1. 1. Guush Berhane, ESSP, IFPRI John Hoddinott, Cornel University (formerly, IFPRI) Neha Kumar, IFPRI June 15, 2015 Addis Ababa, Ethiopia IMPACTS OF SOCIAL PROTECTION PROGRAMS ON CHILD NUTRITION IN ETHIOPIA
2. 2. Introduction: evidence on malnutrition Reducing child malnutrition remains stubbornly a huge global challenge. Substantial progress made over the last 15-20 years in reducing prevalence of (and not necessarily absolute) malnutrition. The pace of progress varies by region, with Africa below the Sahara remaining one of the slowest. Ethiopia has one of high levels of chronic undernutrition. DHS (2011): 44% of children under five are stunted (Have a height for age z (HAZ) score < -2) 10% of children under five are wasted (Have a weight for height z (WHZ) score < -2)
3. 3. Introduction: why should we care? Intrinsic. Chronic undernutrition is a marker of high levels of deprivation. Healthy, well-nourished children is an important development objective in itself. Instrumental. Children who are undernourished are less likely to complete school, have poorer cognitive skills in adulthood and are less economically productive. Evidence from other countries shows that a one SD reduction in HAZ increases the likelihood of being poor in adulthood by 10 percentage points
4. 4. Introduction: what determines malnutrition/child growth? Two groups of factors come into play Immediate: dietary quality and intake, health status Underlying factors: food security, resource availability, knowledge of and care for (mothers and) children, quality of health environment Clearly, improving food security, or resource availability is only a necessary but not sufficient condition to improving nutritional status
5. 5. Data: social protection programs in Ethiopia
6. 6. 1. The Productive Safety Nets Programme (PSNP) Ethiopia runs one of the largest social protection programmes in Africa: The Productive Safety Net Programme (PSNP). The PSNP reaches more than 7 million people in drought-prone woredas in Afar, Amhara, Oromiya, SNNP, Somale and Tigray The objective of the PSNP is to stabilize household asset levels (thereby preventing recurrent shocks from forcing households into destitution) and improve household food security The PSNP: Is well targeted; delivers significant resources (cash and food) to beneficiaries Reduces the food gap; Stabilizes assets The PSNP was a good opportunity to tackle child undernutrition in rural Ethiopia,
7. 7. 1. The Productive Safety Nets Programme (PSNP) However, the PSNP was loosely meshed with direct efforts to reduce undernutrition in rural Ethiopia: chronic undernutrition reduction was not a specific objective of the PSNP. Example: Health Extension Workers were not explicitly embedded in the PSNPs administrative structures that oversee beneficiary selection and that hear appeals;
8. 8. 2. The social cash transfer pilot program (SCT), Tigray The SCT aims to improve the quality of life for vulnerable children, older persons, and persons with disabilities. Three overarching objectives: Reduce poverty, hunger, and starvation in all households that are extremely poor and at the same time labor constrained; Increase access to basic social welfare services such as healthcare and education. Generate information on the feasibility, cost-effectiveness, and impact of a social cash transfer schemes, including for national scaling up.
9. 9. 2. The social cash transfer pilot program (SCT), Tigray The SCT is piloted in two woredas in Tigray, reaching around 5000 households. The SCT is well targeted and well received by the communities. Targeting was effective done entirely through community-based social protection committees the Community Care Coalition (CCC). Again, the SCT did not embed carefully designed nutrition knowledge efforts into the program.
10. 10. Results: household level impacts
11. 11. Both the PSNP and SCT have improved household level food security
12. 12. The PSNP has (among others) causally, reduced food gap by 1.05 months in 2010 and 1.48 months in 2012; increased food and (some) nonfood consumption; increased dietary hh-level diversity/quality. The SCT has (among others) causally, reduced food gap by 0.24 months in May 2012. increased food consumption (calorie availability per adult equivalent) but not nonfood; increased hh-level diet diversity/quality. Both the PSNP and SCT have improved household level food security
13. 13. Results: impact on child malnutrition
14. 14. We find no impact of the two programs on children of their respective beneficiary households on any of the following anthropometric measures: Height-for-Age Z-scores (HAZ) Height-for-Age Z-score of less than -2 (Stunting) Weight-for-Height Z-score (WHZ) Weight-for-Height Z-score of less than -2 (Wasting) Both programs did not have any impact on child health and nutrition
15. 15. Why? No difference in access to nutrition information by PSNP status In the last month: Have you (been) PSNP Beneficiary status in 2012 visited by a Health Extension Worker visited by someone from the Womens Development Army given information about foods to feed young children heard information about foods to feed young children on the radio boiling drinking water before use? PSNP beneficiary 33.3% 18.2% 26.0% 14.9% 11.4% Non-beneficiary 33.4 14.5 28.5 20.2 11.2
16. 16. Why? Child diet quality/diversity is poor Percent consuming any: Region Pulses Dark, leafy vegetables, or Vitamin A rich fruits Other fruits, or vegetables Milk, or other dairy products Eggs Meat, poultry or fish Fats or oils Tigray 22.5 14.7 8.5 12.4 20.9 3.9 17.1 Amhara 16.0 16.0 12.3 21.7 7.5 6.6 21.7 Amhara HVFB 15.5 7.7 4.5 13.5 3.9 5.8 8.4 Oromiya 7.5 14.5 13.7 48.6 9.8 3.5 15.7 SNNP 4.0 30.5 12.0 37.5 5.5 2.5 15.5 All 11.5 17.3 10.7 30.7 9.1 4.1 15.3 Source: PSNP survey, 2012. Foods consumed by children 6-24 months, previous day, by region, 2012Source: PSNP survey, 2012. Foods consumed by children 6-24 months, previous day, by region, 2012
17. 17. Why? Some improvements on child nutrition with maternal schooling but not as evidenced internationally (i.e., 43% of improvement was due to schooling) -2.4-2.2-2-1.8-1.6-1.4-1.2-1 Length/height-for-ageZ-score 0 1 2 3 4 5 6 7 8 Grades of schooling, mother 95% CI lpoly smooth kernel = epanechnikov, degree = 0, bandwidth = 1.08, pwidth = 1.62 No change in HAZ for mothers with grades 0-2; HAZ improves with schooling beyond grade 2 but slowly & less certainly; Meaning, schooling at this stage does not seem to bring about significant changes in HAZ.
18. 18. Why? Evidence of chronic undernutrition at early age (at 6 months) -2.4-2.2-2-1.8-1.6-1.4-1.2-1 Length/height-for-ageZ-score 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 Age (months) 95% CI lpoly smooth kernel = epanechnikov, degree = 0, bandwidth = 2.7, pwidth = 4.05 Swift decline of HAZ from ages 6 to 24 months Shows how badly undernourished children are by the time they get to an age where the PSNP or any other program might have some impact
19. 19. Conclusions
20. 20. Both the PSNP and the SCT dealt with the underlying resource constraint at the household level food availability and food security. Both have improved household level (calorie) availability and food security. Both also improved dietary diversity at the household level. However, these improvements are not seen at the child level. Child diet quality is poor. Clearly, the other critical conditions for the improvements to be sufficient are missing: namely Nutrition knowledge of mothers and the household at large: Most mothers have not had contact with health extension workers, nor have they received information on good feeding practices. Poor hygiene and water practices observed e.g., likelihood of mothers boiling water is low. This may be one sources of infection for young children and hence reason for the poor chronic nutrition status found. The new PSNP (PSNP 4) aims to achieve some of these by wedding some of these nutrition knowledge components with the PSNP. conclusions
21. 21. Thanks! guush.berhane@cigar.org