Government strategies to ensure the human right to adequate and healthy food facing the Covid-19 pandemic in Brazil

The Covid-19 pandemic revealed a concrete and immediate threat to food and nutrition security (FNS), especially for vulnerable groups. This study aimed to identify government strategies implemented in Brazil to provide the Human Right to Adequate and Healthy Food in high social vulnerability contexts during the Covid-19 pandemic. A cross-sectional study was carried out, with analysis of official documents published between March 20 and July 30, 2020, by the Federal Government, Federal District, Brazilian states, and capitals, focusing on measures to ensure availability and physical or financial access to food. Strategies implemented mainly involve food distribution and minimum income assurance. The following were implemented: Basic Emergency Income (Federal Government); Food Acquisition Program (PAA), and emergency financial aid (states); emergency food donation programs (states and municipalities). Existing measures were adapted to the pandemic, such as the National School Food Program (PNAE), the National Food Acquisition Program (PAA), and the distribution of food and staple food baskets. While essential, these strategies have limited scope and are insufficient to ensure FNS.


Introduction
In December 2019, a new coronavirus was responsible for the severe acute respiratory syndrome known as Covid-19. The disease quickly spread globally and, despite the adoption of strict containment and isolation measures in several regions, Covid-19 was considered a Public Health Emergency of International Concern and classified by the World Health Organization (WHO) as a pandemic on March 11, 2020 1 . On August 8, 2020, even with significantly underreported cases caused mainly by low testing, Brazil recorded 100,000 deaths from the disease 2 .
The pandemic does not affect the different territories and populations equally regarding morbimortality and their political, social, and economic repercussions. Its major impacts occur in vulnerable population groups and are closely related to gender, ethnicity/race, and class issues, especially in the suburbs 3,4 .
Global Covid-19 data reveal a concrete and immediate threat to food and nutrition security (FNS) of the most vulnerable populations, particularly traditional peoples and communities 5,6 . The number of people suffering from chronic hunger can hike dramatically, resulting in the global Food and Nutritional Insecurity (FNI) upswing. Assuring survival conditions is essential to face the pandemic changes and should be a priority for public managers, particularly those related to the FNS of vulnerable people. The situation of Covid-19 may reintroduce Brazil to the hunger map, revealing the inability of the government's ultra-liberal project to secure rights and respond adequately to the crisis 7 .
Thus, this study aimed to identify government strategies implemented in Brazil to guarantee the Human Right to Adequate and Healthy Food (DHAAS) in the face of the Covid-19 pandemic, focusing on measures that can directly contribute to ensuring availability and physical or financial access to food, especially to the most vulnerable populations.

methods
A cross-sectional, exploratory, and descriptive study was carried out from documentary analysis 8 . Official documents (normative acts, ordinances, resolutions, and the like) published by the Federal Government, Federal District (DF), Brazilian states and capitals, regarding government strategies were analyzed to ensure the availability and physical or financial access to food, especially to vulnerable populations. We searched for information on the federal, state, and municipal governments' official websites and specific bodies that operate in the management of FNS-related actions and programs, such as citizenship, social assistance, social action, social defense, human rights, agriculture, and education. Publications from March 20, when the state of public calamity in the country due to the Covid-19 pandemic was declared, to June 30, 2020, were considered.
We conducted a thematic analysis of the documents' content, following the stages of pre-analysis, analysis, results' processing, inference, and interpretation, considering explicit and implicit content in the documents. The government strategy/program organized the data. The information extracted from the selected documents was systematized by federative units and capitals and classified by the strategy's purpose and the characteristics of its implementation during the pandemic.
As for the purpose, the strategies were classified according to the DHAAS guarantee dimensions into a) food availability (actions with producers to facilitate the offer of adequate and healthy food); b) physical or financial access to food (food distribution or cash transfer actions that contribute to the purchase of food). Concerning the implementation characteristic, the strategies were organized into a) new strategies created due to the pandemic; b) pre-existing strategies, modified due to the health emergency.

results
The structuring of new initiatives and the adequacy of strategies already implemented in the country contributing to the FNS were identified in the pandemic. The new government measures were Basic Emergency Income (Federal Government); State Food Acquisition Programs (PAA), and emergency food donation (states and municipalities). The pre-existing measures that have changed in the pandemic are the National School Food Program (PNAE), National Food Acquisition Program (PAA), Bolsa Família (Family Aid) Program (PBF), Continuous Cash Benefit (BPC), and food distribution by public FNS equipment (Chart 1).
Concerning the purpose, the strategies identified to ensure physical or financial access to food were Renda Mínima (Minimum Income), PNAE, Popular Restaurants, community kitch-ens, distribution/donation of staple food baskets, and PAA.
Some strategies had some particularities deserving to be highlighted, as per Chart 2.

Government income transfer programs or emergency basic income programs
Government income transfer or minimum income programs are alternatives to fighting hunger and poverty and seeking to maintain basic daily needs. With the pandemic, millions of Brazilians saw their salaries shrink or lost their income sources. The Federal Government introduced an emergency aid to ensure the population's basic needs, called basic emergency income, for the unemployed, self-employed, and formal and informal workers. They were unable to develop their activities and are not beneficiaries of other cash transfer programs 9,10 .
Initially, the amount proposed initially by the President was R$ 200.00, which increased to R$ 600.00 after objections by political leaders. The resource was initially secured for three months 9 and extended for two more due to the delay in the return of economic activities, and its continuity is under debate after the payment of the fifth installment 11 .
Another measure adopted to meet the needs of the poor and extremely poor population during the pandemic was the adequacy of the amounts passed on to the PBF holders and the  1 Only the strategy that was in effect during the data collection period was considered. 2 Only the distribution of food stored in some schools at the beginning of the suspended activities. 3 Association of distribution of staple foods with a food card. 4The only places that mentioned food banks. 5The only places that mentioned community kitchens. modified criteria for receiving the BPC, the main cash transfer program currently implemented in the country.
The BPC includes older adults over 65 years of age or people with disabilities, with a minimum income of less than one-quarter of the minimum wage and not linked to any other benefit or social security system. With the pandemic, the minimum income required to receive the benefit was increased from 25% to 50% of a minimum wage per capita, providing a larger number of households 12 . PBF benefits extremely poor (monthly income up to R$ 89.00/person) or poor households (monthly income of up to R$ 178.00/person), with a fixed amount of R$ 89.00, linked to the fulfillment of conditionalities promoting access to health and education. A variable benefit (R$ 41.00 or R$ 48.00) is attributed to households with pregnant women, children, or adolescents up to the age of 17, where each household could accumulate up to 5 monthly benefits 13 . With the pandemic, the amount was temporarily equal to the R$ 600.00 made available by the emergency aid, where R$ 1,200.00 are for women supporting their households on their own 9 .
The Federal District and some states in the North and Northeast have made their emergency aid available to low-income individuals or households not registered in Federal Government cash transfer programs. The monthly amounts range from R$ 100.00 to R$ 408.00, lasting from three months to as long as the pandemic remains 14 .

National school Food Program (PNAe)
The PNAE is intended to offer adequate and healthy food and food and nutrition education actions for students in basic public education. Through the program, the Federal Government transfers resources to states, municipalities, and federal schools to compose the budget for the acquisition of foodstuffs during the school year, by number of enrolled students. PNAE considers that school meals are the right of all students in basic public education and the State's duty and aims to ensure the FNS with equal access, prioritizing the most vulnerable 15 .
The closure of schools in March 2020 due to the pandemic left a huge number of students without access to the daily meals provided by the PNAE, contributing to the FNI of many students and their families. As a consequence, the program's legal framework was changed and authorized the direct distribution of food purchased with PNAE resources to the parents or guardians of the students at the discretion of the local public authority 16 during the suspension of classes due to emergency/public calamity.
The implementation of the PNAE during this period occurred through the delivery of food kits and payment of financial aid, and the provision of meals in schools.
In total, 23 states, 25 capitals, and the Federal District developed some action in the first half of 2020 related to the PNAE in the pandemic. Of these, 21 capitals and 14 states adopted the distri- bution of food kits, while eight states, the Federal District, and the municipality of São Paulo, adopted the payment of financial aid. Three capitals (Manaus, Porto Velho, and Florianopolis) simultaneously adopted both strategies. João Pessoa adopted its strategy, resuming in June the supply of meals in the other schools of the municipal network 17 (Chart 1). No assistance measures were identified for students in Maranhão, Rio de Janeiro, and Sergipe. The aid ranged from R$ 50.00 and R$ 179.10 and was granted by bank transfer directly to those responsible or delivered via gift vouchers (magnetic cards) to purchase food at accredited establishments. Governments used their resources to pay the aid since the FNDE is exclusive for purchasing foodstuffs, which may explain the variation in the amounts 18 . The information available on the official websites did not explain the origin of the resources used.
Focused coverage was predominant in both formats and aimed only at students from impoverished households, proven through registration in the CadÚnico or participation in the PBF.
As for the onset of the strategies' implementation, only 22 states and capitals started the actions of food assistance to students between March and April.
We could not analyze the effective compliance with the measures disclosed from the consulted sources.

Food distribution
Concerning food distribution, subsidized meal distribution strategies were identified through popular restaurants (PR) and community kitchens, and the provision of staple food baskets, with direct delivery of food or card with a specific amount, exclusively for food purchase.
The PRs and community kitchens are part of the FNS Public Equipment Network, which aims to expand the supply of nutritionally adequate meals at affordable prices to the low-income, socially vulnerable population in situations of FNI. While universally accessible, the public covering this equipment is people living on the streets, informal workers, and the unemployed. For the most vulnerable, meals can be distributed free of charge or for a symbolic value, while the meal amount is established locally for other users 19 . Due to the lack of specific funding, only 12 states and 13 capitals have had some FNS equipment developing special assistance during the pandemic (Table 1). Capitals like Curitiba and João Pessoa opened new equipment to expand assistance to the vulnerable public. The city of São Paulo created a program in partnership with civil society entities and support for the vulnerable population, focusing on generating income and livening up the local economy 20 .
All state and municipal governments prioritized the distribution of staple food baskets as an emergency measure through the direct delivery of food or food cards (Chart 1). Belo Horizonte stood out with an organized staple food basket delivery system, with an estimated coverage of 1 million people and a partnership with 160 supermarkets 21 . Florianópolis also celebrated partnerships with establishments to provide food via food card with payment via an application or phone-based purchase release 22 .
Most administrations established public-private partnerships (PPP) to collect financial resources or foodstuffs from different companies and civil society (Chart 1). In Acre, a live online event was held where the Governor answered donor calls, collecting more than 90 tons of food.
Some states have used the Fund to Combat Poverty (FCP) as a source of resources to purchase food (Chart 2). The Fund's collections direct public resources to social programs aimed at nutrition, housing, education, and health. In Rio Grande do Norte 23 , FCP resources are used to maintain PRs. In Paraná, the resource was used to purchase food from family farming to produce staple food baskets and pay an aid of R$ 50.00 for three months to vulnerable households to buy food in accredited establishments 24 .
The most populous state in the country, São Paulo, established a program to distribute 1 million staple food baskets to extremely vulnerable people. According to the government, the investment of more than R$ 100 million derives from the private sector 25 . However, they emphasize the use of FCP for the purchase of food from family farming and the preparation of 10,000 staple food baskets for needy households 26 , prioritizing investments in settled family farmers and remainders of quilombos.

Food Acquisition Program (PAA)
PAA promotes access to food and fosters family farming through State's purchase of family farming food, contributing to the build-up of public food stocks. States and municipalities implement the program in partnership with the Ministry of Citizenship and the National Supply Company (Conab) through five modalities: pur-chase with a simultaneous donation, institutional purchase, PAA-Milk, stock build-up, and seed purchase 27 .
State government initiatives to purchase products from family farming are underway due to the pandemic. Some states have leveraged existing programs; others have established emergency actions to purchase food from family farming for subsequent donation to people in FNI. In this scenario, one of the measures carried out by Conab was the extension of the PAA projects that expired in December 2019 but still had a balance due until June 2020. As a result, benefited farmers gained more time to deliver food to organizations nationwide 28 .
In April 2020, Conab announced a budget supplement for the PAA, with an estimated R$ 220 million contribution for purchases with simultaneous donations. CONAB still has a budget of approximately R$ 10 million from 21 parliamentary amendments to be allocated to projects in Amapá, Amazonas, Goiás, Maranhão, Minas Gerais, Pernambuco, Piauí, Rio de Janeiro, Roraima, Sergipe, Tocantins, and the Federal District, expected to serve around 1,500 family farmers in these states 28 .
The purchase with a simultaneous donation of family farming food to families in an FNI situation was registered until June 2020 in at least 15 states but generally related to contracts signed before the pandemic in 2019 (Chart 1). The institutional purchase was also registered in Goiás, but without characterizing specific action to face the impacts of Covid-19 28 .
While not structured as a specific action to face the pandemic, support for the build-up of stocks was registered in 2020 in five states (Chart 1), where small farmers received resources to sell their products, referring to contracts signed in 2019 28 .
The distribution of seeds to small family producers was recorded in Alagoas and Amazonas 28 , also referring to 2019 public tenders. In July, the Federal Government released a credit of R$ 156 million to purchase milk to face the pandemic.
Specifically considering traditional communities in Amazonas, the Joint Technical Note ADAF/SFA-AM/5º Ofício-PR-AM enabled the direct purchase of proteins and processed vegetables from indigenous peoples with surplus production, generating income and reducing FNI in the region 29 .
The states of Maranhão, Espírito Santo, Minas Gerais, and Rio Grande do Norte have not launched specific plans to address the pandemic regarding the PAA 30 .

Discussion
The Covid-19 pandemic posed unprecedented challenges for food systems worldwide. The economic and social crisis associated with the health emergency exacerbates social inequities and threatens FNS, driving the growth of poverty and revealing the imminence of the hunger crisis 31,32 .
The effects of the pandemic for those already living in FNI, such as people living on the streets, those below the poverty line, most of the rural population, and traditional peoples and communities, can be "catastrophic", with reduced access to food and income required to acquire other essential items, increased social tensions and conflicts, migration, violence, severe malnutrition, and death 31 .
International entities and agencies point out the need to develop actions in three central areas: a) maintain the supply of food to the population, also adopting measures to facilitate the flow of food produced by small producers; b) support the most vulnerable, ensuring access to production forms and adequate and healthy food; c) invest in sustainable and resilient food systems 31,33 .
In Brazil, the health crisis emerges in a scenario of worsening social indicators and the dismantling of public policies, such as those of social protection and labor. Several factors aggravate the pandemic's impacts and are linked to structural causes of hunger and malnutrition, such as land grabbing, use of pesticides, promotion of ultra-processed and processed foods, privatization, and financialization of the health sector and increased inequalities 34 . The country is experiencing a moment of economic stagnation and paralysis of FNS programs, which increases the vulnerable population, requiring the government to adopt measures to protect these groups.
While important, limitations were recorded in the initiatives adopted and the data available on state and municipal governments' websites. In general, information is made available as news, dispersedly, often without stating the legal provision that establishes and regulates it.

Government income transfer programs or minimum income programs
The consequences of the pandemic on food systems particularly affect the most destitute, who spend a significant share of their income on food, a situation that tends to deteriorate with increasing underemployment and unemployment resulting from the pandemic, which affects the supply and acquisition of food 35 .
This reinforces the importance of structuring specific policies to ensure that quality food reaches the population and that mainly small producers have access to a minimum income during the pandemic, investing in the structuring and strengthening of comprehensive and universal social protection systems 32,35 .
Although the main initiative adopted by the Brazilian Federal Government was the financial transfer to the poorest, as in other countries affected by the pandemic 35 , difficulties in accessing emergency aid were observed. One refers to the requirement to register online to obtain the benefit, although 26% of Brazilians are not connected to the Internet and 16% of illiterates or those with low education do not use the Internet 36 . Likewise, 46 million Brazilians live without a banking account, Internet access, and an active Individual Taxpayer Registration (CPF), hindering access to applications or money withdrawals from banks.
Also, the President vetoed the payment of aid to vulnerable groups, such as artisanal fishermen, family farmers, land reform settlers, taxi drivers, drivers, and application deliverers 9 . In August, the payment of benefits to family farmers was prohibited during the pandemic, escalating the risk of hunger in this group 37 .
Another problem refers to the delay in paying the benefit to those who managed to comply with all registration requirements. A survey of favela residents in all Brazilian states reveals that, until June, 41% of those who applied for emergency aid have yet to receive any installments, and 80% of households are surviving on less than half the income they had before the pandemic 38 .
It is necessary to adjust the requirements for obtaining aid according to the particularities and limitations of these groups. For example, traditional peoples and communities, who already live in severe FNI, struggle to access technology and travel to receive the values they are entitled to. Therefore, it is important to structure alternatives such as extending the deadlines for withdrawing benefits, and facilitating access in remote areas, guaranteeing their social and social security rights 29 .
The Federal Public Ministry (MPF) filed a public civil action to adopt emergency measures in favor of indigenous peoples, quilombola, and traditional communities in Amazonas to facilitate access to social and social security benefits granted by the Federal Government, to ensure FNS to these groups while social isolation measures are in place due to the pandemic 29 .
The essentiality of granting emergency aid and continued cash transfer social programs is reiterated since this money moves the economy and ensures food purchases.

National school Food Program
Due to schools' closure in at least 197 countries, more than 369 million children are not receiving school meals globally, and 40.1 million are Brazilian 39 . In some regions, schools' closure has reduced access to food for children or replaced school food programs with inadequate food supply 34 .
The purchase of food from small producers and or associations to ensure the continuity of the distribution of meals to students during school closure is one of the main measures recommended to mitigate the impacts of the pandemic 33 . Compliance with the nutritional parameters established in the PNAE and the maintenance of public food purchases from family farms is vital for providing adequate and healthy food to schoolchildren 40 and the disposal of production and generation of income for farmers.
In Brazil, despite the transfer of financial assistance to households to facilitate logistics to assist students, the measure does not ensure access to the best food concerning quantity and quality. In several cases, financial aid is limited to some accredited establishments and does not compare to the possibilities of large public bulk purchases 41 .
The focus at the expense of universal assistance to students in several states is also a concern. The escalating economic crisis caused by the pandemic has led many households to poverty and extreme poverty. It is estimated that most of these are not even registered in CadÚnico, which excludes them from access to emergency assistance measures, such as school meals in some states and municipalities 42 .
These limitations prevent broad access to the program and quality food. Also, no PNAE-related measures were observed in some states and capitals, raising concerns about FNS.

Food distribution
The distribution of food through social programs, particularly in Latin American countries, has ensured food for millions of low-income households, mainly through the distribution of meals and income to acquire food 43 .
Among these strategies, the PRs stand out as assistance providers from some states and mu-nicipalities to people living on the streets and low-income workers. With the pandemic, the PRs became even more strategic FNS equipment to the vulnerable public, showing the importance of expanding the initiative and investing in its continued financing. The country currently has only 135 PRs serving up to 1,000 meals/day 19 , an insufficient number to meet the demand. Identifying a few community kitchens and food banks exposes the underutilization of FNS equipment in states/municipalities.
As for staple food baskets, the standardized food items are observed, mischaracterizing the local food culture, especially traditional peoples' singularities. The products in these baskets have been acquired through a Term signed with the Ministry of Women, Family and Human Rights (MMFDH), from the release of extraordinary credit in favor of the Presidency and some ministries. Of the R$ 639,034,512.00 released, only 7.04% went to the MMFDH, whose actions to address the pandemic involve several initiatives, and the only one directly targeting FNS is "providing foodstuffs and hygiene of traditional peoples and communities" 44 .
For these peoples, the estimate is 323,400 staple food baskets during the pandemic, with no other purchases expected for the rest of the year. Although investments in assistance to traditional peoples have been decreasing annually, the Federal Government and CONAB have been distributing baskets 29 in the pandemic.
The provision of meals and food is recommended internationally as a strategy to maintain access to food in the pandemic, pointing out that governments must strengthen social protection mechanisms and emergency food assistance programs. However, the distribution and subsidies for food and ready meals continue as a specific strategy to assist specific groups, characterizing actions directed to consumption without interfering in the production chain. This initiative could even reduce the impacts of social inequities but acts superficially on the causes of inequalities 45 .
Many of the actions implemented were established through public-private partnerships (PPP), with donations from civil society anchored in the third sector, in processes sometimes permeated by conflicts of interest and disregard for labor legislation 46 .
Still regarding the misuse of resources, in Pernambuco, FCP use for purchasing staple food baskets is investigated due to the suspected recruitment of a shell corporation 47 . In Alagoas, the use of the FCP was only under political pressure from the Legislative Assembly and civil society organizations on the Government 48 .

Food Acquisition Program
Food supply through government food purchases is an important strategy for promoting FNS, strengthening local and regional circuits and marketing networks, valuing biodiversity and organic and agroecological food production, encouraging healthy eating habits, and promoting cooperatives and associations. Its link to initiatives such as PNAE minimizes the crisis generated by the pandemic, assuring fresh food to the vulnerable population. These strategies secure the distribution of family farming production, given that access to markets has been deeply affected by the pandemic. Similar measures have been recommended internationally and involve logistics to stabilize the supply of products from family farming, guaranteeing transport and sales of food and minimizing exposure to the virus 33,43 .
Although the PAA has great potential to reduce FNI, the program is underused. For example, seed acquisition was operationalized in some states, but not as a strategy to address the pandemic. To ensure FNS in the Covid-19 context, international organizations recommend that the modality be a priority action 31 .
The purchase with a simultaneous food donation generates income for family producers and serves entities and organizations to promote FNS. This initiative is not specifically aimed at addressing the effects of Covid-19, as it generally refers to pre-pandemic contracts.
PAA is one of the main policies to support and encourage Brazilian family farming, and the increased government incentives to consolidate it should be a priority. Faced with the need to strengthen public procurement for rural social and productive inclusion, the Ministry of Citizenship has proposed distributing an additional budget to face the crisis generated by the pandemic between PAA-Milk and purchase with simultaneous donation 49 .
Unlike direct food donation initiatives, PAA generates income, respects food culture, promotes sovereignty, encourages the consumption of quality food, strengthens short production and consumption circuits, and fosters territorial development. These characteristics make the program turn into the greatest potential to promote "regular and permanent access to quality food, in sufficient quantity, without compro-mising access to other essential needs, based on health-promoting food practices respecting cultural diversity, which are environmentally, culturally, economically, and socially sustainable", rights provided for in the National Food and Nutritional Security System 50 .

Final considerations
It became evident that Brazil's government measures are insufficient to prevent FNI due to the pandemic. Considering the initiatives contributing to FNS, there was a prevalence of actions aimed at consumption in the country, without interfering in the production chain. The need to provide specific assistance to higher vulnerability groups, compatible with socio-territorial differ-ences, was also highlighted, ensuring that specific nutritional needs are fully met.
The health crisis reveals the violation of fundamental human rights, such as the human right to adequate and healthy food, exposing the profound injustice of the food systems, and the need to structure public policies that ensure the supply of food and sufficient conditions for sustaining human dignity, regardless of gender, skin color/ ethnicity, and class issues.
The pandemic highlights the urgent need to adopt coordinated measures at the global, national, and local scales to prevent the impending humanitarian and food crisis, particularly threatening highly vulnerable groups. Social protection initiatives must be implemented and strengthened, ensuring full access to healthy and adequate food.

Collaborations
AM Gurgel worked on the conception and design of the work; provided substantial contributions to data collection, analysis, and interpretation; worked on preparing the manuscript and critical review of the intellectual content and in the review and final approval of the submitted version. CCS Santos provided substantial contributions to the collection, analysis, and interpretation of data; worked on preparing the manuscript and critical review of the intellectual content; and in the review and final approval of the submitted version. KPS Alves, VS Leal, and JM Araujo provided substantial contributions to the collection, analysis, and interpretation of data; worked on preparing the manuscript, and in the review and final approval of the submitted version.