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The nutrition sensitive productive safety net in Ethiopia From Design to Implementation

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Anne Bossuyt
IFPRI, Ethiopia

Published in: Government & Nonprofit
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The nutrition sensitive productive safety net in Ethiopia From Design to Implementation

  1. 1. The nutrition sensitive productive safety net in Ethiopia From Design to Implementation Anne Bossuyt IFPRI, Ethiopia
  2. 2. Context Marked improvements in human development and poverty, but challenges remain Pro-poor investments and programs • Increasing financial allocation for pro- poor sectors • Health Extension Program (over 39,000 health extension workers) • A multisectoral National Nutrition Program • Emergency relief programs • A Rural Productive Safety Net Program (PSNP) - since 2005
  3. 3. PSNP in a nutshell One of largest safety net programs in sub- Saharan Africa • 8 million rural poor - 350 food insecure districts • Community targeting • Provides transfers (food or cash) to chronically food insecure households (6 months/year ) o In return: healthy adults carry out public works (supporting community infrastructures) o Vulnerable clients and pregnant and lactating women: unconditional transfers o Labor constraints households: unconditional transfers o Launched in 2005; gradual expansion (geographic and programmatic) Photo :PSNP DCT (2013) Good results • Well targeted to the poor • Good results in addressing food insecurity, reducing distress sales, improving resilience, increasing access to services (health, education, sanitation), improving household level diet diversity…
  4. 4. PSNP 4 Design – enabling factors to make the program more nutrition sensitive Some early initiatives PSNP 3 - no nutrition objective, but some nutrition sensitive features o Pockets of successful interventions linking PSNP clients with health services o But little attention to defining implementation modalities and accountability structures 2012-2013 – a high level of attention to nutrition o Understanding of high cost associated with malnutrition o Revision of the National Nutrition Program (NNP) in 2013 • Multisectoral approach; importance of accountability • Acknowledgment that the PSNP could become an important vehicle of nutrition sensitive interventions
  5. 5. Design- enabling factors (2) PSNP 4 design guided by multisectoral consultations (2013-2014) o Move towards a system wide approach (linking PSNP clients with social, health and livelihood services) o Considered lessons learned of earlier phases o MOH gradually more involved; Social Affairs: new player New Evidence (2013-2014) o PSNP 3 had no impact on nutrition outcomes of children; limited contacts of PSNP clients with health extension workers (IFPRI, 2014) o Global advocacy on the role of nutrition sensitive programs (Lancet 2013 ; the potentials of nutrition sensitive transfer programs by H. Alderman, IFPRI )
  6. 6. The result: nutrition mainstreamed throughout the design PSNP 4 : considered high potential for nutrition sensitivity, • Because of its scale, poverty focus, potential to empower women, attention to system building, integration of livelihood interventions, gradual involvement of social sector Nutrition : mainstreamed throughout all the PSNP components • PSNP will address some determinants of stunting • Vulnerable clients and communities : mobilized for improved nutrition and uptake of health services • Linkages between agriculture , health and social sectors to be strengthened under PSNP – general principles of collaborative modalities defined • Accountability: nutrition outcomes-level indicators included in results framework
  7. 7. PSNP will address some determinants of stunting • 2014 mini DHS and PSNP baseline surveys: 0verall poor nutrition indicators in PSNP districts, accompanied by low health seeking behavior and caring practices • PSNP-4 : designed to address some of these determinants
  8. 8. Progress : slow but steady roll out • Roll out of PSNP-4 in July 2015 (awareness raising on new provisions) • Growing multisectoral and high level engagement at federal level o Health and Social Affairs gradually more involved o Political buy-in translated in various national strategic and policy documents o Implementation processes defined o Multisectoral process; role of pilots (MOLSA/UNICEF) o PSNP agenda integrated in strengthened community nutrition programs of MOH • Expanded support through NGOs • Measuring progress o Nutrition indicators included in overall PSNP impact assessments o Partnerships for evidence on nutrition outcomes established (BMGF, NGO, UNICEF pilots – role of IFPRI ) o Routine monitoring: some efforts to measure progress on selected nutrition provisions  Interventions gradually rolled out but not yet systematically implemented
  9. 9. Challenges • Translating political buy-in to capacities on the ground • Size of the program (7000 kebeles ; > 15,000 frontline workers ) • Multisectoral approach at decentralized level was not well spelled out at design phase • One program, but different contexts (e.g. regional aspects) • Conflicting priorities : PSNP innovations; Recurrent droughts • Ambitious design not necessary associated with adequate funding : Pulses retracted in 2017; Limited budget and attention for capacity building (hard and soft skills) • Service delivery: Linking safety net clients to basic services vs limited availability of basic services • Accountability : Indicators defined at design, but modalities of reporting only identified later in the project
  10. 10. Lessons learned 1. Focus on defining implementation modalities and creating capacities at decentralized levels is crucial for implementation • The size of the program at grassroot level matters: limited systematic focus on strengthening capacities of front line workers at design phase hampered roll out of the multisectoral collaboration model • In a federal system, it is important to build in accountability modalities at all levels in the implementation manuals 2. Importance of reaching out to other sectors  Improving service delivery: PSNP activities being integrated in plans of Ministry of Labor and Social Affairs (linkages role) and Health sector /nutrition specific interventions (and training for frontlines workers)  Funding for capacity building: Ministry of finance (50 million USD) for capacity building and multisectoral collaboration (ESPES program, 2017)
  11. 11. Lessons learned (2) 3. Advocacy and action requires data and evidence • Measuring progress allows to identify bottlenecks early and to seek solutions • There is lots of evidence and data available on PSNP which can be further analyzed to guide implementation  Important role for programs like Compact 2025 and the National Information Platform for Nutrition, which aim to strengthen capacities to better use existing data for informed decision making for nutrition - essential to move successfully from a nutrition sensitive design to implementation

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