Social safety nets, food security and nutrition February 11, 2014 John Hoddinott International Food Policy Research Institute
Some stylized facts and unresolved issues Social protection in the form of noncontributory programs that transfer resources to poor reach somewhere between 750 and 1 billion people around the world Numerous evaluations have shown that the poor use these transfers effectively, buying food and investing in health and education. In well designed programs: there is little systematic evidence of disincentives or dependency effects; and targeting these interventions enhances their effectiveness. But in the context of enhancing household level food security, there are issues that require attention. 1) What do we know about the relative advantages and drawback of providing assistance in the form of food or cash? There are many informative studies of food transfers and of cash transfers but there are no compelling studies that directly compare the impacts of food and cash in the same setting. There is even less information on relative costs. 2) Are these interventions sufficient to reduce chronic undernutrition in young children?
Stylized facts and unresolved issues This presentation focuses on these unresolved issues, drawing extensively on recently completed and ongoing IFPRI research Four country study looking at the impact of cash and food on household food security outcomes Ongoing work in Bangladesh integrating nutrition Behaviour Communication Change into a pilot social protection intervention Presentation deliberately does not directly discuss social protection and nutrition issues in India; instead it focuses on setting out the issues and describing how they have been addressed in other contexts
FOUR COUNTRY STUDY ON FOOD AND CASH TRANSFERS INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Intervention Design Six 12 months of transfer given to targeted households in four countries: Ecuador (urban, refugees) Niger (agro-pastoralist, classic Sahelian food security) Uganda (post-conflict with high levels of seasonal food insecurity) Yemen (rural, high levels of chronic food insecurity) Beneficiaries randomized at neighborhood level to receive either cash or food transfers (food basket of staples, pulses and vegetable oil) of equal value In Ecuador, an additional treatment arm was implemented; vouchers for the purchase of specified foods in local supermarkets All other aspects of intervention (targeting of beneficiaries; frequency, timing of transfers etc) are the same across transfer modalities
Two measures of household food security Food Consumption Score (FCS), WFP s principal food security indicator, FCS = (# times food group consumed in last seven days) x (weight attached to food group) In Ecuador, Uganda, and Yemen we also calculate household caloric acquisition While FCS and caloric acquisition can increase together: Caloric acquisition can rise without much change in FCS (eg increased consumption of quantities of staples) FCS can change without much change in caloric acquisition (eg increased consumption of vegetables)
Impact of cash transfers relative to food: Percentage change in FCS 15 10 9.2 10.1 5.6 5 0.6 0 Niger, postharvest season Niger, hungry season Ecuador, cash Ecuador, vouchers Yemen Uganda -5-10 -11-9.6-15
Impact of cash transfers relative to food: Percent change in caloric acquisition 20.0 17.9 15.0 10.0 5.0 0.0 Ecuador, cash Ecuador, vouchers Yemen Uganda -5.0-5.0-4.0-10.0-10.0-15.0
Costing transfer modalities Focus on modality specific costs (staff time, goods, services) that are specific to the delivery modality chosen: Food: Staff and monetary costs associated with in-country transport, ration preparation and distribution Cash: Costs associated with contract preparation; cost of debit cards; bank fees for administering transfers Vouchers: Costs associated with supermarket selection; printing vouchers; staff costs associated with liquidating vouchers Common costs that are incurred in program implementation (planning costs, targeting, sensitization, nutrition training etc) are allocated proportionately across modalities or are excluded. How much does it cost to make a cash transfer relative to a food transfer?
Dollar cost of a cash transfer relative to a food transfer 5.00 0.00 Ecuador Niger Uganda Yemen Ecuador, voucher -5.00-10.00-8.47-8.91-2.96-6.28-8.20-15.00-20.00-25.00-30.00
Number of additional beneficiaries gained by switching from food to cash transfers 35000 32802 30000 25000 20000 15000 13858 10000 9062 5000 4841 5041 0 Ecuador Niger Uganda Yemen Total
TRANSFER MODALITY RESEARCH INITIATIVE - BANGLADESH INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
Social protection and undernutrition Given Social protection improves both diet quantity and diet quality and Both diet quantity and quality are important for the growth of young children (<24m) We would expect that social protection interventions would improve the growth of young children It is possible to point to some evidence consistent with this expectation: Cross-country estimates show that a 10% in per capita GDP leads to a 5.9% in stunting There are examples of social protection interventions (eg conditional cash transfers in Mexico; old age pensions in South Africa) that reduce stunting BUT
Social protection and undernutrition Careful review of evidence of impacts of social protection on undernutrition indicates that these positive effects are not found everywhere; in fact they may be exceptional Manley et al (2012) review 20 programs looking at 17 programmes in 12 different countries, most of which are in Latin America (8 countries) or south Asia (3 countries) Both simple averages and more sophisticated meta-analysis shows that the average effect size of social protection programs on HAZ is 0.04, an impact that is neither biologically or statistically significant
Social protection and undernutrition In most but not all of these interventions, social protection and nutrition are loosely wedded ; ie there are nutrition services (sometimes) and health services (usually) available but they are not tied closely to the social protection program This results in two constraining factors that limit impact: Obvious : Health, illness and sanitation Subtle : Behavioral change such as handwashing and meal preparation What would happen if, instead, social protection and nutrition interventions were tightly meshed
Transfer Modality Research Initiative - Bangladesh Two year randomized control trial in northern and southern Bangladesh with following treatment arms 1. Monthly cash tfr (north & south) 2. Monthly cash tfr AND Nutrition behavior change communication (north) 3. Monthly food tfr (north & south) 4. Monthly food tfr AND Nutrition behavior change communication (south) 5. ½ Food AND ½ cash (north & south) 6. Controls (north & south) Tfrs are targeted to v v v poor hh with children <24m Tfrs go to mothers Food is standard WFP-type food basket (grains, pulses, oil) Cash is delivered using mix of sms and hand delivery
Transfer Modality Research Initiative - Bangladesh Behavior communication change is intensive Weekly meetings with a trained community nutrition worker Topics covered follow structured curriculum: (1) importance of nutrition and diet diversity for health; (2) hand-washing/hygiene; (3) micronutrients: diversifying diets, Vitamin A; (4) micronutrients: diversifying diets, iron, iodine, and zinc; (5) breastfeeding (6) complementary feeding; and (7) maternal nutrition Training methods are varied over time Some meetings with CNW and mothers Some meetings with other, influential hh members such as mothers-in-law or husbands Home visits Monthly meetings with community leaders, teachers, religious leaders
Data Baseline quantitative household survey prior to start of intervention, April 2012 Process evaluation, November 2012 Midline survey, June 2013, after completing 12 months of transfers Endline survey scheduled for March 2014, after 22 months of transfers Qualitative fieldwork, ~July 2014 50 clusters (villages) and 10 households per village for each treatment arm and the control. 500 clusters and 5,000 households (4,000 beneficiaries and 1,000 controls) VERY VERY VERY PRELIMINARY RESULTS
Food consumption score Impact of transfer modalities on diet quality: Absolute change in Food consumption score relative to control 20 North 17.0 15 10 8.7 5 5.3 6.0 0 Cash only Food only Cash+Food Cash+BCC Statistically significant Not significant
Increase in calorie (kcal/person/day) Impact of transfers on per capita daily food energy acquisition: Absolute change (kcal) relative to control 300 North 250 232 200 150 100 106 120 50 55 0 Cash only Food only Cash+Food Cash+BCC Statistically significant Not significant
Impact of transfer on stunting (children 6-48 months at baseline) 65 60 North: Stunting by survey round and treatment arm 62 60 55 54 50 45 48 47 50 40 35 Baseline Midline Cash Food Cash+Food Cash+BCC Control
Summary 1) From a household food security perspective, the four country study shows: Cash transfers often but not always - proved more effective in improving food security as measured by the FCS At a significantly lower cost But impact on calories was often higher when food was given We found little evidence that cash had adverse impacts as measured by creation of social tensions, changes in intra-household decisionmaking, or purchase of intoxicants 2) Remembering that the TMRI results are preliminary: BUT Household food security results are consistent with what we see in the four country study Stunting is only affected when transfers are tightly meshed to the delivery of nutrition BCC