Essays /

Healthy Lunch Essay

Essay preview

How Effective are Food
for Education Programs?
A Critical Assessment of the
Evidence from Developing Countries
Sarah W. Adelman, Daniel O. Gilligan, and Kim Lehrer

Food Policy




International Food Policy Research Institute
2033 K ® sustainable solutions for ending hunger and poverty Street, N.W.

Copyright © 2008 International Food Policy Research Institute. All rights reserved. Sections of this material may be reproduced for personal and not-for-profit use without the express written permission of but with acknowledgment to IFPRI. To reproduce material contained herein for profit or commercial use requires express written permission. To obtain permission, contact the Communications Division .

International Food Policy Research Institute
2033 K Street, NW
Washington, D.C. 20006-1002, U.S.A.
Telephone +1-202-862-5600
DOI: 10.2499/0896295095FPRev9
Library of Congress Cataloging-in-Publication Data
Adelman, Sarah.
   How effective are food for education programs? : a critical assessment of the evidence from developing countries / Sarah W. Adelman, Daniel O. Gilligan, and Kim Lehrer.
     p.   cm.—(Food policy review ; 9)
   Includes bibliographical references.
   ISBN 978-0-89629-509-4 (alk. paper)
   1.  School children—Food—Developing countries.   I.  Gilligan, Daniel.   II.  Lehrer, Kim.   III.  Title.   IV.  Series. LB3479.D443A34     2008


List of Tables     v

List of Figures     v

Foreword     vii

Acknowledgments     ix

Summary     xi
Chapter 1

Introduction and Motivation     1

Chapter 2

The Structure and Scope of FFE Programs     5

Chapter 3

Economic Rationale for FFE Programs     9

Chapter 4

ethod for Reviewing the Empirical Literature     19

Chapter 5

Empirical Evidence of the Impacts on Education     23

Chapter 6

mpirical Evidence of the Impacts on Food
Consumption and Nutrition     35

Chapter 7

Other Programs Providing Schooling Inputs     49

Chapter 8

Conclusion     53

Appendix: How an Impact Evaluation Measures
Casual Effects of the Program     57
References     61
About the Authors     69



Table 6.1 tudy design for Murphy et al. (2003) experiment in S

Kenyan primary schools     39


igure 3.1 otential benefits of food for education programs     10 P




ood for education (FFE) programs, including meals served in school and take-home rations conditional on school attendance, have recently received renewed attention as a policy instrument for achieving the Millennium Development Goals of universal primary education and the reduction of hunger in developing countries. FFE programs attract children to school by providing nutritious meals in exchange for school participation. If children are undernourished, the programs may also boost learning and cognitive development by improving attention spans and nutrition. The attraction of these programs is their potential to improve both school participation and learning and cognitive outcomes by increasing the consumption of nutritious food by undernourished children. However, FFE programs also have their critics. They are often more expensive than other programs that provide school inputs to increase school participation, and the nutrition benefits are small compared to those from nutrition programs targeting younger children. As a result, governments and donors are in the midst of a debate about the future of FFE programs.

This food policy review presents a rationale for FFE programs and undertakes a critical review of the causal evidence on the impact of FFE programs on education participation and attainment, learning, cognitive development, and nutrition.

Results from the most careful studies show that in-school meals programs improve primary school attendance of enrolled students where initial attendance was low. Potential impacts on school participation by children not previously enrolled in school are not well known. There is mixed evidence that school meals can improve performance on math and literacy tests, and they may improve cognitive development, depending on the type of food provided, the size of the food rations, and program duration. Several well-designed controlled trials have shown that school




meals have a positive impact on nutrition outcomes, including anthropometry and iron status, though these results have received less support from field trials in more typical settings. There are few studies of scaled-up take-home ration programs, but one study from Bangladesh shows a significant impact on school participation. In general, FFE programs have larger impacts in areas with low school participation and on children with greater initial malnutrition. The impacts of the programs may also be higher when combined with complementary programs to improve schools or child health.

Despite a large literature on the impact of FFE programs, the authors found that many studies suffer from methodological shortcomings that limit the quality of their contributions. They argue for more carefully designed field trials to bolster the evidence. New research should directly compare alternative FFE programs and other programs with similar objectives to identify the program components that are most effective. Within FFE programs, more information is needed on how impacts on school attainment, learning, and cognitive development could be improved through more effective targeting, changes to the size and composition of food transfers, or provision of complementary schooling and health inputs. Sideby-side comparisons to other popular programs, such as conditional cash transfers and deworming, should also focus on the relative cost-effectiveness of achieving the broad set of education and nutrition objectives.

Joachim von Braun
Director General, IFPRI



e gratefully acknowledge funding for this review from the Danish Ministry of Foreign Affairs. We also thank Akhter Ahmed, Harold Alderman, Mary Arimond, Kristian Højersholt, Marie Ruel, three anonymous reviewers, and colleagues in the Danish government for very useful comments. All remaining errors or omissions are ours.




he economic motivations for investing in the education and nutritional status of primary-school-aged children are well established. Moreover, investments in both of these forms of human capital are likely to benefit from substantial complementarities. However, in developing countries, poor and creditconstrained households routinely invest less in education and nutrition than is privately or socially optimal. Food for education (FFE) programs, including meals served in school and take-home rations conditional on school attendance, attempt to improve these investments by subsidizing the cost of school participation through providing food that could improve nutrition and learning. This study examines the economic motivation for the use of FFE programs to increase investments in education and nutrition. The study then presents a critical review of the empirical evidence of the impact of FFE programs on education and nutrition outcomes for primary-school-aged children in developing countries. The main contribution of this study is to judge and summarize the strength of the evidence based on the extent to which existing studies have identified a causal effect of an FFE program, as opposed to finding an association between the program and key outcomes that may have been affected by other contextual factors.

The economic rationale for FFE programs is to offer free food conditional on school attendance to increase the net benefits of schooling enough to change some households’ decisions about their children’s school participation. Although schoolaged children are past the critical window of opportunity during early childhood for the greatest gains from good nutrition, increasing food and nutrient consumption among school-aged children with low baseline food energy or micronutrient intake can improve weight, reduce susceptibility to infection, and increase cognitive function in the short run. Because school meals are usually fortified, a child’s micronutrient intake can improve even if her total calorie consumption does not. These xi



short-run gains may improve a child’s educational attainment and academic achievement, which can improve future welfare.
For logistical and political reasons, school meal programs are commonly provided to all children in a targeted school. This practice raises the cost of achieving program objectives, such as increased attendance rates, because it provides transfers to many children who would have attended school anyway. Take-home rations programs are less subject to this criticism, because they are more easily targeted to groups, such as poor or female children, who are in greater need or who may be more likely to change their human capital investment decisions as a result of the program.

Even when provided at school, food transfers can be diverted to other household members by taking food away from the beneficiary child at other meals. This practice could diminish the size of the transfer received by the beneficiary child, resulting in only a small net gain in the child’s daily consumption. However, empirical evidence suggests that a substantial share of the food provided through in-school meal programs is not redistributed away from the beneficiary child.

The critical review examines the empirical literature on the impacts of FFE programs on education and nutrition outcomes. The education outcomes considered include school participation measured by enrollment and attendance, age at entry, drop-out status, learning achievement, and cognitive development. The nutrition outcomes reviewed include food energy consumption, anthropometry, and micronutrient status. The review focuses on the empirical literature with the strongest methodology for identifying causal impacts. This literature includes experimental studies, such as randomized controlled trials; experimental field trials; studies using quasi-experimental methods, such as natural or administrative experiments; and nonexperimental studies using careful evaluation designs. Although the literature on the impacts of FFE programs is vast, high-quality studies with evaluation designs that provide causal impact estimates are relatively few. The nutrition literature offers many more experimental studies on nutrition outcomes than is yet available in the economics literature on education outcomes, yet many of the nutrition studies are controlled trials in which many components of the intervention typically affected by behavior, such as amount of food available at a meal, are closely managed. The external validity of these studies for programs implemented in the field is often difficult to ascertain. The number of experimental field studies for any outcome is few, but growing. From the existing literature, it is possible to draw conclusions about the likely impact of FFE programs on some outcomes, whereas for other outcomes, the literature is inconclusive.

The empirical evidence suggests that in-school feeding has a positive impact on school participation in areas where initial indicators of school participation are low. In-school meal programs have been shown to have small impacts on school



attendance rates for children already enrolled in school. However, there is no causal evidence for an impact on net primary-school attendance rates for all school-aged children in the service area of a school because of limitations in study design. The only study we found with attendance data for a representative sample of primaryschool–aged children, including those enrolled in school at baseline and those not enrolled, found a strong association between participation in a school meal program and school attendance, but estimated impacts cannot be reliably attributed to causal effects of the program. For similar reasons, there is also scant evidence on the effects of school meals on primary-school enrollment rates.

Two empirical studies find that school meal programs cause a significant increase in learning achievement, as measured by improvements in test scores. However, in each study, scores were significantly higher for school meal recipients on only one of three tests taken. The impact of in-school meals on learning appears to operate both through improvements in school attendance and through better learning efficiency while in school, though no study has separately identified the relative contribution of these effects.

FFE programs may also have an impact on cognitive development, though the size and nature of the effect vary greatly by program, micronutrient content of the food, and the measure of cognitive development used. Empirical evidence on the effects of school meals on cognitive function is mixed and depends on the tests used, the content of the meals, and the initial nutritional status of the children. Most of the studies are conducted in a laboratory setting and look at the short-term impact of feeding on cognitive function. The aspects of cognitive ability tested differ by study, making it difficult to compare results. Nonetheless, there is evidence that school meals rich in animal-source foods improved cognitive function in Kenyan children. Another study demonstrates an effect of school breakfasts on cognitive function. Given the controlled setting that formed the basis for these experiments, it would be useful now to expand the external validity of the evidence through field experiments.

On other outcomes, the evidence of the impact of in-school feeding on primaryschool drop-out rates is inconclusive. We also found no study that examines the impact of school meals on age at school entry, probably because of the expense of collecting data on a representative sample of children around this age. Also, there is little conclusive evidence on the impact of take-home rations on education outcomes.

For nutrition outcomes, most of the evidence comes from randomized trials in the nutrition literature. For food-energy (calorie) consumption, the evidence shows that in-school feeding programs show greater potential to improve children’s total daily energy consumption when children’s baseline consumption is well below their age- or weight-recommended consumption level. Differences in empirical strategy



may account for differences in findings across studies, as randomized experiments found a lower impact than did quasi-experimental studies.
The diversity of program components and target populations in anthropometric studies, as well as the complexity of biological growth mechanisms, make it difficult to assess the effectiveness of FFE on anthropometric indicators. Overall, several studies showed gains in body size (for example, height, weight, body mass index) or composition (for example, mean upper-arm circumference) due to participation in FFE programs, with weight or body mass index appearing to respond most often. Improvements were typically small, though the effects of increased consumption may have been mitigated by increased activity levels in some cases. The micronutrient content of foods provided may contribute to gains in height (iron fortification) and mean upper-arm circumference (providing meat-based snacks). Deworming appears to have an interactive effect with FFE on height in one study.

Turning to micronutrient status, iron fortification of FFE meals appears to improve iron status in nearly all studies reviewed. Evidence for other micronutrients is more sparse. One study found that meat-based meals improve plasma vitamin B12 concentrations but found no impact on other micronutrients. Two studies reviewed the impact of FFE on vitamin A status: one found a positive effect on plasma vitamin A status, whereas the other found no impact. Finally, one study found that iodine fortification reduced the prevalence of iodine deficiencies. The presence of malaria or other infections may impede detection of these benefits, particularly with respect to iron status. Combining the treatment with deworming can improve the effectiveness of iron supplementation, particularly in children with low baseline iron stores.

Summarizing this evidence, FFE programs appear to have considerable impacts on primary-school participation, but the quality of this evidence is weak. Higher quality studies indicate some impacts on learning and cognitive development. There is evidence of effects on food consumption and micronutrient status, provided that initial consumption and nutrient deficiencies are identified and that programs are tailored to address these deficiencies. In many cases, the FFE programs appear to have little impact, because the levels of key outcome variables, such as school attendance or micronutrient status, are already high.

Despite this evidence, significant research gaps remain. A surprising gap in this literature is the lack of convincing evidence of these programs’ effect on school enrollment and attendance for a representative sample of school-aged children from the school’s service area. There is also no conclusive empirical evidence on the impact of FFE programs on age at entry and grade repetition, and little on drop-out rates. In general, the impacts of take-home ration programs are poorly understood. Also, few studies identify the differential impacts of FFE on children by age or



gender. Finally, the impact of FFE programs on learning achievement has not been carefully analyzed by schooling inputs and class size.
Perhaps the greatest omission in current research on FFE programs is the absence of well-designed cost-effectiveness studies. The policy decision on whether to undertake an FFE program or an alternative education or nutrition intervention should be based on relative differences in cost-effectiveness. However, most studies that measure program impact do not collect the additional data needed to obtain a measure of cost-effectiveness. Such studies would identify the cost from various interventions of achieving a certain percentage increase in primary-school attendance, for example. The most convincing approach would be to conduct sideby-side randomized field experiments of alternative programs. To our knowledge, only one study has done so, comparing in-school meals to programs that provide teachers with school supplies or foster parent–teacher communication. However, even these comparisons are complicated by the scarcity of programs likely to have the same kind of combined impacts on both education and nutrition outcomes.

The most immediate policy implication of this review study is that more careful and systematic research is needed to find the most cost-effective combination of programs available. Without rigorous estimates of the impact of FFE programs on school participation, it is not possible to determine whether important secondary effects on learning achievement or cognitive development come primarily through school attendance or through joint effects of schooling and improved nutrition. It is these joint effects that are uniquely available through FFE programs. If the learning and cognitive benefits to school-aged children of simultaneous improvements in nutrition and schooling from FFE programs are small, cash-based programs may be more effective at increasing school participation. If there are no joint education and nutrition effects from FFE programs, it may be more cost-effective to replace these programs with specialized education and nutrition programs that are more narrowly targeted at specific objectives. More comprehensive and rigorous evaluation studies of FFE programs are needed to determine the full scope of the impacts of these programs and their relative cost-effectiveness.

Our interpretation of the empirical evidence reviewed here leads to several recommendations on the design and use of FFE programs. Effects tend to be larger where schooling participation is low or where there are significant nutritional deficiencies. This fact argues for doing an assessment of school needs in target areas before starting an FFE program. Such an evaluation would improve targeting and allow FFE program components, such as the nutrient composition and quantity of food, to be tailored to local needs. Also, program administrators should be willing to consider complementary programs to improve school quality. Learning effects cannot be achieved if the instruction is of little value. Poor school quality lowers



the benefits of participation and discourages attendance. Though much more evidence is needed, results from field experiments in the Philippines suggest that the cost of alternative programs to improve school quality may be only a fraction of the per child cost of an FFE program. Coordinated programs that combine FFE with improvements in school quality may be much more effective.

Chapter 1

Introduction and Motivation


ood for education (FFE) programs, including meals served in school and take-home rations conditional on school attendance, are a common tool used to attract children to school and to reduce short-term hunger to help students concentrate and learn. FFE programs operated by the World Food Programme (WFP) reached 21.6 million children in 2005 (WFP 2004), and many governments operate publicly funded FFE programs. For example, Brazil’s national school feeding program covers 36 million children aged 0–14 (WFP 2006). These programs are also advocated as important interventions for improving the human capital of school-aged children. The Millennium Development Goal (MDG) Task Force Report (Birdsall, Levine, and Ibrahin 2005) on achieving the Education MDG cites FFE programs as one important approach to attract children to school and improve learning. The MDG Task Force Report on Hunger (Sanchez et al. 2005) acknowledges FFE programs as an indirect nutrition intervention that can contribute to the reduction of malnutrition among school-aged children. Although some policymakers and donors push for expanding FFE programs, many question their cost-effectiveness. A recent report by the World Bank (2006) criticizes FFE programs because they are not targeted at the vital first two years of life and they divert resources away from less costly nutrition interventions.

To inform this ongoing debate, this study examines the rationale for FFE programs and conducts a critical review of the empirical evidence of their impacts on education and nutrition outcomes. Several recent studies have addressed the rationale for FFE programs or the empirical evidence of their impacts, including results of a recent experts seminar (WFP 2006), as well as Rogers and Coates (2002), Caldes and Ahmed (2004), and Kristjansson et al. (2007). The research behind this review has benefited greatly from these earlier studies. Although there is an extensive literature on the potential impacts of FFE programs, the strength of the evidence 1


chapter 1

varies greatly, depending on study design and methods of analysis. The main contribution of this study is to provide a critique of the literature on FFE program impacts, judging the strength of the evidence based on the extent to which existing studies have identified a causal effect of an FFE program as opposed to finding an association between the program and key outcomes that may have been affected by other contextual factors.

Often the primary objective of FFE programs is to increase school participation; these programs have been a common tool in developing countries seeking to establish universal primary education. However, the use of food rather than cash as the form of transfer acknowledges that hunger plagues many poor students at school, which may discourage school attendance and also impede learning. Many developing-country governments and international organizations implementing FFE programs have recognized that, by fortifying the food with protein and key micronutrients, they may also be able to improve child nutritional status and reduce morbidity, and so have an additional positive effect on regular school attendance and learning.

Despite these advantages, FFE programs are often criticized as an expensive method for producing the stated education and nutrition objectives. For specific education or nutrition outcomes, other, more cost-effective interventions may exist. Other criticisms include that school meal programs may divert class and teacher time away from learning. In addition, logistical and political considerations often make it difficult to effectively target the program to children who are in greatest need or who are most likely to change their behavior (and begin attending school, for example) as a result of the program. Consequently, many programs choose to supply meals to all students. Although this practice prevents claims of inequity, it raises the cost of achieving program objectives, such as increased attendance rates, because it provides transfers to many children who would have attended school anyway. Also, food transfers, even when provided at school, can be diverted at home by taking food away from the beneficiary child at other meals. This practice may be a rational household decision, but it decreases the potential impact of an FFE program on the target child’s outcomes.

Developing a consensus on the desirability and cost-effectiveness of FFE programs in developing countries has been most difficult with regard to the nutrition objectives. The recent World Bank (2006) report on nutrition refocuses attention on the importance of nutrition interventions that reach children during pregnancy (fetal life) and the first 2 years of life. This period has been referred to as the window of opportunity, because it is a period of accelerated physical growth in which nutrition interventions are most needed and have the greatest impact on child survival, health, and development. Nutritional deficits during this period result in largely irreversible damage. In considering the nutritional impacts, the report criticizes FFE

introduction and motivation


programs not only because they arrive too late in the life cycle, but also because they divert resources away from interventions targeting this most critical period of life for nutrition investments.

However, this critique fails to adequately account for the education objectives of school feeding and the potential joint benefits of feeding hungry children during school. Although the lifetime net nutritional benefits of nutrition investments before age 2 outweigh those made later, educating children is also critical to human capital formation and can have substantial returns later in life (Schultz 1988; Glewwe and Kremer 2006). There is substantial empirical evidence that the economic returns to education are high in developing countries (Psacharopoulos 1985, 1994; Duflo 2001). Education also changes behavior in ways that reduce fertility and improve the health and nutritional status of current and future generations (Strauss and Thomas 1995; Schultz 1997, 2002a,b).1

An assessment of the desirability of funding FFE programs should consider all potential effects of the programs across education, nutrition, and other objectives. Moreover, policy decisions should ultimately be made on the cost-effectiveness of FFE programs relative to alternative education and nutrition programs. Two shortcomings of the existing literature on FFE program impacts are that many studies focus on a limited set of education or nutrition outcomes and that a heavy emphasis is placed on identifying the benefits or impacts of FFE programs without much consideration of the costs. With this caveat in mind, the review examines the strength of the evidence on the impacts of FFE programs, to better inform the policy debate and identify important gaps to be addressed in future research.

The scope of this review includes the empirical literature in economics and nutrition on the impact of programs that provide food transfers conditional on school participation, such as subsidized school meals and take-home rations, on outcomes in primary school where these programs are most common. In addition, the review emphasizes that part of the empirical literature with the strongest methodology for identifying causal impacts. This literature includes experimental studies, including randomized controlled trials; experimental field trials, which have higher external validity; and studies using quasi-experimental methods, such as natural or administrative experiments that identify impacts by exploiting a quasi-random component of program eligibility. The review does not address several related outcomes, including class size and local agricultural production. We also exclude nutrition supplementation or fortification trials conducted in developing-country primary schools that do not include schooling improvements as outcomes. 1See Behrman (1999), Huffman (2001), and Glewwe (2002) for reviews of the impacts of education in developing countries.


chapter 1

This study is organized as follows. Chapter 2 describes the structure and scope of FFE programs. Chapter 3 describes the economic rationale for these programs and explores the mechanisms by which school feeding may affect economic and nutrition outcomes. Chapter 4 describes the methods used to select candidate studies for the review of the empirical literature. Chapter 5 reviews the empirical evidence on impacts of FFE programs on education outcomes. The education outcomes considered include school participation measured by enrollment and attendance, age at entry, drop-out status, learning achievement, and cognitive development. Chapter 6 reviews the empirical evidence for effects on nutrition outcomes, including foodenergy consumption, anthropometry, and micronutrient status. We compare the relative impacts of FFE programs to those of alternative programs that provide schooling inputs and discuss the limited evidence on relative cost-effectiveness, where it exists, in Chapter 7. Chapter 8 concludes.

Chapter 2

The Structure and Scope
of FFE Programs
FFE Modalities


FE programs generally take two forms: in-school meals and take-home rations. The major objectives of both modalities are the same: to improve education outcomes and increase food consumption, and possibly nutritional status, of children. However, differences between these two modalities suggest that they may not be equally effective or may affect different aspects of education and nutrition. Among the differences between the programs are the likely timing of food consumption during the school day; who controls and distributes the food; the ability of recipient households to divert the food to other family members; and the quality of food stemming from differences in storage, sanitation, and preparation practices. The composition of the food provided is also often different. Take-home rations are more likely to be single, nonperishable food items, such as cereals or oil. Moreover, in the FFE modality, individual programs can be implemented very differently to achieve specific desired results. In-School Feeding Programs

In-school feeding programs provide food to children while they are attending school. This food can take the form of breakfast, snack(s), and/or lunch. School meals vary in the quantity of food provided and in their nutritional content, and so their expected impacts also vary. In some cases, the food may be fortified, for example, with vitamin A or iron. School meals are often prepared on site, requiring kitchen facilities, cooking staff, eating and serving utensils, and a space at the school for consuming the meal, making these programs relatively costly to operate. Schools serving meals must set aside time to serve the food, which could disrupt learning, 5


chapter 2

if time for meals would not otherwise be provided. Some programs also offer other health, nutrition, or education programs jointly with in-school feeding. These programs have included deworming, improving school quality and infrastructure, and providing health education. Unlike in the United States, for example, where school meals are targeted to selected students through exclusive breakfast before school or a targeted subsidy of lunch already available for sale, in developing countries, it is often infeasible or undesirable to target individual students for school meals. As a result, all students in program schools receive the food, substantially raising costs.

By providing food at school during the school day, in-school feeding has two advantages over take-home rations. First, it provides an incentive for school attendance directly to the child, rather than through the parents, as with take-home rations. Second, well-timed school meals alleviate short-term hunger, possibly improving students’ ability to concentrate and learn (Caldes and Ahmed 2004). Although it is also possible that take-home rations can achieve this goal, this outcome is not explicit in the take-home rations design.

Take-Home Rations

Take-home rations are food rations given to the household conditional on a child’s enrollment in school and a minimum level of attendance. Usually the ration is given monthly. A common requirement, though often weakly enforced, is that children attend at least 80–85 percent of school days to maintain eligibility for the program. Because the transfer is directed to the household and not the child, the welfare gains may be more dispersed.1 The household can redirect the food ration to whomever it desires or sell it for other goods or cash. In this sense, the ration is comparable to an income transfer. Take-home ration programs place less emphasis on alleviating short-term hunger for children at school, focusing instead on improving food security at the household level (Pollitt 1995). It is often much less costly than inschool feeding and does not take time away from learning. In practice, take-home ration programs are often cheaper to operate, because they are more easily targeted, for example, toward poor households. Although it is often infeasible in developing countries to restrict in-school meals to specific children, either for logistical or political reasons, take-home rations are routinely provided to a select set of children. For example, the WFP sometimes targets take-home rations exclusively to girls, who often lag behind boys in school attendance. In some cases, these take-home rations are provided as a top-up transfer to girls: an additional incentive in areas where all primary-school children receive in-school meals (WFP 2005).

1As described below, this effect depends on whether the transfer is inframarginal with respect to the child’s food consumption.

the structure and scope of FFE programs


The Scope of Today’s FFE Programs

It is difficult to know the full scope of FFE programs in developing countries, but a summary of the programs currently operated by the WFP, likely the world’s largest provider of in-school meals and take-home rations outside of a single country, gives a good indication of the typology and popularity of FFE programs. According to Gelli (2006), WFP’s FFE programs reached approximately 21.6 million children in 72 countries in 2005. In addition to in-school meals and take-home rations, WFP sometimes provides fortified biscuits for distribution at school. Nearly half of WFP FFE programs combine these modalities for linking food to school participation. In 24 percent of FFE schools, only fortified biscuits are provided, whereas 22 percent of program schools use only on-site meals and 6 percent use take-home rations exclusively. On average, in-school meals provide 876 kcal of food energy per child per day; biscuits provide 313 kcal of energy.2

The average cost of running FFE programs at WFP in 2005 was US$15.79 per child per year. The cost of on-site meals alone was slightly higher, whereas that of biscuits averaged US$9 per child. For take-home rations, the annual average cost was much higher (US$30) because of transport costs and differences in food bundles. In addition to the food, WFP also supports complementary activities to improve child health. For example, deworming is provided in 56 percent of WFP-assisted scho...

Read more


+1 -0 -1002 -12 -202 -4 -509 -5600 -862 -89629 .. /0896295095fprev9 /infoods. /reviews/en/ab004676.html. 0 0.10 0.25 0.38 0.4 0.5 0.58 0.62 0.85 00 0225 06 1 1.1 1.34 1.4 1.5 1.9 10 10.2499 10.5 100 1017 102 1067 107 1096 1098 11 11.0 111 112 113 1134 1139 1140 1141 1148 115 117 1177 118 12 123 124 1241 125 126 1278 129 13 1309 1324 1325 133 134 1343 135 137 138 139 14 14.2 140 147 15 15.7 15.79 1526 1533 159 16 16.4 16.6 1638 1641 169 17 174 18 185 19 190 193 194 1955 1956 196 1973 1980 1981 1982/83 1985 1986 1987 1988 1989 199 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 1a 1although 1as 1keywords 1on 1see 1the 2 2.5 2.92 20 200 2000 20006 2001 2002 2002a 2002b 2003 2004 2005 2006 2007 2008 2008013124 201 202 2033 207 209 21 21.6 217 22 221 225 23 233 238 239 24 25 250 251 259 26 262 268 27 27.4 275 28 283 29 2a 2although 2child 2estimates 2see 2several 3 3.1 30 300 305 31 313 32 327 33 333 34 345 349 35 35.9 353 36 363.8 368 37 38 381 39 3950s 3956s 3957s 3964s 3965s 3971s 3972s 3980s 3a 3b 3babu 3other 4 4.3 40 400 41 419 42 427 43 436 437 44 442 45 450 46 464s 467 468 47 476 477s 48 482 49 493 497 4baseline 4the 5 50 50.7 500kcal 503 508 51 52 53 54 55 555 556 56 567 57 571 576 58 583 59 5parent 5this 6 6.1 60 600 604 605 61 62 63 635 64 64.7 644 646 648 65 653 654 66 67 68 69 6another 6there 7 7.5 7.9 70 703 72 724 73 74 75 77 785s 789s 79 790s 794s 795 7the 8 8.4 8.5 8.6 80 81 813 814 83091724 846 85 86 873 876 879 880 891 898 9 9.5 90 91 92 946 95 97.4 978 a.m a1 a2 a3 a4 a5 abil abl abolish absenc absente absorpt abstract academ acceler access accompani accord account accumul accur achiev acid acknowledg acqua across act activ actual ad adair addit address adelman adequ adequaci adjust administ administr admit adolesc adult adulthood advantag advers advoc affair affect affili africa african afridi afternoon age agenc agricultur agroclimat ahm aid aim akhter al alber alderman alk allen allevi alloc allow almost alon alreadi also altern although ambigu america american among amount amsterdam analys analysi analyz and/or andean anecdot anemia anim animal-sourc ann annual anonym anoth answer anthelmint anthropometr anthropometri anyway apart.7 appear appendix appetit appli applic approach appropri approxim april aqua arbor area argu arguabl arimond aris arithmet arm around arous arriv articl ascertain ash ashenfelt asia asid ask aspect assess assign assist associ assum assumpt at-hom at-risk athom att attach attain attempt attend attent attract attribut august author avail averag average-height avoid award away b b-caroten b-carotene-fortifi b12 babu background backward badenhorst banerje bangladesh bank bargain barrier base baselin basi basic basioti bcaroten bcarotene-fortifi becker becom beef began begin behavior behind behrman believ belong benadé benefici beneficiari benefit berkeley bernardo besid best better better-off beverag beyond bi bi-month bias bibliograph biochem biolog birdsal biscuit blood blouin blundel bmi bobadilla boboni bodi bolster book boost boston bourguignon bovin bovine-hemoglobin boy brain braun brazil breakfast brief briefli bring british broad brought brown budgetari bulletin bunch bundl burden burn busi bwibo c calcium calcul cald calif california call calloway calor calori cambodia cambridg came candid cannot capac capit captur card care carlo caroten carri case cash cash-bas cash-for-educ cash-transf casual catalog cataloging-in-publ catch catch-up catchup caus causal caveat cawley cd004676 cell censor center central cereal certain chanc chang channel chapter character characterist chart cheaper cheneri chiappori child child-level child.1 childcar childhood children chile choic choos chosen circumfer circumst cite claim class classif classroom clear clinic close cluster cm coat coauthor cochran code coeffici cognit coincid cole colleagu collect colleg color columbia combin come comment commerci commit common communic communiti compar comparison competit complementar complementari complet complex complic compon composit comprehens compris comput computer-assist concentr conceptu concern conclud conclus condit conduct confid conflict confound congress conner consensus consequ consid consider consist consolid constraint construct consult consum consump8jacoby consumpt consumption.2 contact contain content context contextu continu contract contribut control convinc cook cooki coordin copyright cor57 correct correl correspond cost cost-effect costa costeffect costs.1 could counterexampl counterfactu countri coupl cours covari cover coverag credit creditconstrain crisi criteria critic critiqu cronin crowd cueto cultur cumul current curv cutoff cycl d d.c [email protected] daili dall damag daniel danish data databas dataset day day.8 dc22 ddi ddidatt death debat decentr decid decis decision-mak declin decompos decreas defici deficit defin del delay deliveri demand demment demonstr dens depart depend depth deriv describ descript design desir despit detail detect determin develop developing-countri deviat deworm di dia diarrhea diarrhea-rel diego diet dietari dietet differ difference-in-differ difference-indiffer differenti difficult difficulti digit digit-span dilut diminish direct director disadvantag discern discontinu discount discourag discret discuss diseas disentangl dispersed.1 displac disrupt distanc distinct distinguish distribut divers divert divis dobi doi done donor downward drastic draw drawn drink drive drop drop-out dropout drought due duflo dummi durat durhold e e-mail earli earlier earn earthscan easi easier easili eat eaten econlit econom econometr econometrica economi economist ed edit educ effect efficaci effici effort ei eight eight-year-old either electron elementari elig elimin elsevi elsewher email embarrass emphas emphasi empir employ encourag end endogen energi energy.2 enforc english enhanc enough enrol entir entri enumer environ equal equat equival erad error especi establish estim estimation.3 et ethic ethiopia ethod evalu even event everi evid exact examin exampl exceed except excess exchang exclud exclus exhibit exist expand expect expens experi experienc experiment expert explain explan explanatori explicit exploit explor express extend extens extent extern extramargin extrem eye f faber facil fact factor fail fair fall famili familiar fao fao/who/unu farm farmer fast fat favor fcnd fe fed fee feed feeding.1 fell fellow femal fermin ferritin fertil fetal fewer ffe ffe.3 field field-studi fifteen fifth fifth-grad figur filipino final financ financi find fine fine-motor finish firm first first-grad firstgrad fiscal fit five five.5 fix fixed-effect flip flore fluenci flypap focus folic follow follow-up food food-bas food-energi food-insecur foodenergi foodgrain forc forego foreign foreword forheight form format former fortif fortifi forward foster found four fourth fourth-grad fraction frame framework free frequent friedman frongillo fruit full fulli function fund furthermor futur g gain galda gap garden gardner garza gelli gender general generat generous geneva gertler gewa gibson gillespi gilligan girl give given gleww global glucos go goal goiter good govern government-run gp gp-level grade gradual gram granddaught grandfath grandmoth grant grantham grantham-mcgregor granthammcgregor grate great greater greatest greenfield greenhalgh grillenberg group grow growth guthri h half hallam halv hand hand-wash handbook hanushek hard harder harold harvard hautvast haz health healthi heang heavi heckman height height-for-ag heightfor heightfor-ag help hemoglobin henc herein hertrampf heyneman high high-qual higher highlight hinder histori hoddinott hold holiday holland home hope horney hour hous household household-level howev huaraz huffman human hundr hunger hungri højersholt ibrahim ibrahin ichimura idea identif identifi ifpri ignor igur ii iii ill illness-rel imag immedi immun impact imped implement implic import impos imprecis improv in-school inabl inadequ incent incid includ incom inconclus inconsequenti incorrect increas independ index india indian indic indictor indiffer indirect individu individual-level indonesia induc inequ inexpens infant infeas infect infecti inferenti influenc inform inframargin infrastructur ing ingredi inhibit initi input inschool insecur instanc instead institut instruct instrument instruments.4 insuffici insulin insult intak intake.3 intake.4 intend intent intent-to-treat interact interest interfer intern interpret interrel interrupt intervent interview intestin intra intra-household intrahousehold introduc introduct intuit invari invest investig involv iodin iri iron iron-rich ironfortifi irrespect irrevers isbn isol issu item iv ix j jacobi jamaica jamaican jamison janzen joachim job joint journal jr judg juhlin justifi k kcal kcal.6 keep kelsay kenoy kenya kenyan key kg kim kind king kitchen [email protected] know knowledg known kooreman krasevec kremer kristian kristjansson kruger kvalsvig l label labor laboratori lack lag lalond lane larg large-scal larger largest lassibill last late later latham latin latter laubscher lb3479.d443a34 lead lean learn least lechen led lehrer leibel lend length less less-gener let leteli level level/type levin lewi liang librari life lifetim like likelihood limit linden link list literaci literatur littl live llaguno local locat location-specif logist london long long-term longer longfil longitudin look loss low low-baselin low-incom lower lunch m macdonald macgowan macronutri made magnitud mail main maintain major make makola malaria malnourish malnutrit maluccio manag mani mann manser mansvelt mari market marriag maryland mass massachusett match materi matern math mathemat matric matter maxim may mayhew mcelroy mcgregor mdg meal mean measham measur meat meat-bas mechan medicin medline.1 mehansho member memori menhansho mental mention mertz metabol method methodolog metric mexican mexico mg mich michigan microeconom micronutri micronutrient-fortifi micronutrientdefici mid mid-afternoon mid-morn mid-term middl middle-class midmorn midst miguel milk millennium million mimeo mind minim minimum ministri minor minus miss mitig mix ml modal model moder modifi monitor mont month montreal morbid moreov morn mosley most mother motiv motor moulin mpiric muac muamc much multilevel multipl multiplemicronutri multiplemicronutrient-fortifi mur murphi muscl must mysteri n n.w namunyu narrowli nash nash-bargain nation national-level nationwid natur ndossi near nearbi necessari need negat neglect neighborhood net network neumann neurohormon new next ngo ngos nicaragua night ninno non non-experiment nonbeneficiari nonbenficiari noncompar none nonetheless nonexperiment nonfortifi nongovernment nonparticip nonperish nonprogram nonschool nonstandard norm normal north north-holland northern northholland not-for-profit note notic nourish number nutrient nutrient-dens nutrient-rich nutrit nutriti nutrition-rel nutritionist nw o obes object obscur observ obtain occas occur offer offset often oil old old-ag older olivar omiss omit on-sit one ongo ood oper oportunidad opportun oppos optim oral orang order organ origin osei otenti other otherwis out out-of-school outcom outperform outsid outweigh over-report overal overcom overcrowd overlook overnight overst overview oxford p panchayat paper parent pariti park part partial particip particular partner partnership past pathway patrino pattern pedagog peer peer-review pencil pension per percent percentag percept perceptu perform perhap period permiss persist person pertain peru peso petticrew phase phd phi philippin physic physiolog pizzaro place placebo placement plagu plan plasma plausibl play pleas plus point polici policymak polit pollit pollitt pool poor poorer poorest popul popular portion pose posit possibl post post-intervent post-treat postmenarchi posttreat potenti poverti powder powel power practic pre pre-school preand predict predictor prefer pregnanc pregnant prepar preprogram preschool preschool-ag presenc present press pressur preval prevent previous primari primarili primary-school primary-school-ag primaryschool primaryschool-ag principl prior prioriti privat probabl problem process produc product profit program program-induc program.2 programm programmat progresa progress progressa project promot propens propensity-scor prospect protect protein proteinenergi provid provis proxi psacharopoulo psm psychiatr psycholog psychosoci pubert puberti public purchas purpos push put q qualifi qualiti quantiti quarter quasi quasi-experiment quasi-random quasirandom quebec question questionable.6 quick quisumb quit r radio radio-bas rais ramif random rang rate rather ratio ration rational rausser ravallion raven raw reach reap reason recal receiv recent recipi recogn recommend reconcil record red red-blood-cel redirect redistribut redress reduc reduct refer refin reflect refocus regard regardless region regist regress regular reinfect relat relev reli reliabl religi remain remedi remov renew repeat repetit replac replic report reposit repres reproduc requir research reserv resid residu resist resourc resource-alloc respect respiratori respond respons restrict result retent retinol retriev retrospect return reveal revers review riboflavin rich right rigor risk robinson roger role roll rome rosenzweig rough routin ruel rule run rural s.p s120 s128 s129 s139 s140 s145 [email protected] safeti saharan sale sampl samples.7 samuelson san sanchez sanchez-fermin sangiovanni sanit sarah sarol saw scale scaled-up scant scarciti scheme scholarship scholast school school-ag school-bas school-feed school-go school-level school-lunch school-particip school-rel schoolag schoolbas schoolchildren schultz scienc scope score scrimshaw scrutini searchabl searl season second secondari section secur see seek seem seen select self self-select selfselect sell seminar send sengupta sens sensit separ sequenc seri serious serum serv servic set seventh seventh-grad sever share sharma sharpli shea shock short short-run short-term shortcom show shown shulman sibl sick side side-by-sid sidebi sideby-sid siek siekmann sigman signific significant.1 simeon similar simpli simultan sinc singl sinuon site six size skill skoufia slice slight slum small smaller smith snack social societi socioeconom soeng softwar solon solut solv sometim sourc south space span spars special specialist specif speed spend spent spinnler squar srinivasan ssess staff stage standard stark start state statist status stay stekel stem stew still storag store strategi strauss street strength strengthen stress strong stronger strongest structur stuctur student studi stuijvenberg stunt sub sub-saharan subgroup subject submit suboptim subsampl subset subsid subsidi substanti substitut subtract success suffer suffici suggest summar summari suppl supplement supplementari suppli support surpris survey surviv suscept sustain swaminathan synerg synopsi system systemat t-test tabl tailor take take-hom taken tan tanzania target task tatala tax tea teach teacher teacher/student technic techniqu technolog telephon ten tend term test textbook thank theoret theori therapi therebi therefor thin thinness/fatness third thirti thoma thornton thorough though three threshold thus time time-invari timeli tion tissu titl today todd took tool top top-up total toward tradit train transfer transport travel treat treatment trend tri trial true tudi tuft tugwel tuition turkey turn twelv twenti twenty-f two two-third type typic typolog u u.s.a uganda ultim umbrella un unabl unaccept unannounc unavail unbalanc unclear uncommon uncondit uncorrel underestim underinvest undermin undernourish underst understand understood undertak undertaken underweight undesir unesco unexpect unfortifi unfortun uniform union uniqu unit univers unknown unless unlik unobserv unpublish untreat unusu updat upper upper-arm urban urin urinari us use usual utensil util v valid valu van vancouv vanish vari variabl variables.1 varianc variat various vast vector veer vega veget vegetable-bas vegetarian venu verbal vermeersch versus viabl view vigil vii viii villag visit visual vital vitamin volum von vs vulner vytlacil w wage walk walker walter wambangco want ward wash washington wast way waz weak weakest week weekend weight weight-for-ag weight-for-height weight-forheight weight-recommend weiss welch welfar well well-b well-design well-nourish well-plan well-run well-tim well-train wellb wellcom welsh west western wet wfp wfp-assist whaley wheat wherea whether whole whomev whose whz will window wipe within without wodon woerner women work workbook world world-food worm wors worse-off worsen would written www x xi xib xii xiii xiv xv xvi y y0 y0c y0t y1 y1c y1t year year-old yet yi yield york young younger yuksel z z-score zhao zinc zitzewitz ˆ