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Emergency
Nutrition See Also: Food
Aid; HIV/AIDS; Infant
& Child Nutrition; Community Therapeutic Care Emergency
response is a critical program area for USAID and its partners. Inadequate food
and nutrition programming make huge numbers of people vulnerable to illness and
death in the short term. In the long-term, undernourished and under-stimulated
populations are not equipped to fully benefit form even the best development programming,
resulting in lost opportunities during the post-emergency phase. Crisis and recovery
cycles impact countries to such an extent that intervention, prevention, and mitigation
strategies all remain critical and increasing attention has been paid to the concept
of developmental relief. Considerable gaps also persist in standardization, technical
advances, and collaboration despite great strides over the past decade. These
challenges include training at all levels, common methodologies and reporting
mechanisms, and translation of current technical knowledge into effective practical
programs in the field. FANTA's emergency nutrition model promotes emergency
phase interventions that build local capacity, increase community resilience,
and promote a rapid return to sustainable development. Similarly, FANTA emphasizes
prevention and mitigation strategies so that communities are better able to cope,
minimizing and containing conflict in the event of repeated shocks. Linking relief
to development in practice requires greater resource integration and innovative
interventions that can be replicated and scaled up. FANTA works to promote a better
understanding of the collection, reporting, and use of nutritional data in emergencies. FANTA
collaborates with USAID's
Bureau for Democracy, Conflict and Humanitarian Assistance (DCHA) Office of Foreign
Disaster Assistance (OFDA), Office
of Food for Peace (FFP), Office of Policy, Planning and Management (PPM),
the Bureau for Health,
Office of Health Infectious Disease and Nutrition (HIDN), and international
partners to strengthen implementation of emergency relief programming and
developmental relief. FANTA helps USAID Mission and PVO
partners strengthen reporting for more effective emergency programming and
advance USAID's goals of monitoring the nutritional status of children under five.
Focus areas include strategic planning, revision and development of reporting
mechanisms, and links with the United Nations
System Standing Committee on Nutrition (SCN) in the production of the Nutrition
Information in Crisis Situations (formerly RNIS). 
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Precision, Time, and Cost:
A Comparison of Three Sampling Designs in an Emergency Setting
(2008) An article reporting on the FANTA and SC/US field test in Sudan,
"Precision, Time, and Cost: A Comparison of Three Sampling Designs
in an Emergency Setting", has been published in Emerging Themes in
Epidemiology.
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Review of Community-based
Management of Acute Malnutrition (CMAM) in the Post-emergency Context:
Synthesis of Lessons on Integration of CMAM into National Health Systems
(2008): With Community Management of Acute Malnutrition (CMAM) incorporated
into government health facilities and protocols to varying degrees
in Ethiopia, Malawi and Niger, USAID's FANTA Project undertook a comprehensive
review of the challenges, successes and lessons learned from the experience
in these three countries. The synthesis report discusses recommendations
for successful and sustainable integration of CMAM, outlining specific
steps donors, Ministries of Health, the UN and NGOs can take to facilitate
the process and next steps needed to expand the knowledge and evidence
base for CMAM integration.
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Sudan Food Assistance
Transition Study (2008): The report provides an analysis of
the key issues related to food insecurity and the high rates of malnutrition
in Southern Sudan and the Three Areas (Abyei, the Nuba Mountains and
Blue Nile). It examines current Title II activities and recommends
how to increase their impact on food security and nutrition. The study
proposes possible steps for addressing food security through development
of an integrated food security strategy and by leveraging Title II
and Disaster Assistance funds in a complementary manner that emphasizes
the multiple transitions taking place in the areas of livelihoods,
education, health, nutrition, institutions and security.
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Community-based Therapeutic
Care (CTC): A Field Manual (October 2006): Community-based
Therapeutic Care (CTC): A Field Manual provides program managers,
practitioners, and technical specialists addressing severe acute malnutrition
with the essential design, implementation and evaluation protocols
for implementing the CTC approach. As the CTC model is evolving, this
first edition does not provide a step-by-step workbook for implementers,
but rather offers a solid foundation to build CTC programs at local
and national levels. The manual is a product of a collaboration between
Valid International,
Concern Worldwide,
USAID’s FANTA Project, and Development
Cooperation Ireland. Support for FANTA for the development of
CTC and the production of the manual came from the Office
of Foreign Disaster Assistance (OFDA) and the Office
of Health, Infectious Diseases and Nutrition at the U.S. Agency
for International Development.
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Food and Nutrition Bulletin
Volume 27, No. 3: Proceedings of an Informal Consultation on Community-based
Management of Severe Malnutrition in Children (September 2006)
: A special supplement was produced by the United Nations University
publication Food and Nutrition Bulletin to present the proceedings
of the 2005 WHO and Standing Commitee on Nutrition (SCN)'s informal
consultative meeting on community-based management of severe malnutrition
in children in Geneva. With support from FANTA, the meeting brought
together some 50 international experts and representatives from the
World Food Program (WFP), the United Nations High Commissioner for
Refugees (UNHCR), the Red Cross, research institutions, major international
non-governmental organizations, and representatives of ministries
of health. The consultation agreed on guiding principles for the implementation
of community-based management of severe acute malnutrition and next
steps for updating global recommendations and country level health
policies for the inclusion of management of severe acute malnutrition
as an essential intervention towards achieving the MDGs for poverty
and child mortality reduction. Next steps include the creation of
field guidelines and training modules will be developed based on the
general principles, conclusions, and recommendations derived from
the meeting, which, if implemented on a large scale, will prevent
thousands of child deaths.
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New FANTA Anthropometric Bookmark
(June 2006): In 2002, the first FANTA anthropometric bookmark was
produced to offer simple, at-a-glance information on basic anthropometric
concepts. The bookmark was very popular and further updated in 2004.
This year, FANTA has produced a second bookmark that presents clear
information useful in emergency situations such as malnutrition classification
and cutoffs with commonly used eligibility criteria for selective
feeding programs.
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Community
Therapeutic Care Inter-Agency Meeting, February 28-March 2, 2005:
FANTA collaborated with partner organizations Save the Children USA
and Concern Worldwide to coordinate a three-day Inter-agency Meeting
on Community Therapeutic Care (CTC) in Washington, DC. The meeting
provided a forum for implementing agencies, academics, and donors
to explore issues and challenges in the implementation of CTC, and
to develop mechanisms to ensure quality and coordination in future
CTC programs. Specifically, the meeting had two primary objectives:
1) learn from current CTC field experience to identify issues and
challenges in implementation, scale up, and transitioning; and 2)
establish cross-agency mechanisms for improving and ensuring the quality
of CTC implementation. Sessions included presentations from a number
of implementing agencies, as well as donors, and emphasized experience
to date in Ethiopia, Sudan, Malawi and Bangladesh. The presentations
and meeting agenda are available for download.
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Operational Challenges
of Implementing Community Therapeutic Care (2005): This 2005
Field Exchange Special Supplement of the Emergency Nutrition
Network (ENN) summarizes key elements of the presentations and discussions
that emerged from the Inter-Agency Workshop on Community Therapeutic
Care (CTC) held in March 2005. The workshop, held in Washington, DC,
was a follow-up to a meeting held in Dublin in October 2004. Community
Therapeutic Care (CTC), a community-based approach for managing large
numbers of acutely malnourished people, is gaining attention as a
viable alternative to the traditional therapeutic feeding centers
(TFCs). First implemented in 2000 in Ethiopia, CTC programs have reached
their five-year mark, with efforts now focusing on integrating the
approach into national protocols for treating severely malnourished
people. In response to the growing numbers of agencies and Ministries
of Health implementing CTC, a consortium of U.S. NGOs, the FANTA Project,
Concern Worldwide, Save the Children U.S., and Valid International
organized a workshop to identify issues and challenges in implementation,
integration and scaling up of CTC programming, and discuss mechanisms
to ensure quality control over CTC programming. Participants included
representatives of a broad cross-section of organizations including
U.S. and European NGOs, USAID, the Ethiopian and Malawian Ministries
of Health, the World Health Organization and academia, as well as
the private sector.
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Community-based Therapeutic
Care (CTC) (2004): The Emergency Nutrition Network (ENN) has
published Community-based Therapeutic Care (CTC), a special
supplement to the November 2004 issue of ENN's Field Exchange. The
supplement is a collection of articles that provide a wide range of
evidence-based perspectives from people who have been involved in
CTC programs over the last four years. Specifically, the articles
present the impact and effectiveness of the CTC model in different
contexts through lessons learned from case studies in Ethiopia, Malawi
and North and South Sudan. Additionally, the CTC program has included
substantial research on the development of locally produced Ready
to Use Therapeutic Food to reduce costs of the program and increase
sustainability. More recent work has focused on adapting the CTC approach
for the care of HIV infected individuals.
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Technical
Note No. 8, Community Therapeutic Care (CTC): A new approach to managing
acute malnutrition in emergencies and beyond (2004): Community
Therapeutic Care (CTC) is a new approach to managing acute malnutrition
in emergencies and beyond. Conceived by Valid International, CTC seeks
to address some of the challenges that traditional center-based approaches
face. It aims to provide rapid, effective, low cost assistance that
is least disruptive to affected communities and builds a foundation
to link relief and development interventions for long-term solutions
to food insecurity and threats to public health. CTC aims to treat
the majority of the severely malnourished at home, build local capacity
to better manage care of acutely malnourished children, and address
repeated cycles of relief and recovery. This technical note responds
to the frequently asked questions associated with CTC. It describes
the CTC approach, implementation, and the role of Ready to Use Therapeutic
Food (RUTF). It summarizes results to date and outlines ongoing and
planned activities.
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Treating the Severely Malnourished:
The Community Therapeutic Care (CTC) Approach (2004): Community
Therapeutic Care (CTC) is a community-based approach of care for managing
large numbers of acutely malnourished people in times of stress. The
CTC approach treats the majority of the severely malnourished at home
and uses outreach teams to promote community participation and behavioral
change. CTC aims to build community capacity to manage and to better
respond to repeated cycles of relief and recovery. Providing appropriate
therapeutic foods containing the right mix of nutrients that will
aid in recuperation is central to the home-based care of the severely
malnourished. Ready to use therapeutic foods (RUTF) have been specially
designed for the treatment of severe acute malnutrition. RUTF can
be manufactured locally thereby increasing availability and reducing
costs.
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Community Therapeutic Care
Workshop in Dublin (October 2003): FANTA collaborated with
partner organizations Concern
Worldwide and Valid
International to coordinate a workshop in Dublin, Ireland, from
October 8 to 10, focusing on the Community
Therapeutic Care (CTC) approach. CTC is a community-based approach
for treating acutely malnourished people in times of stress, providing
fast, effective, low-cost assistance. FANTA provides technical assistance
and supports monitoring of the program in Ethiopia, Sudan, and Malawi
with funds from the Office
of Foreign Disaster Assistance (OFDA) of USAID's Bureau for Democracy,
Conflict and Humanitarian Assistance, and the Office
of Health, Infectious Disease and Nutrition (HIDN) of USAID's
Bureau for Global Health. The workshop brought together approximately
70 key players in severe malnutrition management including program
implementers, technical advisors, academics, bilateral donors and
multilateral agencies such as the United Nations Children's Fund (UNICEF)
and the United Nations World Food Program (WFP).
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Tajikistan Food
Aid Review (2003): A USAID Food for Peace team assessed the
implications of the potential close-out of USDA's food programs in
Tajikistan and recommended appropriate uses of food aid, including
Title II resources. The Tajikistan Food Aid Review identifies the
underlying causes of high reported rates of chronic and acute malnutrition;
key factors that support and constrain food availability and access;
whether current food aid programming is responding appropriately to
the current situation and is still recommended; and key constraints
in implementing food security and food aid programs.
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Caring for Severely Malnourished Children (2003): Many
severely malnourished children still die unnecessarily due to inadequate
in-patient care. This new book, supported by FANTA with funding from
USAID's Bureau for Global Health and published by TALC
(Teaching Aids at Low Cost), describes the ten treatment steps
needed to manage these children successfully. It is based on guidelines
developed by the World Health Organization and on training modules
prepared for nurses in Africa. It takes into account the limited resources
in many hospitals and health centers, and the fact that many malnourished
children are also HIV positive. It is a suitable manual for nurses
and other pediatric health workers in developing countries, for their
trainers and supervisors, and for those working in emergency situations
and is available from TALC.
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A Review of the
Advances and Challenges in Nutrition in Conflicts and Crises over
the Last 20 Years (2002): The main purpose of this paper is
to assess the principal advances made over the past years in nutrition
in conflicts and crises and to propose direction for further advances
in the field. The term ‘advances’ refers to developments in technical
knowledge and nutrition policy and practice. The Project Cycle Management
is used as a framework for presenting these advances and the challenges
that remain. It is hoped that this will contribute to the development
of a plan of action for the international community that will accelerate
the pace of advances in the field of emergency nutrition: advances
that will lead to significant improvements in relieving the suffering,
death and degradation of disaster-affected communities. The first
step in this process would be a plan of action developed through the
collaboration of bilateral agencies, UN Agencies, and NGOs through
the UN ACC/Sub-Committee on Nutrition.
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Standardized Monitoring and
Assessment of Relief and Transitions (SMART) Workshop (July
2002): Standardized Monitoring and Assessment of Relief and Transitions
(SMART) is a U.S. inter-agency global initiative to improve the reporting,
monitoring and evaluation of humanitarian assistance interventions.
This initiative aims to provide implementing partners and the broader
humanitarian community with a range of tools to support humanitarian
program assessment. In July 2002, the Food and Nutrition Technical
Assistance Project (FANTA), with funding from USAID, organized and
conducted a workshop on Standardized Monitoring and Assessment of
Relief and Transition -- the SMART Technical Working Sessions. For
the first time, U.S., Canadian, and European private voluntary organizations
(PVOs) and non-governmental organizations (NGOs), international organizations,
academia and donors met to review and resolve problems of using assessment
tools and methodologies in emergency situations.
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Assessment of Nutritional
Status of Adolescents in Emergency-Affected Populations (2000):
According to the UN Standing Committee on Nutrition's Assessment of
Nutritional Status of Adolescents in Emergency-Affected Populations,
more accurate identification of adolescent nutritional status relative
to other vulnerable groups will yield both more effective distribution
of relief food and valuable dietary opportunities among displaced
and emergency-affected populations. The supplement suggests new methods
for determining undernutrition cut-off points and proposes adjustments
for ethnic differences with less regard for pubertal maturity and
relative physical development.
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Assessment of Nutritional
Status of Adults in Emergency-Affected Populations (2000):
According to the UN Standing Committee on Nutrition's Assessment
of Nutritional Status of Adults in Emergency-Affected Populations,
current World Health Organization standards for identifying undernutrition
are inappropriate in this setting, leading to misdiagnosis and numbers
of needless admissions to therapeutic feeding centers. Based on awareness
of relevant social factors and situation-specific criteria, the supplement
recommends interim measurement techniques that should be used until
further research can be conducted.
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Resources for Emergency Food Aid Managers:
Resources include manuals, training curricula, websites and journal
articles. A range of emergency food aid management topics are covered:
logistics, targeting, monitoring and evaluation and nutritional and
food security assessments.
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Conference on Emergency Relief Diets 1999: FANTA co-sponsored
a three-day conference on "Enhancing
the Nutritional Quality of Relief Diets." This conference
focused on what can be done to address the inadequate provision of
micronutrients in large relief programs. Recent outbreaks of scurvy
due to Vitamin C deficiency in refugee camps highlight the need for
better technical and logistical support. Recommendations were made
for the need to establish protocols for ensuring nutrient needs are
met.
*Please note that links to these sites do not imply that FANTA supports either
the organization listed or the views and content presented.
Center
of Excellence in Disaster Management and Humanitarian Assistance [http://www.coe-dmha.org]
The Center of Excellence in Disaster Management and
Humanitarian Assistance supports disaster relief and humanitarian assistance through
research, education and training with a focus on civil and military cooperation
in the Asia Pacific region. Daily reports on disaster management and assistance
and links to publications and training programs are provided.
Emergency
Nutrition Network (ENN) [http://www.ennonline.net/index.html]
The Emergency Nutrition Network (ENN) aims to improve the effectiveness of emergency
food and nutrition interventions by providing a forum for the exchange of field
level experiences and current research between staff, academics, researchers and
organizations working in the food and nutrition sector in emergencies.
NutritionNet
[http://www.nutritionnet.net]
This website aims to provide online discussion between nutritionists, humanitarian
assistance personnel, academics, NGOs and donors about nutrition in the emergency
context. Visitors register with NutritionNet and use their login information on
subsequent visits.
Internal
Displacement Monitoring Centre [http://www.internal-displacement.org/]
Launched by the Norwegian Refugee Council, the Internal
Displacement Monitoring Centre integrates and reports on information and statistics
associated with IDPs worldwide. The site contains a database that provides background,
factual, analytical, and cultural information on IDPs in selected countries. Information
on their Global IDP Training Project, links to related organizations, and a listing
of their publications are also provided.
Integrated
Regional Information Network (IRIN) [http://www.irinnews.org]
Another strong UN website, this time from the Integrated
Regional Information Network. IRIN, a unit of the UN Office for the Coordination
of Humanitarian Affairs, provides information about sub-Saharan Africa and the
Caucasus and Central Asia from a regional perspective, to foster greater awareness
and understanding of regional issues and events and to contribute to better-informed
and more effective humanitarian action and media coverage, including emergency
preparedness and advocacy. The site provides daily
and weekly humanitarian news updates, archived by country and date. For those
looking for specific information about food or other issues, the site has a home
page link to the Relief Web search engine, which finds articles from IRIN and
similar news sources and services.
Médecins
Sans Frontières/Doctors Without Borders (MSF) [http://www.msf.org/]
MSF is an international humanitarian aid organisation that provides emergency
medical assistance to populations in danger in more than 80 countries
Nutrition
Information in Crisis Situations (NICS) [http://www.unsystem.org/scn/Publications/html/rnis.html]
The Nutrition Information in Crisis Situations (NICS)
Series (formerly RNIS) site features quarterly reports on the nutrition situation
of refugee and displaced populations in sub-Saharan Africa and parts of Asia.
It is an activity of the ACC/SNN which is the focal point for harmonizing the
policies and activities in nutrition of the entire UN system.
ReliefWeb
[http://www.reliefweb.int/rw/dbc.nsf/doc100?OpenForm]
ReliefWeb provides time-critical humanitarian information on Complex Emergencies
and Natural Disasters.
The
SPHERE Project Humanitarian Charter and Minimum Standards in Disaster
Response [http://www.sphereproject.org/]
The Sphere Project was launched in 1997 by a group of humanitarian NGOs and
the Red Cross and Red Crescent movement. Sphere is based on two core beliefs:
first, that all possible steps should be taken to alleviate human suffering arising
out of calamity and conflict, and second, that those affected by disaster have
a right to life with dignity and therefore a right to assistance. Sphere is three
things: a handbook, a broad process of collaboration and an expression of commitment
to quality and accountability.
Standardized
Monitoring and Assessment of Relief and Transitions (SMART) [http://www.smartindicators.org/]
is a U.S. inter-agency global initiative to improve the reporting, monitoring
and evaluation of humanitarian assistance interventions. This initiative aims
to provide implementing partners and the broader humanitarian community with a
range of tools to support humanitarian program assessment.
UNICEF
- United Nations Children's Fund [http://www.unicef.org/]
UNICEF is mandated by the United Nations General Assembly to advocate for
the protection of children's rights, to help meet their basic needs and to expand
their opportunities to reach their full potential. UNICEF is guided by the Convention
on the Rights of the Child and strives to establish children's rights as enduring
ethical principles and international standards of behaviour towards children.
United
Nations High Commissioner for Refugees (UNHCR) [http://www.unhcr.ch/]
Excellent website from the United Nations High Commissioner
for Refugees, who is mandated by the United Nations to lead and coordinate international
action for the world-wide protection of refugees and the resolution of refugee
problems. The World section provides map- and text-based
access to country-specific information about refugees and their states of origin.
The Statistics and Issues sections are also useful, but specific information about
food issues is difficult to find because the site lacks its own search engine.
The Official UN Web Site locator at the bottom of the home page, however, has
a link to UNIONS, the easy-to-use search system for all on-line UN organizations.
United
Nations System Standing Committee on Nutrition (SCN)
[http://www.unsystem.org/scn/]
The United Nations System Standing Committee on Nutrition
is the focal point for harmonizing the policies and activities on nutrition of
the UN system. Its role is to serve as a coordinating mechanism, for exchange
of information and technical guidance, and to act dynamically to help the UN respond
to nutritional problems. The site provides links to SCN
news and reports
on nutrition worldwide.
USAID
Famine Early Warning System (FEWS) [http://www.fews.net/] The
Goal of the Famine Early Warning Systems Network (FEWS NET) is to strengthen the
abilities of African countries and regional organizations to manage risk of food
insecurity through the provision of timely and analytical early warning and vulnerability
information. FEWS NET is a USAID-funded activity that collaborates with international,
national, and regional partners to provide timely and rigorous early warning and
vulnerability information on emerging or evolving food security issues.
USAID
Humanitarian Response [http://www.usaid.gov/our_work/humanitarian_assistance/]
The Humanitarian Response section has information about
USAIDs Title II, Title III and International Disaster Assistance Programs,
information about specific country missions, situation reports and strategy papers,
and a searchable Commodities
Reference Guide. This Guide contains detailed fact sheets and information
about the availability and characteristics of 28 different food commodities, storage
and shelf life specifications, and how to control damage to these food commodities.
The homepage also has links to the 2002
U.S. International Food Assistance Report, USAIDs
Office of Food for Peace, and Office
of U.S. Foreign Disaster Assistance.
USAID
Office of US Foreign Disaster Assistance (OFDA) [http://www.usaid.gov/our_work/humanitarian_assistance/disaster_assistance/]
The Office of US Foreign Disaster Assistance assesses
the need for US assistance in foreign disasters. OFDA works with USAID Missions
to provide grants and field assistance through US Embassies and non-governmental
and international organizations. OFDA also sponsors the development of early warning
system technology and training programs to strengthen the ability of foreign governments
to rely on their own resources. The website has reports on recent disasters, training
information, and links to other resources.
Valid
International [http://www.validinternational.org/pages/]
is a United Kingdom-based consulting firm focusing on operational research in
emergency situations. The Community Therapeutic Care
(CTC) program is managed by Valid International with support from FANTA.
World
Food Program (WFP) [http://www.wfp.org/]
A useful website from the frontline food aid organization
of the United Nations. The world's largest international food aid organization,
the World Food Program buys goods and services from developing countries in an
effort to spur their economies, and focuses in particular on efforts to help women,
children and the elderly. The site features reports
and newsletters on policy themes such as gender issues, and the homepage also
has links to detailed information about WFPs emergency operations and development
projects, resources and appeals, country strategy outlines, situation reports
and evaluations and studies. The site also has a large database of WFP statistics
on projects, resources, global food aid and procurement.
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