Publications

Integrated social protection programmes are increasingly being pursued as more effective and efficient ways to improve children’s health and nutrition outcomes. UNICEF Ethiopia is implementing a pilot Integrated Safety Net Programme (ISNP) in the Amhara region of Ethiopia aimed at integrating a cash transfer (through the Productive Safety Net Programme (PSNP)), a health insurance (the Community Based Health Insurance (CBHI)), social and behaviour change communication (on nutrition, feeding practices, sexual and reproductive health, gender equality, and child marriage), and case management (for malnourished and out of school children).

The ISNP implementation began in early 2019. Knowing that integration comes with its own challenges in terms of planning, coordination, harmonization of systems and tools, and the alignment of budgets, this qualitative study sought to understand the status of implementation, emerging challenges, and potential remedial actions to ensure the intervention achieves the stated objectives. The study shows that while there is progress, more action is needed in terms of implementing the planned management information system (MIS), ensuring adequate and well trained frontline workers are in place, further improving harmonization of targeting tools, and increasing budgetary allocation.

Integrated social protection programmes are increasingly being pursued as more effective and efficient ways to improve children’s health and nutrition outcomes. UNICEF Ethiopia is implementing a pilot Integrated Safety Net Programme (ISNP) in the Amhara region of Ethiopia aimed at integrating a cash transfer (through the Productive Safety Net Programme (PSNP)), a health insurance (the Community Based Health Insurance (CBHI)), social and behaviour change communication (on nutrition, feeding practices, sexual and reproductive health, gender equality, and child marriage), and case management (for malnourished and out of school children).

The ISNP implementation began in early 2019. Knowing that integration comes with its own challenges in terms of planning, coordination, harmonization of systems and tools, and the alignment of budgets, this qualitative study sought to understand the status of implementation, emerging challenges, and potential remedial actions to ensure the intervention achieves the stated objectives. The study shows that while there is progress, more action is needed in terms of implementing the planned management information system (MIS), ensuring adequate and well trained frontline workers are in place, further improving harmonization of targeting tools, and increasing budgetary allocation.

UNICEF supports the Government of Ethiopia to implement a pilot Integrated Safety Net Programme (ISNP) in the Amhara Region from 2019 to 2023. The objective of the programme is to harness the potential synergies that can be realized by integrating social protection policies and programmes. It seeks to test the efficacy of combining cash and services to improve nutrition and health outcomes for children and their households.

This report describes the conceptual framework and methodology for an impact evaluation of the ISNP intervention and presents findings from a baseline study. The baseline study confirms the low socio-economic status of PSNP households in the domains of housing conditions, sanitation, schooling, health seeking, food security, women’s agency, subjective wellbeing, sexual and reproductive health, access to social services, child nutrition and child protection. The PSNP clients are found to be generally worse off than the entirety of rural Amhara – confirming the targeting effectiveness of the PSNP. The study highlights the gaps that the ISNP interventions are meant to address and provides concrete action points for successful implementation.

We examine the effect of the Zambia Child Grant Programme – an unconditional cash transfer (CT) targeted to rural families with children under age five – on height-for-age four years after programme initiation. The CT scheme had large positive effects on several nutritional inputs including food expenditure and meal frequency. However, there was no effect on height-for-age. Production function estimates indicate that food carries little weight in the production of child height. Health knowledge of mothers and health infrastructure in the study sites are also very poor. These factors plus the harsh disease environment are too onerous to be overcome by the increases in food intake generated by the CT. In such settings, a stand-alone CT, even when it has large positive effects on food security, is unlikely to have an impact on long-term chronic malnutrition unless accompanied by complementary interventions.

Seasonality in agricultural production continues to shape intra-annual food availability and prices in low-income countries. Using high-frequency panel data from northern Ethiopia, this study attempts to quantify seasonal fluctuations in children's weights. In line with earlier studies, we document considerable seasonality in children’s age and height adjusted weights. While children located closer to local food markets are better nourished compared to their counterparts residing in more remote areas, their weights are also subject to considerable seasonality. Further analysis provides evidence that children located closer to food markets consume more diverse diets than those located farther away. This leads us to conclude that households located near these food markets are not able to insulate their children from seasonal weight fluctuations.

This study investigates whether cash transfers enable households facing weather and other negative income shocks to avoid adverse coping strategies that can lead to poverty traps. While cash transfers are not routinely considered in the policy discourse concerning climate adaptation programming, because ex-ante transfers enable households to avoid negative coping strategies and even increase food consumption in the face of covariate weather shocks, cash transfers offer a sound approach for building climate-resilience amongst the world’s most vulnerable and facilitating their “autonomous adaptation” to a changing environment. Cash also enables households to productively cope with the many other idiosyncratic shocks the rural poor routinely face.

This paper aims to provide a comprehensive overview of the impacts of cash transfer programmes on the immediate and underlying determinants of child nutrition, including the most recent evidence from impact evaluations across sub-Saharan Africa. It adopts the UNICEF extended model of care conceptual framework of child nutrition and highlights evidence on the main elements of the framework – food security, care and health care. It finds that several key gaps should be addressed in future including cash transfer impacts on more proximate nutrition-related outcomes such as children’s dietary diversity, as well as caregiver behaviours, intra-household violence, and stress, all of which have implications for child health and well-being.

After the collapse of the communist system in 1989, most Eastern European countries experienced a mortality and health crisis. However, this did not hit the traditionally most vulnerable groups - children, adolescents, women and the elderly - but male adults in the 20-59 age group. The Report indicates that the surge is largely dependent on three transition-related factors: widespread impoverishment, erosion of preventive health services, sanitary and medical services and social stress. Although infants, children and young adolescents have not been greatly or directly affected by the mortality crisis, the Report points out that their situation has been severely threatened by more frequent sickness and greater nutritional imbalances, while the upturn in adult deaths is leading to a considerably heightened risk of poverty, abandonment or orphanhood.

After the collapse of the communist system in 1989, most Eastern European countries experienced a mortality and health crisis. However, this did not hit the traditionally most vulnerable groups - children, adolescents, women and the elderly - but male adults in the 20-59 age group. The Report indicates that the surge is largely dependent on three transition-related factors: widespread impoverishment, erosion of preventive health services, sanitary and medical services and social stress. Although infants, children and young adolescents have not been greatly or directly affected by the mortality crisis, the Report points out that their situation has been severely threatened by more frequent sickness and greater nutritional imbalances, while the upturn in adult deaths is leading to a considerably heightened risk of poverty, abandonment or orphanhood.

Nutrition is mentioned specifically only three times in the Convention on the Rights of the Child. However, through its emphasis upon food, health, and care, the Convention makes it clear that good nutrition should be regarded as a fundamental human right. This study reviews the progress that governments have made in implementing this aspect of the Convention, providing ‘status reports’ on the inclusion of nutrition goals in individual ‘National Programmes of Action’. The paper includes a background overview of the development of human nutrition as a science, together with a survey of current trends in thinking on the subject.

The first wave of historical studies of breastfeeding was instrumental in allowing economists, social scientists and decision-makers to guage the order of magnitude of the potantial demographic effects of changing infant feeding patterns that were apparantly underway in many third world countries. In the past 20 years much more information has become available on the effects of feeding patterns on infant mortality in developing countries, yet there are still interesting lessons to be learnt from the past. A blending of quantitative and qualitative evidence can contribute to a better understanding of behavioural dilemmas and can also help us to assess the impact of innovation and official intervention on the survival chances of infants and young children.