We (the Mainstreaming Nutrition Team, Nutrition Division FAO) have been following with great enthusiasm your contributions to the FSN discussions on Social Protection and Nutrition and we welcome the various proposals and suggestions of how to shape social protection programmes to maximise positive impact on nutrition security.
Good nutrition is a prerequisite for peoples’ good health, learning capacity and productivity. Taking into consideration how social protection schemes impact nutrition can therefore benefit the overall outcome of social protection schemes. Social protection can for example increase food expenditure, food consumption and dietary diversity via food, cash and voucher transfers and price subsidies, smoothing consumption during lean seasons and/or periods of crisis. But the implications of social protection programmes on nutrition go beyond the mechanisms related to food security.
Our team recently prepared a document on Social Protection and Nutrition, and we welcome you to consult the document on line: http://www.fao.org/fileadmin/user_upload/wa_workshop/docs/SocialProtection-Nutrition_FAO_IssuePaper_Draft.pdf. Please note that this is work in progress (draft version), and that we welcome any comments or suggestions.
Below, we would like to share some of the main points raised in the above mentioned paper:
Main issues for policy-makers to consider in the design, formulation and implementation of nutrition-enhancing social protection measures:
Good practices to foster cross-sectoral linkages:
We hope to pursue these discussions and the promotion of social protection for food and nutrition security in collaboration with you in the future!
Charlotte Dufour and Martina Park
on behalf of the Nutrition Mainstreaming Team
Nutrition Division (ESN)
Economic and Social Development Department
Food and Agriculture Organization (FAO) of the United Nations
I have few comments to add to the Social Protection if it is not too late:
Targeting to the most vulnerable population: these are children under 5 years, orphans, women in reproductive age, elderly, people living with disability (socially and physically), HIV and farmers/ fishers
In protecting the vulnerable, it is important to include the very people who depend on the environment or natural resources for their livelihoods: farmers/ fisher folk; herders/ pastoralists and rural poor mostly women and forest dwellers. Women of reproductive age and children are mostly affected by under-nutrition.
Women are also the primary care givers at the household and community levels and therefore need to be empowered. Free mosquito nets should be distributed to pregnant women, and dewormers giving to all children and women in reproductive age. Direct cash transfers alone may not always be the best, in addition, the poor households should be educated on the use of the cash transfers and the importance of nutrition for getting the household or family out of poverty. Vouchers could be given for the people to purchase essential food commodities from certain points. Schools enrolment and retention should be enforced for all children of school going age; and hot nutritious meals provided to the children. Such poor households should receive free medical care. Education on personal hygiene and nutrition should be given. Communities should also enforce construction of household latrines/ toilets. The social protection should also include/ cover good portable drinking water.
There is the need for entrepreneurship training for both on-farm and off-farm work, and funds allocated for the poor and vulnerable to engage in Income generating activities (IGAs). Planting materials/ stock should be provided as a start up together with other inputs. The On-farm could be crops and/ or animals especially small ruminants, and the off-farm could also be non-traditional farming : snail and grasscutter rearing, mushroom cultivation and other IGAs like basket/ mat weaving etc must be encouraged.
Supply of Basic needs: In addition to the cash transfer, food vouchers could be provided to be redeemed at designated shops or centers. Children should be enrolled in schools. People registered to receive special social protection should be registered for free medical attention and provided with cards. In addition, they should have access to energy and clean water sources.
Key institutional and governance challenges:
Best Practices and lessons learnt:
SOCIAL PROTECTION TO PROTECT AND PROMOTE NUTRITION
STRENGTHEN INSTITUTIONAL POLICY COHERENCE AND COORDINATION TO IMPROVE NUTRITION, MOBILIZE RESOURCES NEEDED TO IMPROVE NUTRITION
To design and put in place, or strengthen, comprehensive, nationally-owned, context-sensitive social protection systems for food and nutrition security;
To embrace a twin-track strategy to maximize impact on resilience and food and nutrition security;
To adopt human rights norms and standards to guide the process of elaborating social protection programmes for food and nutrition security;
To improve the design and use of social protection interventions to address vulnerability to chronic and acute food and nutrition insecurity;
Nutrition is an issue that is not just related to enhancement of production and having supply chain but it is more an issue of access to ‘right kind of food’ by the vulnerable population of each of the country and region. Access is used here in broader terms of not just access to food grains (protein and carbohydrate) but also capacity of body to assimilate the intake. Thus, the strategy besides enhanced production of agriculture produce and its distribution is to educate, assimilate and encourage the habits in the vulnerable groups in terms of cooking and eating habits, health and hygiene care and sanitation. It also covers opportunity to enhance the livelihood and income levels.
The approach therefore is multipronged with need to have holistic delivery mechanism converging all the aspects to ensure nutrition and eradication of hunger and malnutrition.
It is a cross-sectoral approach with multi-stakeholder partnership. However, it is easier said than done and therefore the strategy should be ‘Holistic Single Point Delivery Mechanism’. It is equally important that one shoe size does not fit all and thus there has to be enough space for local adaptation.
The challenge is therefore the recommendation that will change the policy, fund flow and implementation mechanisms to achieve the same. It is important that each country map their areas of concern and rank them in order of priority. Once ranked, the status will be to ensure focused mechanism to draft interventions with listed benchmarks for achieving the desired goals. This will enable intermediate course corrections.
The focus of this background paper is on design, formulation and implementation strategies for Nutrition Enhancing Social Protection Measures.
Design: The first step is to identify the geographical, social and ethnic class prone to nutrition deficiencies. The need is to map these deficiencies and list out the holistic steps to be taken with bench marks with dual goal of bringing those affected above the malnutrition levels and ensure no mal/under nutritional incidences in the identified groups.
The immediate response will be this is exactly what is being attempted since last number of years, but micro-evaluation will not corroborate the same. The incidences of mal/under nutrition are exactly failure of these designs where the holistic approach is not adopted and only fringe or isolated interventions are done.
Formulation: Thus the holistic design is to have a team of para-medics, nutritionist, food grain supplying agency, extension staff for habit change, sanitation focus and livelihood enhancement interventions. The list itself will reflect as to the gaps that are obvious where malnutrition interventions still persist. Thus, the design to be is to have a team leader at micro level with experts from the above listed subject matter and focus on interventions for each individual. There is need to maintain benchmark progress and modify interventions to achieve the ultimate objective of improvement in the nutrition levels and most important to make it sustainable. The livelihood opportunities are to focus on mass scale competitive quality production to sustain the competition in the market.
Thus, the country has to make the formulations as listed above at the micro-level of village as a unit and constantly ensure financial/manpower/technical flow of assets and information to the group.
Implementation: The major challenge is to translate the intention and policy into action and that is where real access to the vulnerable groups is assured. The implementation will only happen if there are accurate monitoring parameters. Each of the target beneficiary need to be monitored as each individual is unique in itself to assimilate the nutrition supplied, thus constant monitoring and freedom to modify and adapt will only ensure focused and quick results. Eradicating malnutrition is not a millennium level achievement if attacked as recommended it can show tremendous results and improvements in two to three years. But, the secret is in detailing, without micro level monitoring the years will roll down with under performance levels.
Dear ICN Moderator,
Please consider me as one of your correspondents. What are you doing is marvelous and great. I wish you good success for the preparation of ICN 2.
I would like to make the following comments:
1- It is surprising that in all the background papers I read, there was not a single one belonging to the Middle East and North Africa, as if there are no problems of nutrition in these countries. This is not the case as you agree with me.
2- Just to illustrate my point, I would like to send you a paper which I am going to present to the Workshop organized by the Ministry of Environment of Lebanon, in cooperation with the Forum Fancophone des Affaires (FFA), in Beirut, 10 August 2013. The title of the paper is:" Challenges of Food Security in Lebanon". I trust that this paper will shed some lights on food security and nutrition problems in my country and many Arab countries.
Social Protection to protect and promote nutrition
Reflections from HelpAge International
Submitted by Andrea Vilela (Social Protection Policy Adivser) and Tessa Vorbohle (Food Security and Livelihoods Adviser)
HelpAge International welcomes the focus on social protection as a key thematic issue to play into the preparations for the ICN 2. We welcome the shift to a more sophisticated understanding of the potential for social protection to enhance nutritional outcomes and recognise that there is rightfully a new emphasis on enhancing nutritional outcomes as social protection gains prominence as a preferred mechanism for delivering Aid and responding to crisis.
However, we are concerned that the concept note in its current state neglects the question that lies at the very core of the discussion: What concept of social protection do we apply? This bears the risk of falling back on dated conceptions of social protection that are instrumentalist and temporary in nature.
Despite recent high level support for rights based definitions of social protection as recognised by the G20, EU, Sociall Protection Inter-Agency Cooperation Board, and the Recommendation 202 on Social Protection Floors approved by 184 Governments at the 101st International Labour Committee in 2012, social protection still often tends to be interpreted in instrumentalist, short term and programmatic ways, entrenched in a safety net approach. Social protection floors are nationally defined systems that guarantee access to basic services and income security across the lifecourse.
The ICN 2 has a crucial role to play in highlighting the need for comprehensive rights based approaches to social protection such as national Social Protection Floors to protect and promote nutrition.
What are the main issues for policy-makers to consider in the design, formulation and implementation of nutrition-enhancing social protection measures?
A key consideration is ‘coverage’ and achieving political will for significant investments necessary to achieve comprehensive social protection. Policy makers should consider the importance of achieving a social protection for all that provides access to basic services and basic income guarantees across the life-course. The UN Special Rapporteur on the Right to Food states
“While the benefits of social protection are well acknowledged, they are too often unavailable. According to estimates from the International Labour Organization (ILO), seventy-five to eighty per cent of the world population does not have access to “comprehensive social security” protection to shield them from the effects of unemployment, illness or disability – not to mention crop failure or soaring food costs.” http://www.ohchr.org/Documents/Issues/Food/20121009_GFSP_en.pdf
A key issue for policy makers is to clarify the conceptual basis of social protection and close the space for ambiguity regarding objectives. The objectives of social protection should not be over-emphasise, or be reduced to individual outcomes. The emphasis is on achieving coverage and ensuring no-one is left behind. It is important not to overemphasise technical design options and programmatic responses at the expense of establishing comprehensive social protection floors.
For example the PSNP in Ethiopia is widely cited as a successful social protection programme and it is utilised as a modality for the National Nutrition Strategy which aims to reduce stunting by 4% in 2 years. However, despite being one of the largest social protection projects in Africa, the current coverage does not address vulnerable households in other locations, including those vulnerable to sudden onset shocks. UNICEF have also highlighted the need for social protection to cover urban areas where urban poverty is increasing. There have also been calls about the “need to move beyond a crisis agenda towards a longer-term solution to malnutrition”.
National social protection floors (rather than separate stand alone programmes) provide a framework through which the broad range of factors that impact on food and nutrition security can be addressed in a coherent way as well as meeting the twin track objective referred to in the concept note.
Another and partly related aspect is that of protecting and improving nutrition “throughout the lifecycle” as mentioned in the concept note. The right to adequate food applies to people of all ages. Yet, in reality, people in old age are invisible in nutrition statistics and are by and large excluded from programmes that address acute malnutrition. Moreover, regular safety net programmes seldom cater for the specific nutritional needs of people in old age. Adopting a rights based social protection approach to protect and promote nutrition requires policy makers to address this dimension of inequality
What are the key institutional and governance challenges to the delivery of cross-sectoral and comprehensive social protection policies that protect and promote nutrition of the most vulnerable?
The foremost governance challenge facing the expansion of social protection for all is an absence of political commitment and prioritisation of social protection by Governments. This is in part responded to through the international mechanism for social protection articulated by the Special Rapporteur on the Right to Food and the Special Rapporteur on Extreme Poverty and Human Rights in their call for a Global Fund for Social Protection. This is conceived of in recognition of the broad and high level international support for rights based social protection and the need to support low income countries who face administrative capacity constraints and highly instable export revenue dependency. There is more to be said on means of implementation and potential additional benefits of such an international social protection mechanism.
At the national level, HelpAge acknowledges and supports the observations of other submissions to this online consultation that emphasise institutional challenges and call for cross-sectorial dialogue on social protection policy and practice.
In your experience, what are key best-practices and lessons-learned in fostering cross-sectoral linkages to enhance malnutrition and poverty reduction through social protection?
There are promising experiences in many countries where inter-ministerial committees have driven the development of social protection policies to meet a range of interests (including nutrion security). These seem to work best where there commitment and leadership from Planning and Finance Ministries as well as utilise broad consultation mechanisms to ensure the inclusion of civil society voices and expertise.
With all this in mind, it is important not to overstate the role of social protection in achieving the nutritional outcomes sought at the national level. It plays a distinctive role in supporting increased consumption and supporting small holder farmers, but in reality targeted nutritional strategies are best build on top of a social protection floor. This might include complimentary programming but don’t let pursuit of perfection be the enemy of the good.
By this we mean, a focus on technical innovation and additional bolt-on’s can distract from the fact that coverage and investment in basic protection is a first step. Basic social protection is a blunt instrument to address many objectives – poverty elimination, redistribution, state building through governance outcomes and social dialogue – HelpAge therefore, in line with the Global Coalition for Social Protection Floors, encourages that the ICN 2 strongly endorses and utilises the language of the social protection floor as a basis for discussion and clarity on the subject.
“Social protection systems have the potential to contribute to the realization of basic human rights, such as the rights to food, education and health, and to combat systemic inequality. Building from this, social protection provides States a means to support marginalized groups, tackle the immediate problems of child hunger and malnutrition,”
 Taylor 2012
Having read with great interest the contributions of this forum, I realized that much attention is legitimately given to food security and agriculture. Tdh believes that addressing social protection in the health sector to tackle the burden of undernutrition is also of paramount importance.
Terre des hommes (Tdh), together with national and international partners steered since 2008 a strategy aiming at promoting child health and fighting acute malnutrition. Supported by the European Commission Humanitarian Office (ECHO), this strategy consist in eliminating health care user fee payment for the children under five and pregnant women.
The various phases of the implementation process, as well as Lessons Learnt & Best Practices can be found at the following link: http://www.tdh.ch/en/documents/freeing-up-healthcare-universal-access-to-health-care-for-children-under-5-and-pregnant-women.
In terms of results and impact, studies and researches (that also concern a similar project implemented by the German NGO HELP) have demonstrated that:
User fee exemption addresses the three main pathways through which social protection programs impact nutrition (as defined by the World Bank in ‘Improving Nutrition Through Multisectoral Approaches - Social Protection’):
It is worth mentioning that the same results have been obtained over the last year while Terre des hommes has handed-over most of the implementation process to District Health staff (though still funded by ECHO).
The Ministry of Health of Burkina Faso has conducted Feasibility study in order to estimate the cost of a national scaling-up of this strategy. It is now a matter of political will.
Design, Formulation and Implementation Considerations:
While social safety nets are rightly touted as an important way to protect vulnerable groups from food price spikes and other shocks, it is important to note that risk management activities for producers are often adversely affected by ad-hoc safety net programmes designed to support consumers. For example, untargeted staple food subsidies can divert government investment in warehouse receipt systems, commodity exchanges and other price risk management tools. In contrast, high quality, well-targeted safety nets grounded in broader social protection programmes deliver timely, multi-year, guaranteed and predictable transfers to the poor without undermining investment in risk management tools.
From a nutrition perspective, safety nets work best when they protect consumption by preventing decreases in dietary quality and quantity. Again, it is important to consider design, as staple food subsidies can create disincentives to dietary diversity. A second, but no less important, consideration is protection of income and livelihoods. The former is essential to protecting nutrition status in the short-term, while the latter is necessary for increasing longer-term resilience and decreasing risk aversion, both of which are essential to preventing coping mechanisms which can impact nutrition indirectly.
In regards to formulation and implementation, the World Bank’s Global Monitoring Report 2012 includes “building blocks” for effective social protection programmes, as listed below. Many have already been cited by other contributors to this forum:
In regards to best practices and lessons learned:
Cash transfers have been repeatedly shown to improve child growth and increase both total household food security and dietary diversity. However if inflation is high, food transfers may be a better choice than cash.
School-feeding programmes in developing countries can include a meal at school and take-home rations. Both have been shown to improve nutritional status, not only for schoolchildren but also for their younger siblings. However, costs may prove prohibitive, for example in some low-income African countries school-feeding programmes have been shown to be on par with basic education costs. Moreover, implementation may be difficult in remote areas, reducing cost-efficacy. That said, in terms of design, school feeding programmes are easy to scale up during a crisis. On balance, it is unclear whether the costs of implementation outweigh the benefits
Cash-for-work programmes are naturally self targeting and as such offer a good delivery platform for a nutrition component. This can include nutrition education, regular home visits by community health and nutrition workers and distribution of food supplements during the lean season. Ideally, the nutrition component leverages the effects of the additional income provided by the programme to improve intake. Including a nutrition component in cash-for-work schemes can also increase the chances that female employment has a net positive effect on child welfare.
This contribution draws on The Impact of High Food Prices on Nutrition (Meerman & Aphane) posted on the ICN2 website. Full references for the 2012 World Bank GMR as well as other articles and reports which informed this contribution may be found in the paper.
Les mots « Vulnérabilité, fragilité, précarité, pauvreté, malnutrition, insécurité alimentaire » peuvent être classés dans une même case, car ils produisent plus ou moins les mêmes effets. Mais d’où proviennent-ils ? Ils proviennent des maux « sécheresse, ravageurs de récolte, infertilité des sols, réduction surface cultivée, conservation inadéquate des produits agricoles, utilisation des outils aratoires, problèmes fonciers, faible revenu, indisponibilité des actifs due à des maladies et à l’exode rurale, problèmes d’hygiène et assainissement, logement, enclavement et ignorance sur la diversification alimentaire». Ces maux se rencontrent le plus souvent dans des endroits défavorisés « Bidon ville, zones rurales »
Fort de ce qui précède, le combat du renforcement de la nutrition doit se faire d’une manière holistique. Prendre en compte :
- Financement de la recherche agricole
- Formation des chercheurs : mettre fin au critère d’âge dans les programmes d’attribution de bourse concernant le Master et le Doctorat
- Création des comités locaux pour le foncier
- Création des banques nationales de crédit agricole avec simplification d’accès aux crédits pour les femmes
- Création des Ministères de la ville avec une des prérogatives « l’hygiène et l’assainissement des villes »
- Les agences du Système de Nations Unies doivent renforcer la collaboration avec les Gouvernements et les ONG.
- Construction des logements sociaux
- Lutte contre les maladies transmissibles (VIH et autres qui déciment les actifs et les chefs de familles)
-Education nutritionnelle : utilisation des médias, des réunions de démonstration culinaire des mères etc.
Adèle Irénée GREMBOMBO
Ingénieur Agronome Nutritionniste
Consultante Indépendante en Nutrition
I would beg to jump in on these last days to share a little bit of my experiences in a Food Transfer Based Program designed to cushion producers from asset loss and guarantee food consumption. I thank the moderator and those who have contributed the wealth of experience already shared.
What are the main issues for policy-makers to consider in the design, formulation and implementation of nutrition-enhancing social protection measures?
Nutrition experts will agree with me that even when food is available consumption patterns, intra-house household food allocation, preparation methods and storage have an impact on how the available food can impact nutrition. Food supply, voucher systems and cash transfers assumed to impact nutrition without accompanying behavior change are unlikely to achieve the changes that need to be attained in reducing under nutrition in many developing countries.
In Ethiopia the Productive Safety Net Program is designed to prevent the loss of productive asset loss at the same time smoothing consumption. This program has made admirable steps in addressing both of these aspects and resulted in great enhancements in productivity of land and quality of natural resources.
Commendable as this may be questions linger over how improved production, incomes, protected assets and even direct food transfers have resulted in nutritional impacts. Studies on how this have come together point to a number of areas of considerations:
1. Clear Linkages with the National Nutrition Program. Where there has been a clear connection between food transfers and Therapeutic Feeding Programs, the Health Extension System and other health and nutrition promotion activities, positive changes are noted.
2. Determination of non-food causes of under-nutrition: Water health and sanitation and health care are the other key determinants of nutritional outcomes besides food security. any program aiming to have an impact on the nutrition will need to interrogate these other determinants and ensure that there is a clear link. Examples from Ethiopia include food for work activities that promote clean water provision, construction and connection to health posts for safety net beneficiaries.
3. Transfer Values, Timing, Targeting and Delivery. Transfer programs often address overall situations eg population level 50% lack of food 3 months a year. It is however the case that households have different gaps and needs. Designs that bring this on board are paramount to ensure that enough transfers are received by all. There is initial good progress in this approach in the variable wage rate and transfers in Ethiopia's PSNP. On the same note, targeting, delivery will need closer consideration to reduce time and effort it takes in collecting transfers in themselves.
1. Institutional - Governments often plan resources under one ministry, line, bureau and department and the bureaucracies then set out to achieve their individual targets almost in competition. This package of the household in compartments eg. economic development differentiated from health or education is a regular pitfall. Growth indicators that don't connect health, education, income etc into one target that each player targets often leads to successes in one being drained by an unmatched focus in the other.
2. Related to above , the delivery of the programs happens at district and lower levels. well written and intended programs with potential for good impact are often watered down as they go through the hierarchy. The fault could be juggled across the layers but often times a district province, village responsible has on his plate political tasks, security etc., and yet needs to ensure success of an ambitious.
In your experience, what are key best-practices and lessons-learned in fostering cross-sectoral linkages to enhance malnutrition and poverty reduction through social protection
when social protection programs sit in a core government department and or ministry with a steering committee of major players, clear synergies and efficiencies are created. Packaging is as important as the contents, good programs can be watered down by sitting in the wrong line department based on political goodwill and perceptions on importance of the department.
Thanks all and looking forward to final recommendations from the conclusions of this thought provoking discussion about a very real and current development agenda.
This week we move on to the final question for our discussion.
In your experience, what are key best-practices and lessons-learned in fostering cross-sectoral linkages to reduce malnutrition and enhance poverty reduction through social protection?
Your contributions on the key best practices can cover the key policy, design and implementation factors that enable successful cross sectoral linkages for nutrition sensitive and poverty reducing social protection policies.
Your contributions should discuss any/or all the sectors that you feel should be linked with social protection to reduce malnutrition and enhance poverty reduction. e.g. health, agriculture, education, finance ministries, private sector, CSOs, CBOs, donors, UN etc
Please feel free to cite case studies, impact evaluations and also identify and share lessons learned from successful or failed cross sectoral social protection policies that promote nutrition.
Links and resources:
Concept note on social protection and nutrition
Social Protection for Food Security HLPE Report
Improving Nutrition through multisectoral Approaches – Social Protection
Talking points on social protection and nutrition, Centre for Social Protection
Post-2015 Development Agenda - Joint Chairs and co-Leads Synthesis Report
TST Issues Brief: Food Security and Nutrition
Lancet article on maternal and child nutrition