H5N1

Brazil: At the height of the pandemic, civil society is organizing itself against hunger

Via DW Brasil: At the height of the pandemic, civil society is organizing itself against hunger. Excerpt from the Google translation:

"People are to shine, not to starve to death," sings Caetano Veloso in the song Gente. In fact, access to adequate food is a basic, fundamental human right. It is provided for in the Universal Declaration of Human Rights of 1948 and is ensured by the Brazilian Constitution.  

However, according to the latest data from the Brazilian Institute of Geography and Statistics (IBGE), last September 10.3 million people did not have regular access to food in the country. That is, they were hungry. And the situation has worsened even more in recent months, experts point out, amid the intensification of the covid-19 pandemic and the context of economic crisis. 

For José Graziano da Silva, former director-general of the Food and Agriculture Organization of the United Nations (FAO), Brazil is back on the Hunger Map , from where it had officially left in 2014. This means that more than 5% of the population is in a situation of severe food insecurity, without consuming the recommended calories for a healthy and dignified life. 

In the midst of the pandemic, sad stories and pleas for help multiply on the streets, in the media and on social networks. In view of this, civil society has been organizing itself in different ways to assist the population. Dozens of food collection campaigns, led by different entities and organizations, are in action. 

 Aid falls, food prices rise 

The suspension of R $ 600 emergency aid, paid by the federal government from April to December 2020, has had enormous effects on the population in a situation of social vulnerability. The Getúlio Vargas Foundation (FGV) projects that in August 2020 - with the assistance - 9.5 million Brazilians (4.5% of the population) lived in extreme poverty. In February 2021, the number increased to 27 million people (12.2% of the population). Living in extreme poverty means surviving on R $ 246 per month (R $ 8.20 per day). 

As of April, the emergency aid will be deposited again for four months, but with lower amounts: R $ 150 for families of one person, R $ 250 for families of 2 people or more, or R $ 375 in the case of mothers unmarried. 

In addition to the interruption and reduction of aid, data from the IBGE show that the price of food has increased by more than 15% in the 12 months since the beginning of the pandemic. The number is almost triple inflation, which was 5.2% in the same period.

Once the breadbasket of Africa, Zimbabwe now on brink of man-made starvation, UN rights expert warns

Via the UN Office of the High Commissioner of Human Rights, a warning about a story far graver than Ebola: Once the breadbasket of Africa, Zimbabwe now on brink of man-made starvation, UN rights expert warns. Excerpt and then another link:

GENEVA / HARARE (28 November 2019) - Despite the constitutional protection of the right to food and a sophisticated set of human-rights based national laws and policies, man-made starvation is slowly making its way in Zimbabwe, said the UN expert of the right to food after visiting the country from 18 to 28 November 2019.  

"More than 60% of the population of a country once seen as the breadbasket of Africa is now considered food-insecure, with most households unable to obtain enough food to meet basic needs due to hyperinflation," said Hilal Elver, Special Rapporteur on the right to food, presenting a preliminary statement at the end of an 11-day visit. 

"In rural areas, a staggering 5.5 million people are currently facing food insecurity, as poor rains and erratic weather patterns are impacting harvests and livelihoods. In urban areas, an estimated 2.2 million people are food-insecure and lack access to minimum public services, including health and safe water.  

"These are shocking figures and the crisis continues to worsen due to poverty and high unemployment, widespread corruption, severe price instabilities, lack of purchasing power, poor agricultural productivity, natural disasters, recurrent droughts and unilateral economic sanctions." 

Elver said women and children were bearing the brunt of the crisis. 

"The majority of the children I met were stunted and underweight," she said. "Child deaths from severe malnutrition have been rising in the past few months. 90 % of Zimbabwean children aged six months to two years are not consuming the minimum acceptable diet.  

"I saw the ravaging effects of malnutrition on infants deprived of breast feeding because of their own mothers' lack of access to adequate food. 

"In a desperate effort to find alternative means of livelihood, some women and children are resorting to coping mechanisms that violate their most fundamental human rights and freedoms. As a result, school drop-outs, early marriage, domestic violence, prostitution and sexual exploitation are on the rise throughout Zimbabwe."  

Elver said people she met in the drought-affected areas of Masvingo and Mwenezi, located in the driest regions of the country, told her they ate only one portion of cooked maize a day. Women, the elderly and children are barely able to meet their minimum food needs and are largely dependent on food assistance, while most of the men are abroad seeking work, she added. 

"Without access to a diversified and nutritious diet, rural Zimbabweans, particularly younger children, barely survive," she said, adding that the agricultural and food system needs immediate reform.  

"I strongly urge the Government to take the necessary measures to reduce the country's dependence on imported food, particularly maize, and to support alternative wheats to diversify the diet. The Government should create the conditions for the production of traditional seeds to ensure the country's self-sufficiency and preparedness for the climate shocks that hit the country." 

The Special Rapporteur said the crisis in Zimbabwe's cities was no less severe than in rural areas.

"I witnessed some of the devastating consequences of the acute economic crisis in the streets of Harare, with people waiting for hours on long lines in front of gas stations, banks, and water dispensaries," she said. 

"The Zimbabweans I spoke to in Harare and its suburbs explained that even if food was widely available in markets, the erosion of their incomes combined with an inflation skyrocketing to over 490%, made them suffer from food insecurity, also impacting the middle-class. 

Elver also said that she received "disturbing" information that public hospitals have been reaching out to humanitarian organizations after their own medicine and food stocks were exhausted.  

Elver also received indication that the distribution of lands or food had been manipulated for political ends throughout the last two decades, favoring those who support the ruling political party. 

"I call on the Government of Zimbabwe to live up to its zero hunger commitment without any discrimination," Elver said.

Meanwhile, The Zimbabwean reports striking doctors say poor conditions in hospitals are causing a "silent genocide":

The senior doctors described the situation at the country’s hospitals as a silent genocide, saying doctors are forced to work without basics such as bandages, gloves, and syringes.

“We have watched the past few months as the situation in our hospitals continues to deteriorate.

“In March this year, the situation in hospitals deteriorated to the point where there were no bandages, gloves, and syringes available forcing senior doctors to highlight the dire situation publicly. It is important to find out why this has taken so long to be resolved as a silent genocide continues to be perpetrated upon the people of Zimbabwe,” the statement said.

Food insecurity in Nunavut following the introduction of Nutrition North Canada

Via CMAJ: Food insecurity in Nunavut following the introduction of Nutrition North Canada. The abstract:

BACKGROUND: Household food insecurity, a measure of income-related problems of food access, is a pressing public health problem in Canada’s North, especially in Nunavut. We aimed to assess the impact of Nutrition North Canada, a food retail subsidy intended to improve food access and affordability in isolated communities, on household food insecurity in Nunavut. 

METHODS: Using data from 3250 Nunavut households sampled in the annual components of the Canadian Community Health Survey (2007 to 2016), we conducted interrupted time series regression analyses to determine whether the introduction of Nutrition North Canada was associated with changes in the rates of self-reported food insecurity, according to a validated instrument. We used propensity score weighting to control for several sociodemographic characteristics associated with food insecurity. 

RESULTS: Food insecurity affected 33.1% of households in 2010 (the year before the launch of Nutrition North Canada), 39.4% of households in 2011 (the year of the launch) and 46.6% of households in 2014 (the year after full implementation). After controlling for several covariates, we found the rate of food insecurity increased by 13.2 percentage points (95% confidence interval [CI] 1.7 to 24.7) after the full implementation of the subsidy program, and the increase in food insecurity first occurred in 2011 (9.6 percentage points, 95% CI 2.7 to 16.4), the year Nutrition North Canada was launched.  

INTERPRETATION: Food insecurity was a pervasive problem in Nunavut before Nutrition North Canada, but it has become even more prevalent since the program was implemented. Given the important health consequences of food insecurity, more effective initiatives to address food insecurity in Canada’s North are urgently needed.

Household food insecurity, defined as insecure or inadequate access to food because of financial constraints, is increasingly recognized as a serious public health problem in many affluent nations. The latest national estimate for Canada indicates that 12.6% of households experienced food insecurity in 2012, but important geographic variations exist within the country, with heightened vulnerability in the North. Since national monitoring began, Nunavut has consistently had the highest rates of food insecurity, with the rate reaching 46.8% in 2014. 

Food insecurity is strongly associated with poor nutrition and adverse mental and physical health outcomes across the life cycle. Recent research also indicates that food insecurity is a robust and independent predictor of increased health care use and expenditures. Food insecurity represents an experience of material deprivation strongly influenced by the economic resources of households, but high food prices are also considered an important driver of food insecurity in Canada’s North. In April 2011, the Government of Canada replaced the long-standing Food Mail Program with Nutrition North Canada, a market-driven food retail subsidy intended to make perishable, nutritious foods more affordable and accessible in northern communities that do not have year-round rail, road or marine access. 

Similar to the Food Mail Program, Nutrition North Canada serves communities that are predominantly inhabited by Indigenous Peoples and have high rates of food insecurity, low educational attainment, low income, underemployment and unemployment. 

Whereas the Food Mail Program consisted of an air freight transportation subsidy transferred to Canada Post for the delivery of numerous perishable foods, nonperishable foods and essential nonfood items, Nutrition North Canada is a retail subsidy focused primarily on perishable, nutritious foods and transferred directly to southern suppliers and northern retailers, who are expected to pass on the full subsidy to consumers at the point of purchase (a summary of the programs is provided in Appendix 1, Supplemental Table A1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.181617/-/DC1). 

Nutrition North Canada follows a market-driven approach predicated on the assumption that giving full control to retailers and suppliers over the supply chain and relying on market competition can reduce the prices of subsidized foods more effectively. The program’s focus on perishable, nutritious foods and its market-driven approach were strategies adopted to help contain program costs. Nutrition North Canada also includes a small nutrition-education component, and it is assumed that reductions in the prices of perishable, nutritious foods coupled with nutrition education will improve northerners’ food access. 

Although Nutrition North Canada does not explicitly aim to reduce food insecurity, the pervasiveness of food insecurity in the North is embedded in the rationale for the program. 

Our objective was to assess the impact of the introduction of Nutrition North Canada on household food insecurity in Nunavut communities.

The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report

The Lancet has published The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. The key messages:

The pandemics of obesity, undernutrition, and climate change represent three of the gravest threats to human health and survival. These pandemics constitute The Global Syndemic, consistent with their clustering in time and place, interactions at biological, psychological, or social levels, and common, large-scale societal drivers and determinants. Their interactions and the forces that sustain them emphasise the potential for major beneficial effects on planetary health that double-duty or triple-duty actions, which simultaneously act on two or all three of these pandemics, will have. 

To mitigate The Global Syndemic, the Commission proposed the following nine broad recommendations, under which sit more than 20 actions: 

• Think in Global Syndemic terms to create a focus on common systemic drivers that need common actions. 

• Join up the silos of thinking and action to create platforms to work collaboratively on common systemic drivers and double-duty or triple-duty actions. 

• Strengthen national and international governance levers to fully implement policy actions which have been agreed upon through international guidelines, resolutions and treaties. 

• Strengthen municipal governance levers to mobilise action at the local level and create pressure for national action 

• Strengthen civil society engagement to encourage systemic change and pressure for policy action at all levels of government to address The Global Syndemic 

• Reduce the influence of large commercial interests in the public policy development process to enable governments to implement policies in the public interest to benefit the health of current and future generations, the environment, and the planet 

• Strengthen accountability systems for policy actions to address The Global Syndemic 

• Create sustainable and health-promoting business models for the 21st century to shift business outcomes from a short-term profit-only focus to sustainable, profitable models that explicitly include benefits to society and the environment 

• Focus research on The Global Syndemic determinants and actions to create an evidence base of systemic drivers and actions, including indigenous and traditional approaches to health and wellbeing

WHO: Three in five babies not breastfed in the first hour of life

WHO has published 3 in 5 babies not breastfed in the first hour of life. Excerpt:

An estimated 78 million babies – or three in five – are not breastfed within the first hour of life, putting them at higher risk of death and disease and making them less likely to continue breastfeeding, say UNICEF and WHO in a new report. Most of these babies are born in low- and middle-income countries.  

The report notes that newborns who breastfeed in the first hour of life are significantly more likely to survive. Even a delay of a few hours after birth could pose life-threatening consequences. Skin-to-skin contact along with suckling at the breast stimulate the mother’s production of breastmilk, including colostrum, also called the baby’s ‘first vaccine’, which is extremely rich in nutrients and antibodies. 

“When it comes to the start of breastfeeding, timing is everything. In many countries, it can even be a matter of life or death,” says Henrietta H. Fore, UNICEF Executive Director. “Yet each year, millions of newborns miss out on the benefits of early breastfeeding and the reasons – all too often – are things we can change. Mothers simply don’t receive enough support to breastfeed within those crucial minutes after birth, even from medical personnel at health facilities.”

Breastfeeding rates within the first hour after birth are highest in Eastern and Southern Africa (65%) and lowest in East Asia and the Pacific (32%), the report says. Nearly 9 in 10 babies born in Burundi, Sri Lanka and Vanuatu are breastfed within the first hour. By contrast, only two in 10 babies born in Azerbaijan, Chad and Montenegro do so.* 

“Breastfeeding gives children the best possible start in life,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We must urgently scale up support to mothers – be it from family members, health care workers, employers and governments, so they can give their children the start they deserve.”

US opposition to breast-feeding resolution stuns world health officials

Via The New York Times: U.S. Opposition to Breast-Feeding Resolution Stuns World Health Officials. Excerpt:

A resolution to encourage breast-feeding was expected to be approved quickly and easily by the hundreds of government delegates who gathered this spring in Geneva for the United Nations-affiliated World Health Assembly.  

Based on decades of research, the resolution says that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes. 

Then the United States delegation, embracing the interests of infant formula manufacturers, upended the deliberations. 

American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children. 

When that failed, they turned to threats, according to diplomats and government officials who took part in the discussions. Ecuador, which had planned to introduce the measure, was the first to find itself in the cross hairs.  

The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced. 

The showdown over the issue was recounted by more than a dozen participants from several countries, many of whom requested anonymity because they feared retaliation from the United States. 

Health advocates scrambled to find another sponsor for the resolution, but at least a dozen countries, most of them poor nations in Africa and Latin America, backed off, citing fears of retaliation, according to officials from Uruguay, Mexico and the United States. 

“We were astonished, appalled and also saddened,” said Patti Rundall, the policy director of the British advocacy group Baby Milk Action, who has attended meetings of the assembly, the decision-making body of the World Health Organization, since the late 1980s.  

“What happened was tantamount to blackmail, with the U.S. holding the world hostage and trying to overturn nearly 40 years of consensus on best way to protect infant and young child health,” she said. 

In the end, the Americans’ efforts were mostly unsuccessful. It was the Russians who ultimately stepped in to introduce the measure — and the Americans did not threaten them.

The long-term health burden of childhood diarrhea

Via The Lancet Global Health: Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrhoeal diseases in children younger than 5 years. The summary:

Background 

Diarrhoea is a leading cause of death and illness globally among children younger than 5 years. Mortality and short-term morbidity cause substantial burden of disease but probably underestimate the true effect of diarrhoea on population health. This underestimation is because diarrhoeal diseases can negatively affect early childhood growth, probably through enteric dysfunction and impaired uptake of macronutrients and micronutrients. We attempt to quantify the long-term sequelae associated with childhood growth impairment due to diarrhoea. 

Methods 

We used the Global Burden of Diseases, Injuries, and Risk Factors Study framework and leveraged existing estimates of diarrhoea incidence, childhood undernutrition, and infectious disease burden to estimate the effect of diarrhoeal diseases on physical growth, including weight and height, and subsequent disease among children younger than 5 years. The burden of diarrhoea was measured in disability-adjusted life-years (DALYs), a composite metric of mortality and morbidity. 

We hypothesised that diarrhoea is negatively associated with three common markers of growth: weight-for-age, weight-for-height, and height-for-age Z-scores. On the basis of these undernutrition exposures, we applied a counterfactual approach to quantify the relative risk of infectious disease (subsequent diarrhoea, lower respiratory infection, and measles) and protein energy malnutrition morbidity and mortality per day of diarrhoea and quantified the burden of diarrhoeal disease due to these outcomes caused by undernutrition.  

Findings 

Diarrhoea episodes are significantly associated with childhood growth faltering. We found that each day of diarrhoea was associated with height-for-age Z-score (–0·0033 [95% CI −0·0024 to −0·0041]; p=4·43 × 10−14), weight-for-age Z-score (–0·0077 [–0·0058 to −0·0097]; p=3·19 × 10−15), and weight-for-height Z-score (–0·0096 [–0·0067 to −0·0125]; p=7·78 × 10−11). 

After addition of the DALYs due to the long-term sequelae as a consequence of undernutrition, the burden of diarrhoeal diseases increased by 39·0% (95% uncertainty interval [UI] 33·0–46·6) and was responsible for 55 778 000 DALYs (95% UI 49 125 400–62 396 200) among children younger than 5 years in 2016. 

Among the 15 652 300 DALYs (95% UI 12 951 300–18 806 100) associated with undernutrition due to diarrhoeal episodes, more than 84·7% are due to increased risk of infectious disease, whereas the remaining 15·3% of long-term DALYs are due to increased prevalence of protein energy malnutrition. The burden of diarrhoea has decreased substantially since 1990, but progress has been greater in long-term (78·7% reduction [95% UI 69·3–85·5]) than in acute (70·4% reduction [95% UI 61·7–76·5]) DALYs. 

Interpretation 

Diarrhoea represents an even larger burden of disease than was estimated in the Global Burden of Disease Study. In order to adequately address the burden of its long-term sequelae, a renewed emphasis on controlling the risk of diarrhoea incidence may be required. This renewed effort can help further prevent the potential lifelong cost on child health, growth, and overall potential.

MSF in Iraq: Thousands of wounded and sick coming from western Mosul

Via MSF.org: Iraq: Thousands of wounded and sick coming from western Mosul. Excerpt:

Erbil -  As fighting rages in Mosul, Iraq, civilians in the city are caught in the crossfire with limited access to lifesaving medical care. Risking their lives, tens of thousands have fled since the offensive on the western part of the city started on 19 February. Thousands of wounded have been rushed from the conflict area by ambulance. 

In and around Mosul, there is a lack of medical resources to treat the high number of patients. Ambulances referring medical emergencies to hospitals outside the city are simply unable to cope with the numbers of trauma victims and to travel long distances to transfer patients in need of further treatment. 

“The need for emergency medical care has risen drastically,” said Dr Isabelle Defourny, MSF director of operations. “We have teams working around the clock treating men, women and children injured by bullets, blasts and shells. Other life-threatening emergencies also need a rapid medical response, such as for pregnant women in need of a caesarean.”  

MSF teams in and around Mosul have received more than 1,800 patients in need of urgent or lifesaving care in the last two months. Of those, 1,500 needed treatment for conflict-related trauma. As the scale of the non-trauma needs also became apparent, MSF opened maternity services in eastern Mosul at the beginning of February. The teams have since assisted 100 births and performed 80 caesareans. 

In early March, MSF started to see children from western Mosul with severe malnutrition. Rapid malnutrition assessments were conducted in two camps for the most recently displaced people. According to people MSF met who are fleeing western Mosul, there is no infant formula milk left, there is a lack of food and clean water, and conditions are expected to worsen now that supply routes have been cut off. This has led MSF to set up a therapeutic feeding centre at its hospital in Qayyarah. 

“It is urgent that malnutrition treatment be provided to meet the needs, and that those displaced from western Mosul receive adequate food aid when they arrive,” Dr Defourny emphasised.   

While MSF teams are providing health care in camps for displaced people, lifesaving emergency care has been the main MSF activity so far. A surgeon in MSF’s field trauma hospital south of Mosul city described it as one of the toughest experiences in his long MSF career. 

“The situation here is really intense,” he said. “Every case we receive in the operating theatre is severe and almost every day we have to deal with mass casualties.” 

WHO: Global conference sets health action agenda for the implementation of the Paris Agreement

WHO has published Global conference sets health action agenda for the implementation of the Paris Agreement. Excerpt:

Participants attending the Second Global Conference on Health and Climate, hosted by the Government of France, COP21 presidency, proposed key actions for the implementation of the Paris agreement to reduce health risks linked to climate change. The action agenda is a contribution to COP22, under the Presidency of the Government of Morocco, in Marrakech in November 2016. 

Climate change and health 

The World Health Organization estimates that climate change is already causing tens of thousands of deaths every year. These deaths arise from more frequent epidemics of diseases like cholera, the vastly expanded geographical distribution of diseases like dengue, and from extreme weather events, like heat waves and floods. At the same time, nearly 7 million people each year die from diseases caused by air pollution, such as lung cancer and stroke. 

Experts predict that, by 2030, climate change will cause an additional 250 000 deaths each year from malaria, diarrhoeal disease, heat stress and undernutrition alone. The heaviest burden will fall on children, women, older people and the poor, further widening existing health inequalities between and within populations. 

Need for urgent action 

The conference highlighted the benefits of switching to cleaner energy sources. These will help reduce levels of climate and air pollutants, as well as providing desperately needed power for health facilities in low-income countries. The health sector should themselves make a greater effort to promote low-carbon healthcare facilities and technologies; these can simultaneously improve service delivery and reduce costs as well as climate and environmental impacts. 

Participants recommended moving to more sustainable food production and healthier diets to improve the environment and reduce noncommunicable diseases. One way to do this would be to promote diets rich in fruits and vegetables including local in-season varieties.  

They called for countries to adopt a new approach to link health economics assessment and climate change, for example, by calculating the avoided healthcare costs, when countries invest in mitigation of climate emissions, and protection from climate risks. 

To develop this work, WHO announced a new working group which will articulate a new coherent approach to health economics and climate change. To do so, it is recommended that countries spend more on protecting health from risks linked to climate, such as extreme weather events and outbreaks of infectious disease and in cleaner energy sources, more sustainable transport systems and urban planning that also reduces major health risks, for example air pollution in cities and in the home. 

Recommendations also focus on scaling up financing on climate change and health through additional resources and mechanisms and existing resources earmarked for adaptation.

Ebola’s second punch: Hunger

Via ReliefWeb, a report from USAID: Ebola’s Second Punch: Hunger. Excerpt:

Fudia Lansana once felt that nothing could be as terrifying as becoming one of more than 14,000 people infected with Ebola in Sierra Leone. But as her household of nine went from eating three meals a day to two, and then from two to one, Fudia realized she was facing something just as scary: hunger. 

Under normal circumstances, Fudia would walk a few miles from her village to work on her farm with friends and family, but these were far from normal times. The government—in an effort to stop the spread of Ebola—restricted movement and prohibited public gatherings. 

“Farming is our source of survival, but things were locked down during the Ebola era,” says Fudia. “We couldn’t reach the farm, so having enough food was very difficult.”  

Fudia survived for months on savings and borrowed money. But even now that the Ebola outbreak is over, she and other farmers still feel its effects. Their farms are overwhelmed by weeds after months of neglect. It will be a while before they can prepare the land, plant new crops and collect the harvest to replenish their depleted food stocks. 

Immediate relief has come in the form of cash transfers distributed by Catholic Relief Services with support from USAID’s Office of Food for Peace. The monthly $30 distributions target nearly 24,000 people in Kenema district, which has one of the highest rates of extreme poverty and chronic malnutrition in Sierra Leone. 

The cash distributions are a bridge to get farmers over the next 10 months. They help farmers make ends meet until markets and food production recover and income-earning opportunities increase. 

Life Before Ebola 

Before the Ebola outbreak, Sierra Leone was still feeling the effects of a brutal decade-long civil war that ended in 2002. More than 60 percent of the population lived on less than $1.25 a day, according to the United Nations Development Program, and life expectancy was 48.  

“Life was difficult then too,” says Battu Koroma, the breadwinner for her household of eight. “Since I lost my husband during the war, things were hard. But then during the outbreak, I could not farm or visit my family. I would take loans from people. I would give away my clothes just for a cup of rice.” 

Ebola’s Economic Impact 

“If you didn’t have money saved, you couldn’t afford to buy food,” explains Fudia. “During the Ebola outbreak, I was surviving on plain rice.”  

She buys the rice, fish and fruit at markets in her village. Fudia and others who received cash distributions were encouraged to buy locally produced food, which ensures the money supports local merchants and stays in the community. This helps local markets to recover from the shock of Ebola and helps community-based food producers and buyers to get back on their feet. 

“Everyone is benefitting from this, including local businesses,” Fudia says. “When the money isn’t there in the community, businesses can’t sell, so they don’t make money.” 

Cash distributions also mean people have the flexibility to purchase what’s most important for their family. For example, they are able to buy a variety of nutritious foods at the market or seeds to restart their farm.