Presentación de James Garrett and Lucy Basset, International Food Policy Research Institute IFPRI, durante el Tercer Seminario de Transferencias Condicionadas de Ingresos, realizado en Santiago de Chile el 01 y 02 de Diciembre de 2008.
Gender in Agriculture for Nutrition and HealthIFPRI-PIM
This poster was presented by Hazel Malapit (A4NH / IFPRI) for the pre-Annual Scientific Conference meeting organized for the CGIAR research program gender research coordinators on 4 December.
The annual scientific conference of the CGIAR collaborative platform for gender research took place on 5-6 December 2017 in Amsterdam, the Netherlands, where the Platform is hosted (by KIT Royal Tropical Institute).
Read more: http://gender.cgiar.org/gender_events/annual-scientific-conference-capacity-development-workshop-cgiar-collaborative-platform-gender-research/
4. day 2 session 1 nutrition sensitive programs and policiesPOSHAN
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Neha Kumar, IFPRI - Evidence review on women's group platforms and pathways t...POSHAN
Presentation made at an IFPRI event on "What Lies Beneath:
Women’s and Girls’ Wellbeing as a Critical Underpinning of India’s Nutritional Challenge" on December 10, 2018, in New Delhi
Helping countries improve nutrition outcomes through agriculture and food - w...Francois Stepman
11 December 2017. Brussels. DevCo Infopoint. Countries are seeking to improve nutrition through multiple sectors, including agriculture and food systems. This requires navigating dietary transitions, strengthening country ownership of programmes and investment decisions, working with public and private partners, and better understanding drivers that shape demand. These are key considerations for lesson learning moving forward.
Introduction: Bernard Rey, Deputy Head of Unit, DEVCO C1- Rural Development, Food Security, Nutrition
Panel discussion:
John McDermott, Director, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)
Namukolo Covic, Senior Research Coordinator, IFPRI, Addis Ababa, Ethiopia
Roseline Remans, Research Scientist, Bioversity International, Brussels
Thom Achterbosch, Senior Researcher, Wageningen Economic Research, International Policy
Please find also the link to the video of the conference:
https://ec.europa.eu/europeaid/news-and-events/agriculture-nutrition-outcomes-countries_en
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Integrating Care Groups into Government Structures: Learning from an Operatio...CORE Group
The document summarizes an operations research study conducted in Burundi comparing a traditional Care Group model led by NGOs to an "Integrated" Care Group model led by the Ministry of Health. The study found that:
1) The Integrated model achieved similar improvements in knowledge and health practices as the traditional model.
2) The Integrated model functioned as well as the traditional model in terms of volunteer attendance and household visits.
3) The Integrated model showed potential for sustainability similar to the traditional model during the initial post-project period.
The Integrated model integrated Care Groups into the Ministry of Health structure using community health workers and showed promise for increasing scale and sustainability while building local capacity.
Gender in Agriculture for Nutrition and HealthIFPRI-PIM
This poster was presented by Hazel Malapit (A4NH / IFPRI) for the pre-Annual Scientific Conference meeting organized for the CGIAR research program gender research coordinators on 4 December.
The annual scientific conference of the CGIAR collaborative platform for gender research took place on 5-6 December 2017 in Amsterdam, the Netherlands, where the Platform is hosted (by KIT Royal Tropical Institute).
Read more: http://gender.cgiar.org/gender_events/annual-scientific-conference-capacity-development-workshop-cgiar-collaborative-platform-gender-research/
4. day 2 session 1 nutrition sensitive programs and policiesPOSHAN
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Neha Kumar, IFPRI - Evidence review on women's group platforms and pathways t...POSHAN
Presentation made at an IFPRI event on "What Lies Beneath:
Women’s and Girls’ Wellbeing as a Critical Underpinning of India’s Nutritional Challenge" on December 10, 2018, in New Delhi
Helping countries improve nutrition outcomes through agriculture and food - w...Francois Stepman
11 December 2017. Brussels. DevCo Infopoint. Countries are seeking to improve nutrition through multiple sectors, including agriculture and food systems. This requires navigating dietary transitions, strengthening country ownership of programmes and investment decisions, working with public and private partners, and better understanding drivers that shape demand. These are key considerations for lesson learning moving forward.
Introduction: Bernard Rey, Deputy Head of Unit, DEVCO C1- Rural Development, Food Security, Nutrition
Panel discussion:
John McDermott, Director, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)
Namukolo Covic, Senior Research Coordinator, IFPRI, Addis Ababa, Ethiopia
Roseline Remans, Research Scientist, Bioversity International, Brussels
Thom Achterbosch, Senior Researcher, Wageningen Economic Research, International Policy
Please find also the link to the video of the conference:
https://ec.europa.eu/europeaid/news-and-events/agriculture-nutrition-outcomes-countries_en
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Integrating Care Groups into Government Structures: Learning from an Operatio...CORE Group
The document summarizes an operations research study conducted in Burundi comparing a traditional Care Group model led by NGOs to an "Integrated" Care Group model led by the Ministry of Health. The study found that:
1) The Integrated model achieved similar improvements in knowledge and health practices as the traditional model.
2) The Integrated model functioned as well as the traditional model in terms of volunteer attendance and household visits.
3) The Integrated model showed potential for sustainability similar to the traditional model during the initial post-project period.
The Integrated model integrated Care Groups into the Ministry of Health structure using community health workers and showed promise for increasing scale and sustainability while building local capacity.
Pathways from Women’s Group-based Programs to Nutrition Change in South Asia:...CGIAR
This presentation was given during a webinar on May 9, 2018. Neha Kumar of the International Food Policy Research Institute (IFPRI) gave the presentation. Find out more at: http://gender.cgiar.org/webinar-womens-group-nutrition/
This document discusses gender and food security in Arab countries. It begins by outlining women's varied roles and status across different sectors in the Arab world. It then examines how cultural and religious factors can both support and hinder gender equity. The document introduces the concept of the "food value chain" to illustrate women's contributions across agriculture, processing, retail, and more. It argues that supporting women's roles in these areas can boost food security, nutrition, health and well-being. The document concludes by proposing policy measures and further research to better recognize and optimize women's impact on food security through integrated, multisectoral approaches.
The document summarizes presentations from a 90-second science seminar on various topics related to women's empowerment, maternal and child health, nutrition science, and improved measurement tools.
The first presentation discussed the impact of a women's empowerment initiative in Ethiopia that built community capacity and social capital. The second presentation found that empowering marginalized women in India through self-help groups improved reproductive and child health outcomes.
Other presentations discussed male involvement during obstetric emergencies in Ghana, expanding maternal and newborn health coverage in Ethiopia, and a social accountability approach in India and Kenya. Additional topics included the role of African indigenous foods in food security, micronutrient interventions in Bangladesh, and
"Empowering Women as Key drivers of Food System Change Lindiwe Majele Sibanda...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 3.3: Empowering women as key drivers of food system change"
This document discusses the challenges and potentials of linking agriculture, health, and nutrition. It notes that while agriculture provides livelihoods and nutrients, the sectors of agriculture and health have traditionally been separate due to different goals and institutional structures. Agriculture-led growth can positively impact rural incomes and community infrastructure, which can then lead to better health and nutrition outcomes. However, negative effects of agriculture such as diseases and environmental degradation must also be addressed. The document calls for more integrated, multisectoral approaches and policies to better connect these sectors and maximize mutual benefits like increased food security, food safety, and reduced disease burden.
Presented by Muntita Hambayi
Presented at Report Launch "Mapping Linkages Between Agriculture, Food Security and Nutrition in Malawi"
Ufulu Gardens, 28th April, 2015
Care group presentation 29 may2014-finalCORE Group
This document summarizes the history, implementation, and evidence for Care Groups, a community-based model for improving maternal and child health outcomes. Some key points:
- Care Groups began in the 1970s and involve volunteer community health educators who each visit 10-15 neighboring households to promote behavior change.
- They are currently implemented by 27 organizations across 23 countries, reaching over 1 million households.
- Evidence comes from mostly unpublished project evaluations and surveys that show improvements in coverage and reductions in mortality, though more randomized studies are still needed.
- Process research also examines how well the model is implemented and how volunteers' effectiveness increases with experience over time.
Reach, Benefit, Empower: Indicators for measuring impacts of programs and pol...IFPRI-PIM
This presentation was given by Agnes Quinsumbing (IFPRI), as part of the Annual Scientific Conference hosted by the CGIAR Collaborative Platform for Gender Research. The event took place on 5-6 December 2017 in Amsterdam, the Netherlands, where the Platform is hosted (by KIT Royal Tropical Institute).
Read more: http://gender.cgiar.org/gender_events/annual-scientific-conference-capacity-development-workshop-cgiar-collaborative-platform-gender-research/
1. Nutrition surveillance systems collect, analyze, interpret and report on nutritional status data to inform emergency response strategies. They vary based on context and resources.
2. Key challenges include ensuring reliable, timely data and effective links between data and action. Interpreting data requires understanding local contexts and underlying causes of malnutrition.
3. The objectives of surveillance systems are advocacy, identifying responses, triggering actions, targeting at-risk areas, and identifying malnourished individuals. Representative data that monitors standard indicators is most useful.
This presentation gives an outline on:
- identifying what data are needed to characterize the nutrition situation
- tracking progress in policies and programs at global, regional, and country level
- becoming familiar with common data sources for obtaining nutrition indicators
- identifying priority information gaps for nutrition measurement in the West Africa Region
The Multi-Source Method (MSM) was used to develop a weight loss intervention for low-income, multiethnic postpartum women. MSM combines information from the target population, scientific evidence, and behavior change theory. It includes positive deviance methods, focus groups, community advisors, and the Social Cognitive Theory. A 13-week pilot intervention addressed nutrition, physical activity, behavioral skills, and psychosocial factors to increase self-efficacy and facilitate approximately 11 pound weight loss. Effectiveness will be assessed by changes in weight, self-efficacy, and well-being. The MSM engages the target community and integrates their perspectives into a theoretically-grounded intervention tailored to their needs.
IFPRI Policy Seminar “It Is Time— Gendered Time Use in Agriculture-Nutrition Pathways” on May 7, 2015. Presentation by Deborah Johnston, SOAS, University of London & Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH).
The document discusses coordination of nutrition partners and programs in Ghana. It finds that malnutrition is addressed by many actors across different sectors, but coordination is challenging. Existing coordination mechanisms at the national level, like NANUPACC and the SUN CSPG, are functionally inactive. Coordination is also limited at regional and district levels. Key barriers to effective coordination include limited nutrition capacity and prioritization across agencies, incomplete decentralization, and reliance on donor funding. Improving coordination will require establishing a National Food and Nutrition Commission to lead engagement across sectors, strengthening multi-sectoral capacity, and increasing dedicated government funding for nutrition programs at all levels.
Strengthening Nutrition Governance: Lessons Learned from REACHTransform Nutrition
The document summarizes lessons learned from the UN's REACH program in strengthening nutrition governance in eight countries over three years. Key outcomes included increased awareness, strengthened nutrition policies and plans, and improved human and institutional capacity. Barriers included political instability and lack of capacity, while enabling factors were political will, nutrition champions, and coordinated advocacy. The main lessons were that longer facilitation is needed, high-level support is important, stakeholders need alignment, and capacity building is critical alongside coordination.
as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.
In recent years, the world has seen unprecedented attention and political commitment to addressing malnutrition. As nutrition rapidly rises on the global agenda, guidance is urgently needed on how to design, implement, and evaluate nutrition-enhancing policies and interventions. Nourishing Millions: Stories of Change in Nutrition brings together the most intriguing stories about improving nutrition from the past five decades. These stories provide insight into what works in nutrition, what does not, and the factors that contribute to success.
This document discusses gender mainstreaming in India's national health programs from a historical perspective. It outlines how early women's health programs from the 1950s focused narrowly on women's reproductive roles and population control rather than women's overall health and rights. While the National Rural Health Mission and other current programs now acknowledge gender, implementation has been lacking. The document calls for strengthened implementation of gender-sensitive approaches across health programs to address issues like maternal health, malaria in pregnancy, and tuberculosis from a gender perspective. It emphasizes the important role that district collectors can play in convergence between departments, ensuring reporting and reviews of maternal deaths, community monitoring, and functioning of district health structures.
Guatemala city conclusions and recommendationsSUN_Movement
The document summarizes the conclusions and recommendations from a workshop on costing and financial tracking for nutrition in Guatemala City from April 28-30 2015. It was found that national government budgets only included on-budget funding and did not account for off-budget donor, NGO, or private funding. There was consensus to use the Lancet recommendations to define nutrition-specific interventions and importance was placed on interventions targeting women and children under 3. For nutrition-sensitive interventions, judgement is needed on what to include based on observable nutrition impact. Recommendations include coordinating tracking systems with nutrition outcomes, conducting robust country-owned budget analyses, and clarifying communication aims around mobilizing funding.
Wash, Nutrition and ECD Matter_Julia Rosenbaum_4.25.13CORE Group
The document discusses the importance of integrating water, sanitation, hygiene (WASH), nutrition, and early childhood development (ECD) interventions. It notes that diarrhea is a leading cause of child mortality, contributing to 11% of under-5 deaths, and that undernutrition contributes to one third to one half of child mortality. There is a vicious cycle between undernutrition and diarrhea, as undernourished children are more susceptible to diarrhea and diarrhea causes children to eat and absorb nutrients less. The document advocates for recognizing the interconnections between WASH, nutrition, and ECD and provides some program examples that have integrated these areas.
This document summarizes the findings of a systematic review mapping existing peer-reviewed research on adolescent nutrition in West Africa between 1999-2019. The review identified 154 relevant studies, with most focusing on prevalence and drivers of undernutrition, overweight/obesity, and diet-related non-communicable diseases. Few studies evaluated nutrition programs or policies. While research output has increased over time, evidence remains limited across most West African countries. The review highlights key gaps including a lack of intervention research and nutrition policies specifically targeting adolescents in the region.
This document summarizes presentations from the First Global Conference on Biofortification. It discusses research presenting evidence on the bioconversion and effectiveness of provitamin A carotenoids from biofortified staple crops. It also examines gaps and constraints in demonstrating efficacy, and strategies for optimizing delivery and community acceptance of biofortified crops. Finally, it addresses progress and challenges in iron and zinc biofortification, and the need for further research to demonstrate efficacy and improved absorption.
This document discusses the activities and responsible parties required for scaling up biofortification programs. It outlines that population nutritional assessments, breeding targets, cultivar development, efficacy testing, yield and consumer assessments are led by academia. Advocacy, resource mobilization, seed production, social mobilization, training and monitoring involve public, private and civil society sectors. Close coordination is needed across technical disciplines and sectors to ensure the complex operations of biofortification interventions are successfully implemented and evaluated.
Pathways from Women’s Group-based Programs to Nutrition Change in South Asia:...CGIAR
This presentation was given during a webinar on May 9, 2018. Neha Kumar of the International Food Policy Research Institute (IFPRI) gave the presentation. Find out more at: http://gender.cgiar.org/webinar-womens-group-nutrition/
This document discusses gender and food security in Arab countries. It begins by outlining women's varied roles and status across different sectors in the Arab world. It then examines how cultural and religious factors can both support and hinder gender equity. The document introduces the concept of the "food value chain" to illustrate women's contributions across agriculture, processing, retail, and more. It argues that supporting women's roles in these areas can boost food security, nutrition, health and well-being. The document concludes by proposing policy measures and further research to better recognize and optimize women's impact on food security through integrated, multisectoral approaches.
The document summarizes presentations from a 90-second science seminar on various topics related to women's empowerment, maternal and child health, nutrition science, and improved measurement tools.
The first presentation discussed the impact of a women's empowerment initiative in Ethiopia that built community capacity and social capital. The second presentation found that empowering marginalized women in India through self-help groups improved reproductive and child health outcomes.
Other presentations discussed male involvement during obstetric emergencies in Ghana, expanding maternal and newborn health coverage in Ethiopia, and a social accountability approach in India and Kenya. Additional topics included the role of African indigenous foods in food security, micronutrient interventions in Bangladesh, and
"Empowering Women as Key drivers of Food System Change Lindiwe Majele Sibanda...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 3.3: Empowering women as key drivers of food system change"
This document discusses the challenges and potentials of linking agriculture, health, and nutrition. It notes that while agriculture provides livelihoods and nutrients, the sectors of agriculture and health have traditionally been separate due to different goals and institutional structures. Agriculture-led growth can positively impact rural incomes and community infrastructure, which can then lead to better health and nutrition outcomes. However, negative effects of agriculture such as diseases and environmental degradation must also be addressed. The document calls for more integrated, multisectoral approaches and policies to better connect these sectors and maximize mutual benefits like increased food security, food safety, and reduced disease burden.
Presented by Muntita Hambayi
Presented at Report Launch "Mapping Linkages Between Agriculture, Food Security and Nutrition in Malawi"
Ufulu Gardens, 28th April, 2015
Care group presentation 29 may2014-finalCORE Group
This document summarizes the history, implementation, and evidence for Care Groups, a community-based model for improving maternal and child health outcomes. Some key points:
- Care Groups began in the 1970s and involve volunteer community health educators who each visit 10-15 neighboring households to promote behavior change.
- They are currently implemented by 27 organizations across 23 countries, reaching over 1 million households.
- Evidence comes from mostly unpublished project evaluations and surveys that show improvements in coverage and reductions in mortality, though more randomized studies are still needed.
- Process research also examines how well the model is implemented and how volunteers' effectiveness increases with experience over time.
Reach, Benefit, Empower: Indicators for measuring impacts of programs and pol...IFPRI-PIM
This presentation was given by Agnes Quinsumbing (IFPRI), as part of the Annual Scientific Conference hosted by the CGIAR Collaborative Platform for Gender Research. The event took place on 5-6 December 2017 in Amsterdam, the Netherlands, where the Platform is hosted (by KIT Royal Tropical Institute).
Read more: http://gender.cgiar.org/gender_events/annual-scientific-conference-capacity-development-workshop-cgiar-collaborative-platform-gender-research/
1. Nutrition surveillance systems collect, analyze, interpret and report on nutritional status data to inform emergency response strategies. They vary based on context and resources.
2. Key challenges include ensuring reliable, timely data and effective links between data and action. Interpreting data requires understanding local contexts and underlying causes of malnutrition.
3. The objectives of surveillance systems are advocacy, identifying responses, triggering actions, targeting at-risk areas, and identifying malnourished individuals. Representative data that monitors standard indicators is most useful.
This presentation gives an outline on:
- identifying what data are needed to characterize the nutrition situation
- tracking progress in policies and programs at global, regional, and country level
- becoming familiar with common data sources for obtaining nutrition indicators
- identifying priority information gaps for nutrition measurement in the West Africa Region
The Multi-Source Method (MSM) was used to develop a weight loss intervention for low-income, multiethnic postpartum women. MSM combines information from the target population, scientific evidence, and behavior change theory. It includes positive deviance methods, focus groups, community advisors, and the Social Cognitive Theory. A 13-week pilot intervention addressed nutrition, physical activity, behavioral skills, and psychosocial factors to increase self-efficacy and facilitate approximately 11 pound weight loss. Effectiveness will be assessed by changes in weight, self-efficacy, and well-being. The MSM engages the target community and integrates their perspectives into a theoretically-grounded intervention tailored to their needs.
IFPRI Policy Seminar “It Is Time— Gendered Time Use in Agriculture-Nutrition Pathways” on May 7, 2015. Presentation by Deborah Johnston, SOAS, University of London & Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH).
The document discusses coordination of nutrition partners and programs in Ghana. It finds that malnutrition is addressed by many actors across different sectors, but coordination is challenging. Existing coordination mechanisms at the national level, like NANUPACC and the SUN CSPG, are functionally inactive. Coordination is also limited at regional and district levels. Key barriers to effective coordination include limited nutrition capacity and prioritization across agencies, incomplete decentralization, and reliance on donor funding. Improving coordination will require establishing a National Food and Nutrition Commission to lead engagement across sectors, strengthening multi-sectoral capacity, and increasing dedicated government funding for nutrition programs at all levels.
Strengthening Nutrition Governance: Lessons Learned from REACHTransform Nutrition
The document summarizes lessons learned from the UN's REACH program in strengthening nutrition governance in eight countries over three years. Key outcomes included increased awareness, strengthened nutrition policies and plans, and improved human and institutional capacity. Barriers included political instability and lack of capacity, while enabling factors were political will, nutrition champions, and coordinated advocacy. The main lessons were that longer facilitation is needed, high-level support is important, stakeholders need alignment, and capacity building is critical alongside coordination.
as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.
In recent years, the world has seen unprecedented attention and political commitment to addressing malnutrition. As nutrition rapidly rises on the global agenda, guidance is urgently needed on how to design, implement, and evaluate nutrition-enhancing policies and interventions. Nourishing Millions: Stories of Change in Nutrition brings together the most intriguing stories about improving nutrition from the past five decades. These stories provide insight into what works in nutrition, what does not, and the factors that contribute to success.
This document discusses gender mainstreaming in India's national health programs from a historical perspective. It outlines how early women's health programs from the 1950s focused narrowly on women's reproductive roles and population control rather than women's overall health and rights. While the National Rural Health Mission and other current programs now acknowledge gender, implementation has been lacking. The document calls for strengthened implementation of gender-sensitive approaches across health programs to address issues like maternal health, malaria in pregnancy, and tuberculosis from a gender perspective. It emphasizes the important role that district collectors can play in convergence between departments, ensuring reporting and reviews of maternal deaths, community monitoring, and functioning of district health structures.
Guatemala city conclusions and recommendationsSUN_Movement
The document summarizes the conclusions and recommendations from a workshop on costing and financial tracking for nutrition in Guatemala City from April 28-30 2015. It was found that national government budgets only included on-budget funding and did not account for off-budget donor, NGO, or private funding. There was consensus to use the Lancet recommendations to define nutrition-specific interventions and importance was placed on interventions targeting women and children under 3. For nutrition-sensitive interventions, judgement is needed on what to include based on observable nutrition impact. Recommendations include coordinating tracking systems with nutrition outcomes, conducting robust country-owned budget analyses, and clarifying communication aims around mobilizing funding.
Wash, Nutrition and ECD Matter_Julia Rosenbaum_4.25.13CORE Group
The document discusses the importance of integrating water, sanitation, hygiene (WASH), nutrition, and early childhood development (ECD) interventions. It notes that diarrhea is a leading cause of child mortality, contributing to 11% of under-5 deaths, and that undernutrition contributes to one third to one half of child mortality. There is a vicious cycle between undernutrition and diarrhea, as undernourished children are more susceptible to diarrhea and diarrhea causes children to eat and absorb nutrients less. The document advocates for recognizing the interconnections between WASH, nutrition, and ECD and provides some program examples that have integrated these areas.
This document summarizes the findings of a systematic review mapping existing peer-reviewed research on adolescent nutrition in West Africa between 1999-2019. The review identified 154 relevant studies, with most focusing on prevalence and drivers of undernutrition, overweight/obesity, and diet-related non-communicable diseases. Few studies evaluated nutrition programs or policies. While research output has increased over time, evidence remains limited across most West African countries. The review highlights key gaps including a lack of intervention research and nutrition policies specifically targeting adolescents in the region.
This document summarizes presentations from the First Global Conference on Biofortification. It discusses research presenting evidence on the bioconversion and effectiveness of provitamin A carotenoids from biofortified staple crops. It also examines gaps and constraints in demonstrating efficacy, and strategies for optimizing delivery and community acceptance of biofortified crops. Finally, it addresses progress and challenges in iron and zinc biofortification, and the need for further research to demonstrate efficacy and improved absorption.
This document discusses the activities and responsible parties required for scaling up biofortification programs. It outlines that population nutritional assessments, breeding targets, cultivar development, efficacy testing, yield and consumer assessments are led by academia. Advocacy, resource mobilization, seed production, social mobilization, training and monitoring involve public, private and civil society sectors. Close coordination is needed across technical disciplines and sectors to ensure the complex operations of biofortification interventions are successfully implemented and evaluated.
This chapter discusses principles for planning a healthy diet, including adequacy, balance, calorie control, nutrient density, moderation, and variety. It covers dietary guidelines such as choosing a variety of grains, fruits, and vegetables daily. The chapter also discusses food groups, daily food guides, food labels, and provides tips for choosing healthy options from guidelines to groceries.
This document discusses fortification of staple foods like wheat and maize flours, and rice with micronutrients. It outlines how iron, folic acid, and other B vitamins added through fortification can reduce anemia and birth defects. The document also addresses constraints of fortification like nutrient stability and costs, as well as the status of fortification in Qatar where wheat and rice are imported and voluntary fortification occurs.
This document discusses two approaches to consumer-oriented evaluation: summative and formative. It introduces Consumer Union, an independent nonprofit organization founded in the 1930s to assist consumers. Consumer Union publishes Consumer Reports magazine and website to evaluate products. The document also profiles Michael Scriven, considered a major contributor to consumer-oriented evaluation, and his extensive checklist for evaluating products. Both the checklist and Consumer Union aim to provide consumers with independent and thorough evaluations to make informed purchasing decisions.
National nutritional programmes in indiautpal sharma
The document discusses India's efforts to address malnutrition from the pre-independence period to present day. It describes 4 phases: 1) threat of famine pre-independence, 2) food production phase in 1940s, 3) direct community interventions starting in 1960s, and 4) multi-sectoral approach from 1970s onwards involving multiple ministries. It provides details of various national nutrition programs over time including ICDS, mid-day meals, and programs focused on anemia, vitamin A deficiency, and iodine deficiency.
"Designing, implementing and monitoring evidence-based policies effectively ExternalEvents
This document discusses strengthening accountability systems to improve nutrition outcomes. It emphasizes setting specific, measurable goals and monitoring policy implementation and food environments, not just individual behaviors and health outcomes. Effective monitoring requires coordinated, comprehensive systems that also assess private sector impacts. Power imbalances need addressing; strengthening civil society and independent accountability can help rebalance power away from food corporations and give governments more support for nutrition policies.
Gender in the CGIAR Research Program on Agriculture for Nutrition and Health ...CGIAR
This poster was presented by Hazel Malapit (PIM), as part of the Gender Research Coordinators' meeting (4 December 2017), related to Annual Scientific Conference hosted by the CGIAR Collaborative Platform for Gender Research. The event took place on 5-6 December 2017 in Amsterdam, the Netherlands, where the Platform is hosted (by KIT Royal Tropical Institute).
Read more: http://gender.cgiar.org/gender_events/annual-scientific-conference-capacity-development-workshop-cgiar-collaborative-platform-gender-research/
9 February 2017, the first Food for All Talk (#FFATalks) under the WBG-Netherlands Partnership took place on the subject: Food Systems for Healthier Diets.
This document discusses malnutrition in India, providing statistics on the scope of the problem and its causes. It notes that two-thirds of the world's malnourished children live in India, where malnutrition contributes significantly to mortality and hampers development. Key causes are identified as inadequate food intake by pregnant women and children, lack of sanitation and healthcare access, and low awareness. Several government schemes aim to address malnutrition but face issues with implementation quality, gaps between aims and outcomes, and lack of decentralization. Proposed solutions emphasize strengthening existing systems like PDS, boosting community involvement, improving health services, and adopting more holistic, integrated approaches.
The Statewide Health Improvement Program (SHIP) is a collaboration between 4 Minnesota counties aimed at preventing chronic diseases like obesity and tobacco use. SHIP uses policy, systems, and environmental changes across schools, communities, worksites and healthcare to promote healthy behaviors. The goal is to create sustainable changes that make healthy choices easier through initiatives like increasing physical activity opportunities, improving nutrition, and supporting healthcare provider guidelines. SHIP will be implemented in 4 communities over 2 years and success will be measured by increased healthy policies and lower rates of obesity, tobacco use, and other chronic disease risk factors over time.
as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.
Lessons Learned Collecting Most Significant Change Stories in an Impact Evalu...MEASURE Evaluation
This document summarizes the use of Most Significant Change (MSC) stories to evaluate a nutrition program in Malawi. It finds that MSC stories revealed improvements in household health status and nutrition knowledge as the most significant impacts according to participants. Stories also highlighted increased time and money savings from healthier children. However, the process uncovered challenges like the education level of data collectors and issues using stories to identify program needs. Overall, MSC provided insights into what matters to participants, though the method may need adjustments for different contexts.
Livestock-Climate Change CRSP Annual Meeting 2011: Integrating Human Nutritio...Colorado State University
Tips for integrating human nutrition into research on the interaction between livestock/agricultural production and climate change; overview of the Global Livestock CRSP's ENAM project in Ghana. Presentation given by G. Marquis (McGill University) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Data compilation during the intermediate phase in preparation for the next wo...TransformNutritionWe
This presentation is about TNWA Policy and programs component and more specifically on search approaches for current/ongoing policy and programs focusing on nutrition at national level for Nigeria and Burkina Faso
It also presents TNWA's Stories of Change: change over time in policy and programs: Examples of Senegal and Zambia.
CAFS Cura Overview (Williams and Gillis) May 2010 (Final)banjomanjeff
This document summarizes a research project called the Community University Research Alliances (CURA) that aims to address food insecurity and social justice across Canada. The CURA brings together stakeholders to better understand the determinants of community food security and build capacity for improved food security policy. It uses participatory action research and deliberative dialogue processes to engage communities and integrate different types of knowledge. The CURA is conducting case studies in Nova Scotia to assess community food systems and policies impacting food security. It also involves education, knowledge mobilization, and evaluating its participatory and leadership models to enact real policy change at the community level.
This document discusses the importance of implementation research in nutrition to address challenges in scaling up nutrition interventions. It provides context on global nutrition targets that most countries are not on track to meet. Implementation research is defined as the systematic approach to understanding and addressing barriers to effective implementation of nutrition policies and strategies in different contexts. The document outlines key questions implementation research can help answer related to design, delivery, scale-up, impact pathways, and cost-effectiveness of nutrition programs. It also describes common methods and tools used in implementation research like process evaluations, costing studies, and experimental design studies.
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Designing CCT Programs to Improve Nutrition Impact
1. Designing CCT Programs to
Improve Nutrition Impact
Principles, Evidence, and Examples
James Garrett
3d International Seminar on Conditional Cash Transfers
December 1-2, 2008
Santiago, Chile
*paper by James Garrett, Lucy Bassett, Marie Ruel, Alessandra Marini
2. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Overview of the Presentation
• Pathways of Impact
• Structuring Design Analysis
• Effect Pathways: Summary of the Evidence
• Enhancing a Focus on Nutrition
• role of a CCT in a strategy for nutrition
• considerations on design
• Country Study: Peru
Income
Conditionalities
(Co-responsibilities)
Design & Operation
3. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Use of H&N
Services
Health
Supply
Health
HH Income
+ Women
Income
Control
Child Nutrition
Food/
Nutrient Intake
Long term
Education
Supply
Education
(Condition)
HH Food
Security –
Diet Quality/
Quantity
Women’s
time
Educated
Girls
ProgramUnderlyingCausesImmediateCausesOutcomes
School
Enrollment +
Attendance
Health visits
(Condition)
Cash to
women
Feeding &
Care
Practices
Fortified
Products
Women’s
Knowledge &
Awareness
Education in Health
&Nutrition (H&N)
to Women
CCT Effect Pathways: Nutrition
Seven Pathways
poverty and food
insecurity, and diet
women’s income
and control over
resources
maternal
knowledge
health services
women’s time
micronutrient
fortification and
supplementation
girls’ and boy’s
education
Source: Leroy et al. (2008)
4. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Categorizing Pathways:
Structuring CCT Design for Nutrition
•Poverty food
insecurity,
and diet
quality
•Women’s
knowledge and
awareness
•Health services
utilization and
child health
•Girls’ and boys’
education
•Women’s
income and
control over
resources
•Women’s time
•Micronutrient
fortified foods
and
supplements
Income Conditionalities
(Co-responsibilities)
Design & Operation
5. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Effect Pathways: Evidence Summary
Poverty, Food Security, Diet Diversity
Program
(country)
Poverty
(numbers)
Food
Expend
Diet Quality
AP F&V
Oportunidades
(rural Mexico)
-12 pp
(-17 %)
3 %
(kcal)
13 % 16 %
Red de Protección Social
(Nicaragua)
-7 pp
(-5 %)
~ 24 % 64 %
71 %
(sweets
34 %)
Familias en Acción
(Colombia)
NS
(extreme rural
poverty: -6 pp)
~ 24 % 20 % NS
Programa de Asignación
Familial (PRAF)
(Honduras)
NS NS NS NS
1
6. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Effect Pathways: Evidence Summary
Effect on Women
Program
(country)
Women’s
Control over
Resources
Knowledge Time
Oportunidades
(rural Mexico)
no change
increase in
autonomy?
general
no info on child h & n
general burden
not perc’d as problem
Red de Protección
Social
(Nicaragua)
na na na
Familias en Acción
(Colombia)
na na na
Programa de
Asignación Familial
(PRAF)
(Honduras)
na na na
1
7. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Effect Pathways: Evidence Summary
Effect on Children
Program
(country)
Children’s
Health
Services Use
Micronutrient Status
Health Status
/ Growth
Oportunidades
(rural Mexico)
use
immunization NS
iron, zinc, vit A
(w / fortified food)
NS
(w/o fortified food)
overall illness
-23 % /
YES
Red de
Protección Social
(Nicaragua)
use
immunization NS
na
na /
YES
Familias en
Acción
(Colombia)
use
immunization NS
AP
vegetables
fruit NS
diarrhea, resp
NS
: rural diarrhea /
YES
Programa de
Asignación
Familial (PRAF)
(Honduras)
`
na
diarrhea NS /
NS
1
8. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Enhancing Pathways
Impacts on nutrition less than
possible
• pathways not thought through
• actions not focused on supporting
them
Determine actions to support
elements of the CCT
• pay greater attention to design and
implementation (3 areas)
• income, co-responsibilities,
operation
9. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Foundations of a Strategy
Co-responsibilities of greatest relative import
• income effect on nutrition, by itself, is limited
• other factors important (care and feeding practices, water and sanitation, health
services)
• higher incomes do not eliminate nutritional deficiencies
• transfers may be on items with no / little nutrition impact
Use a Systems Analysis
• how does each component / actor work
to produce “good nutrition”?
• alone and with other
• how does the CCT fit into a broader strategy
for nutrition / social protection?
• purpose, cost- effectiveness,
coordination / integration
10. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Essential Nutrition Actions
• exclusive breastfeeding for 0-6 months
• adequate complementary feeding 6-24 months
• appropriate care for sick and severely malnourished
children
• adequate intake of vitamin A, iron, iodine
• care: health and hygiene
11. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Country
Health
Check-ups
Growth
Monitoring
Educ Workshops Micronutr Suppl
Mexico
children & adults
iron & papilla
Nicaragua
children 0-5
iron
Colombia
children 0-6
enc, but not required
Honduras
children &
pregnant women
Peru
children 0-5 &
pregnant women
planned
hhs with children
6-36 mos
planned
CCTs in Latin America:
Nutrition-Related Services and Conditionalities
12. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Enhancing Pathways
• transfer
amount
• essential
nutrition
actions
• beneficiaries,
program
operators /
providers (all
levels)
• target groups (women, 0-3 y.o.)
• efficiency of transfer and service
delivery (education, health care)
• micronutrient suppl / fortification
• supply-side quality, incl feedback
mech
• interagency and actor coordination
Income
Transfer
Conditionalities
(Co-responsibilities)
Design and Operation
13. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
• transfer
amount
Enhancing Pathways: Income
provide a substantial incentive
20 to 40 % of hh income?
cover costs of compliance
o.c. of time, travel, etc
Income
Transfer
14. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Enhancing Pathways: Co-responsibilities
consider how system (including other
agencies, legal framework) works to achieve
essential nutrition actions
CCT can coordinate, integrate, or incentivize
actions
others have responsibilities, too – and
services must be available and of high quality
incentives must exist for everyone to do their
part
different ministries / agencies, and their staff; public,
private, hh; national, subnational, local
• essential
nutrition actions
• beneficiaries,
program operators
/ providers (all
levels)
Conditionalities
(Co-responsibilities)
15. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Enhancing Pathways: Design & Operation
evidence on unconditional transfers?
easier administration
same effect?
whom to target
fathers, non-traditional hh, community
transfer efficiency
electronic transfers
easy access (networks of state banks,
community NGOs, etc)
convenient times (non-work hours)
effective delivery (health, education)
excellent guides on training / counseling – use
them!
• target groups (pregnant /
lactating women, 0-3 y.o.)
• efficiency of transfer and
service delivery (education,
health care)
• micronutrient suppl /
fortification
• supply-side quality, incl
feedback mech
• interagency and actor
coordination
Design and Operation
16. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Enhancing Pathways: Design & Operation
supply-side
ensure accountability (as with hh!)
reimburse based on performance?
public reporting, citizen scorecards, and
oversight committees
channels for comments, complaints, and appeals
interagency / actor coordination: lateral
leadership
linking mechanisms
incentivize partnerships::
transparent decisions, funding, accountability
ownership: shared understanding, vision,
participation
known roles and responsibilities
• target groups (pregnant /
lactating women, 0-3 y.o.)
• efficiency of transfer and
service delivery (education,
health care)
• micronutrient suppl /
fortification
• supply-side quality, incl
feedback mech
• interagency and actor
coordination
Design and Operation
17. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Nutrition-Focused CCT: Example from Peru
Holistic Analysis Renewed emphasis on:
Co-responsibilities
Management and Capacity
Co-responsibilities
• key age group: pregnant/ lactating women; 0-3 year olds
• eliminate papilla: add “dispersible micronutrients”
• pay per number of conditionalities and household members
• change requirement that all conditions always have to be met
• identify state responsibilities
• coordinate, integrate, incentivize?
18. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Multi-Actor Production Function:
Providing Services to Beneficiaries
Take
beneficiary list
and provide to
local health
center
Reimburse
health
center for
services
provided
Synchronize lists
between SIS and
JUNTOS
Open clinical history
Fill out conditionalities
form
Set beneficiary
appointment schedule
Report lack of
compliance to
JUNTOS
File end-of-month reports with
SIS, JUNTOS, and municipality
Promoter visits household, determines services
and conditionalities
JUNTOS – Beneficiary signs contract,
including conditionalities
Beneficiary
receives
payments,
including first
incentive
Promoter
visits non-
compliant
households
Validate
application
Provide services as
scheduled
Bill SIS for
services
Apply algorithm
to determine
beneficiary
payment, taking
compliance into
accountMUNICIPALITY
reports to community
SIS
Complete form to
join SIS
Health Center JUNTOS Household
Take beneficiary list
and provide to
community promoters
19. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Nutrition-Focused CCT: Example from Peru
Management and Capacity
• ensure verification is independent
• informally transferred to promotoras (incentive to report compliance)
• make payment / verification timeline more realistic / less burdensome
• focus on results (political commitment, RBB)
• integrate into social protection / child nutrition strategy
• work with others who provide information and services (ID, MINSA
• MINED? water / sanitation? MINAG?
• interagency ownership and integration
• inter- sector, actor, agency working group
• merge information systems
20. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Conclusions: Improving CCT for Nutrition
• Consider pathways
• appropriate targets and nutrition actions
• consider characteristics of income transfer, co-responsibilities,
and design & operation
• Think holistically
• Think how CCT can enhance pathways
• but also complement other ongoing or potential actions and
actors
• cost effectiveness of actions within a CCT are, or better simply to
complement others
• attention to operations and management
• institutional arrangements, capacity, incentives
The basic question asked in this presentation is: if we want to improve the impact of a CCT on nutrition, what do we need to do? We must go beyond evaluations that tell us whether nutritional status was improved or not to pay attention to design, implementation, and operation. We must know how a CCT affects nutrition, and know what to do affect those different elements of the program that impact nutrition. First, we can use a conceptual model to identify the potential pathways of impact. To structure the analysis to make it useful for design we can then divide them into 3 categories to reflect the ways that a CCT affects nutrition: by giving income to the household, by requiring certain behaviors (“the conditionalities” or co-responsibilities), and by making sure the design makes sense to achieve program goals and the program itself works well.
I will then present some of the limited empirical evidence we have on those pathways…and then suggest how we might support those pathways through improved design and operation. Finally, I will briefly discuss some of these issues using a case study from Peru, which is now modifying their current CCT to develop a more nutrition-focused CCT.
In a recent paper, Leroy and other authors identified 7 different pathways by which a CCT could improve or affect child nutritional status: - Building on standard conceptual model of Determinants of Nutrition (food, health / environment, care): 1. giving income can directly reduce poverty and food insecurity, and improve diet quality (because normally the diet becomes more diverse with an increase in income); 2. giving the transfer to women increase their status within the household and increase their control over how to allocate money, which usually results in greater attention and greater expenditures to child health, education, and nutrition; 3. requiring mothers to attend classes on health, household hygiene, and nutrition, especially caring and feeding practices, can improve the mother’s knowledge about what to do; 4. this can be effectively complemented with more specialized knowledge and preventive or curative treatments received from the health services – especially prenatal checkups and growth monitoring, promotion, and counseling; 5. although the idea is that the time will be well-spent getting health care or participating in counseling and courses, the program still does require the beneficiary to take time out of her day to receive or deposit the transfer, and to satisfy conditionalities, perhaps time that could be otherwise spent in directly earning more income or taking care of the children 6. some programs directly give micronutrient supplements, such as Sprinkles or tablets, or foods that have been fortified with micronutrients and energy, una papilla, to the household, or they make receipt one of the conditions: this can also directly improve nutritional status; 7. in the long term, the common requirements that girls and boys attend school will improve their own knowledge and awareness – their human capital – and so improve their own productivity
These pathways can reasonably align with the structure for analysis set out at the beginning. The CCT has effects through the income transfer (reducing poverty and hunger, improving diet quality); through imposing certain conditionalities or complying with certain co-responsibilities (so educating mothers and children or improving use of health services); and through choices made in terms of design and operation, which do not directly relate to the fundamental aspects of providing an income transfer or determining which behaviors to change. Also: Outcomes (poverty, food security, mn status), Intermediate Effects on Women (knowledge, empowerment, time) and Children (health services utilization, education)[STOP]
Operation and design choices would affect the decision to provide the transfer to the mother (as opposed to someone else); ways to improve the efficiency of providing services or delivering the transfer, and so reduce the burden on women’s time; and the direct provision of fortified foods or supplements. The usefulness of this rather simplistic scheme is that it separates out the different operational components so policymakers and programmers can look at them individually, and understand that they can indeed make individual choices about each of the categories, even though they all, in the end, work together.
Most program evaluations (the few rigorous ones that exist) look at the effect of the program as a whole on desired objectives, such as reduced poverty or malnutrition. We do not have studies that separate out the specific effect of each of the potential pathways of impact from that of others in a CCT. Still, we do have some indication, from these evaluations and from the literature, of how CCTs affect these pathways or how the factors associated with the pathways (improved maternal education, for instance) can affect nutrition. Let’s summarize the evidence relating to the pathways using results from 4 available impact evaluations (Mex, Nicaragua, Colombia, Honduras):More details in the paper; results are from endline surveys when there is more than one – effects are those after approx. 2 years. AP = animal products (meat in Nicaragua).
First, what have been the effects of a CCT on the “first” pathway – poverty, expenditures, and dietary quality.
Generally, significantly reduced poverty and increased food exp, improved dietary quality (AP, F&V) in the hh, which should improve mn status. [More detail in other presentation…] Of course, sometimes expenditures on dietary “bads” also go up…like the 34% increase in sweets in Nicaragua. [STOP]
Effects on poverty: substantial and significant in Mexico and Nicaragua, 7 to 12 percentage point drop. The impact on overall poverty in Colombia was insignificant but extreme poverty in rural areas declined by 6 pp. Food expenditures went up substantially in Nicaragua and Colombia, except Honduras, and calorie consumption went up in Mexico.
The data were not very complete but they suggest that dietary quality also improved, with expenditures increasing on on key dietary items, like animal proteins and fruits & vegetables, by more than the increase in hh expenditures.
What is really lacking, however, is knowledge about how the income transfer or conditionalities reduce poverty or improve nutrition. We have very little information on some of the key assumed pathways of impact: such as changes in women’s status, and maternal knowledge about how to care and feed the child. Of the four rigorous evaluations examined here, 3 of them had no information on how the program affected women’s power and decisionmaking within the household, how it changed their knowledge of health and nutrition, or how the program affected the use of their time. The evaluation in rural Mexico suggested the program had no effect on women’s status within the household, although it may have had some effect on general knowledge of health and nutrition (but it asked no specific questions on child health and nutrition), and although there was some additional burden placed on women to participate in the program, they did not generally perceive that to be a problem. We don’t really know what time shifts this caused, however, because no study has yet looked at it.
As far as the effects on pathways for children, the picture is generally positive but more or less mixed. It is clear we do not have a clear idea of how or why the programs have effects on child health. For example, generally health service use increased – but I put only a general trend because the actual numbers of increase vary greatly, from say 5 pp to 50 pp. And this changes across programs, and depending on preventive or curative care, the age of the child, and the length of time the household has been “exposed” to the program (generally declining over time). Somewhat surprisingly the program had little effect on rates of immunization – but this may be due to generally already high levels across the beneficiary and non-beneficiary populations. Micronutrient status of children, when measured, also seems to have improved, although in Mexico this seems to be from the provision of the food rather than a cash-effect. It is also worth noting this is probably a *minimum* because the food was not always prepared properly or given completely or consistently to the target child. This is again a design and operational consideration that the program should take into account to improve impact. As we know, the programs did generally positively affect child health and growth, though again we have little hard evidence about why or how. ***
The prevalence of illness in Mexican children dropped precipitously – but in Colombia and Honduras the impact was not significant. Child growth – the standard measure of child malnutrition – improved in Mexico, Nicaragua, and Colombia – again showing the programs have impacts on the outcomes but we have less idea about why or how.
Although CCT clearly have some general impacts on outcomes (poverty, food security, malnutrition), the impacts on nutrition are most certainly less than they could be because the pathways are not well thought through. What should be the specific conditionalities to promote actions that will improve nutrition (supporting the pathways)? [STOP]
Can a CCT do that? Even if we determine the appropriate conditionalities, we have not paid sufficient attention to the implementation (that is, the management) of the programs to make sure they work well, even if they have a good basic design. Improving CCTS for nutrition means paying more attention to the larger issues of design and operation, regarding the transfer, the coresponsibilities, and management.
Most probably the coresponsibilities are of greatest importance to have an impact on child nutrition, because the impact of income alone on nutrition is relatively limited. [SEE SLIDE]
So getting the coresponsibilities right is essential. And this means making both beneficiaries and government fulfill their responsibilities to make the program work. In addition to design considerations (such as the size of the transfer), the fact that the determinants of good nutrition are multisectoral, and involve many actors, public and private, and many layers of government and civil society, from national to the community, means it is also important to take a systems analysis of the program itself – how each component and actor works with the other to produce the outcomes - -and of how the CCT fits within a broader strategy of social protection.
We know the essential actions to improve nutrition, that we can use to build on these principles of a strategy.
[SEE SLIDE] (John and Lucy: international best practices…)
Many of the programs already have many of these essential actions, or mechanisms that could promote them (such as educational workshops), in their programs. For example, through the health checkups, growth monitoring and counseling sessions, or educational workshops, mothers could learn about the importance of essential actions such as exclusive breastfeeding and high-quality complementary foods, and they could receive micronutrient supplements. But unless the program conditionalities and operations specifically address the known essential nutrition actions (and just checking off the box doesn’t tell us) it probably will not have an impact on nutrition.
So we need to make sure that actions in each of these areas actually 1) follow recommended international practice (eg., not just “program requires health checkups” but that conditionalities matches up with the international recommendation of the appropriate number of prenatal checkups or well-baby visits); and 2) beneficiaries can access the services; and 3) the services are of high quality. Keeping these in mind, what are specific actions to take to design a more effective CCT for nutrition? using the categories for strategic analysis we developed at the beginning…
INCOME: size of the transfer: 20-40% of household income to make a difference: provide an incentive, allow coverage of costs of compliance (e.g., opportunity costs of time or direct costs of undertaking co-responsibilities, such as travel costs or complementary purchases). One reason we think the CCT program in Honduras did not have a significant impact is bc the transfer size was so small, only about 4 percent of household income.
The conditionalities should focus on what the individuals need to do to achieve the essential nutrition actions. But 1. determinants of nutrition are complex and multisectoral, and multiple actors: need to see what others are doing (water / sanitation, education and early childhood development, for example): 2. the CCT’s role can be to coordinate, integrate or provide incentives for them to act; 3. as mentioned, other sectors have to provide high quality services, as part of the conditionalities, or rather their co-responsibilities, in making sure the program works; 4. but incentives may need to exist so that everyone does their part…across sectors, and across levels of action [more later: using accumulating evidence from examples of working multisectorally and building political commitment in nutrition]
[BASICALLY READ SLIDE] guides and experience: many national and international organizations and NGOs (CARE, UNICEF, WFP) on logistics;
on training (USAID – models like BASICS, HEARTH, PROFILES); WB on GMP in Central America
varied modalities for interagency coordination
Now to finish a quick illustration from how Peru’s CCT program, called JUNTOS, is dealing with some of these issues as it refocuses its CCT to be more nutrition-centered…
1. they undertook a holistic analysis…leading them to a renewed emphasis on: [SEE SLIDE]
Let’s take just one example to illustrate the complexity of management and the importance of coordination and capacity in designing a nutrition-focused CCT. This is just one aspect of JUNTOS. I won’t go into all the links, but it is just to show that just in providing health services to beneficiaries – which is a conditionality for beneficiaries but is a responsibility of the state to provide them – determining which households should get which services are the responsibility of community-level promotoras who are part of JUNTOS staff…but almost all the rest of whether this system works and gets the required services to the households is beyond JUNTOS’ control. We often focus on what incentives the household has to comply with the conditionalities (the cash transfer) – but this diagram shows how involved other agencies are in making the system work. SIS, the health insurance program for the poor, has to validate applications and reimburse the health center for services provided. And the local health center must complete forms, check lists, provide services, bill services, report lack of compliance…and then prepare end of the month reports for the other actors in the system: SIS, JUNTOS and the municipality.
What is their incentive for working with JUNTOS? Just that they should? What power does JUNTOS have over them, or their lead ministry? or the regional governments or localities to which they are also accountable. For example, if there are breaks or delays in payments between SIS and the health center, this may lead to poorer service and may impact the effect of JUNTOS – and it’s a headache for JUNTOS but they have little direct control over whether the situation gets resolved. And there is a public accountability mechanism, with reports to the municipality, who should report to the community…but there is not a way for the community and municipality to report back and AFFECT what these higher-level agencies are doing.
This just shows the complexity of the system..and the need for serious attention to supply-side quality, including operation and management, and interagency collaboration.
What is JUNTOS doing on this front? [SEE SLIDE]