Natalia Winder Rossi, Maria Angelita Ruvalcaba & Joan Matji (Food and Agriculture Organization of the United Nations), October 2015
Despite improvements in terms of undernourishment, stunting and wasting across regions, absolute numbers remain unacceptably high:
- Almost 800 million people suffer from chronic hunger.
- 161 million children under the age of five are stunted.
- The economic burden of malnutrition is of about 3.5 trillion USD per year
Accelerated progress requires bold moves.
Materializing our commitments to move from ‘poverty alleviation’ to eradication for all, and to end hunger and all forms of malnutrition by 2030, requires a change in the way we work. We must slip free from thinking through vertical, sectoral and silo-type approaches and embark on new, creative, and, in some instances, risky interventions. We must in particular be alert to strategic opportunities. For example, the time has come to bring together efforts in nutrition and agriculture with social protection.
Nutrition experts have long recognized that long-term outcomes require a multi-sector lens: a combination of high-impact nutrition interventions with ‘nutrition-sensitive’ approaches that address the underlying causes of malnutrition: food security, infant care and feeding practices and access to clean water and health, sanitation and hygiene services. As showcased by the 2013 Lancet series and conceptual framework, nutrition sensitive programming – ie: programmes that address key underlying determinants of nutrition such as social protection – would assist in further reducing stunting by an additional 20%.
For instance, it is now a well-known fact that breastfeeding and complementary feeding programmes need to go hand in hand with policies that would ensure not just the availability but also the economic accessibility and use of food. One way is to support rural farmers in order to diversify production and livelihoods as well as to increase production of nutrient-dense foods or smart agriculture. Another strategic and complementary entry point is Social Protection.
Social protection, including cash transfers, public works, school feeding and other programmes, can impact all dimensions of food security by:
- Increasing households’ food consumption and dietary diversity
- Minimizing negative coping mechanisms affecting nutrition and health such as reducing children’s food intake, or pulling them from school in time of crises
- Supporting families’ ability to afford the indirect (eg: transport, school uniforms) or direct costs of accessing services (out of pocket health costs, health and education fees).
- Enhancing households’ productive capacity through supporting investments in agricultural inputs and tools, ownership of livestock, as well as shifts from casual wage labour to on-farm activities.
Social protection programmes also go beyond bolstering food security and contribute to better health outcomes by reducing financial barriers to access health services, and can help adolescent girls stay in school as well as offer critical support to young mothers during the first 1,000 days of their child’s life.
Enabling access to health services, especially for young women from pregnancy through the first 1,000 days of an infant’s life, is another area where social protection programmes may contribute effectively to food security.
The need for a comprehensive and multi-sector approach is not new or creative, nor is it specific to nutrition. Understanding the need to move from concept to practice is also not new. What is new, or needs to be new, is the way this thinking can be implemented and made to work.
Let’s move from a conceptual understanding to concrete synergies.
Support for social protection programmes in developing countries is gaining momentum. It is no longer a regional ‘fad’, but a global priority – it will soon be a formal target of the Sustainable Development Goals and is increasingly prominent in global forums and calls for action- on HIV, health, nutrition, resilience- and the concrete political and financial commitment of countries to develop and strengthen social protection is now an irreversible trend.
The mindset is changing: Social protection is no longer seen as a cost, but as a critical investment for success in eradicating hunger and poverty.
For instance, in regions such as Eastern and Southern Africa, virtually every country has some form of social protection. But most importantly, there is a rising tide in terms of scaling up pilot programmes to national ones; and most critically, moving from donor-funded to nationally owned interventions.
The emerging strategy clearly has a strategic relation to nutrition, which is driven by multiple factors and is a clear priority across sub-Saharan Africa, in particularly as regards stunting.
How can we concretely bring these current priorities close together? Some food for thought
Evidence from Latin America, and more recently from Sub-Saharan Africa is showing the clear impact of social protection, specifically cash transfers, on a wide range of nutrition indicators- such as increased daily caloric intake in Ethiopia-Tigray region; food expenditure and increased consumption of meat and dairy products in Kenya and Peru, improvements in infant and young feeding practices in Zambia; as well as impact in anthropometrics, such as reduction in prevalence of underweight in Mexico, and stunting (height for age) in South Africa.
While the critical mass of evidence comes from income transfers, it offers a strong starting point for consideration, while we continue to strengthen the evidence base for other types of Social Protection programmes.
From visibility of impacts to identifying clear entry points for collaboration:
Some ideas to consider, particularly for contexts of high poverty rates and stunting prevalence:
Social Protection PLUS (+): effectively combining interventions to maximize impacts and taking advantage of the targeting used for social protection programs, which aim to reach the poorest and most vulnerable, to provide nutrition services and information to those hardest to reach, designed in a way supporting local production. Some examples: combining cash transfers, school meals and procurement from local farmers; taking advantage of pay points for cash transfers to implement nutritional and health talks/information sessions;
How to align objectives?
- Coherent targeting: Include both poverty and nutrition as criteria for geographic targeting, using : overlapping poverty and nutrition maps; consider the relevance of including nutrition, as well as poverty indicators in constructing eligibility criteria (eg: households where at least one member is malnourished)
- Include specific nutrition objectives and indicators to assess the impact of social protection interventions. Monitoring frameworks should include a wide range of indicators, including anthropometric measure but also dietary diversity or meal frequency, food consumption, as well as participation in health and nutrition activities and the use of public awareness and national health nutrition campaigns.
- Evaluation time frame: Set an adequate and realistic time frame to effectively assess progress (in terms of impact evaluation), specifically in terms of anthropometrics and behavior change.
- Integrated case management– Coordinate follow-up protocols for social protection beneficiaries with health and nutrition services and community-level social workers with an eye to identifying malnourished or at-risk children.
The current sense of urgency needs to be translated into new ways of thinking. The proposal is to see nutrition-sensitive social protection as an innovative opportunity; one with increasing political clout at all levels. Linkages between social protection, agriculture and rural development within a framework of nutrition seem to be the obvious next step.
We know, social protection is not the silver bullet; but acceleration requires not one, many bullets, aiming from different fronts and perspectives.
This blog was originally posted on http://www.fao.org/world-food-day/blog/time-to-bring-on-reinforcements-to-end-hunger-social-protection/en/