The Use of BP-5 Biscuits in Supplementary Feeding Programmes

Fitsum Assafa MSF, Nutritionist, Jalalabad, (Dec 1995-April 1996) Peshawar 1996

MSF has been involved in giving emergency medical/nutritional assistance to Sarshahi and New Hadda camps for internally displaced persons (IDPs) in Nangahar Province, Eastern Afghanistan since early 1994. The nutritional assistance at the initial stage included therapeutic and targeted/curative wet and dry supplementary feeding programmes. As the emergency situation was increasingly brought under control, MSF gradually stopped all its feeding programmes in these camps.

Between July 1995 - Feb 1996, MSF ran a small scale Dry Supplementary Feeding (DSF) programme in New Hadda camp. The food ration in the DSF programmes included BP-5 biscuits, donated by NCA (Norwegian Church Aid).

This paper attempts to present the lessons learned from the last supplementary feeding programme with regard to the use of BP-5 and was partly written in response to a request from a NCA evaluation team for feedback on the use of BP-5.

In December 1995 MSF performed a nutritional survey in New Hadda camp and evaluated its DSF programme. The overall malnutrition rate in the camp was acceptable with 4.0% global acute malnutrition (WFH <80%) and 0.6% severe acute malnutrition (WFH <70%), although there was evidence that the inhabitants were still vulnerable in terms of food security and were dependent on a continuation of the WFP general food ration. In addition 65.0% of the children attending the feeding centre were in fact well nourished (>/= 85% W/H). They did not require supplementary feeding and no longer met the entrance criteria.

The reason for this 'over attendance' was believed to be due to the high degree of cheating on the part of beneficiaries and some staff involved in the feeding centre and responsible for making referrals to it. Some of the practices occurring were: double registration, a lack of strict monitoring of beneficiary nutrition status, those recovered not being discharged on time, children from outside the camp claiming to be from the camp and being admitted to the programme.

The MSF local feeding centre staff and home visitors in the camp claimed not to be able to control these activities and that if they tried their security was threatened. On more than one occasion MSF had to withdraw staff from the centre for security reasons and on the day of closure a near riot occurred, with a crowd of parents and others trying to get a share of the remaining commodities.

The supplementary ration included per 2 week period for each child or pregnant/lactating woman:

• BP-5 biscuits (37 bars)
• Wheat Flour (200g)
• Lentils (50g)
• Oil (50g).

This is a generous supplementary ration but it was well known that a lot of sharing within the family took place (higher than in other MSF project countries) and it was felt to be justified. The BP-5 was found to be the most attractive of the food commodities and was believed to have attracted people outside the target groups to try and become enrolled on the feeding programme. Towards the end of the programme it was well known that a lot of beneficiaries were selling their BP-5 ration. In Jablalabad town there was a good market for it (other agencies - UNICEF and ERU - were also distributing it with, if anything, less strict criteria than MSF was using).

The nutritional surveys conducted between December 1995 - February 1996 in New Hadda camp and Sarshahi camps, Jalalabad city and Shenwar district looked into infant/child feeding practices. While BP-5 is also very popular among the other family members, at all the locations, it was observed that people believed that BP-5 was the best food on earth for children and tended to disregard the other weaning food they had at home. Many people were buying BP-5s at expensive prices. It was worrying to see that children liked the BP-5 a great deal and cared less for the local foods. A particularly worrying aspect was the increasing use of BP-5 as weaning food. While the food itself is not inappropriate for weaning, this use of BP-5 changes traditional food habits to a food source which was more expensive, no better for weaning purposes than local foods and the supply of which is not sustainable (it is not officially available commercially).

These special biscuits are particularly meant for use in the early stages of a wet SFP in situations where other commodities are not immediately available and cooking is difficult. However the high market price of BP-5 biscuits caused by creating an increased demand could jeopardise the appropriate use of it during future emergencies.

Conclusion

A feeding programme that uses BP-5 biscuits is prone to cheating, corruption and in extreme cases, purposive starvation of children so that they can be enrolled in programmes. All this type of behaviour was observed by MSF when running the dry supplementary feeding programme in New Hadda camp.

Blended food rations should always be provided in preference to BP-5 biscuits for supplementary feeding programmes and where possible local blended foods should be used. MSF should only consider using BP-5 biscuits again in situations where there is not enough blended foods available for the feeding programme.

MSF feels that this information should be shared with organisations involved in donating and distributing BP-5 biscuits and policies concerning the appropriateness of the present use of BP-5 biscuits should be revised within MSF.