from asset preservation to food consumption.

At this point, all else has either failed to provide sufficient food quantities or the crisis has prolonged itself into a dire situation. All livestock remaining at this juncture will be sold, all personal items sold, possibly even the sale of housing material, and the pledging and/or sale of land or productive rights. This disposal of all assets ensures current survival, but severely jeopardises the future security (livelihood system) of the household. In the case of natural disasters, such as drought, many assets will be lost involuntarily, specifically livestock succumbing to disease or starvation. When the crisis has reached this stage, famine conditions have essentially set in. Indicators of stage three might include those set out in Box 8.3.

Box 8.3  Stage 3 food insecurity indicators
  • Sale of all livestock
  • Sale of productive equipment
  • Sale or mortgage of land
  • Redistribution of children (rare)
  • Migration.

Stop reading for a while and think of some of the coping strategies that are used in your community or in another community you know when food insecurity occurs.

Stage 4: Distress strategies

Stage 4 is the last in the line and represents complete destitution.

The household no longer exists as it once did. Permanent migration (either the whole or part of the household) occurs in order to attempt to resettle on suitable land, find wage labour or, more likely, to seek food aid assistance. Individuals are generally too weak to work and simply need food and care to survive. Box 8.4 overleaf highlights indicators of stage 4.

Box 8.4  Stage 4 food insecurity indicators
  • Permanent migration
  • Begging for food/resources
  • Complete dependence on external aid.

There is a spectrum of situations that may precipitate crises, possibly ranging from normal, seasonally linked low or zero production, to consecutive years of poor production, to natural disasters and armed conflict. Coping strategies need to be seen in context, and in complex emergencies the situation is different from those situations relating to consecutive seasons of crop failure or seasonal dips in the amount of stored food or resources to obtain food. For example, people suffering due to poor agricultural production might slowly move from stage 1 to stage 2 or 3, whereas in acute emergencies, people might be ‘shocked’ directly into strategies of state 3 or 4, due to sudden external forces such as a flood or armed conflict.

8.4.2  Dietary diversity score

Dietary diversity (DD) has long been recognised as a key element of food security. It is usually measured by summing up the number of foods or food groups consumed over a period of time. Consumption of a more diversified diet is an indicator that the household is food secure; while a less diversified diet is an indicator of food insecurity. You looked at how to measure dietary diversity in Study Session 5 of this Module.

  • What is the relationship between food insecurity and dietary diversity?

  • Food insecurity leads to consumption of less diversified diet and therefore, a lack of dietary diversity is a measure of food insecurity.

8.4.3  Consequences of household food insecurity

Many countries, including Ethiopia, experience perpetual food shortages and distribution problems leading to chronic and often widespread hunger amongst significant numbers of people.

The body’s response to chronic hunger and malnutrition is a decrease in body size. As you will recall from an earlier study session, in small children this is known as stunting, or stunted growth, and is indicated by low weight for height. This process starts as the baby is growing in the uterus, if the mother is malnourished, and continues until approximately the third year of life. It leads to higher infant and child mortality, with rates increasing significantly during famines. Once stunting has occurred, improved nutritional intake later in life cannot reverse the damage. Stunting itself is viewed as a coping mechanism, designed to bring body size into alignment with the calories available during adulthood in the location where the child is born.

Limiting body size as a way of adapting to low levels of energy (calories) adversely affects health in many ways:

  • Premature failure of vital organs occurs during adulthood. For example, a 50-year-old individual might die of heart problems because their heart suffered structural defects during early development
  • Stunted individuals suffer a far higher rate of disease and illness than those who have not undergone stunting
  • Severe malnutrition in early childhood often leads to defects in mental development
  • Chronic food insecurity will lead to poor growth, slower development, low educability, school absenteeism or dropout, and increased morbidity and decreased survival impacting on the socioeconomic development through several generations.
  • Can stunting that occurred due to food insecurity during the earlier periods of life be reversed at a later age?

  • Once stunting has occurred, improved nutritional intake later in life cannot reverse the damage. Stunting itself is viewed as a coping mechanism, designed to bring body size into alignment with the calories available during adulthood in the location where the child is born.

  • What are the ways in which food insecurity impacts on a person’s development?

  • Food insecurity decreases adequate and balanced food consumption, leading to poor physical growth and mental development. It also increases vulnerability to morbidity and mortality. Food insecure people are less productive both physically and intellectually.

8.5  Food insecurity situations in Ethiopia

Ethiopia has been renowned as a country of famine and food insecurity for many years. Drought impacts on the ability of livestock to survive (see Figure 8.3), but food insecurity has grown worse in recent years for several reasons. This includes increased land degradation due to increased population pressure.

Drought can affect animals extremely
Figure 8.3  Drought can affect animals extremely. (Photo: Dr Basiro Davey)

When we look at the distribution of food insecurity in Ethiopia, the majority of people living in the northern and eastern part of the country are living in arid regions that are prone to food insecurity.

8.6 Ethiopian food security strategy

Ethiopia’s food security strategy highlights the government’s plans to address the causes and effects of food insecurity in Ethiopia. The food security strategy has two major approaches towards achieving food security in Ethiopia:

  1. Enhancing agricultural productivity
  2. Asset building/productive safety net programmes (PSNP).

PSNP aim to build the assets of the poorest of the poor to enable them to develop means of living (livelihood).

Therefore, the food security strategy places a significant focus on the following issues:

  • Environmental rehabilitation: Measures to reverse the level of land degradation and create a source of income generation for food-insecure households through a focus on biological measures, such as re-forestation and land preservation.
  • Water projects: Water harvesting and the introduction of high-value crops, livestock and agro-forestry development.
  • Enhancing agricultural productivity: Agriculture is considered to be the starting point for initiating the structural transformation of the economy. Because of this, agricultural development-led industrialisation (ADLI) has been pursued as a major policy framework since 1991. ADLI assists the development of agriculture and helps expand markets for domestic production leading to increased incomes for small holders.
  • Controlling population growth: High population growth rates continue to undermine Ethiopia’s ability to be food secure and provide effective education, health and other essential social and economic services. The central elements of the policy focus on a multi-sector approach, improving family planning services and expanding education.
  • Prevention and control of HIV/AIDS: HIV/AIDS is a formidable challenge to the pursuit of food security in Ethiopia as it reduces and debilitates the productive population and society as a whole. The government has put in place a national policy and countrywide programme for the whole population to control and reduce the spread of the disease.
  • Gender: Women have a substantive productive role in the rural sector, including participation in livestock maintenance and management, crop production, and the marketing of rural produce. Integration of gender perspectives in the design and implementation of economic and social policies, programmes and projects is considered central to the national food security strategy.
  • Environmental sustainability: This is critical to the pursuit of food security and economic development generally. Development depends on the appropriate and sustainable use of the environment and the management of natural resources. Given the high environmental degradation in drought-prone and pastoral areas, environmental rehabilitation (soil and water conservation) is an essential element.
  • What are the approaches of the National Food Security Strategy and why are they important?

  • The two major approaches for achieving food security in Ethiopia are: enhancing agricultural productivity and asset building/PSNP. They are important approaches which aim to tackle the causes of food insecurity and the serious problems created by these for social wellbeing and economic growth in Ethiopia.

8.7  Nutrition emergency interventions

Nutrition emergency interventions are set up to prevent the death of many people in the community and to protect their livelihood systems. The interventions are aimed at reducing excess mortality that might result during the first few weeks to months of the emergency situation. The emergency interventions might involve provision of:

  • Food
  • Shelter (if people are already displaced)
  • A programme to control diarrhoeal diseases and follow up (surveillance) of epidemic occurrence
  • A curative care unit
  • Coordination of operational partners, including the sector offices and non-governmental organisations working in your community.

Responses include those that are curative, such as therapeutic care and those that are preventative of further problems such as improving the water supply and sanitation to prevent epidemics of disease.

Two main interventions to protect livelihood and prevent deaths are:

  1. General food distribution (GFD)
  2. Selective feeding programmes, such as:
    • Supplementary feeding programmes (SFP)
    • Blanket supplementary feeding programmes (BSFP)
    • Therapeutic feeding programmes (TFP).

8.7.1  General food distribution

The aim of general food distribution (GFD) is to cover the immediate basic food needs of a population in order to eliminate the need for survival strategies which may result in long-term negative consequences to human dignity, household viability, livelihood security and the environment. Ideally a standard general ration of food is provided in order to satisfy the full nutritional needs of the affected population.

In a population affected by an emergency, the general ration should be calculated in such a manner as to meet the population’s minimum energy, protein, fat and micronutrient requirements for light physical activity. There are two ways of distributing a general ration:

  1. Employment generation schemes (EGS); a conditional transfer of rations that requires public work for a person to qualify for the ration
  2. Gratuitous relief (GR)/general food distribution (GFD); an unconditional (free) distribution scheme.

Due to the fact that food aid dependency is a major concern in Ethiopia, 80% of the food aid is distributed through EGS, especially in areas that are chronically food insecure. Healthcare systems and water resources may also require support. In a famine the primary goals are to ensure survival and reduce mortality.

8.7.2  Selective feeding programmes

There are two approaches to the actual distribution of food: targeted and blanket. Within these two approaches there are two kinds of programmes: supplementary feeding programmes (which may be ‘targeted’ or ‘blanket’) and therapeutic feeding programmes.

Targeted supplementary feeding programmes

In this approach supplementary food is restricted to those individuals identified as the most malnourished, or most nutritionally vulnerable or at risk during nutritional emergencies. This includes pregnant women, lactating mothers and young children under five years of age (see Figure 8.4). The main objective of a targeted supplementary feeding programme is to prevent the moderately malnourished from becoming severely malnourished and consequently, to reduce the prevalence of severe acute malnutrition and associated mortality.

Children and women form an early morning queue
Figure 8.4  Children and women form an early morning queue to await a food distribution at a supplementary feeding centre in Gode, Ethiopia. (Photo: UNICEF Ethiopia)
Blanket supplementary feeding programme

In blanket supplementary feeding programmes (SFP) food is distributed as a temporary measure to all vulnerable members of a population at risk of becoming malnourished without identifying the most malnourished. The general objective of a blanket SFP is to prevent widespread malnutrition and mortality.

Therapeutic feeding programme

Therapeutic feeding programmes (TFPs) provide a rehabilitative diet together with medical treatment for diseases and complications associated with the presence of severe acute malnutrition.

The specific aim of TFPs is to reduce mortality among acutely severely malnourished individuals and to restore health through rehabilitating them. TFPs may be administered through the following venues:

  • Therapeutic feeding centre (TFC)
  • Nutrition rehabilitation unit (NRU) at a hospital or health facility
  • Community-based therapeutic care (CTC/OTP) programme.

Figure 8.5 shows a five-year-old Khesna, who is severely malnourished, drinking therapeutic milk at the UNICEF-supported feeding unit of Bissidimo Hospital in East Harerghe Zone of Oromia Region. The milk is rich in micronutrients and is the first phase of a feeding regimen—eight times daily—that helps the body recover from the shock of malnutrition and conditions it to digest food. Khesna must initially be fed small portions, slowly.

Severely malnourished child drinking therapeutic milk
Figure 8.5  Severely malnourished child drinking therapeutic milk. (Photo: UNICEF Ethiopia)
  • What is the objective of blanket supplementary feeding?

  • It is temporary measure for all vulnerable members of a population at risk of becoming malnourished, without identifying the most malnourished, to prevent widespread malnutrition and mortality.

In conclusion, food insecurity obliges households to use coping strategies that can, over time, lead to poor health consequences especially for vulnerable segments of the population. As a Health Extension Practitioner, household food insecurity is one of the major issues you should address, working closely with other stakeholders in your community.

Summary of Study Session 8

In Study Session 8 you have learned that:

  1. Household food insecurity is where no-one in the household has physical, social and economic access to sufficient, safe and nutritious food that meets dietary needs and food preferences for an active and healthy life at all times
  2. Chronic food insecurity is commonly perceived as a result of overwhelming poverty indicated by a lack of assets, while acute food insecurity is viewed as more of a transitory phenomenon related to man-made or unusual shocks, such as drought
  3. The major causes of food insecurity are man-made and natural disasters, rapid population growth, and increased land degradation interfering with food productivity, marketing and distribution
  4. Indicators for household food insecurity include coping strategies, based on the stage of food insecurity, and a low dietary diversity score
  5. Ethiopia’s food security strategies focus on mechanisms of enhancing productivity and asset building programmes like productive safety nets programmes
  6. Different emergency nutrition interventions may be set up if the need arises. These include: blanket supplementary feeding, targeted supplementary feeding and general ration distribution.

Self Assessment Questions (SAQs) for Study Session 8

Now that you have completed the study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers on your study diary and discuss them with your Tutor at the next Study Support meeting. You can check your answers with the Notes on the Self Assessment Questions at the end of the Module.

SAQ 8.1 (tests Learning Outcomes 8.1, 8.2 and 8.3)

Why might household food insecurity exist even when there is enough food available?

Answer

Availability of food is only one aspect of food security. People must also be able to access the food and then make it into something that can be eaten.

SAQ 8.2 (tests Learning Outcomes 8.1, 8.2 and 8.3)

  • a.Who are the people in your community who are most vulnerable to chronic food insecurity?
  • b.What other groups in your community are vulnerable to acute food insecurity?
Answer
  • a.Who is the most vulnerable to chronic food insecurity will depend on whether you live in a rural or an urban community.
  • b.You will probably have noted that the additional groups vulnerable to acute food insecurity are those affected by sudden shocks like drought or a rise in food prices (look back at Table 8.1 if you need to see the range of vulnerable groups).

SAQ 8.3 (tests Learning Outcomes 8.3 and 8.5)

Identify three possible causes of food insecurity in your community.

Answer

You may well think of many causes of food insecurity in your community. However, try to choose three that you think are the most important and be ready to discuss the reasons for your choice with your Tutor.

SAQ 8.4 (tests Learning Outcomes 8.4, 8.6 and 8.7)

If people start to leave an area each day to look for work, what stage of the coping strategy is this?

Answer

If people are leaving their area each day to look for work, this is a stage 2 coping strategy. Once people sell land or livestock they are putting their futures at risks, so will leave this until they have tried all other coping strategies.

SAQ 8.5 (tests Learning Outcomes 8.5, 8.8 and 8.9)

  • a.Why is food insecurity such an important issue for Ethiopia?
  • b.Is your community in an area that is likely to have food insecurity? Give reasons for your answer.
Answer

According to the Food and Agriculture Organisation, Ethiopia is one of the countries where more than 30% of the population is insecure. A child’s body responds to chronic hunger by decreasing in size (stunting). This results in poor physical growth, mental development, affecting socioeconomic development. It also results in more illness and higher death rates in children and adults.

The greatest food insecurity is in the north and east of the country.

SAQ 8.6 (tests Learning Outcomes 8.6, 8.7, 8.8 and 8.9)

What role do women have to play in Ethiopia’s Food Security Strategy?

Answer

Women play a crucial role in agriculture and marketing of produce; they are also key to controlling population growth and to controlling HIV.

SAQ 8.7 (tests Learning Outcome 8.8)

Imagine you are a Health Extension Practitioner living in a community where there has been a severe drought for three years.

  • a.Describe who are likely to be the most vulnerable people in that community and why.
  • b.What strategies might be used to support these vulnerable people?
Answer
  • a.The most vulnerable people in your community are likely to be very young children, pregnant and breastfeeding mothers, the elderly, orphans and disabled people
  • b.Strategies to help these groups of people include selective feeding programmes, either targeted supplementary programmes or blanket supplementary programmes.