SFPs have been a major component of nutrition interventions in developing countries for many years. Traditionally, these programmes are linked to national health programmes and are incorporated into mother and child health programmes (MCH) which form part of the primary health-care infrastructure in developing countries.
MCH programmes offer a variety of health and nutritional services including ante- and post-natal care, immunisations, nutrition and health education, and growth monitoring of young children (normally those under five years of age). In many countries, the growth monitoring system is linked to supplementary feeding for children who are not growing adequately or who are already malnourished.
A definitive review of non-emergency SFPs in developing countries in the 1970s1 concluded that these programmes were frequently unable to demonstrate any significant impact upon the growth of participating children, and called into question the cost-effectiveness of these interventions. Several explanations were offered for the apparently limited impact of these programmes, namely that:
• supplements would be shared with other family members or the meal would be used as a substitute for what the child would otherwise receive at home
• a large part of the supplement has an impact upon children's physical activity and health status, e.g. immunity, which can not be easily measured
• the size of the supplement was too small in relation to household food shortages, or the medical inputs to the programme were inadequate.
1 Beaton G (1993) Nutritional Issues in Food Aid. Papers from the ACC/SCN 19th Session, April 1993, pp. 37-55. Ghassemi H (1992) 'Supplementary Feeding Programmes in Developing Countries: Lessons of the 1980s'. Part 2, Discussion and References, Asia Pacific Journal of Clinical Nutrition (1992), Vol. 1, pp. 195-206.
A number of subsequent reviews also called into question the efficacy of such programmes in both development and emergency situations2. Arguments against the use of these types of programme increased during the 1980s. Typically it was argued that they were divisive within households and removed the responsibility for feeding to an outside agency. It was also argued that they were 'patronising' in that the intervening agency was making the assumption that intra-household targeting of food was incorrect, e.g. the most needy were not given priority. Implementing agencies were effectively accused of saying 'we know best when it comes to targeting scarce food resources'. These criticisms were translated into policy by at least one agency (ICRC) whose subsequent strategy in its emergency operations was to provide a very large general ration which would automatically provide sufficient food for the whole household, thus making it unnecessary to provide supplementary feeding for selected members within the household3.
2 Godfrey N (1986) Supplementary Feeding Programmes in Refugee Populations. Evaluation and Planning Centre for Health Care, LSHTM.
3 It should be noted, however, that the ICRC is in an unusual position compared with most other relief agencies, in that it is able to obtain sufficient food from donors to implement emergency general feeding programmes and also has the institutional capacity to manage such programmes.
Despite these debates, the vast majority of relief agencies continued to implement emergency SFPs. During the 1970s and early 1980s emergency programmes were predominantly in support of refugees in camp situations, and the evolving guidelines on emergency SFPs were generally based upon these experiences. Generally speaking these programmes often achieved their short-term objectives in that a high proportion (usually in excess of 80%) of previously malnourished beneficiaries were discharged on attaining satisfactory weights.
The numbers of refugees and emergency-affected populations increased, particularly after 1985. Simultaneously the number of agencies involved in relief operations also increased, a large proportion of them being international and indigenous NGOs, which routinely implemented SFPs in their emergency operations. An increasing number of these programmes were targeted on non-camp populations, either internally displaced or resident populations afflicted by conflict and food insecurity.
As will be discussed in Chapter 3, the present review takes the view that, whilst relief programmes should be sufficiently timely and designed to minimise the need for emergency supplementary feeding, a combination of political, institutional and resource factors will limit the effectiveness of the overall response, and consequently emergency SFPs will continue to form an important part of many emergency programmes. Not only are such programmes required in many emergency situations but, if implemented well, they can also have a significant impact in reducing mortality generally.