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Re: Social protection to protect and promote nutrition

Nyasha Tirivayi facilitator of the discussion, FAO, Italy

Dear participants

Thank you for a lively and insightful discussion last week. Here is a summary of last week's contributions.

The guiding question for last week's discussion was: What are the main issues for policy-makers to consider in the design, formulation and implementation of nutrition-enhancing social protection measures?

Here were your contributions

  • Include clear nutrition goals and actions in the programs.
  • Consider the different environment, cultures, gender and age and the economic capacities of the different social groups.
  • Complementary?
  • Promote access to clean water and reduce the incidence of water borne diseases as they adversely affect nutrition.
  • Linking the transfer to health and/or education conditions may increase the nutrition impact of social protection programs.
  • Extension and agricultural advice plays an important role in supporting women to food security for their families. Would be useful complementary intervention to nutrition enhancing social protection
  • Obesity
  • Also address the other side of malnutrition i.e. obesity and the consumption of sugars, additives and other non-nutritious foods
  • Consider reforming the food price system in developed and middle-income countries by increasing the retail prices of food to prevent over eating and reduce overweight/obesity outcomes. Can be achieved by increasing taxes of retail food prices and ploughing back the revenues into social protection systems for the poorest.
  • Re-designing school feeding programmes to take into account the growing risk of obesity.
  • Eliminate corruption and misuse of resources in the process of designing, formulating and implementing social protection programs.
  • Take into account the sustainability of these programs without compromising the well being of the beneficiaries. This can be achieved through favoring asset holding, income generation and social justice for the beneficiaries.
  • During administration of cash transfers, use electronic means of delivery such as cash withdrawal cards or telephone money transfer systems so as to minimize risks of rent-seeking behaviour in the administration.
  • Avoid mistiming social protection interventions such that they divert labour away from food production activities e.g. public works… or food aid which can discourage local food production and trade
  • Targeting
  • Increase social security coverage especially for women e.g. only 10% of the rural women /girls and children of Georgia  have adequate social security coverage, and more than 90% have none.
  • Experience from CCT in Latin America suggests that positive nutrition outcomes may be greater when the social safety transfers cash and a fortified food for groups with high nutrient needs (pregnant and lactating women and young children).
  • While targeting young children is critical, other population groups have consumption needs e.g. older children and the elderly. And for equity reasons they need to be addressed. But with few resources available, there is need to balance between the twin priorities of equity and efficiency.

Questions to the contributors: Summary of Answers

  1. Studies have shown that the first 1000 days of life are a crucial window for preventing irreversible undernutrition like stunting. Yet other research rebuts this position by showing that catch-up growth is still possible even after the first 1000 days of life. From your experiences, who should we target when implementing nutrition enhancing social protection measures? Under 3 years or over?

    Near consensus that the critical window for targeting nutrition-sensitive social protection programmes for children under 3 years or within the first 1000 days of life and for pre-conception women and girls. Others noted that recent literature shows that there is catch up growth after the 1000 days period, though there is little evidence at scale up, these programs would be as effective as during the 1000 day period. Cost wise, targeting the first 1000 days of life would be more efficient than after. For instance food supplements have been shown to be more effective during weaning than after. Addressing stunting after second birthday may increase obesity and risk of chronic disease in adulthood. But, recent literature also shows there is potential to effectively improve cognitive and socio-eomotional skills after the first 1000 days of life.

  1. Should we only always give cash or food transfers to women?

    Overall, there consensus is that when women are the recipients of the social transfers, there are nutrition and food security related benefits to the household, especially to children. Some contributors feel that cash transfers work better than food transfers. However, others point out that social transfers oftern have multiple objectives and gender targeting or non-gender targeting might fulfill an objective but not necessarily enhance nutrition. Targeting of the transfers might also depend on the household’s commitment to the diets of pregnant and lactating women and young children. If the commitment exists, the control of the transfer would be dependent more on the additional objectives of the social safety net programme (such as women’s empowerment, self-confidence, etc).

  1. Should we only always target the poorest? Rural households? Or should we consider universal social protection schemes?

    The poorest and most marginalized are the popular target group for the contributors. This was defined by one as those least able to access goods and services (which may be rural households, but this not a general rule as urban populations can be greatly affected by inequitable access or lack of quality services). However, others point out that it is very challenging to reach the poorest and most excluded as such to minimize the risks for low institutional capacity, would be better to have universal coverage.

  1. Recent research shows that stunting has far reaching consequences even affecting income earning capacities in adulthood and on a national scale leading to two –three percent losses in GDP (Bhutta, Sachdev et al. 2008). In that case, should we prioritize eliminating stunting over wasting or underweight? Or we should not prioritize one over the other?

    One contributor would prioritize the elimination of stunting. Another urges caution and argues that since interventions would be context specific, it doesn’t seem appropriate to suggest prioritization of one over the other. They also argue that children with acute malnutrition are at immediate risk of mortality while the mortality for stunted children greater in absolute numbers. Social safety nets or transfers cited as nutrition sensitive interventions as they operate at scale and target the poorest (The 2013 Lancet Series -Ruel et al- Paper 2). Another contributor argues that wasting is transitory and usually addressed by non-social protection measures unlike stunting which is chronic.  Social protection programs targated to poor families with children would likely address both stunting and underweight.

  1. What are some of the lessons you have learned, best practices concerning social protection measures implemented to enhance food security and nutrition? E.g. cash transfers
  • Rwanda. Girinka “one cow per family” programme. A livestock transfer programme, where a poor family receives a cow for free on condition they give the first female calf (cow offspring) to their neighbor. Programme increased milk supply and consumption to beneficiaries and non-beneficiaries.
  • Ethiopia. The successful integration of Infant and Young Child Feeding practices into  PSNP has been done through behavioural communication change approach, addressing social norms and via community based delivery.
  • Ethiopia. Fresh food vouchers programme where vouchers are exchanged for locally sourced fruits and vegetables and eggs. Programme successfully improved dietary diversity and promoted the consumption of fruits and vegetables.
  • Malawi. Mchinji Social cash Transfer scheme. At the household level, the analysis shows a substantial impact on household food and non-food expenditure as well as a shift in the consumption preferences towards better nutrients. At the individual level, we find children of age 0-5 residing in beneficiary households being, on average, taller compared to the control group, which translates into a significant reduction in the stunting rate among children. Further, we find that the programme positively affected food consumption out of own production and that children living in families experiencing a shift toward home production of foods, such as meat and fish, dairy products and pulses benefitted more in terms of nutritional outcomes.