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Re: Social protection to protect and promote nutrition

Mr. Pankaj Kumar Ethiopia
11.06.2013
Pankaj

Dear Moderator,

We would like to add our contributions on on-going debate to  social protection to protect and promote nutrition. We had two examples from Ethiopia which states how nutrition can be incorporated into  existing social protection programmes, or social protection programmes can become nutrition –sensitive.

First example is Integration of Infant and Young Child Feeding in to Productive Safety Net Programme (PSNP) of Government of Ethiopia, and second is promotion of Fresh Food Voucher as a nutrition sensitive social protection measure.

Integration of IYCF into PSNP programme

Three years ago, Concern Worldwide documented the poor nutritional situation in Ethiopia and the multiple obstacles hampering previous efforts to improve it. It concluded that a multi-sectoral approach to improve infant and young child feeding (IYCF) practices and to increase access to food were among the responses needed. The project also aimed how two national programmes of Government of Ethiopia- National Nutrition Programme (NNP) and Productive Safety Net Programme (PSNP) can be brought together which works in same geographical area with more or less similar targets. In 2010, the IYCF – Productive Safety Net Programme (PSNP) project was launched as a pilot multi-sectoral approach aimed at reducing malnutrition in Dessie Zuria. It targeted poor households enrolled in the existing PSNP as well as the general population and addresses both the direct and root causes of malnutrition. The project aimed to develop an effective, sustainable and scalable model to improve IYCF practices in the most vulnerable households. The final results have been impressive, with large improvements in IYCF practices and a positive response from the communities and stakeholders involved in the project.

A number of factors contributed to the success of the IYCF – PSNP project. The project took a multi-sectoral approach, involving actors across a wide range of groups and sectors. It went beyond simply behaviour change communication, targeting the enabling environment as well as social norms, and involving the community at large. The project used multiple platforms and approaches to disseminate messages, and used a targeted approach to behaviour change, basing project activities and messages on formative research and emphasizing simple, do-able actions rather than health education messages.

  • Multisectoral approach: This project engaged actors from a range of sectors, including agriculture, education, women’s affairs, and health. This aspect was described as a key strength of the project, with each sector working together towards a common purpose, leading to increased ownership and accountability. A multi-sectoral approach also provides greater opportunities for engaging with communities. Cooking demonstrations, school clubs, and agricultural support were all combined to provide an overall aim of preventing malnutrition among children.
  • A multi-level approach: As well as working across sectors, the project also created strong links between woreda, kebele and community levels through a cascading style of training and through the continued provision of support and supervision.
  • A social and behavioural change approach: Early assessments showed that simply providing behaviour change communication alone was unlikely to be effective, given widespread food insecurity and other barriers to behaviour change. This project went beyond simply carrying out BCC, to influencing the community and social norms as a whole, as well as addressing barriers to practicing recommended IYCF behaviours.

The results of this project suggest that it is effectively fostering behaviour change, and  increasing levels of awareness among woreda officials, kebele level leaders and community members alike. It has differed from previous efforts to reduce malnutrition because it has shown people how to make simple, practical changes and reinforced the messages through a multitude of actors, contact points and methods, vastly increasing the likelihood of behaviour change. It is also focused on prevention of malnutrition rather than cure. The approach has been able to reach a large number of people who are widely dispersed over challenging terrain. Channeling activities through the PSNP creates additional contact points and ensures targeting of the poorest households.

Experiences from this project was recently presented in an International Conference on Child Under-Nutrition, organized by UNICEF France (link to the presentation) and also published in Field Exchange, Issue 44.

For further information see also the full report.

Fresh Food Vouchers- a nutrition sensitive social protection measure

Wolaiyta zone in SNNPR of Ethiopia is one of the most densely populated zones in the region with a population of 1,792,682. Kindo Koysha woreda is one of13woredas in Wolaiyta zone and is extremely vulnerable to malnutrition. It was ranked a “no.1 hotspot” woreda by UNOCHA in 2012. A Concern baseline survey conducted in December 2012 found that the average household ‘food gap’ in Kindo Koysha is seven months.

In August 2012, Concern initiated Fresh Food Vouchers in Kindo Koysha  to supplement the foods provided by the TSFP and improving caretakers’ knowledge and skills using local foods to promote child nutrition over the long term.  The FFVP offered a practical means of exposing mothers to nutritious local fresh foods while actively demonstrating how to incorporate them into their children’s meals. The aim of the project was to contribute to a reduction of mortality, morbidity and suffering associated with moderately acute malnutrition (MAM) amongst children aged 6-59 months and PLW in the target area. This was to be achieved by improving dietary diversity of target beneficiaries through the provision of Fresh Food Vouchers which were exchanged for fresh fruit, vegetables and eggs at weekly distributions. A voucher scheme was also considered more appropriate than a cash distribution due to the  limited availability of fresh foods in local markets, limited existing knowledge of the importance of fresh fruit and vegetables and eggs in a child’s diets. Prior to initiation of the activities, a market assessment (based on the Emergency Market Mapping and Analysis tool) was undertaken to assess available fresh foods in the community and to identify vendors who were already in the market and trucking foods to neighbouring towns for sale.  The ration for FFV was followings .

Table 1: Ration size

 

Type

Servings per day per beneficiary

Servings per month

Fruits

Mango

0.66 pcs

19 pcs

 

Avocado

0.66 pcs

19 pcs

 

Banana

0.66 pcs

19 pcs

Vegetables

Dark green leafy veg

200 g

6 kg

 

Carrot

115 g

3.45 kg

 

Tomato

155 g

3.45 kg

Animal Products

Egg

0.28 pcs

8 pcs

Cost of the fresh foods for the programme was on average 381 Ethiopian birr (17 euro) per individual per month.  The cost included transport cost and other related cost, excluding Concern staff to monitor the programme.

The programme findings indicate that the proportion of children 6 – 59 months of age who consumed different numbers of food groups based on the baseline (at admission) and endline (at discharge) questionnaires[1].

Figure 1: Percentage of children who ate at least one item of the food group the previous day (24 hours dietary recall)

The mean dietary diversity score changed from 1.96 at admission to 4.17 at discharge and the proportion of children who received more than four food groups increased from 4.2% to 71.4%. Children who predominantly ate from one food group at admission, increased to eating three or more food groups by discharge, with increased consumption of dark green vegetables, egg and fruits especially.

Conclusions and recommendations

The FFVP was well received by communities. The beneficiaries based on qualitative study reported health and nutrition benefits for their children above those from the TSFP alone. The awareness of importance of fresh foods seems to have been raised by the project – not just by the beneficiaries, but also the wider community, vendors, health workers, Concern WW staff and local government employees. This is an additional benefit and more lasting aspect of the project. This project can be also taken as nutrition sensitive social protection measure, or complement existing Government of Ethiopia’s social protection programme- Productive Safety Net Programme (PSNP).

Experiences from the initial pilot was published in recent Field Exchange, Issue 45 (http://www.ennonline.net/pool/files/fex/fx-45-web.pdf)

The project is further piloted this year to test following assumptions

1. Whether such food based approach can be an alternative or complement existing CMAM programming in Ethiopia and in medium to long term help in reducing under-nutrition rate and decreasing the overall need of humanitarian emergency nutrition interventions?
2. Whether such approach can also be taken as a social protection measure and complement existing PSNP programme where target beneficiaries could be those who are nutritionally vulnerable and can be provided with such support during hunger season when malnutrition rates usually peak?
3. Whether food based approach or cash vouchers along with IYCF practices will lead to change that can be rolled at the national scale in lieu of food aid?

We will be very happy to share further details of these two initiatives with interested participants. I am also sharing this training guide.

Thank you once again.

Warm Regards,

Pankaj Kumar
Concern Worldwide
Ethiopia


[1] The seven food groups per international guidelines consisted of cereals, grains, roots and tubers; pulses, legumes and nuts; milk and dairy products; meat & poultry; eggs; vitamin-A rich fruits and vegetables; and other vegetables and fruits. Oils and fats were not included as a food group.