Monday 18 November 2013

Is social protection an effective toolkit for addressing undernutrition?

by Stephen Devereux

On 13-15 November 2013 a preparatory technical meeting for next year’s ‘Joint FAO/WHO Second International Conference on Nutrition’ (ICN2) was held at FAO in Rome. One panel discussed the role of social protection in protecting and promoting nutrition. The discussion paper for the panel was presented by Harold Alderman of IFPRI, [1] and it included this policy recommendation, which sparked as lively a discussion as is possible in a meeting of 200+ delegates:

“Include nutrition outcomes as an explicit objective of social protection programmes, to promote improved nutrition”.

The discussion paper poses significant challenges to everyone who works on social protection, because many of us have invested much effort into trying to make a convincing argument for the effectiveness of social protection as a set of policy instruments, not only for addressing poverty and vulnerability but also for tackling food and nutrition insecurity. This paper, and the discussion at the ICN2 preparatory meeting, made me realise that we still have some work to do in making that convincing case, especially in terms of nutrition outcomes.

Several findings in the discussion paper suggest that we have too little evidence to give a definitive answer to the question about whether social protection does have significant positive impacts on nutrition status. This statement, about Ethiopia’s ‘Productive Safety Nets Programme’, could be generalised across many other social protection programmes.

“While the program has been successful in improving food security and asset accumulation, there is no evidence to date that this has translated into improved nutritional outcomes for children.”

We do know from impact evaluations that the Productive Safety Nets Programme (PSNP) reduced the annual ‘hunger gap’ by more than one month in participating households, from 3.6 to 2.3 months, between 2006 and 2010. [2] This is a significant positive impact on household food security, so why does it not translate into measurable impacts on children’s nutrition status? I can think of three plausible hypotheses.
  1. Maybe it is because nutritional outcomes aren’t measured – but if not, why not? Surely this is one of the most robust and relevant indicators of social protection effectiveness? An important methodological point is that food security indicators, such as dietary diversity and the number of meals consumed per day, are quantifiable indicators but they are self-reported, so they are prone to all kinds of potential bias. Anthropometry is one of the few objectively measured indicators of food security outcomes, so shouldn’t it be included in rigorous impact evaluations whenever possible?
  2. Is it because programme evaluators and administrators don’t want to monitor nutrition status, in case they find little evidence of nutritional impacts and their programme will be judged a failure, despite achieving success in terms of other indicators?
  3. Or maybe it is because social protection should not even be expected to improve nutrition status? If one primary objective of social protection is to protect vulnerable people against downside risk, then stabilising food consumption through bad times is certainly a core social protection function, but raising food consumption sustainably is arguably more appropriate for poverty reduction and broader development policies.

Whatever the explanation, it is clear that the evidence base on causal linkages from social protection to reduced undernutrition is limited, and needs to be strengthened. This could certainly be achieved by insisting that nutrition is included as a direct objective of social protection programmes. But do we agree with the implication that nutrition outcomes should be included as an impact indicator for all social protection programmes? One contributor to the discussion at FAO pointed out that it depends on the objectives and design of each specific programme, but argued that the overall social protection system in each country should be oriented towards reducing undernutrition rates, as one fundamental indicator of wellbeing that social protection should seek to influence.

“It depends” is always a safe non-committal academic answer, but I tend to agree. Improvements in nutrition status should not necessarily be an indicator of success for each and every social protection programme, but social protection definitely needs to be an integral component of any integrated and systematic approach to reducing malnutrition.


[1] Alderman, H. (2013) Social Protection and Nutrition Discussion Paper, Preparatory Technical Meeting, Joint FAO/WHO Second International Conference on Nutrition (ICN2). Rome: FAO, 13-15 November.
[2] Guush Berhane, Hoddinott, J., Kumar, N. and Alemayehu Seyoum Taffesse (2011) The Impact of Ethiopia’s Productive Safety Nets and Household Asset Building Programme: 2006-2010. Washington DC: International Food Policy Research Institute.