Protocol 2.2: Compare evidence against the IPC Chronic Food Insecurity Reference Table

The purpose of the IPC Chronic Food Insecurity Reference Table  is to guide comparison of available evidence against generally accepted international standards and thresholds (Table 25).

The IPC Chronic Food Insecurity Reference Table is organized according to the IPC Analytical Framework – i.e. outcomes of food consumption (organized into quality and quantity of dietary intake) and nutrition; and contributing factors of vulnerabilities and hazards, and the four food security dimensions. The Table guides critical evaluation and contextualization of evidence in relation to different severities of chronic food insecurity. 

The IPC Chronic Food Insecurity Reference Table is organized into four severity levels: Level 1: No or Minimal; Level 2: Mild; Level 3: Moderate; and Level 4: Severe (Box 49). The Table describes the typical characteristics for each level and assumes that populations of households under each level are likely to share the same general characteristics (Box 50).

Each level is linked to priority response objectives (Box 51). While the Chronic Food Insecurity Reference Table links response objectives with each level, subsequent to the completed analysis, it is necessary to conduct a Response Analysis to determine which particular interventions and activities are best suited to mitigate chronic food insecurity.

The IPC Chronic Food Insecurity Reference Table identifies globally comparable cut-offs for key food security outcome indicators so that the population of households can be commonly distributed across the four levels. Although the IPC identifies “generally globally comparable” indicator cut-offs, it acknowledges that, inevitably, indicator cut-offs at times do not align due to issues related to context and to indicator characteristics. Thus, while the IPC Chronic Food Insecurity Reference Table provides general guidance for evidence alignment, it is the convergence of evidence based on critical contextualization that will allow analysts to conclude on classification (Box 52). Analysts will be required to explain their reasoning for classification, including reference to supporting and contradictory evidence. Table 24 provides a summary of the IPC Chronic Food Insecurity Reference Table.

Although the IPC Chronic Food Insecurity Reference Table identifies only selected indicators as direct evidence, it does not preclude the use of information from other indicators not included in the Table during the analysis. In fact, the IPC encourages the inclusion of other relevant indicators in the analysis. The Reference Table is not for review at the country or regional levels; however, it may be updated by the Global IPC partnership, considering users’ feedback and the latest technical developments.

Indirect evidence includes all relevant evidence not listed in the IPC Chronic Food Insecurity Reference Table, including locally specific indicators on outcomes and most indicators on contributing factors. Indirect evidence is usually available at the subnational levels with greater frequency, since it is often collected through national monitoring systems.  

Furthermore, some of these locally specific indicators may have been calibrated for local conditions. Since the Reference Table does not identify globally applicable cut-offs for indirect evidence, such evidence needs to be interpreted and analysed within the context.

If, however, locally applicable cut-offs have been developed, analysts may refer to them. In the absence of locally applicable cut-offs, it is the task of the analysts to understand and infer the meaning of the evidence and to relate the evidence to the Level descriptions and other indicators and their cut-offs. 

Table 25: IPC Reference Table for Classification of Severity Levels of Chronic Food Insecurity

Purpose: To identify areas at different levels of chronic food insecurity based on convergence of available evidence at the population level. The classification is intended to guide decision-making associated with medium- and long-term improvements in food security.

Use: For each listed indicator, the Table identifies thresholds that correspond as closely as possible to the Chronic Food Insecurity level description in the first row. Based on the respective thresholds for each indicator, a convergence of available evidence is used to estimate the percentage of households in each Chronic Food Insecurity level in the study area. The area is then classified in the most severe level that affects at least 20 percent of the population. Cut-offs presented for indicators prone to change within a year are set for the lean season of years with non-exceptional circumstances.

Explanatory Notes for the IPC Chronic Food Insecurity Reference Table

1. Response planning should include monitoring and consideration of disaster risk reduction activities across all IPC levels of chronic food insecurity, including IPC Level 1. For the most chronically food-insecure households (IPC Levels 3 and 4), responses focusing on disaster risk reduction, protection and strengthening of livelihoods, and monitoring activities are assumed necessary to decrease chronic vulnerability and to increase resilience to recurrent shocks. Response planning should also consider complementary and mutually reinforcing interventions among households at different levels of food insecurity.

2. Food consumption indicators that are included in the IPC Chronic Food Insecurity Reference Table have been identified by the IPC Global Partners who participate in the IPC Food Security Working Group. Most of these indicators capture overall food consumption and experiences; the IPC Global Support Unit and Food Security Working Group have interpreted some of them to be more closely correlated with either the quality or the quantity of food consumption. This grouping is illustrative and aims only to facilitate understanding and analyses of how aspects of quality and quantity are characterized in the area under analysis. The indicators included in the IPC chronic food insecurity Reference Table are not direct measures of each food consumption component; rather, the convergence of evidence on these different aspects from available information makes it possible to characterize the severity of chronic food insecurity for the area, based in part on the relationships between quality and quantity of food consumption.

3. The IPC Food Security Working Group recognizes that indicators based on the analysis of households’ responses to and experiences of food insecurity, such as the Reduced Coping Strategies Index, the Food Insecurity Experience Scale, the Household Food Insecurity Access Scale, the Latin American and Caribbean Food Security Scale and the Household Hunger Scale, may be useful as part of the convergence of evidence process to classify the severity of Chronic Food Insecurity in a given area. With the exception of Household Hunger Scale and Food Insecurity Experience Scale, these indicators and their respective cut-offs are not included in this version of the IPC Chronic Food Insecurity Reference Table. National IPC Technical Working Groups, in close collaboration with the IPC Global Support Unit and Food Security Working Group, are asked to carefully include all existing coping and experience-based indicators in their Chronic Food Insecurity Analyses as indirect evidence of household responses to food insecurity, and to provide feedback to the Global Support Unit and Food Security Working Group to inform decisions on the possible inclusion of these other indicators in future versions of the IPC Chronic Food Insecurity Reference Table.

4. Adequate dietary nutrient intake relates to the condition of regularly consuming, over a relevant period of time, an amount of food that provides the dietary energy needed to cover the requirements and recommendations of nutrients for an active and healthy life. Although the IPC Chronic Food Insecurity Reference Table does not weigh indicators, a tier rating of indicators is provided to guide analysts in considering how strongly each of the indicators included in the food consumption quality portion of the IPC Chronic Food Insecurity Reference Table relates to the quality of food consumption. Indicators with stronger relationships to food consumption quality are given a tier rating of 1, while indicators with a weaker relationship are given a tier rating of 3 (Table 26).

5. The macronutrient cut-offs presented for Level 1 are drawn from the Joint WHO/FAO Expert Consultation guidelines for a balanced diet. (World Health Organization. 2003. Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. WHO, Technical Report Series No. 916. Geneva: World Health Organization.) It is hoped that in future collaborative efforts through partnerships and applied analyses, it will be possible to identify specific cut-offs for the share of energy from macronutrients for IPC Levels 2, 3 and 4 of the IPC Chronic Food Insecurity Reference Table. In addition, national IPC Technical Working Groups are urged to use this and any other similar indicators in close collaboration with the IPC Global Support Unit and the Food Security Working Group for convergence toward classification in IPC Levels 2, 3 and 4, and to seek assistance for analyses of data on share on energy from macro¬nutrient intake with the IPC Global Support Unit for use in IPC Chronic Food Insecurity analysis.

6. Minimum dietary diversity among children aged 6–23 months is a WHO standard indicator on infant and young child feeding practices and is collected from the self-reporting of mothers in Standardized Monitoring and Assessment of Relief and Transitions surveys, Demographic and Health Surveys and Multiple Indicator Cluster Surveys. It has been noted that information on the diversity of dietary intake at the individual level relates more strongly to dietary quality than to dietary quantity. (FAO, 20107. Guidelines for measuring household and individual dietary diversity. www.fao.org/docrep/014/i1983e/i1983e00.pdf)

7. Indicators of women’s dietary diversity, developed by FANTA and FAO, are used to signify the overall quality of an individual’s diet during the previous day. These indicators are based on women’s self-reporting and include either nine or ten food groups, depending on whether the evidence comes from the Individual Dietary Diversity Score, which is composed of nine food groups, or from the Minimum Dietary Diversity for Women (MDD-W), which is composed of ten food groups. Independent of the source of evidence, a cut-off of five or more food groups for an acceptable diet has been validated for both Individual Dietary Diversity Score and MDD-W. (FAO and FANTA. July 2014. Consensus Meeting on a Global Indicator to Measure Women’s Dietary Diversity. www.fantaproject.org/news-and-events/2014-consensus-meeting-on-mddw) Since 2014, however, MDD-W has emerged as the main indicator used to measure women’s dietary diversity and as a result, it rather than Individual Dietary Diversity Score has been included in the IPC Chronic Food Insecurity Reference Table. For the Individual Dietary Diversity Score and MDD-W indicators, women are defined as females aged 15 to 49. It has been agreed that information on the diversity of dietary intake at the individual level relates more strongly to dietary quality than to dietary quantity (FAO, 2010).

8. The Starchy Staple Ratio (SSR) indicates the proportion of energy from starchy foods, such as maize, rice, potatoes and cassava, based on self-reporting of foods consumed. This indicator is used as one piece of evidence to indicate the adequacy of the share of energy from macronutrients. Although there is a direct relationship between SSR and the share of energy from carbohydrates, it is expected that SSR will be lower than the percentage of total energy coming from carbohydrates, since non-starchy foods such as sugar and vegetables are also considerable sources of carbohydrates. The cut-offs for SSR identified in the IPC Chronic Food Insecurity Reference Table are based on unpublished applied research conducted by the World Bank. Further research is recommended to assess the appropriateness of these SSR cut-offs.

9. The Starchy Staple Expenditure Ratio (SSEXR) indicates the share of self reported food expenditure on starchy staples, which are typically among the cheapest sources of calories. The cut-offs for SSEXR identified in the IPC Chronic Food Insecurity Reference Table (as for SSR described above) are based on unpublished applied research conducted by the World Bank. Further research is recommended to assess the appropriateness of these SSEXR cut-offs.

10. Non-defining characteristics (NDCs) relate to the inability of the IPC Global Support Unit and Food Security Working Group to identify cut-offs needed to assist in estimating the proportion of households in specific levels of Chronic Food Insecurity. Often, this occurs either because an indicator is binomial (yes/no), or because the IPC Global Support Unit and Food Security Working Group have not found sufficient evidence to inform specific cut-offs by the time of the release of this IPC Chronic Food Insecurity Reference Table.

11. Adequate dietary energy intake relates to the condition of regularly consuming, over a relevant period of time, an amount of food that provides the dietary energy needed to cover the requirements for an active and healthy life. Although the IPC Chronic Food Insecurity Reference Table does not weigh indicators, a tier rating of indicators is provided to guide analysts in assessing to what degree each of the indicators included in the food consumption quantity section of the IPC Chronic Food Insecurity Reference Table is correlated to the quantity of food consumption. Indicators with stronger relationships are given a tier rating of 1, while indicators with a weaker relationship are given a tier rating of 3 (Table 27).

12. The IPC Global Support Unit and Food Security Working Group acknowledge that an assessment of the probability of insufficient dietary energy intake in a population or group of individuals is best obtained from data collected through individual dietary intake survey. Although highly preferred, data from such surveys are seldom available from representative surveys at the needed disaggregation level.

13. The prevalence of undernourishment (PoU) is a corporate FAO indicator and refers to the percentage of the population with any gap in their habitual dietary energy consumption. It can be calculated from individual dietary intake assessments or household food consumption data. When no data from individual dietary intake assessments are available, the PoU is computed based on food consumption data from household surveys, for example from Income and Expenditure Surveys. For IPC Chronic Food Insecurity analyses, the PoU is first used to estimate the percentage of the population in Levels 3+4. In a second step, differentiation between Levels 3 and 4 is conducted based on the size of the mean dietary energy consumption gap in the undernourished population. The percentage of the population that is undernourished is divided in two groups: those that have an estimated average gap lower than 10 percent of the minimum dietary energy requirements, and those that have a gap equal to or greater than 10 percent of the minimum dietary energy requirements. The two shares are assigned, respectively, to Levels 3 and 4. Testing conducted by Global Support Unit, FAO and Central American Integration System (SICA) with two PoU datasets have confirmed the appropriateness of the selected cut-offs. It should, however, be noted that food consumption data collected in household surveys are often imprecise. While use of a statistical model for the PoU helps in reducing the risk of relevant bias, the estimates can still be unreliable, especially when based on small samples or when appropriate sampling weights are not available. Global Support Unit and Food Security Working Group acknowledge the difficulties in analysing this indicator, and the FAO Statistics Division (FAO/ESS) is committed to assisting countries’ National Statistical Offices in carrying out estimations of PoU at the national and sub-national levels in the context of the support given for the monitoring of the 2030 Agenda for Sustainable Development.

14. The Food Consumption Score (FCS) is an indicator collected in all WFP assessments and monitoring activities. The FCS is a composite score based on self-reported information on dietary diversity, food frequency (number of days food groups were consumed during the past 7 days), weighted by the ascribed relative nutritional importance of different food groups. Based on standard thresholds, households are classified into one of three Food Consumption Groups: poor, borderline, or acceptable.

15. The Food Insecurity Experience Scale (FIES) is an FAO indicator and a global metric for the severity of household or individual food insecurity (defined as the inability to access food during the last 12 months). The metric is based on information provided by data on self-reported experiences and conditions typically associated with food insecurity, analysed through Item Response Theory methods. Data collected with the FIES Survey Module or with other existing experience-based food security scales (e.g. the Household Food Security Survey Module, the Latin American and Caribbean Food Security Scale, the Mexican Food Security Scale, or the Brazilian Food Insecurity Scale) can be used to estimate the distribution of households or individuals by level of severity. The levels of severity are expressed on the FIES global reference scale defined by FAO, thus improving cross-country comparability of the classifications. (Ballard, T.J., Kepple, A.W. & Cafiero, C. 2013. The food-insecurity experience scale: development of a global standard for monitoring hunger worldwide. Technical Paper. Rome: FAO. www.fao.org/economic/ess/ess-fs/voices/en) Pending further validation to be conducted as more FIES datasets become available, the threshold currently defined by FAO as indicative of moderate or severe and used for global monitoring of Sustainable Development Goal Target 2.1 will be used to support the convergence of evidence to estimate the percentage of households in IPC Chronic Food Insecurity Levels 3+4 for the IPC Chronic Food Insecurity Reference Table.

16. The Household Dietary Diversity Score (HDDS) developed by FANTA and FAO aims to reflect the economic ability of a household to access a variety of foods and is based on household self-reporting of the number of food groups (out of a total of 12) consumed in the previous 24 hours. Studies have shown that an increase in dietary diversity is associated with higher socioeconomic status and household energy availability. (Hoddinott, J. & Yohannes, Y. 2002. Dietary diversity as a food security indicator. Washington D.C.: FANTA. www.aed.org/Health/upload/dietarydiversity.pdf / Hatloy, A., Hallund, J., Diarra, M.M. & Oshaug, A. 2000. Food variety, socio-economic status and nutritional status in urban and rural areas in Koutiala (Mali). Public Health Nutrition, 3: 57–65.) Cut-offs presented in the IPC Chronic Food Insecurity Reference Table are based on case studies and the FANTA-FEWS NET Household Food Consumption Indicator Study report (2015).

17. The Household Hunger Scale (HHS) developed by FANTA assesses whether households have experienced problems of food access in the preceding 30 days, as self-reported by the households to classify the severity of food insecurity. The household hunger scale assesses food consumption strategies adopted by households facing a lack of access to food. The household hunger scale is composed of three questions, which were found to be valid across cultures: (i) In the past four weeks or 30 days, was there ever no food to eat of any kind in your house due to a lack of resources to obtain food? (ii) In the past four weeks or 30 days, did you or any household member go to sleep at night hungry because there was not enough food? and (iii) In the past four weeks or 30 days, did you or any household member go a whole day and night without eating anything at all because there was not enough food?

18. The Household Economy Analysis (HEA) is a livelihoods-based framework created by Save the Children UK and is currently used by various organizations, including Save the Children, the Food Economy Group, FEWS NET and Oxfam. The HEA is founded on the analysis of people in different social and economic circumstances. In particular, HEA analysis examines the self-reporting of information on: (i) how people access the food and cash needed; (ii) their assets, the opportunities available to them, and the constraints they face; and (iii) the options open to them in times of crisis. Two thresholds define basic needs in the HEA, i.e. the survival threshold and the livelihoods protection threshold, although only the survival threshold is used as direct evidence in IPC Chronic Food Insecurity Analyses. The HEA survival threshold represents the most basic of needs, including minimum food energy requirements (calorie requirements), the costs associated with food preparation and consumption if associated inputs are purchased (e.g. salt, firewood or kerosene [paraffin]), as well as expenditure on water for human consumption. The HEA survival deficit should reflect the whole baseline/normal year, which should not have any exceptional circumstances.

19. Minimum meal frequency among children aged 6–23 months is a standard infant and young child feeding indicator and collected among mothers/caretakers in the Demographic and Health Surveys, Multiple Indicator Cluster Surveys and Standardized Monitoring and Assessment of Relief and Transitions surveys. The indicator assesses whether a child is fed a predetermined number of times in the previous 24 hours, as per age-specific requirements.

20. Months of Adequate Household Food Provisioning (MAHFP) indicates how many months of the past year a household selfreports that it was able to access enough food. MAHFP was designed by Africare to classify the magnitude of food insecurity in project-targeted areas, facilitating targeting of vulnerable households, as well as design and implementation of intervention strategies. MAHFP focuses on household access to food, taking into consideration own production, stocks, purchases, gathering, and food transfers from relatives, members of the community, the government or donors.

21. Although evidence suggests that Chronic Food Insecurity may increase the risk of mortality, no thresholds for mortality are provided in the IPC Chronic Food Insecurity Reference Table, in part because mortality indicators are typically presented as a rate, rather than as prevalence, making it difficult to use these indicators to classify households into IPC Chronic Food Insecurity levels.

22. For nutrition area outcomes, chronic malnutrition should be related to household food consumption deficits. A dose-response relationship between Chronic Food Insecurity and stunting is assumed based on available research, for example, a study by Saaka and Osman (2013) showing correlation between height-for-age Z-score (HAZ) and FCS/HDDS.

23. Chronic malnutrition is classified by stunting levels in terms of the standardized height-for-age Z-score score among children (height or length for specific sex and age). Stunting is the measure of growth retardation due to the persistent inability to meet minimum micro- and macronutrient absorption requirements, frequent recurrence of acute malnutrition episodes, or a combination of these.

24. Hazards are any phenomena that have the potential to cause disruption or damage to food security in a household or area. Vulnerability is defined as exposure and sensitivity to hazards.

25. Livelihood strategies are the activities people employ to earn food and income. The IPC Chronic Food Insecurity Analysis focuses on understanding and estimating the extent to which livelihood strategies of the population allow them to satisfy their food and essential non-food needs from day to day in a sustainable manner. The livelihood assets that people own or have access to (e.g. education, housing conditions, productive assets) and the existing policies, institutions and processes (e.g. access to health care, vaccination campaigns and agricultural policies) influence their ability to generate sustainable livelihoods. The IPC Chronic Food Insecurity Analysis focuses on the analysis of livelihood strategies, assets and policies, institutions and processes that exist under non-exceptional circumstances while also looking at long-term trends.

26. The categorization of low-value livelihood strategies should be contextually constructed and may include, inter alia: high dependency on firewood, grass and/or charcoal sales; high dependency on consumption or sale of wild food. The categories of low-value livelihood strategies presented in the IPC Chronic Food Insecurity Reference Table are based on the importance of these sources of income within the three main income sources of the populations under analysis.

27. The National Poverty Line (NPL) is used to assess national poverty rates (i.e. the percentages of the population living below the extreme and moderate national poverty lines). The NPL is based on the cost of basic food and non-food needs, and whether households can afford: (i) the basic food basket (extreme poverty line); and (ii) other essential expenses, such as health and education, in addition to the basic food basket (moderate poverty line).

28. Household expenditure surveys can be used to estimate the percentage of households’ total expenditure that is spent on food. Experts typically agree that the food share of total expenditure is inversely related to wealth (i.e. as households become wealthier, the percentage of their total expenditure on food will decline). This transition is typically also accompanied by a change in the composition of food demand among wealthier families, including reduced consumption of unprocessed and lower-value commodities (such as starchy foods) and increased consumption of higher-value commodities (such as meat, fruits and dairy products). Conversely, as a food security indicator, a higher percentage of total expenditure on food has been related to food deprivation at the household level. (FAO, 2003. Keynote Paper: FAO methodology for estimating the prevalence of undernourishment. Presented by L. Naiken, in the International Scientific Symposium on Measurement and Assessment of Food Deprivation and Undernutrition. Rome, 26−28 June 2002.)

29. The total income as a percentage of survival needs from the HEA provides information on the strength of livelihoods with respect to the cost of minimum needs and can be used as an indicator of food insecurity.

30. Due to ongoing global efforts to define and measure resilience and to relate it to food security measures, and given the current lack of accepted globally comparable resilience indicators, the IPC Chronic Food Insecurity Reference Table does not include specific indicators for resilience. Nevertheless, the IPC recognizes that various resilience initiatives have been adopted around the world. IPC analysts are encouraged to use available resilience data to complement the vulnerability analysis section of Chronic Food Insecurity analysis and to provide feedback on their experiences to the IPC Global Support Unit.

31. Although iodized salt is a useful contextual indicator, it should not be considered as heavily as other contributing factor indicators. Other country-specific indicators of micro¬nutrient fortification should also be taken into account. In all cases, consideration of micronutrient fortification information should include coverage, fortification adequacy and actual consumption.

32. Water is an important aspect of food security and especially pertinent for analysis of utilization. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation has defined a number of standard drinking water and sanitation categories. According to the Programme, the category of ‘improved’ drinking water source includes sources that, by nature of their construction and if properly used, are adequately protected from outside contamination (specifically from faecal matter). Improved water sources include piped water at the household level located inside the user’s dwelling, plot or yard. Other examples of improved drinking water sources are public taps or standpipes, tube wells or boreholes, protected dug wells, protected springs and rainwater collection. The cut-off of 15 litres per person per day is derived from Sphere guidance, according to which 15 litres per person per day is an acceptable quantity, covering basic needs.

33. In 2010, the United Nations General Assembly and the United Nations Human Rights Council recognized adequate access to safe drinking water as a human right. Specifically, it is recognized that “everyone has the right to a water and sanitation service that is physically accessible within or in the immediate vicinity of the household, educational institution, workplace, or health institution”, According to the World Health Organization (WHO), the water source must be within 1,000 m of the home, and collection time should not exceed 30 minutes. The water requirements identified in the Sphere Handbook for total combined survival needs are between 7.5 and 15 litres per person per day, depending on a number of local factors, including climate, individual physiology and social/cultural norms.