Nutrition Sensitive Social Protection Programs Within Food Systems

Investments in social assistance programs (SAPs) in low- and middle-income countries (LMICs) are increasing. As investments increase, the objectives of these programs are expanding from focusing on reducing poverty to addressing other social issues such as improving diets and nutrition. At the same time, there is increasing interest in addressing all forms of malnutrition within the framework of food systems. Given the intersections between SAPs and food systems, we reviewed the effectiveness of SAPs (agriculture asset transfers, cash transfers, in-kind transfers, vouchers, public works and school meals programs) for reducing all forms of malnutrition across the lifecycle within a food systems framework. As several programs included multiple treatment arms, each representing a unique program design, we used study arm as the unit of analysis and assessed the proportion of study arms with positive or negative program impacts on diet and nutrition outcomes among men, women and children. The majority of the studies included in this review were from evaluations of agriculture asset, cash and in-kind transfer programs. There was clear evidence of positive impacts on women’s and children’s diet-related outcomes. Very few studies assessed program impact on women’s nutritional status outcomes. However, there was some evidence of impacts on increasing body mass index and hemoglobin concentration (Hb) with in-kind transfer programs. Among children, several study arms across the agriculture asset, cash and in-kind transfer programs found positive impacts on increasing height-for-age Z-score (33%-45% of study arms) and weight-for-height Z-score (33%-50% of study arms) and decreasing the prevalence of wasting (43%-60% of study arms). Cash and in-kind transfer programs also found positive effects on reducing stunting prevalence in 33% and 45% of study arms, respectively. Lastly, a few study arms assessed program impact on increasing Hb with some evidence of positive impacts in in-kind and school feeding programs. There was a paucity of relevant evidence of the effectiveness of voucher and public works programs on diet and nutrition outcomes, for men’s outcomes and on micronutrient status. Several challenges remain in understanding the potential for SAPs to improve diet and nutrition outcomes within food systems including the heterogeneity of program and evaluation designs, populations targeted by the programs and included in evaluations and indicators used to assess impact. Addressing these challenges in future evaluations is important for informing program and policy actions to improve the effectiveness of SAPs within food systems for improving diet and nutrition outcomes across the lifecycle.

This publication provides a list of food system-based intervention options to improve nutrition and a set concrete entry points for maximizing the impact of each intervention. Developed through leveraging different expertise in FAO, it is a key resource to assist professionals involved in different areas - from breeding to production; from food transformation and packaging to transportation and trade; from marketing and value chain to food safety; from food labelling to consumer education - to u nderstand the linkages with nutrition, and to increase their contribution for a world free from malnutrition in all its forms.

Background paper prepared for the Global forum on nutrition-sensitive social protection programs, September 2015, Moscow, Russian Federation. Building on the momentum created by ICN2, the BRICS countries have actively participated in and facilitated global discussions on nutrition-sensitive social protection; in particular, during the Global Forum on Nutrition-Sensitive Social Protection, held in Moscow, Russian Federation, from 10 to 11 September 2015, which brought together policy-makers, researchers and experts in the areas of nutrition and social protection from 27 countries.

The food systems approach can contribute to food security and reduced malnutrition levels by identifying key investments and policies throughout the food system, including production, processing, marketing, and consumption of food. However, in countries facing fragility and conflict, it has proven difficult to implement such an approach and achieve the desired results. This has been the case in Afghanistan, where high levels of malnutrition stem in part from an undersupply of nutritious food. Multi-sectoral approaches to promote nutrition sensitivity and achieve diet-based solutions have also had only limited impact. This paper reports on an analysis of the nutrition sensitivity of food systems in Afghanistan using multi-sector consultations and gap analyses to examine two key food and nutrition policies, the National Comprehensive Agriculture Development Priority Program and the Afghanistan Food Security and Nutrition Agenda. It highlights gaps in the policies and identifies investment priorities to make food systems more nutrition sensitive. The results show that instilling nutrition sensitivity into the operation of Afghanistan’s food systems can only be accomplished if certain key measures are incorporated into the food system. These include addressing the absence of knowledge in the population regarding healthy diets, the lack of sufficient food for vulnerable populations, weak irrigation systems, capacity constraints at individual and institutional levels, data challenges, and weak natural resource management. In addition, the above weaknesses are compounded by the continued violence and conflict-induced insecurity, weak government, and inadequate investments. Given the role of different sectors in contributing to improved nutrition, appropriate and effective multi-stakeholder coordination and collaboration is paramount to such efforts.

Malnutrition can best be addressed by a combination of nutrition specific interventions and nutrition sensitive programs, including social protection. This study reviews mechanisms of transfer program in order to better design nutrition sensitive social protection. Social protection programs typically increase income as well as influence the timing and, to a degree, control of this income. Additionally, social protection programs may achieve further 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. This paper discusses what might be expected from such programs and reviews some of the evidence from specific transfer programs.

We assess the impact of Ethiopia’s flagship social protection program, the Productive Safety Net Program (PSNP) on the adverse impacts of the COVID-19 pandemic on food and nutrition security of households, mothers, and children. We use both pre-pandemic in-person household survey data and a post-pandemic phone survey. Two thirds of our respondents reported that their incomes had fallen after the pandemic began and almost half reported that their ability to satisfy their food needs had worsened. Employing a household fixed effects difference-in-difference approach, we find that the household food insecurity increased by 11.7 percentage points and the size of the food gap by 0.47 months in the aftermath of the onset of the pandemic. Participation in the PSNP offsets virtually all of this adverse change; the likelihood of becoming food insecure increased by only 2.4 percentage points for PSNP households and the duration of the food gap increased by only 0.13 months. The protective role of PSNP is greater for poorer households and those living in remote areas. Results are robust to definitions of PSNP participation, different estimators and how we account for the non-randomness of mobile phone ownership. PSNP households were less likely to reduce expenditures on health and education by 7.7 percentage points and were less likely to reduce expenditures on agricultural inputs by 13 percentage points. By contrast, mothers’ and children’s diets changed little, despite some changes in the composition of diets with consumption of animal source foods declining significantly.