UNICEF’s innovative approach to tackling child malnutrition and poverty

01 Feb 2024 --- Social protection practitioners may be able to support governments in creating synergies between poverty and nutrition among children, according to a new report by UNICEF. The organization emphasizes the importance of understanding existing nutrition and social programs to build capacity and describes how it can be accomplished.

Nutrition Insight sits down with Annalies Borrel, UNICEF senior advisor of Nutrition and Social Protection and Chloe Angood, nutrition specialist at the UNICEF Eastern and Southern Africa Office, to better understand the reports and the organization’s findings.

“It is necessary to map and analyze national nutrition policies and social protection policies to identify entry points for building synergies between existing systems, structures and programs to maximize the impact of both sectors for the most vulnerable children in societies. It is rare that entirely new programs are needed,” explain Borrel and Angood. 

Governments are more likely to invest in nutrition and social protection when they have evidence of the impact of these programs on nutrition.“Rather, countries can adapt existing programs and build convergence so that the same vulnerable children can be reached with both social protection and nutrition services. Sometimes, as nutrition practitioners, we may be unaware of existing social protection programs and vice versa, so a mapping exercise carried out jointly usually highlights multiple new opportunities,” they add. 

The experts explain that the UNICEF’s Program Guidance is organized around five entry points and ten priority actions designed to strengthen synergies between child nutrition and social protection policies and programms and make them more impactful. The five entry points consist of:

1. Evidence to understand the links between malnutrition and poverty.

2. Development of policies and governance.

3. Design of programs that address both child malnutrition and poverty.

4. Implementation capacity to support program delivery.

5. Monitoring and learning to inform program improvement.

Social transfers
The framework of action outlined in the new report focuses on social transfer methods, namely, cash, food, vouchers, and school meals, as key programs for addressing both child malnutrition and social protection issues. 

“Social transfers are often the largest form of social protection in countries — usually targeting cash to the most poor and vulnerable households. These programs can be designed in a way that helps prevent child malnutrition,” states Borrel and Angood. 

Addressing how to ensure that social transfers are truly responsive to the nutritional needs in the local context to maximize their impact on child nutrition and poverty reduction, the nutrition experts elaborate that: “This first requires that the design is based on a good understanding of the main drivers of malnutrition and poverty and a theory of change that demonstrates how the program will make a difference.” 

“Second, the social transfers (for example, regular cash) must reach the most vulnerable, both socio-economically and nutritionally. For example, reaching all pregnant women and children under two years of age in poor households. Third, while cash must be regular, sufficient and sustained, these same households need to be supported with the information, support and services that allow them to improve their own nutrition. Cash alone will only go so far.”

“Fourth, these same households need support to help them sustain positive changes — for example, jobs and livelihood support. Lastly, these social protection and nutrition programs need to be shock-responsive; that is, they need to be built to scale up early in response to shocks, for example, climate-related shocks such as floods or droughts, or disease epidemics or pandemics, to help prevent malnutrition and increased vulnerability that is likely to otherwise occur.” 

Implementation capacity
Strengthening local implementation capacities, including the nutrition and social protection workforces and information systems, is critical to ensuring successful program implementation, Borrel and Angood argue.

“At the local level, sufficient workforce capacities must exist to support strong nutrition and social protection services and to ensure that there is effective communication, decision-making and cross-referrals.”

“New digital technologies can be used to build the interoperability of registration systems and databases for both social protection and nutrition. This will really help to strengthen program convergence and prevent sector programs from operating in parallel so that the participants in the program receive all of the support and services that they need,” they add.

Nutrition policies should recognize that good child nutrition requires addressing child poverty and multiple other drivers of malnutrition.Discussing how governments can effectively leverage public finance to ensure resources for child nutrition, social protection and the synergies between them, Borrel and Angood comment: “Governments are more likely to invest in nutrition and social protection when they have evidence of the impact of these programs on nutrition challenges that children face in their country, whether this is stunting, wasting or overweight or a combination.”

“Results from trial programs can be used to demonstrate feasibility and impact to encourage governments to further invest. It is widely recognized that fiscal space is ever decreasing, and therefore, not only is it necessary to demonstrate the benefits of this investment in children but also to explore innovative financing instruments such as taxes on unhealthy foods, match funding and climate funding.”

Creating policies
Borrel and Angood talk about the need to mutually reinforce commitments in policies to facilitate coordination in the context of child nutrition and social protection.

“Policies present important entry points for defining program commitments. Where social protection policies explicitly commit to nutrition improvement, this creates an opportunity to design and implement programs likely to have more impact on nutrition.” 

“For example, cash transfer programs that reach pregnant women and children under two years — the most nutritionally vulnerable point in the life cycle — and link them to multiple nutrition services,” they point out. 

“Likewise, when nutrition policies explicitly recognize that good child nutrition requires addressing child poverty and multiple other drivers of malnutrition, this creates opportunities and obligations to bring together multiple sectors, including nutrition and social protection, to build comprehensive programs to address problems such as child stunting or overweight.”

They point to multi-sectoral platforms, the coming together of decision-makers representing two or more sectors to address an issue, as important to building capacity to enable the “coordination and collaboration of multiple sectors at national down to local levels to make this kind of comprehensive programming possible.”

Measuring impact
Sharing insights on the importance of monitoring, understanding the impact and learning from child nutrition and social protection programs for the purpose of scaling them up, Borrel and Angood state: “It is paramount that we understand not only what results we can achieve but also how we can continuously adapt the program in response to changing needs.”

“Measuring success is not necessarily best done by measuring child nutrition outcomes, such as stunting or overweight, or child poverty since these are ‘stubborn’ indicators that take a long time and multiple interventions to change.”

“But as a minimum, we must measure the coverage of nutrition-responsive social protection programs and the extent to which these programs impact changes in affordability and access to nutritious foods — also called ‘child food poverty’ — changes in how caregivers feed and care for their children, and the uptake of different health and nutrition services. These factors are all critical along the pathway to improved child nutrition.”

“Therefore, when these indicators show positive trends and these trends are sustained, we can be reassured that we will likely see reductions in child malnutrition and poverty in the longer term,” Borrel and Angood conclude. 

By Milana Nikolova