CHAPTER TWO

Targeting Practices

The wide variation of social contexts in which different activities are undertaken will often lead to wide differences in the final choice of targeting method.

Once a rationale for targeting has been defined for a food or nutrition programme, the selection of a targeting scheme becomes part of the programme design and development process. A programme's specific objectives are particularly relevant to targeting. The at-risk population, and thus the target group, and the programme objectives are identified through a problem analysis, a vulnerability assessment and a poverty profile which are usually the first steps in the programme design process. Within this context, it is important to make a distinction between food- or nutritionally insecure individuals or households, and individuals or households that are vulnerable to (or at risk of) food and nutritional insecurity (see the Box on Targeting terms in Chapter 1).

It should be remembered that there are no simple rules for selecting an appropriate targeting method. The wide variation of social contexts in which different activities are undertaken will often lead to wide differences in the final choice of targeting method. For example, the determinants of malnutrition vary greatly from place to place and across populations. As a result, the best indicators for predicting the risk of future malnutrition for screening purposes are also likely to vary.

In addition, selection of the best targeting strategy depends on the type of programme. For example, a programme involving on-site feeding could take advantage of the gathering of beneficiaries to carry out a continuous screening programme, such as anthropometric screening that calls for monthly weighing. Such screening in a take-home feeding programme would require the additional effort of bringing a weighing scale to each participant and, thus, would have to rely on less frequent weighing.

Generally, targeting strategies must be consistent with the existing level of infrastructure (logistical, human resources, institutional) and the area, and must be conceived within the political, financial, cultural and technical constraints of the programme.

Any intervention may be targeted by using multiple methods and multiple selection criteria. Combined methods are often used to strengthen overall targeting efficiency. Geographic targeting may be combined with community, household or individual targeting mechanisms. For example, emergency relief food is often targeted first on a geographic basis, according to the general severity of the crisis in different regions, and then through household screening criteria that rely on community-based channels to allocate relief to specific households (see the Ethiopia case study in the Annex.)

Food and nutrition programmes can be targeted through various schemes. Essentially, programmes are either administratively targeted or self-targeting. Administrative targeting involves the selection of specific regions, areas or communities (geographic targeting), or of specific households or individuals. The latter may be done by programme planners and staff, or by communities (community-based targeting). Self-targeting does not involve the selection of programme participants, but instead relies on programme incentives to induce maximum participation by members of a target group. When programme incentives are introduced through changes in market forces, they are referred to as market-based targeting.

Targeting can also be a multi-stage process. For example, certain regions may be targeted first because the food or nutrition problem is deemed to be most severe there, perhaps resulting from a natural disaster. Next, within each selected region, communities that meet certain criteria may be selected, such as communities with a high percentage of woman-headed households or communities with a high proportion of internally displaced households. After that, specific households and/or individuals in the selected communities who meet certain eligibility criteria may be targeted. The targeting mechanism is the application of a set of rules through which it is decided whom to include and whom to exclude. The different targeting mechanisms are explained in greater detail in the following sections.

Administrative targeting

In an administratively targeted scheme, decisions on the eligibility of individuals or groups (including regions) are determined by programme staff on the basis of whether or not candidates meet defined eligibility criteria. These are based on one or more indicators that have been previously defined for the purpose of targeting. Administrative targeting may also be based on a so-called "means test", i.e. in order to qualify for participation in the programme, the household or individual must not have the means, or a minimum set of assets, to obtain an adequate level of food intake (this can be decided in terms of, for example, per capita income, amount of land under cultivation or herd size). Means tests may be established on the basis of targeting indicators, but such tests are usually more costly to apply and administer. Indicator-based targeting usually involves the collection and analysis of data on those targeting indicators that are thought to be the most objective and representative of the defined selection criteria. The criteria must be defined and measured consistently for each candidate individual, household or group of individuals or households.

Most forms of targeting include an administrative element in the definition of programme areas, the definition of targeting criteria or the definition of target groups. Each form of administrative targeting may be used alone or in conjunction with other methods of targeting. For example, the selection of different markets for market-based interventions or of different communities for self-targeting public works activities represent forms of administrative targeting.

The first step in the development of an administrative targeting methodology is assessment of the various levels of administration and decision-making that are necessary to implement a programme, and of the information available on which to base decisions for targeting at each level. In many cases, programme resources will be managed initially at the central level and allocated incrementally to lower levels of administrative decision-making, until they finally reach the beneficiary population.

Once the administrative structure and decision-making needs have been defined at each level, administrative targeting requires the following additional tasks:

• definition of eligibility criteria at each level of administrative decision-making;
• identification of the indicators that best express those criteria;
• development of data collection or screening methods that assist in the identification of beneficiary households or individuals, based on accurate and efficient targeting criteria;
• definition of exit criteria to determine when beneficiaries graduate from the particular intervention;
• definition of resource allocation rules for the programme at each level of decision-making, on the basis of screening outcomes.

Advantages

1. Because it relies on the use of objective indicators, administrative targeting is considered to be a fairly unbiased, impartial tool for determining eligibility which is applicable in a fairly standardized way across a variety of different populations in different locations. Thus, it may make programme management at the national level easier.

Disadvantages

1. The eligibility criteria and targeting indicators are defined and assessed by outsiders, typically those working for government or non-governmental agencies. As outsiders, programme staff may have limited access to information regarding the intended target population and limited understanding of the primary issues of concern within participating communities. Decisions concerning the definition of targeting criteria and the application of related targeting indicators may be subject to biases in the social or cultural perceptions of staff who do not have a clear insight into local conditions.
2. The administrative costs associated with identifying beneficiaries, screening programme applicants, monitoring eligibility, preventing participation by the non-eligible and correctly applying exit criteria are high. The use of sampling methods to reduce the cost of individual screening is generally not appropriate, since it excludes potential beneficiaries and may lead to high exclusion errors in programme targeting.
3. The use of a standardized method for targeting across all populations is not always appropriate. The determinants of deprivation may vary significantly from one community to another or across socio-economic groups; for example, there are often differences in the determinants of poverty among farmers and among pastoralists. These different contexts may imply that very different indicators are necessary to capture a relevant target group. There are also likely to be differences in the level of income that defines poverty across communities (e.g. urban compared with rural), suggesting that different targeting criteria be defined for each setting.
4. Poorly defined, understood or applied eligibility criteria, perhaps resulting from inadequately measured and analysed targeting indicators, may undermine the effectiveness of an administrative targeting method.
5. There is the potential for corruption because a small number of programme staff has control over the allocation of programme resources and there may be non-transparent administrative procedures. Administratively targeted schemes generally require systems that do not merely establish eligibility but also monitor, confirm, enforce and appeal eligibility decisions.

Community-based targeting

Community-based targeting schemes depend on decision-making structures at the community level to allocate programme goods and/or services effectively according to the criteria defined in the programme objectives. In some cases, the communities themselves may contribute to defining these objectives through a participatory decision-making process. In other cases, such as in emergency feeding activities, the objectives may be more self-evident and universally applicable. As communities can interpret criteria differently, leading to differences in the allocation of relief food supplies, it is important to ensure that community members understand clearly the programme objectives, and the basis on which relief supplies are allocated, prior to programme implementation.

Effective community-based targeting requires preliminary efforts in the following areas:

• Assessment of community decision-making structures to address the following questions:
  • Do effective decision-making structures exist within every community in the programme area? Are these structures representative or autocratic?
  • What is the nature of participation in community-level decision-making by the general population, and can marginalized groups be effectively brought into the decision-making process?
  • What are the sources of potential bias in the allocation of programme benefits among the community's most needy? Sources of bias may include male dominance, ethnic influence, existing political and/or economic power structures or outright corruption.
• What are the potential differences in the understanding of programme objectives that might lead to biases in the allocation of benefits across communities?
  • What is the local interpretation of the programme's selection criteria?
  • How are disputes typically resolved within participating communities?

  Assessment serves to examine what the likely outcomes will be from a community-based targeting scheme, in terms of who in the community will be reached by the programme and the extent to which the programme can be expected to deal effectively with food and nutrition problems in the community. The assessment may also help to determine whether the programme needs to include specific activities to strengthen the decision-making structures in the community.

• The analysis of existing community support mechanisms in order to understand the potential effectiveness of community-based targeting methods. Support mechanisms may be based on cultural or religious customs, family relationships, or ethnic or tribal groups. They are likely to be indicative of the criteria on which private resource transfers are made, the extent to which marginalized groups have access to support, and other factors that might influence the outcomes of community-based targeting efforts. Rather than set explicit priorities, communities often choose to allocate programme resources evenly across all households, relying on existing support mechanisms to redistribute benefits to the most needy. An understanding of traditional support mechanisms provides a strong indication of whether or not any further redistribution would benefit the intended target population.
  
  When programme resources are clearly insufficient to provide minimal benefits to all households or individuals in the community, implicit or explicit selection criteria are applied by community leaders or others to the selected households or individuals who are most in need. Empirical evidence of what such criteria typically are point to a ranking based on an indication of economic or social vulnerability, which is in turn based on indicators such as households headed by the elderly, women, ill or incapacitated persons; households with a large number of small children; and households with no land to cultivate or with no or very few animals.



• Public participation and education to ensure local ownership of programme objectives and targeting criteria through the promotion of direct and broad-based participation in decision-making regarding programme implementation in the community, and through ensuring that potential beneficiaries are informed of the composition of benefits to be distributed, as well as the options for recourse when disputes arise in the allocation of those benefits.

The frequent and participatory auditing of community-based targeting outcomes is very important to ensure that targeting errors are identified and corrected. Such auditing can serve as a monitoring tool and can help communities to review and adjust local targeting practices.

Advantages

1. In community-based targeting, benefits from the insights are obtained by community insiders - members of the community, or their representatives, who actually face a particular food security or nutrition challenge and who are in the best position to define the nature of that challenge, as well as to define the objective targeting criteria and target population for an intervention designed to address specific problems.
2. Targeting costs are basically limited to the time spent by the community itself to reach and monitor programme allocation decisions.
3. Targeting criteria are more likely to be appropriate to local conditions, and are easily understood and accepted by the general population.
4. Community-based targeting is more likely to result in a greater understanding of the objectives of the targeted programme, to confer a greater sense of ownership among the community's population and programme participants and, potentially, to increase grassroots empowerment in
   general.

Disadvantages

1. Because communities typically develop their own criteria independent of one another, community-based targeting may result in differences in targeting outcomes across different locations, which may make programme management and administration at the central level more difficult. It is difficult to carry out targeting consistently when the programme covers a large area. Across locations and communities, differences in cultural norms, standards of living, livelihood sources, ethnic composition and the effectiveness of local political institutions can lead to inconsistencies in the allocation of benefits.
2. For many nutrition-related problems, in which the definition of need is largely a technical one, reliance on community-based targeting methods alone may not always be appropriate.
3. When resource allocation decisions are being made, it is difficult to determine who effectively represents, and who best represents, the community. It is also difficult to ensure that disadvantaged groups such as women or ethnic minorities are given an equal voice in the decisions. There is therefore the danger that the most needy are not adequately reached by the programme.
4. Reaching consensus between community leaders and community members, and between community members and leaders and outside agencies, of what constitutes a fair and equitable distribution of programme goods and/or services may be an arduous and time-consuming process.
5. Social pressures, or the need of local political leaders to strengthen their power base, may bias the allocation decisions to the detriment of those who are relatively powerless and should benefit most from the programme goods and/or services.

Self-targeting

The central aspect of self-targeting mechanisms is that the decision of individuals or households on whether or not to participate in a given programme is the main determinant of who receives programme benefits. In other words, self-targeting occurs when benefits are available to all, but programme incentives are set in such a way that the non-needy elect not to participate. While other targeted programmes require social workers or other human resources to establish eligibility criteria, screen and monitor eligibility, with self-targeting the decision to participate is made by the households or individuals themselves.

Universal access to programme benefits in the form of goods, services or employment is necessary in a purely self-targeting scheme. If programme benefits need to be rationed because of resource constraints, self-targeting may take place in combination with some form of administrative or geographic targeting. For example, if a food-for-work programme intends to generate non-farm income for women in a drought-affected region, a combination of geographic targeting, administrative targeting (only women are eligible) and self-targeting (food ration levels are set at such levels that only the neediest women are likely to decide to participate) will be involved.

Three main elements influence an individual's decision to participate in a given activity:

1. the costs of participation;
2. the quantity and quality of the goods and/or services to be obtained by participating, and the value that the participants place on those benefits;
3. the social stigma associated with participation (which may also be considered as part of the participation costs).

A key to successful self-targeting is the clear definition of the target population during the programme development stage, such that the offered benefits are likely to be demanded only by that target population at a price that only the target population is willing to pay.

Effective self-targeting of food programmes requires detailed information about market conditions with regard to supplies and prices of specific foods, and the income and the consumption patterns of different segments of the population (i.e. price elasticity of demand from various income groups). The key is to segment the population in order to identify major differences in the preferences and market behaviour of various groups, such that differences in the type, quality and cost of the food item(s) offered lead to self-selection by the intended target population. For example, when there is a reduction in the price of a food product that most consumers consider to be of inferior quality and/or low social value, the demand for that food is likely to increase substantially more for poorer groups than for higher-income groups. The use of a quality differentiation device (based on market mechanisms) to promote self-targeting schemes has been successful in many developing countries, especially in food subsidy programmes. However, a number of important considerations must be taken into account if self-targeting is to work (see the Tunisia case study in the Annex.)

The design of a self-targeting food subsidy programme that is based on quality grading involves examining household expenditure data to determine whether there are significant differences in consumption patterns across income groups, especially with regard to basic food commodities. For example, yellow maize flour is considered to be inferior by consumers in Central America compared with white maize flour. Yellow maize flour (which is of higher nutritional value) is consumed by the poor, and white maize flour by higher-income groups. Where the poor consume a different basket of goods from higher-income consumers, the price of one or all of the foods contained in that basket is to be subsidized. Quality grading can also be introduced through different packaging, colour coding and labelling, which provide the image of a superior food by giving it more attractive packaging without basically changing the food commodity itself.

An important issue involved in self-targeting food programmes is the question of consumer acceptance. Care must be taken that, by making a food product unattractive to higher-income consumers, it does not also become unappealing to the poor.

Some examples of activities with built-in self-targeting mechanisms are:

• price subsidies, especially of so-called inferior food commodities that only the poorest are likely to purchase;
  • food-for-work or cash-for-work programmes, which target benefits by setting food rations or wage rates that are low enough to induce only those unable to find more remunerative employment to participate;
• public health and primary education services, which often self-target on the basis of the relatively poorer quality of services available in comparison with privately offered services.

The self-targeting that results in the last example is (or should be) unintentional, in the sense that efforts should always be geared towards improving public health and education services.

Food subsidies are one way of increasing the purchasing power of the poor and compensate for losses in real income caused by economic crisis, unemployment, income gaps or disparities, or wars. Subsidies serve as part of social safety-net measures. In several countries, such programmes have had a positive effect on household food security and nutrition, especially among urban populations. It has been reported in India and the Philippines that these programmes have reduced the prevalence of underweight children. Some food subsidy programmes based on foreign food aid have helped to offset the fiscal costs of food subsidies, and contributed to increased public investment in social services. Current economic crises are forcing many governments to look into the use of self-targeting for subsidy programmes as a means of reducing budgetary costs and finding more efficient ways of directing benefits to those most in need.

In practice, the development of self-targeting activities may also include dimensions of geographic targeting, by locating public works programmes in specific geographical areas or distributing subsidized food commodities through retail outlets in low-income neighbourhoods.

Market-based interventions aim to increase the demand or supply of a particular food among the target population.

Advantages

1. The administrative costs of self-targeting are low, because these programmes rely primarily on the initiative of the potential beneficiaries themselves to gain access to food or services, and there is no need to screen and monitor the eligibility of programme participants.
2. It is relatively easy to implement, provided that enough information on the food consumption of low-income groups or on market wage structures is available.
3. In the case of food- or cash-for-work programmes, self-targeting reduces the perception that such programmes offer long-term employment prospects, as participants will leave the programme as soon as better employment opportunities present themselves.
4. Beneficiaries decide for themselves whether or not to participate, thus minimizing the opportunities for corruption to bias the distribution of programme resources.
5. The self-esteem and privacy of the target population are well maintained, as there is essentially no interaction between programme beneficiaries and programme staff.
6. Leakage through resale of the subsidized food is likely to be minimal since, when the subsidized food has been selected well, there is no demand for it among higher-income consumers.

Disadvantages

1. With self-targeting, it is difficult to know who really benefits from the food subsidy, and to what extent the food subsidy contributes to a reduction in overall food insecurity or to an improvement in nutritional status among low-income groups.
2. In the case of food- or cash-for-work programmes, the time cost involved is often a greater barrier to participation for the poor, who are less able to afford to lose productive time than the non-poor. In the case of food subsidies, there is presumably no marginal time cost involved.
3. The poor often face great difficulties of access, which may be an obstacle for participation, unless careful geographic targeting that takes full account of the access factor is involved.
4. Even when the needy do choose to participate, in self-targeting factors such as low-quality foods or services, or opportunity costs associated with programme participation, tend to reduce the net benefit of participation.
5. In the case of self-targeting through food subsidies, there is a need for constant monitoring of whether the subsidy is effectively passed on to the consumers by retailers. Information on the subsidy needs to be provided to consumers, and a complaint referral system should be put in place. Purchases of subsidized food commodities need to be monitored, as do the prices of substitute food commodities, so that the food subsidy can be adjusted to ensure continued consumption by low-income groups.
6. As with any subsidy programme, the fiscal costs of the subsidy may be substantial and may grow over time as a result of general price inflation. Subsidies also introduce distortions in the market and can lead to economic losses for domestic producers.

Market-based targeting

Market-based targeting is very similar to self-targeting, as it depends on the choices of individuals to buy or sell goods or services in the market. The basis of market-based targeting is the supply-demand equation. The application of both market-based and self-targeting methods relies on the assumptions that:

• programme goods and services have sufficient value to imply a significant change in the pattern of incentives and disincentives faced by potential beneficiaries;
• in response to the revised incentives, there are also likely to be significant changes in behaviour, which will vary across different segments of the population;
• the behavioural changes can be exploited in order to reach programme objectives more effectively and efficiently than other methods of targeting.

Market interventions may be oriented to influence market supplies of foods and services available for purchase; for example, through the local sale of grain from reserves or the marketing of oral rehydration salts or locally produced weaning foods. These types of interventions may also address market demand, either directly through official market purchases of commodities to support local prices and the incomes of producers, or more indirectly through public education and social marketing intended to influence consumer preferences for key goods and services.

Market-based interventions may also choose to reach their objectives through price means, with the aim of increasing the demand or supply of a particular food or service among the target population. This can be done through price controls or price subsidies of key food commodities or services so that consumers choose to purchase more of a particular food or service. Nowadays, price controls are applied less and less frequently, while price subsidies (which are also less frequently applied in market-oriented economies), when applied to basic foods, closely resemble self-targeting mechanisms. Improving the productivity of domestic food producers and expanding commercial food imports are more sustainable ways of increasing domestic market supplies of food and decreasing domestic food prices.

A clear understanding of the different characteristics of a selected market, including its level of integration, is essential in determining the appropriate intervention, its probable effectiveness and coverage and the level of resources necessary to meet the stated objectives. For example, decisions on whether to employ cash-for-work or food-for-work as a means of transferring purchasing power to poor households depend critically on the level of market integration in the programme area. When markets are well integrated and food supplies flow freely in response to changes in demand, the use of cash transfers is likely to minimize the distorting effects of food transfers on local market incentives. Similarly, when markets are well integrated, the price effects of a local food purchase activity may be diluted over a broader area, requiring larger purchases to bring about a given price change.

Advantages

1. It is relatively easy to implement market-based targeting, although when there are resource constraints the best way to intervene in the market needs to be identified, involving either the implementation of a single programme or, more likely, a combination of programmes.
2. The margin for corruption is fairly limited.
3. Similar to self-targeting, market-based targeting requires no programme staff or expenditure for individual eligibility screening and monitoring.

Disadvantages

1. In general, market-based targeting is unlikely to be effective without significant investments in information gathering and analysis regarding the determinants of market demand and supply of specific food commodities, prices and income elasticities.
2. Because differences in market preferences across groups are often small, the impact of activities targeted through market mechanisms may not be sufficiently discriminating and significant benefits may leak to the less needy. Activities such as livestock price supports, for example, tend to help pastoralists in proportion to the size of their herds, so that larger owners benefit more than smaller ones. Without some effort to different groups of pastoralists on the basis of need and to identify market mechanisms that can exploit their distinct patterns of market behaviour, the impact of this kind of market-based intervention may be directly contrary to that intended.
3. There is a significant chance of substantial leakage resulting from poor recognition of the target population or failure to monitor its behaviour responses over time.
4. Market-based targeting may rely on a range of administrative targeting decisions. Particular population groups are often singled out by administrative means to be the focus of an activity that is targeted through market mechanisms. The geographic scope of the market selected for intervention will necessarily have an influence on the population that is ultimately targeted by that activity.

Geographic and regional targeting

Geographic or regional targeting can be accomplished through a variety of methods. The simplest form is based directly on local estimates of need for demand-driven activities, where resources are allocated to various regions in proportion to stated levels of need. However, local needs are likely to be overestimated, as part of the inter-regional bargaining process for programme resources. A more complicated but increasingly common form of regional targeting involves poverty, food insecurity and vulnerability assessment and mapping systems, which use rapid rural appraisal, participatory rural appraisal or rapid food and livelihood security assessment methodologies. The construction of a poverty map based on a composite poverty index is another method (see the geographic targeting element of the national school feeding programme in the Costa Rica case study in the Annex). Such efforts utilize a range of information sources and indicators. They usually involve the development of a multivariate index or statistical model aimed at capturing the basic dimensions of the stated targeting criteria by using different socio-economic indicators such as literacy rate, female education rate, unemployment rate, level of income, agricultural failure, population growth rate and prevalence of malnutrition.

Early warning information systems contribute information and data on emerging food crises in specific locations, based on agroclimatic conditions, food crop estimates and food market conditions as indicated by local food prices. Regional food balance estimates, particularly when they are calculated on a monthly basis, may also provide early warning information regarding food shortages. Structural vulnerability assessments and detailed food and livelihood insecurity analyses provide information and data for the design and implementation of local development programmes.

Although regional targeting is sometimes carried out, the methodologies for doing so efficiently and effectively are not always well developed (see some of the country case studies in the Annex). For example, it is often assumed that regional disparities in food security and other welfare measures can readily be understood and identified through the informed judgement of local informants and decision-makers. However, biases in the perception of the determinants of food insecurity have led to serious inefficiencies in geographic targeting. To avoid such biases, there is a clear need for a more focused understanding of regional food security and nutrition conditions. This is particularly true when emergency food relief is being allocated among the various regions affected by a natural or human-incurred disaster (see the Ethiopia case study in the Annex).

In fact, nutrition programmes may be geographically targeted, but the selection of service area boundaries may not always be based on nutritional criteria. Non-nutritional concerns frequently dominate when broad service areas (regions, provinces, states, etc.) are designated, and nutritional concerns may govern the selection of specific villages, households and individuals within the broadly defined service area.

Advantages

1. Geographic and regional targeting can usually be updated on a relatively infrequent basis, primarily because they typically rely on existing census data, secondary data collected annually for various economic and social sectors, or periodic sample surveys or rapid appraisals.
2. They may be relatively low-cost and require the effort of a fairly small number of analysts at the central or regional level.
3. The cost savings obtained from regional targeting can increase significantly, thus enabling more efficient and effective coverage of the finely specified geographic areas.
4. The political costs of targeting can be minimized by focusing on small geographic areas. Since the constituencies of most political leaders are defined, at least in part, on a geographic basis, the targeting of small geographic units increases the likelihood that local leaders will have some constituents with a significant interest in a given local activity.
5. Local-level information obtained as part of the geographic targeting process can also support a more decentralized decision-making and planning process. This will allow the development of policies and programmes that are more finely tuned to local conditions.

Disadvantages

1. In practice, the targeting of highly decentralized administrative units or areas is often difficult, since the majority of targeting data are typically available and valid only for larger geographic units. In addition, in most developing countries, secondary data such as those on crop production are normally available only for a small number of fairly large regions. For primary data generated through surveys, limitations in sampling methods prevent the reliable estimation of targeting indicators at higher levels of disaggregation.
2. Some form of explicit allocation rules are required for more effective targeting; for example, allocating resources across regions based on the predicted proportions of levels of poverty or malnutrition prevalence. Regional targeting methods are often based on an index, which provides only a ranking of conditions across locations and does not account for absolute levels of need within each location.

Household and individual targeting

The selection of target groups, households or individuals is often determined through a multistage targeting approach: first, an administrative and/or a geographic targeting approach leads to the selection of broad service areas (regions, groups of villages, provinces, states), then household- or individual-level eligibility criteria are applied. Target groups are selected through the use of specific criteria that discriminate the most needy from the less needy within a given community.

Choosing the most appropriate criteria is the key to minimizing inclusion and exclusion errors when potential beneficiaries at the household or individual level are being screened. Such criteria are based on the characteristics of households or individuals.

Infants and young children are particularly at-risk of not getting the food they need for good health, growth and development.

For nutrition programmes, households are often screened mainly on the basis of their size, their socio-economic status, the education level of the mother, child spacing within the family, and/or a history of poor nutrition for any family member. A household's socio-economic status can be a useful way of identifying malnourished individuals of those at high risk of malnourishment. Relevant socio-economic indicators include individuals living in families or households in which an infant has died, in which the mother is very young or relatively old, or in which there are many young children.

Targeting all the at-risk individuals in a nutrition programme area is basically done through such indicators as:

• nutritional status, as assessed through anthropometric measurements and clinical or laboratory examinations (weight-for-age, height-for-age, weight-for-height, haemoglobin levels, urinary excretion of iodine, serum retinol levels);
• physiological status (e.g. pregnant and/or lactating mothers);
• health status (incidence of diarrhoeal disease, ARI);
• age;
• sex;
• individual's socio-economic status.

Any of these indicators can be applied, singly or in combination, when selecting potential recipients. The screening indicators most commonly used in individual targeting are age and anthropometric measurements. The concept of selecting individuals of a specific age cohort has been developed because certain age groups are at risk, or high-risk, of developing a state of malnutrition. Examples of such age groups and the particular risks that they face are osteoporosis in elderly women and malnutrition in small children of 6 to 36 months of age.

The most useful anthropometric indicators are:

• birth weight;
• weight-for-height;
• height-for-age;
• weight-for-age;
• rate of weight gain;
• mid-upper arm circumference (MUAC).

Weight-for-age and height-for-age are the most commonly used measures of malnutrition in children under five years of age, although in emergency situations weight-for-height or MUAC are often used to identify the most at-risk children. When severe protein malnutrition is a main problem, as when kwashiorkor develops, weight-for-age may provide a false assessment because of the presence of oedema, and thus there is the possibility of an exclusion error. The rationale for using weight gain criteria for targeting is that a child under five years of age who fails to gain weight over a period of time is at extreme risk of malnutrition. In areas where malnutrition is prevalent, weight gain criteria screen out, relatively effectively, the children aged under five years who have a normal nutritional status but miss a large proportion of those whose nutritional status would deteriorate over time in the absence of supplementary feeding. A combination of age and anthropometric values is also often applied to target more narrowly the children who are most at risk, say those in the 6 to 36 months age group.

Advantages

1. Individual/household targeting improves the accuracy of targeting through reducing leakage.
2. It allows subjective verification of living standards and other information.
3. It lowers the undercoverage rate.
4. It improves the aggregate social benefit of an activity.
5. On-site information collection through direct measurement by trained programme staff provides accurate data and is a low-cost activity.
6. Individual/household targeting provides the opportunity for immediate intervention.

Disadvantages

1. When the necessary information is lacking, the cost for data collection on indicators is high, especially for those related to nutritional status which require trained personnel, logistics and financial support if they are to provide reliable information on biochemical, clinical, anthropometric and/or dietary aspects.
2. Reported data/information collected on-site may lead to high undercoverage or self-selection biases in programme coverage. Depending on the information requested, it may be prone to inaccuracies as a result of purposeful false reporting by respondents, leading to large inclusion errors.