المشاورات

Nutrition-sensitive social protection programmes around the world – What’s being done and to what effect?

SecureNutrition and FAO's FSN Forum are partnering for the second time in order to host this online discussion in conjunction with the Global Forum on Nutrition-Sensitive Social Protection Programs in Moscow, Russia (September 10th – 11th 2015).

The purpose of this joint effort is to take stock of what countries around the world are doing in the area of nutrition-sensitive social protection – their successes and their challenges - and to provide a mechanism for stakeholders globally to engage in the dialogue and exchange experiences and lessons learned. The outcome of this online discussion will be used to enrich the discussions at the Global Forum and beyond. More information about the Global Forum is available at: https://www.securenutritionplatform.org/Lists/Events/DispForm.aspx?ID=300

Key documents describing the linkages between nutrition and social protection that undergird the Global Forum are linked in the Resources section.

Background

Social protection programs are dynamic components of the budgets of most countries, and in low and middle income countries their share of government expenditures has been growing more rapidly compared to investments in other sectors.  By the beginning of 2015 1.9 billion people were enrolled in social safety net programs in 136 countries. 

The large number of programs reveals the complexity of social protection programs; an average low income country has 20 different social protection initiatives. Cash transfers alone have been credited as supporting between 0.75 billion and 1.0 billion people in low- and middle-income countries at the end of the first decade in this century; more than one quarter of the rural poor and roughly one fifth of the poor in urban areas received some cash assistance.  Two countries had introduced conditional cash programs in 1997; that number grew to 27 by 2008 and to 64 by 2015, many of these running as pilots or otherwise localized projects.  The number of countries in Africa with unconditional cash transfers doubled from 20 to 40 between 2010 and 2015. 

Social protection expenditures cover both programs that can be classified as social assistance, or safety nets, as well as programs categorized as social insurance—including contributory pensions and unemployment assistance. Both types of social protection programs can contribute to increasing current consumption as well as long-term capital, thereby reducing poverty and improving social equity.  They can also enhance human capital, and particularly nutrition.[1]

Nutrition and Social Protection[2]

Nutritional status reflects the interplay of food consumption, access to health and sanitation, and nutrition knowledge and care practices. When child nutrition is improved the risk of mortality is reduced, future human capital is built, and productivity is increased. Yet, evidence shows that economic growth will only reduce malnutrition slowly. Investments in nutrition and early childhood development are therefore key determinants of long-term economic growth, and are increasingly recognized as integral components of a coherent social protection system to prevent the intergenerational transmission of poverty.

Social protection programs typically increase income (linked to food access), as well as influence the timing, and to a degree, the control of this income. Additionally, such programs may have greater impact on nutrition by fostering linkages with health services or with sanitation programs, and specifically through activities that are related to nutrition education or micronutrient supplementation. By taking into consideration the window of opportunity - the “1,000 days” from a woman’s pregnancy through her child’s 2nd birthday - for investing in nutrition, social protection programs can be targeted to enhance their impact on nutrition and lock-in future human capital.

As the number and complexity of social safety nets globally has grown over the past twenty years, so too has interest in making them work better for nutrition. Related initiatives by many development partners are underway around the world. Through the Global Forum and this online discussion, we aim to take stock of current nutrition-sensitive social protection programming, and understand what’s working, what’s not working, and what the challenges are in design and implementation.

Discussion questions

We would like to hear your comments on the following guiding questions:

  1. Setting the stage: Why are you interested in Nutrition-Sensitive Social Protection?  What is Nutrition-Sensitive Social Protection? What makes a social protection intervention “nutrition-sensitive”?
  2. Nutrition-Sensitive Social Protection Programs: In your country, what nutrition problems are being tackled through social safety nets or other social protection instruments/programs? What type of program(s) are being implemented and at what scale?
  3. Nutrition-Sensitive Aspects: To what extent is this/are these intervention(s) nutrition-sensitive? What makes it/them so? What is working well? What are some design and implementation challenges?
  4. Institutional arrangements: Which agency (e.g. health, social welfare, a special agency) is in charge? By whom is it delivered: health workers, social protection agents, volunteers, special agents? Are there policies in place that either foster or hinder such cross-sectoral collaboration?
  5. Monitoring and Evaluation: Are you evaluating the effectiveness of these programs on nutrition outcomes? What have you found? What are the challenges? What are the criteria of success?

We look forward to your contributions to this online discussion and support to share it widely within you professional networks.

 

Lucy Bassett 

Social Protection Specialist 

World Bank
Ahmed Raza

Nutrition Specialist

FAO
 

[1] Nutrition and Social Protection: Background paper for the Global Forum on Nutrition-Sensitive Social Protection Programs, Harold Alderman (Próxima publicación, 2015)

[2] Improving Nutrition through Multisectoral Approaches – Social protection, World Bank (2013)

 

 

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Dear all,

Many thanks to our early contributors. I am just back from Guatemala, and was looking first-hand into how to deliver nutrition services to the most vulnerable. Some of what is discussed resonates already.

Inherent to many discussions of social protection are issues around human rights, respect, and equity. Who is included? Under what criteria? In what locations? Do the programs fundamentally impact their dignity? Should we even *need* programs?

In fact, the scope of this conversation is at its core about experience, and the opportunity here through the FSN Forum and in-person in Moscow is to examine how we can collectively increase quality of life across multiple fronts. Thanks for the comments on food education and measurement of nutrition outcomes, which are examples of things we need to think about in more detail.

These conversations, and the questions included here, reflect an identified need to link nutrition and social protection programs. We often discuss ways to ‘reduce the equity gap’, and this is one of them; what we anticipated when putting this discussion together, is a way to compare, contrast, and share ways that address the roots of malnutrition better than has been done. There is an old proverb saying, “If you want to go fast, go alone. If you want to go far, go together.” While the FSN Forum may not be a channel reaching directly to those affected by the programming, it is a powerful tool to reach many outside the ‘ivory towers’ who know how to improve programming. We are convening as a global community, taking a small slice of a much larger issue, and pushing forward together.

We look forward to remaining weeks of this discussion (and hope to see more contributions from social protection experts)!

Though posts have been few so far, we have had a really interesting spread on this really interesting subject, and I have appreciated all of them very much. The pictures of the children and the eggs were especially nice  - thank you, Dr Emal,  and thank you for telling us a tale where the eggs went into the family meals and not just to the market.

Social security schemes seem to be a foundation stone of social democracy and I don't see a lot of difference from social protection schemes (maybe someone can correct me).  However, I'm bypassing the question of whether such strategies should be put in place by governments to redress inequity.  I am also risking the wrath of Claudio Schuftan by flying the flag for food education, which in my vision is everyone's birthright, especially in view of the nutrition transition and the present power of Big Food. 

Bringing social protection and food education together, I would like to raise three points:  

The first, which now has quite a lot of supporting evidence, is that many interventions aiming at increasing food security (including social protection handouts, food vouchers, income generation, agricultural projects etc.) fail to have a significant impact on nutrition status because they simply enhance existing inadequate dietary profiles and patterns of household expenditure. Adding a little food education to the mix can significantly tilt the outcomes of such actions towards better family diet. The best-known case in social protection is probably that of SNAP in the USA, which found it necessary to create SNAP-ED to introduce the missing education component.  

The second is about how we measure nutrition status.  In one major social protection scheme the indicator selected was dietary diversity. This was shown to be increased by regular cash handouts, mainly because most households enjoyed their higher income by eating more meat. This was all to the good, but they did not at the same time eat more fruit and vegetables, in which their diet was also deficient, and which were equally important to improving nutrition status, nor was dietary varied assessed.  Meat generally has status in poor communities and vegetables do not, while fruit is often regarded as a non-food, nice but not necessary.  I am asking if our indicators are sufficiently sensitive to the concept of a good diet.

My third question is Why are we not hearing from the social protection people?  

Jane Sherman, nutrition education consultant, FAO

Dear FSN-Moderator,

Attached please find an article on Innovative Backyard Poultry Development for increased assets, income and nutrition, which is in line with "Nutrition-Sensitive Social Protection Programs Around the World – What’s being done and to what effect?.

Best regards

Dear Lucy and Ahmed,

My serious concerns on the matter of this consultation all revolve around question 1.

1. Setting the stage: Why are you interested in Nutrition-Sensitive Social Protection? What is Nutrition-Sensitive Social Protection? What makes a social protection intervention “nutrition-sensitive”?

Your intro piece has, in my view, multiple flaws that will bias the consultation. Let me explain in the form of bullets.

You call for:

Making social safety nets and targeting work better. Safety nets have been designed to throw a crumb of bread to the needy without pulling them out of poverty. So we target ‘the poor’ (grr!) and do nothing about the system that perpetuates their poverty. Ultimately and dispassionately, it is all about avoiding social upheaval that will threaten the haves.

Social protection. To improve social protection, it would be nice to start asking the affected what they think needs to be done, no? This is a fundamental human rights principle… I feel the call may be bringing responses from top-down initiatives around the world which will mostly be localized with little replication prospects.

Stakeholders. (grr!) Isn’t it high time we begin using claim holders and duty bearers instead?

Poverty reduction vs disparity reduction. When will we understand that the challenge is not poverty reduction, but disparity reduction? The pie is only so big; we do not need to make it grow with the same slicing; we must re-slice it far more equitably…. and nutrition-sensitive social protection will simply not do this.

Equity vs equality. You use equity where you should be using equality. Equity is a justice concept; equality is a human rights concept (and nutrition and social protection are HR issues).

Increasing productivity. For God’s sake, we are trying to deal with a HR issue. We do NOT need an economic justification. Nutrition and social protection are a high priority, because HR are being violated. Point finale!

‘Investments in nutrition and early childhood development are therefore (therefore?) key determinants of long term economic growth’.  Investing in nutrition is a HR priority, no more, no less. Forget the economic growth justification. Growth for what? for more 99/1? For more depletion of natural resources and environmental degradation and precipitating climate change? We simply have to stop using this fallacious argument.

‘Programs targeted (?? see above) to enhance their impact on nutrition and lock in future human capital’. Ayayay! More of the same…. Human capital is such a neoliberal term. What we need is to lock-in is the respect and fulfillment of, in this case, the human right to nutrition and the human right to social protection.

Activities related to nutrition education and micronutrient supplementation… Nutrition education to teach people what they cannot afford? We have over 4 decades of negative experiences on this. Micronutrient supplementation is a darling of donors….it does not require addressing the thorny issue of the political roots of malnutrition as stunting more does.

I hope this contributes early-on to guide the agenda of the consultation. If this perspective is not brought up in Moscow, we may as well stay in our ivory towers.

Claudio in Ho Chi Minh City

[email protected]