ACTION AGAINST ACF International 2010 Annual Report ACTION AGAINST HUNGER | ACF INTERNATIONAL

Action Against Hunger is an international humanitarian organization committed to ending world hunger. Recognized as a leader in the fi ght against acute , Action Against Hunger works to save the lives of malnourished children while providing communities with sustainable access to safe water and long-term solutions to hunger.

With over 30 years of expertise in emergency situations of confl ict, natural disaster, and chronic food insecurity, our 4,600+ fi eld staff—seasoned professionals and technical experts in nutrition, water and sanitation, public health, and —carry out life-saving programs in more than 40 countries.

In 2010, ACF’s humanitarian programs directly assisted some 6.4 million people, along with countless others through capacity building programs in collaboration with government ministries. Committed to principled humanitarian action, Action Against Hunger restores dignity, self-suffi ciency, and independence to vulnerable populations around the world.

ACF-USA www.actionagainsthunger.org Chairman: Raymond Debbane Chief Executive Offi cer: Nan Dale

ACF- www.actioncontrelafaim.org President: Denis Metzger Executive Director: François Danel

ACF- www.accioncontraelhambre.org President: José Luis Leal Maldonado Executive Director: Olivier Longué

ACF-UK www.actionagainsthunger.org.uk Chairman: Paul Wilson Executive Director: Jean-Michel Grand

ACF- www.actioncontrelafaim.ca President: Diane Bussandri Executive Director: Richard Veenstra

Refl ects the leadership of each ACF headquarters as of December 31, 2010

Cover(Cover photos: Photo): ACF-, ACF-, S. Remael courte ACTION AGAINST HUNGER LETTER FROM THE CHAIRMAN

The causes of hunger and malnutrition are no mystery, and the severity of ACF INTERNATIONAL’S the problem is no secret. While almost one billion people across the globe suffer from some form of hunger, there are 19 million whose very lives CORE PRINCIPLES are threatened by severe acute malnutrition. At a time when some enjoy The ACF International Charter unprecedented wealth, many struggle with day-to-day needs. And the most affi rms six core principles that all deadly form of hunger kills an estimated 3.5 million children every year. staff members worldwide pledge to Action Against Hunger | ACF International continues working to save lives, uphold in carrying out their work. bring independence—and restore dignity—to vulnerable communities around the world. INDEPENDENCE In 2010, ACF was able to mount swift, life-saving responses to several large-scale natural disasters. When 125,000 homes in were NEUTRALITY destroyed by a tropical storm, ACF provided safe drinking water and supplies for thousands of families. Within hours of the earthquake that devastated NON-DISCRIMINATION —killing hundreds of thousands, destroying homes, and crippling infrastructure—ACF had emergency supplies en route, and responded quickly FREE AND DIRECT to provide badly needed drinking water. When fl oods in destroyed ACCESS TO VICTIMS water and sanitation infrastructure, ACF built latrines, showers, and repaired water sources. Through cash grants and cash-for-work programs, ACF helped PROFESSIONALISM reinvigorate the livelihoods of thousands of Pakistani workers and businesses. The strength of this organization lies in a rare commitment to communities TRANSPARENCY affected by hunger. Our innovation can be seen in programs that not only address immediate needs, but help communities develop the resources to be self-suffi cient. Last year, ACF trained over 16,000 health workers and community volunteers in the Democratic Republic of Congo alone. When providing seeds and tools to communities in ’s West Timor province—which suffers from high child malnutrition—we also provide training in sustainable farming practices, health and nutrition education, and train local health workers. And in , where ACF operates over 40 nutrition centers, we also help establish grain banks to store excess crops, and advocate for policies to help the country become resilient to food shocks.

As we move forward, ACF will build on our skills and experience responding to large emergencies like those in Haiti and Pakistan. We will continue to develop new and diverse sources of private funding to ensure a rapid response whenever and wherever disaster strikes, and to have the fl exibility to address the full range of underlying causes of hunger. We will reach a greater number of vulnerable communities, and use our experience to help local humanitarian actors face new challenges. ACF is more than ever committed to confronting the most serious challenge of our time: eliminating the injustice of hunger.

I am proud, on behalf of all the ACF fi eld staff and on behalf of the International Chairmen’s Council, to present this report highlighting some of ACF’s accomplishments in 2010. ACF INTERNATIONAL

ON THE COVER Our comprehensive approach to global hunger delivers a range of community-centered solutions to populations in crisis, like this DENIS METZGER child’s community in Nepal. Chairman, International Chairman’s Council 1 ACF’S INTEGRATED APPROACH TO

FOR ALMOST FIGHTING HUNGER For more than 30 years, ACF has led the way in restoring 30 YEARS, ACTION dignity, self-suffi ciency, and independence to vulnerable AGAINST HUNGER populations around the world. With program expertise in nutrition, food security & livelihoods, and water, sanitation HAS LED THE WAY & hygiene, ACF provides comprehensive solutions that are IN DEFINING THE needs-based, context-specifi c, and customized through direct community participation. IDEA OF GLOBAL PARTNERSHIP. NUTRITION Action Against Hungerʼs methods for detecting and treating deadly malnutrition are internationally renowned.

Evaluate Nutritional Needs To assess the root causes of a malnutrition outbreak, ACF collects baseline data on key nutritional indicators like local capacities and resources, cultural practices, infrastructure and geography. Th ese nutrition surveys are essential for mounting an eff ective, customized response.

Treat Acute Malnutrition ACF treats cases of severe acute malnutrition with inpatient care (for those with medical complications) and with community-based, outpatient programs. Without treatment severely malnourished women and children would likely face imminent death.

Prevent Acute Malnutrition ACF’s prevention activities provide Ready-to-Use-Foods to patients discharged from therapeutic care, children with moderate acute malnutrition, and children in communities faced with seasonal hunger. Prevention can save millions of lives while long-term solutions are developed.

Build Local Capacity ACF strengthens public health systems to combat malnutrition. We fi eld teams that consist overwhelmingly of local staff and integrate our programs into existing health structures. When crises subside, we ensure local capacity is in place to support continued improvements in communities’ nutritional health

22 ACF-, S. Vera ACTION AGAINST HUNGER

WATER, SANITATION & HYGIENE FOOD SECURITY & LIVELIHOODS ACF provides access to clean water and ACFʼs food security & livelihoods programs tackle improved sanitation for communities at risk the root causes of hunger: problems of access, of acute malnutrition. income, and production.

Provide Access to Safe Water Evaluate Local Needs During emergencies, ACF trucks water into aff ected areas To determine what’s causing hunger in a given area, ACF and installs storage tanks and reservoirs. Where water carries out comprehensive evaluations by collecting and is scarce or unsafe, we drill and decontaminate wells, analyzing key data on local assets, resources, and livelihoods install hand-pumps, protect natural springs, tap aquifers, strategies. Our teams meet directly with community rehabilitate damaged infrastructure, and pipe water into members to better understand local conditions and create a hard-to-reach villages and health centers. collaborative plan of action.

Promote Sanitation & Hygiene Respond to Emergencies To prevent outbreaks of disease during a crisis, ACF’s teams When disasters destroy infrastructure and food supplies, distribute hygiene kits and build latrines and hand-washing when violence forces thousands to fl ee, or when drought stations. In communities at risk, we construct water fi lters disrupts food production, ACF responds with distributions made from basic materials and teach healthy practices like of food, cash, and other items to prevent hunger in the short- hand-washing, cooking with clean utensils, and drawing term and ensure that crops can be replanted and livestock water from protected sources. restocked in the future.

Ensure Lasting Change Provide Long-Term Solutions ACF’s commitment to community participation ensures Designed in collaboration with local populations, our long-term capacity: we train community-based water strategies are context-specifi c: micro-grant support for committees to manage their water and sanitation families recovering from confl ict; seeds and tools for infrastructure themselves, and organize Village Health Teams agricultural recovery; livestock and veterinary services where to model good sanitation and hygiene practices needed; small business assistance; and other programs that for their communities long after we leave an area. help families regain self-suffi ciency.

ACF’s programs Our food security & ACF ensures provide immediate livelihoods programs effective assistance ACF INTERNATIONAL assistance and offer a broad range by working directly long-term relief to of solutions for with communities malnourished children generating income to customize lasting and their families. and food production. solutions to hunger.

(From left): ACF-D.R. Congo, S. Vidyarthi; ACF-Sudan, T. Frank; ACF-Pakistan, N. Sobecki 3 PROGRAM MAP

ARMENIA

MALI CHAD

NIGER HAITI GUATEMALA

MAURITANIA GUINEA HONDURAS COLOMBIA ECUADOR DEMOCRATIC REPUBLIC OF THE CONGO (DRC)

BOLIVIA

PARAGUAY

In 2010, Action Against Hunger assisted some 6.4 million people in over 40 countries around the world.

The breadth of Action Against Hunger’s international expertise goes beyond the scope of our current programs. Additionally, we have worked in many other countries, including Bosnia-Herzegovina, , , North Korea, Mozambique, Macedonia, Rwanda, and .

(From left): ACF-Sudan, J. Seagle/Counterpart Images; ACF-Sudan, T. Frank; ACF-Sudan, T. Frank; ACF-, T. Frank; ACF-Sudan, J. Seagle/Counterpart Images

4 GEORGIA

AFGHANISTAN

PALESTINIAN TERRITORIES SOUTHERN SUDAN

SOMALIA

CENTRAL AFRICAN REPUBLIC

UGANDA

BANGLADESH ZAMBIA

INDONESIA

SWAZILAND

ZIMBABWE

5 SELECT PROGRAMS

HAITI tritional, and psychological support. And as the risk of life-threatening On January 12th, the world watched malnutrition grew, ACF established in horror as a 7.0 magnitude 10 emergency treatment centers and earthquake struck Haiti, killing distributed high-protein biscuits to over 230,000 people and turning thousands of children. To assist well the capital and surrounding areas over 30,000 families in regaining to rubble. Action Against Hunger, their livelihoods and restoring their delivering humanitarian programs food supplies, ACF implemented in the country since 1985, was well cash-for-work programs and con- positioned to respond. Within hours nected people to fresh food vendors of the quake, ACF had sent its fi rst in local markets through an innova- shipment containing reinforcements tive voucher program. and emergency supplies for thou- sands of survivors in Port-au-Prince PAKISTAN and outlying areas. In July 2010 Pakistan was hit by After a disaster of this magnitude, the worst fl ooding in its history. An clean water and sanitation are urgent estimated 20 million people were priorities to prevent outbreaks of aff ected by the monsoon rains, which deadly water-borne illnesses. ACF swept away homes, bridges, and was one of the fi rst organizations roads, leaving millions displaced and to provide safe drinking water for in need of immediate assistance. people congregated in makeshift With water and sanitation sources camps amidst the destruction. Since completely destroyed in many areas, the earthquake, ACF’s specialists millions were forced to drink con- installed 177 large water reservoirs taminated fl oodwater. Action Against and water points in stricken areas Hunger’s fi rst priority was to contain that ensured daily access to clean the spread of water-borne disease water for 300,000 people. ACF while working to rehabilitate water teams also constructed over 1,000 networks and distribution systems. latrines, conducted broad public After the fl oods, ACF provided over awareness campaigns on emergency 300,000 people with access to clean hygiene practices, and distributed drinking water by trucking in over kits containing soap, buckets, plastic 50 million liters and rehabilitating sheeting, and other essential items 325 water points, built over 1,000 to thousands of families. When the emergency latrines and showers, cholera outbreak hit, ACF ramped and distributed more than 27,000 up its programs in Artibonite and hygiene kits to families at risk of North West districts, the epicenters contracting illnesses like cholera and of the crisis, providing over 50,000 dysentery. at-risk families with water purifi ca- ACF also helped thousands of tion tablets, rehydration packets, families whose homes, livestock, soap, and other essential hygiene ma- crops, small trades, and only sources terials to control the disease’s spread. of income were washed away in the Amidst the makeshift camps and fl oods. ACF disbursed over 2,500 rubble-strewn streets of Port-au- cash grants to small business owners Prince, ACF set up 13 special tents to re-start their micro-enterprises, designed to provide mothers and distributed food to 5,000 families, their infants with a safe place for and provided cash-for-work opportu- breastfeeding, as well as medical nu- nities to nearly 3,500 people.

6 ACF-Uganda, T. Frank ACTION AGAINST HUNGER

UGANDA bathe and wash their clothes. It’s easier nutrition programs. to water our animals, to get water for Northern Uganda has been wracked In the remote stretches of southern construction, and the water we now by nearly 20 years of armed confl ict D.R. Congo, thousands of people are drink is safe. Life has really improved that forced some two million people at risk of Konzo, a severe neurological a lot,” said Gira Walter, a resident of into squalid camps. Since the fragile ailment triggered by exposure to cya- the village of Akadikum in northern peace process began in 2006, nearly all nide present in improperly processed Uganda. of them have returned home, only to cassava, a staple crop in the region. fi nd they lack basic resources to begin DEMOCRATIC REPUBLIC ACF helped aff ected communities rebuilding their lives. In 2010 Action OF CONGO address this public health crisis by Against Hunger provided over 195,000 distributing seeds and tools to support northern Ugandans with access to safe Th e Democratic Republic of Congo diversifi ed diets; rehabilitating water water and sanitation services. is still a nation in crisis, reeling from networks, drilling wells, and installing years of brutal confl ict and neglect, and water tanks to improve access to clean To improve clean water access, ACF struggling with widespread poverty, water for proper cassava processing; drilled wells, installed hand pumps, food insecurity, uneven economic de- and leading a broad public awareness trained community members in water velopment, and regional instability. As campaign on the causes of the illness. resource management, and engaged a result, the country experiences rou- rural water departments to ensure tine outbreaks of acute malnutrition Meanwhile, in eastern D.R. Congo, sustainable infrastructure. Because that threaten thousands of lives. Since where confl ict still rages, ACF set up inadequate sanitation is a leading cause 2003, Action Against Hunger has been a voucher system for destitute farmers of water-borne illnesses like cholera building the capacity of local health to purchase surplus seeds from other and dysentery, ACF trained thousands systems to tackle this deadly condi- growers, distributed agricultural inputs, of people in healthy hygiene prac- tion. In 2010 alone ACF equipped provided training in basic farming tices and provided materials to build 476 treatment centers and trained techniques, supported communities in sanitation facilities, including latrines, over 16,000 public health workers and their eff orts to battle a crop disease rav- hand-washing stations, and trash pits. community volunteers, ensuring that aging banana plants across the region, “People no longer have to walk far 42,000 lives were saved—the most and supplied fl edgling entrepreneurs or be dependent on bicycles to carry ever in a single country through ACF’s with the tools they needed to begin the water, making it easy for them to generating income.

ACF’s therapeutic We work directly ACF’s expertise ACF INTERNATIONAL programs target with local populations draws on 30 years children under fi ve as to identify existing of humanitarian the most vulnerable coping mechanisms action in a wide to malnutrition. and develop range of countries appropriate solutions. and cultural contexts.

(From left): ACF-Nepal, S. Remael; ACF-Sudan, J. Seagle/Counterpart Images; ACF-Haiti, R. Aujard 7 SELECT PROGRAMS

PALESTINIAN TERRITORIES gency food provisions of corn, beans, by insuffi cient funding, medicine, sugar, oil, and vitamin supplements; nurses, and administrative staff —and Th ousands of people experienced and supplying tools to assist the local at strengthening the country’s resil- water shortages in the southern West population with clean-up eff orts. ience to food shocks. Bank as a result of unusually low rain- Already providing ongoing support fall and soaring prices in 2009. Action to people aff ected by Hurricane Stan, BOLIVIA Against Hunger improved access to which destroyed large swaths of the clean water and sanitation for families A protracted drought in Bolivia country in 2005, ACF teams reha- spending up to 30% of their income resulted in severe water scarcity and bilitated damaged wells and restored to buy water, improving economic ruined staple crops across the country. safe water in areas where supplies were security and curbing the spread of Action Against Hunger, in coordina- contaminated by the recent fl ooding. water-borne illness for over 12,500 tion with local institutions, ensured an emergency water supply for 50 com- people in some of the places hardest CHAD hit by last year’s drought. munities facing extreme shortages and While Chad’s Sahelian region helped 4,500 farming families whose ACF constructed and rehabilitated frequently experiences high rates harvests were destroyed through corn pipelines and water points; built and of acute malnutrition during the and seed distributions. ACF also rehabilitated cisterns for people to col- “hunger gap”—a period of routine installed early warning systems to lect rainwater; increased water access scarcity between harvests—2010 was mitigate future disasters and trained for pastoralists and their animals to particularly harsh. Insuffi cient rainfall community leaders on how to prevent help protect livelihoods; conducted over the past two years helped push and respond to emergencies brought educational sessions for woman and nearly two-thirds of families in Chad on by water shortages. students on effi cient water usage and into food insecurity, and the lack of To help poor farmers conserve their safe hygiene practices; provided train- access to arable land, water, and health ing for engineers and technicians from scarce arable land for the future, Ac- care also contributed to skyrocketing tion Against Hunger implemented six municipalities on water manage- malnutrition rates. ment, maintenance, and system a sustainable community-based design; and built shelters for vulner- After fi nding that one in four children agriculture program. In areas aff ected able Bedouin families living in remote under fi ve in Western Chad suff ered by recurrent drought, ACF promoted areas to help protect against the harsh from acute malnutrition, ACF scaled a variety of measures to preserve climate and decrease environmental up its treatment programs. Already moisture and avoid soil erosion, from health risks. supporting 33 nutrition centers in introducing environmentally-friendly the arid Kanem and Bahr El Ghazal manure, to teaching crop rotation GUATEMALA regions, Action Against Hunger techniques, to off ering solutions to the extended its programs to an additional problem of livestock overgrazing. On June 1st, tropical storm Agatha 10 health centers in areas with soaring battered much of Central America, in- malnutrition rates to signifi cantly INDONESIA cluding Guatemala, where 250 people increase the accessibility and qual- were killed or went missing and at Action Against Hunger mounted an ity of care for severely malnourished least 125,000 others lost their homes, emergency response in the fall of 2010 children. livelihoods, and small trades. Action after the eruption of Mount Merapi Against Hunger mounted an emer- To help avert future malnutrition forced over 340,000 Indonesians to gency response for 50,000 people in crises, ACF supported local markets fl ee, most to camps and makeshift the hard-hit area of Escuintla, where and helped struggling families regain settlements. In the immediate after- severe fl ooding contaminated drinking their livelihoods by setting up grain math of the disaster, ACF drew from water and threatened food supplies for banks for farmers to store their excess its pre-positioned stock of emergency thousands of families. crops, establishing vaccination and supplies to provide access to life- de-worming programs for livestock, saving sanitation services in displace- In Guatemala since 1998, Action and training fl edgling female entrepre- ment camps, supported 35 outpatient Against Hunger responded to the im- neurs in small business management. health centers to head off the risk of mediate needs of the aff ected popula- ACF also advocated for long-term deadly malnutrition among displaced tion by helping families left homeless investments aimed at bolstering the children, and rehabilitated water sys- by the storm relocate to shelters and country’s health care system—crippled tems damaged by the eruption. More other safe spaces; distributing emer-

8 ACTION AGAINST HUNGER

than 6,200 families whose livelihoods their families’ diets and keep their Children in Distress (CINDI), to were destroyed by the volcanic ash children safe from disease through provide support to orphans and their also received seeds, livestock, or fi sh- comprehensive health education ac- caregivers in Kitwe, one of the poorest ing supplies to restart their trades and tivities, and built clean water systems areas of Zambia. feed their families. managed by local water committees. With support from ACF, CINDI Meanwhile, in the West Timor prov- ZAMBIA trained 11 community-based orga- ince, where poor infrastructure and nizations to improve the health and a lack of access to basic services such In Zambia and other countries badly nutrition of HIV-aff ected households as health and education have resulted aff ected by HIV/AIDS, an estimated in 2010. As a result, some 4,000 in high childhood malnutrition rates, 20% of children under 17 are or- people received counseling and ACF addressed the problem through phans. Th ese orphans, often stigma- referrals for HIV testing and other tized because of their association with an integrated set of programs. Th e related services, over 7,000 people ACF INTERNATIONAL organization trained health staff and the disease, thrown into poverty, and accessed information on HIV/AIDS equipped community centers to traumatized by the death of their par- and nutrition to improve their health, detect and refer severe malnutrition ents, tend to strain extended families’ and 40 households hosting over 200 cases, distributed seeds and tools to resources and overwhelm national orphans were supported with small families aff ected by malnutrition, pro- health and education systems. Since business loans to increase their house- vided training in eff ective agricultural 2006, Action Against Hunger has hold income. techniques, helped parents diversify been working with a local partner,

ACF-Sudan, T. Frank 9 A QUESTION OF SCALE: THE PROMISE OF COMMUNITY- BASED MODELS FOR MANAGING ACUTE MALNUTRITION Revolutionary new tools and methods allow for a public health approach to managing deadly acute malnutrition.

Th e fi ght against deadly malnutrition is at a crossroads today: For the fi rst time in history, the prospect of ending child deaths from acute malnutrition is within our reach—existing solutions can be brought to scale to save the millions of lives lost each year to this preventable condition. Recent advances in therapeutic care, both technical and organizational, have opened up new possibilities for expanding our reach and impact in ways previously unthinkable. Th ese new advances can be summarized by two key developments: the creation of more stable therapeutic ready-to-use-foods, and the community-based models developed to deploy them. Th ese twin developments have reshaped how we manage acute malnutrition today, with far-reaching implications for the 3.5 million lives lost each year to deadly hunger.

THE LIMITS OF AN INTENSIVE CARE MODEL Th e fi eld of emergency nutrition has evolved signifi cantly over the past 20 years, with occasional breakthroughs making new care practices possible. One such breakthrough occurred in the early 1990’s, when Action Against Hunger’s Scientifi c Committee created two revolutionary therapeutic milk formulas, F-75 and F-100, that reduce mortality rates by 75% among children in treatment for severe acute malnutrition. Unpatented and fi eld tested by Action Against Hunger in 1993, these nutritional products and their protocols were eventually adopted by the UN’s World Health Organization as the industry standard.

While these new therapeutic formulas and protocols represented life-saving developments, they implied an “intensive-care unit” approach to managing deadly malnutrition: treatment required medically-intensive hospital settings where malnourished children and their caretakers would receive round-the-clock medical care for a month or more. Th e reach and impact of this “ICU” model had inherent limitations: it required medical personnel and access to clean water (for mixing and administering the therapeutic milk formulae); it required patients to travel signifi cant distances to reach treatment facilities; it required caretakers to be away from home and work for the month of treatment; and it only addressed the severest cases of malnutrition—it could not accommodate children with moderate acute malnutrition until their condition deteriorated. In essence, these new tools and protocols made humanitarians more eff ective at saving lives, but the model ensured that only a tiny percentage of the millions suff ering from acute malnutrition received treatment.

TOWARDS A READY-TO-USE REVOLUTION Th e next great shift in therapeutic nutritional care came in the late 1990s with the development of therapeutic ready-to-use-foods (RUTF) and the rise of community- based models for managing acute malnutrition. Th e revolutionary nutritional product Plumpy’nut was created when the nutritionist André Briend, in partnership

10 ACF-Sudan, J. Seagle/Counterpart Images ACTION AGAINST HUNGER with Nutriset, repackaged the F-100 milk formulation malnutrition out of the hospitals and into the homes of as a more stable peanut butter-based product, making children in need of life-saving treatment. this life-saving formula available without the need for Th e concept of community-based care—fi rst developed preparation, clean water, or refrigeration. In 1997, Action by Valid International—adopted a public health Against Hunger carried out initial fi eld tests to develop approach to managing acute malnutrition and aimed protocols for using Plumpy’nut in the treatment of to maximize impact and coverage. Now known as the severe acute malnutrition, and since then, RUTFs like Community Management of Acute Malnutrition, or Plumpy’nut have become essential to ensuring cure rates CMAM, this model combined the promise of therapeutic of more than 90% among the populations ACF treats for ready-to-use-foods with a more expansive outpatient deadly malnutrition. framework designed to broaden access to treatment. Th e advent of therapeutic RUFs like Plumpy’nut gave After years of fi eld testing, it is this very model that holds rise to another revolutionary breakthrough: community- such promise as a scalable solution with the prospect of based models for managing acute malnutrition, which expanding access to life-saving treatment for the millions enabled humanitarians to bring the fi ght against deadly of children in need.

ACF’S THERAPEUTIC NUTRITION PROGRAMS Action Against Hunger’s therapeutic nutrition programs employ the Community-based Management of Acute Malnutrition model to save lives from deadly malnutrition, which consists of the following components:

OUTPATIENT THERAPEUTIC POINTS children with severe acute malnutrition suffer from other ACF’s Outpatient Therapeutic Point (OTP) programs medical complications as well (e.g., malaria, anemia, allow children with severe acute malnutrition to receive severe diarrhea, etc.) and are referred to Stabilization therapeutic care at home, outside of a hospital setting, Centers for additional medical oversight using a range using the therapeutic ready-to-use food Plumpy’nut. of nutritional products—from therapeutic milk formu- As such, this outpatient program is often referred to las F-75 and F-100, to solid therapeutic products like as “home treatment,” and as a rule, some 90% of all Plumpy’nut. Children receive inpatient care for the fi rst severe acute cases can be referred for treatment in these 1-2 weeks until they stabilize and can be referred back ACF INTERNATIONAL OTP programs with 90% cure rates. to the OTP programs to fi nish their treatment regimen. Both Stabilization Centers and Outpatient Therapeutic INPATIENT THERAPEUTIC CENTERS Programs run simultaneously, being core components In addition to the outpatient programs, ACF’s therapeu- of ACF’s Therapeutic Nutrition Programs, as each ad- tic programs employ Stabilization Centers that provide dresses the specialized needs of children suffering from inpatient therapeutic care. An estimated 10% of all severe acute malnutrition.

(FromACF- left):placeholder ACF-Sudan, text J. Seagle/Counterpart Images; ACF-Sudan, J. Seagle/Counterpart Images 11 ACF INTERNATIONAL FINANCIAL RESOURCES

INCREASING FUNDS TO EXPAND GLOBAL EFFECTIVENESS

Over the past fi ve years, ACF International’s fi nancial resources €180M have increased by nearly €65 million. Th is steady growth at an average rate of more than 13% annually has allowed ACF to €160M implement strategies that prevent and treat acute malnutrition and help restore communities to self-suffi ciency, while still having €140M the capacity to respond rapidly and eff ectively to nutritional crises €120M whenever and wherever they occur. €100M Th e chart below presents a fi ve year history of the growth in ACF International’s annual operating budget. While the revenues €80M received in any given year include dollars (in some cases both US and Canadian), euros, and pounds, the totals have been €60M

converted into a single currency for the purposes of comparison. € 101.01 € 104.75 € 126.73 € 129.80 € 165.49 €40M Th e conversion rates used in this table refl ect the historical average rates of exchange for the year in question. €20M

Please note that the 2010 numbers are preliminary fi gures pending 0 a fi nal audit. 2006 2007 2008 2009 2010

ACF INTERNATIONAL REVENUES & EXPENSES

in thousands of Euros FY 2009 FY 2010 REVENUES 129,804 165,486 Executed Grants 90,968 112,298 Unrestricted Private Support 34,869 47,110 Other 3,966 6,078

EXPENSES 128,195 158,743

Programs €130.59 94,719 120,913 Program Support in HQ 10,676 11,925 Communication & Fundraising 14,120 16,705 Management & General 6,947 5,697 Other 1,733 3,503

BALANCE (transfer to reserve) 1,608 6,743

(Bottom): ACF-D.R. Congo, S. Vidyarthi; ACF-Sudan, T. Frank. (Right): ACF-Uganda, T. Frank. (Back Cover): ACF-Uganda, T. Frank

1212 ACTION AGAINST HUNGER 9

ACF INTERNATIONAL 13 5.8% 83.7% Other Goverments* Other USA Kingdom United France Spain Nations United Community European WEST AFRICA WEST € 6,400,258 OTHER € 2,477,658 SOUTHERN AFRICA SOUTHERN € 8,472,229 AMERICA LATIN € 8,217,406 EAST MIDDLE € 7,325,025 Canada, Norway, Sweden, Sweden, Norway, Canada, and Switzerland * Other Governments include: Governments Other * 10.5% PROGRAMS & SERVICES TO FIELD PROGRAMS & SERVICES €132,838,000 FUNDRAISING & COMMUNICATIONS €16,705,000 MANAGEMENT & ADMINISTRATION €9,200,000 ect 2010 ASIA € 23,017,747 gures refl gures 2009 expenses ces, along with the general balance covered e in nutrition, eld programs CARIBBEAN € 18,919,831 0 EAST AFRICA EAST € 17,822,436 CENTRAL AFRICA CENTRAL € 16,206,445 20M 40M 80M 60M 100M 120M € € € € headquarterve offi SAHEL € 12,053,966 ACF INTERNATIONAL EXPENSES BY REGION ACF INTERNATIONAL ACF INTERNATIONAL INSTITUTIONAL FUNDING BY DONOR ACF INTERNATIONAL related to fundraising, press relations, and relations, press to fundraising, related public outreach. these fi As on the opposite page, In 2010, nearly 84% of all funds directly 2010, nearly 84% of all funds directly In supported our fi hygiene, and food security sanitation & water, Th & livelihoods. costs of the management and administration fi ACF INTERNATIONAL ALLOCATION ALLOCATION ACF INTERNATIONAL TO COMMITTED OF EXPENSES: SERVICES DIRECT FIELD preliminary, pre-audited totals. pre-audited preliminary, € € ACF-USA ACF-France ACF-Spain ACF-UK ACF-Canada 247 West 37th Street 4, rue Nièpce C/Caracas, 6, 1º First Floor, Rear Premises 1150, boulevard St-Joseph est 10th Floor 75662 Paris Cedex 14 28010 Madrid 161-163 Greenwich High Road bureau 302 New York, NY 10018 www.actioncontrelafaim.org www.accioncontraelhambre.org London SE10 8JA Montréal, QC H2J 1L5 www.actionagainsthunger.org Tel : +33 01.43.35.88.88 Tel.: +34 91.391.53.00 www.actionagainsthunger.org.uk www.actioncontrelafaim.ca Tel. +1 212.967.7800 Tel: +44 20.8293.6190 Tel: +1 514.279.4876