For the poor, therefore, household food security is often extremely precarious. Agricultural production varies with the season and longer-term environmental conditions. Families selling crops may find themselves paid fluctuating prices depending on a variety of factors beyond their control, while those who need to buy food may encounter exorbitant prices. Families living on the edge of survival have few opportunities to build up sufficient stocks of food, or to develop alternatives that would cushion them in times of hardship. So while poor families may have adequate access to food for one month, what is essential is access that is consistent and sustainable.
Women have a special role to play in maintaining household food security.
For house hold food security to translate into good nutrition, this often overwhelming burden of work must be redistributed or reduced so that other needs of children, also related to nutrition, can be met. An essential element of good health is access to curative and preventive health services that are affordable and of good quality. Families should have a health centre within a reasonable distance, and the centre's staff should be qualified and equipped to give the advice and care needed. In Africa, the programme known as the Bamako Initiative was launched in 1987 to address the crisis in health care that came on the heels of budget cuts and economic decline in the 1980s. It is a strategy for improving health services by moving their control, management and even some of their financing out of central jurisdiction and into communities.