Angela CéspedesRegional Nutrition Advisor

Regional Office for Latin America and the CaribbeanWorld Food Programme

Nutritional Dimension within

Social Safety Nets in Central America and the Dominican Republic

Organization of American States (OAS)Third Meeting of the Inter-American Committee on Social Development

April 6Th and 7Th 2010, Washington DC

Contents

Social Safety Nets Concept

General objectives of the Study

Methodology

Results

Conclusions

Recommendations

Study Dissemination and Next Steps

What are Social Safety Nets?

“Social Safety Nets (SSN) are instruments of social public policy that States can and should use to comply with their role in the

guaranteeing of human rights, specially the Right to Food, giving priority to groups that are in a situation of major

vulnerability to undernutrition, poverty, exclusion, discrimination and stigmatization. SSN are articulate mechanisms with a

common end, consisting of free or subsidized programmes that aim to: develop human capital, reduce inequity and social exclusion; ensure adequate levels of nutrition, health and

well being; improve living conditions; help families minimize nutritional and food related vulnerability;

promote self-sufficiency and empowerment; and redistribute income among groups in extreme poverty

situation, aiming to obtain an immediate impact on poverty and inequity reduction”

Adapted by WFP from the ILO,FAO, UK International Dept and others.

General Objective of the Study

To understand the scope of the nutritional

dimension of Social Safety Nets in Central America

(Belize, Costa Rica, El Salvador, Guatemala,

Honduras, Nicaragua and Panama) and the

Dominican Republic, as well as the priority given by

these nets to children under 2 years, pregnant and

lactating women, people with HIV, indigenous

peoples and Afro-descendants populations.

Study Collaborators

About 200 people involved:

Public institutions, NGOs and cooperation agencies from each country. A High Level Technical Group (HLTG) consisting of 27 experts from 16

institutions and from regional and international agencies. WFP technical team: from the regional and country offices focal points of

the nutrition and HIV areas. Consultants, supported by a team of statisticians.

Methodology:

Information Gathering

MAIN SURVEY(Technical sheet)

• Use of secondary data sources.

• An inventory of programmes, policies, plans and strategies.

•70 questions that include multicausality, undernutrition determinants, poverty, exclusion and discrimination.

INTERVIEWS TO KEY INFORMANTS

•Political leaders, current and former public officials, community leaders, nutrition and breastfeeding experts, artists, people with HIV.

• A SWOT qualitative analysis.

Main Survey ContentsI. Identification, programme type and coordination.II. Duration and norms.III. Objectives, components, lines of action.IV. Target population, targeting criteria, coverage, filtration.V. Human rights approach, gender approach, ethnic-cultural relevance and community participation.VI. Human resources and training.VII. Management, supervision, monitoring and evaluation.VIII. Investment, collateral effects, sustainability and degree of compliance to national strategies to fight poverty.

• The logical framework uses the human rights approach, gender approach, the intercultural perspective and scientific evidence.

• A holistic approach and considers several undernutrition determinants.

• Simultaneously prioritizes several excluded groups with no information available.

• Wide range of social programmes by using, in a combined way, qualitative and quantitative methods and instruments.

• Programmes from public sector, NGOs, privates and international cooperation agencies.

Methodology:

Study Innovation

Evidence has demonstrated that the success of strategies and programmes to improve nutrition requires of the ownership and

responsibility not only from governments, but also from civil society, NGOs , cooperation agencies and the private sector.

Scaling up Nutrition: A framework for Action (2009)

Methodology:

Types of Studied Programmes

1. Conditional Transfers*

2. Mother Child Nutrition**

3. Mother Child Health**

4. Food Based**

5. Nutritional Recovery**

6. Micronutrients Supplementation**

7. Micronutrients Fortification

8. Biofortification

9. Productive Programmes

10.Childhood and adolescence attention programmes

11.HIV specific programmes

* Cash, in kind, vouchers, others* *Classified as Food and Nutrition Programmes.More than 60% of the analyzed programmes are integrated.

RegionalResults

Transversal analytical epidemiological Study, basically descriptive. Sample close to the universe reflecting the diversity of existing programmes.

Number and types of programmes and plans analyzed by country (n=120)

Type of Programme Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panama Dominican Republic Total

Conditional Transfers 1 2 1 2 4 1 2 2 15

Mother child nutrition* 1 3 8 5 3 5 2 2 29

Mother child health* - - - 1 1 2 - 2 6

Food Based* - 1 1 3 1 2 2 2 12

Nutritional Recovery* - - 2 - - 1 - - 3

Micronutrients Supplementation* ** ** ** ** 1 ** 2 1 4

Micronutrients Fortification - 1 - 1 - 1 2 1 6

Biofortification - - - 1 - 1 1 1 4

Productive programmes - - 2 - - 4 - - 6

Childhood and adolescence attention programmes 2 3 - - - - - - 5

HIV specific programmes 3 1 2 2 6 1 4 1 20

Programmes Sub-Totals 7 11 16 15 16 18 15 12 110

Plans and Policies - 2 1 - 4 1 2 - 10

Total Programmes, Plans and Policies 7 13 17 15 20 19 17 12 120

Source: Study on Nutritional Dimension of Social Safety Nets in Central America and the Dominican Republic, 2009The sign (-) in some types of programmes does not mean that the country does not have this type of programme. It just means that it was not included within the sampling or that it is part of other integrated programmes.

Notes: * To facilitate the presentation of tables and figures (and also because they share similar actions) Mother & child nutrition and health programmes, Food-based programmes, nutritional recovery and micronutrients supplementation have been grouped into one category: food and nutrition programmes (n = 54). ** Micronutrient supplementation in Belize, Costa Rica, El Salvador, Guatemala and Nicaragua are part of integrated programmes of nutrition, classified under the category Mother child nutrition in this study.

Programmes that identified nutritional objectives (n =110)

Notes: In parenthesis number of programmes (n).* To facilitate the presentation of tables and figures (and also because they share similar actions) Mother & child nutrition and health programmes, Food-based programmes, nutritional recovery and micronutrients supplementation have been grouped into one category: food and nutrition programmes (n = 54).

Source: Study on Nutritional Dimension of Social Safety Nets in Central America and the Dominican Republic, 2009

Target population

identified in the

programmes (n=110)

i

Source. Study on Nutritional Dimension of Social Safety Nets in Central America and the Dominican Republic, 2009

Notes: In parenthesis number of programmes (n).

Priority actions

identified in the

programmes (n=110)

Source. Study on Nutritional Dimension of Social Safety Nets in Central America and the Dominican Republic, 2009

Notes: In parenthesis number of programmes (n).

Presence and types of evaluations conducted in the programmes (n=110)

Source. Study on Nutritional Dimension of Social Safety Nets in Central America and the Dominican Republic, 2009Notes: In parenthesis number of programmes (n).

Impact evaluations (n=110)

Source. Study on Nutritional Dimension of Social Safety Nets in Central America and the Dominican Republic, 2009Notes: In parenthesis number of programmes (n).

¨The same programmes can have more than one type of impact evaluation.DHS: Demographics and Health National Survey.

Funding sources according to types of programmes (n=110)

Food nutrition programmes

(54)

Conditional Transfers (15)

Fortification and Biofortification

(10)

Productive Programmes

(6)

Childhood and Adolescence

Attention Programmes (5)

HIV specific programmes

(20)Total (110)

% (n) % (n) % (n) % (n) % (n) % (n) % (n)

Public funds exclusively 19% (10) 27% (4) 20% (2) - 80% (4) 15% (3) 21% (23)

Public funds and foreign cooperation (loans and donations)

30% (16) 67% (10) 30% (3) 17% (1) - 15% (3) 30% (33)

Public funds and private sector 4% (2) - 30% (3) - - 10% (2) 6% (7)

Public funds, private sector and foreign donations

7% (4) - - - - 5% (1) 5% (5)

Foreign cooperation (donation) exclusively

28% (15) - 10% (1) 50% (3) - 20% (4) 21% (23)

Private sector exclusively 2% (1) - - 17% (1) - 5% (1) 3% (3)

Private sector and foreign cooperation 7% (4) - - - 20% (1) 5% (1) 5% (6)

Others (sponsorship, own resources) 2% (1) - - 17% (1) - 20% (4) 5% (6)

No information about funding 2% (1) 7% (1) 10% (1) - - 5% (1) 4% (4)

Funding Sources

Source. Study on Nutritional Dimension of Social Safety Nets in Central America and the Dominican Republic, 2009Notes: In parenthesis number of programmes (n).

SWOT Analysis

STRENGHTS OPPORTUNITIES WEAKNESSES THREATS

•More political support for nutrition and other social programmes.

•Favorable legal framework.

•Conditional cash transfer programmes increase women’s self esteem.

•In emergencies food is crucial to avoid nutritional deterioration.

•Mother child health programmes with major achievements: reducing infant and maternal mortality.

•Demand increase for these programmes.

• International commitment assumed by governments (MDG).

• Global food crisis raises the importance of nutrition and feeding issues.

•Solidarity among populations in the region: countries share experiences and resources.

• The increasingly stronger academic sector provides greater chances of success.

• Indigenous peoples and Afro descendants in government positions (less discrimination).

• Lancet Series reiterates importance and evidence on breastfeeding.

•No programme sustainability and continuity.

•Programme dispersion and no results

• Very low social investment (public) in nutrition.

• Lack of evaluations,specially impact ones.

•Lack of human rights approach, programmes lack cultural relevance.

• Weak community participation (only in the implementation phase).

• Insufficient budget allocated to breastfeeding promotion.

• Crisis leads to budget cuts in public sector and donors community.

•Dependency on external cooperation and “indebtedness”.

•In general, no state or institutional policies insocial protection.

• “Assistentialism and politization” of programmes.

•Lack of technical information in the decision makers.

•Lack of information and nutritional education for the population.

•Discrimination and stigmatization of excluded groups (indigenous peoples and Afro descendants, people with HIV).

CONCLUSIONS

Increasingly political commitment at the highest levels of governments in order to position the eradication of child and maternal undernutrition as central to human and economic development.

Supportive legal framework and areas of high level multisectoral coordination (Secretariats and National Councils for Food and Nutritional Security in ELS, GUA and PAN. However, coordination –both intersectoral and multisectoral – is variable and ineffective, being the establishment of articulate and coherent social safety nets yet a challenge to be overcome in those countries.

Nutritional dimension reflected through the explicit incorporation of objectives, actions/interventions and nutritional indicators is rare in most social protection analyzed programmes.

… CONCLUSIONS

Programmes such as conditional transfers and childhood and adolescence attention programmes have great potential that is not being properly used to improve child nutrition and of other priority groups. Conditional cash transfer programmes since their inception have had goals related to poverty reduction and investment in human capital, but did not explicitly incorporated the nutritional dimension into it (it is expected that the improved nutritional status will be attained by the compliance with co-responsibilities or through other sectors intervention).

Most of the actions are concentrated on pregnant women, children under five years old; and in families on poverty and extreme poverty. There is no prioritizing for children under 2 years old (Positive examples ELS and NIC), nor on indigenous peoples. In general, people with HIV are not included in the public social safety net programmes; their attention is through HIV specific programmes (Positive example HON).

… CONCLUSIONS

Programme coverage is low or unknown; less than 20% of the programmes analyzed have adequate information on their coverage. There are geographical areas with higher concentration of programmes, suggesting possible overlaps and in turn, there are priority areas with child and maternal undernutrition problems that do not have extensive coverage sub national programmes.

In the area of human resources, there are insufficient numbers of nutritional and social programmes qualified/trained individuals in relation to needs. There is no evidence of training being effective.

The lack of evaluation and monitoring systems with their respective financing constitutes a weakness. Only 6% of the totality of the analyzed programmes have rigorous nutritional impact evaluations (Positive example PANAMA). Some programmes gather up information about nutritional indicators, there is no evidence that the information is being used to reroute the interventions, strategies and programmes.

… CONCLUSIONS

The majority of the programmes use the framework of human rights and take account of interculturality, community involvement and gender approach. Practically all the countries have laws on food and nutrition security framed onto those approaches (Guatemala incorporates them into the National Constitution). Failures are detected during the implementation of these approaches and large gaps in knowledge about them (offer and demand of services). Community participation is confined to the stage of programme implementation.

Public social investment, specially in nutrition, is low. The largest funding source (Table 3) of the programmes is external cooperation (donations and loans). Positive example Costa Rica, with greater social investment and longer duration programmes, shows lower prevalence rates of undernutrition.

Recommendations

Strengthen the political commitment of governments for the improvement of the nutritional situation of the population, specially in regards to the priority groups.

Advance gradually in the formation of genuine social safety nets that encourage concurrence in the multi-sectoral interventions and programmes and offer integrated and participatory social services.

Promote a greater and better knowledge of the legal and regulatory frameworks conducive to nutrition in each country and strengthen intra-and inter-sectoral linkages with other areas/institutions responsible for the strategies for poverty reduction and the national development.

… Recommendations

Incorporate objectives, components and nutritional indicators (nutritional dimension) at different stages of social protection programmes: design, implementation, monitoring and evaluation. In the social programmes that do not depend on the health sector, is required to establish effective coordination with it in the search to obtain a preventive approach, adequate coverage and provision of quality services.

Conditional transfer programmes: Review the design and operation of these programmes to increase their nutritional impact, incorporating from the start specific objectives to improve nutrition, especially children under 2 and women (positive example Dom Rep). The following issues are fundamental and should be considered in the review of programmes: criteria and targeting mechanisms; time or hours that the people served have to spend; the amount and the type or composition of the transfer or input; the delivery mechanisms for transfers or other services; the quality of supplies and services delivered; and intersectoral coordination and integration.

Check the targeting criteria and disaggregate the statistics in order to the interventions be directed to the priority groups, specially children under two, pregnant women, indigenous peoples and Afro-descendants. Also that people living with HIV should have better access to public sector´s social protection.

Review the geographical location of programmes to identify potential duplication of interventions and verify that the populations covered correspond to the targeting criteria.

Strenghten the human resources capacities on up to date and relevant (evidence based) nutrition and health topics and on social programmes management. Elaborate a comprehensive plan of human resources regarding training that includes the monitoring and evaluation of the results with a short, medium and long term vision.

Solve the technical and financial limitations in monitoring and evaluation and incorporate these aspects since the programmes design. Start from the establishment of a baseline and the definition of nutritional indicators in order to measure progress in a permanent way and evaluate the mid and long term impact, make the necessary adjustments and establish accountabilities.

… Recommendations

… Recommendations

Incorporate the human rights approach as the major framework for all of the social safety net actions from the programmes design to the evaluation stages, ensuring that the gender perspective, cultural relevance and community participation are explicitly considered in the programmes. To evolve from the passive or utilitarian participation of the community members toward a social actors vision, which is fundamental in nutrition improvement and their own development.

Gradually increase the allocation of public nutrition budget for social programmes in a framework of policies that exceed government cycles, with a view to ensure sustainability of interventions, gradually decreasing external economic dependence. In this line, States must progressively assume the financing of conditional cash transfer programmes.

Study dissemination and next steps

Preliminary study results have been shared in different regional and international meetings: WFP Executive Board, he “Global South-South Development Expo 2009” (awarded for being an innovative solution contributing to MDG achievements).

Dissemination plan with involved countries (sharing the final reports -subregional and eight countries- with the active involvement of various actors.

Use the study results and strengthen the coordination with other regional initiatives to optimize cooperation with the countries and increase internal and external support to governments in the nutrition area, within the foreign aid principles expressed in the Paris Declaration and the Accra Action Agenda (AAA).

To put into practice the recommendations: support and technical assistance will be channeled to countries based on their necessities, capacities, limitations, challenges and priorities with the aim of strengthening the nutritional dimension of the social safety net programmes studied as well as other similar programmes implemented on those same countries or in different contexts.

“ A Social Safety Net should be an instrument and a central concept to advance towards equity, and also to achieve it in concrete and particular

circumstances. But under the evidence that for different social risks (traditional and new), the coverage is not universal, there has to be a

recognition of the lack of a real protection net. Countries in the region have programmes, activities, regulations and experiences pertaining to almost all

the risks and, even though the vision pretends to be comprehensive, in reality there is misprotection and inequity, because not every programme functions, or because each one does not function at full capacity, meaning that there is

no universal coverage on any of the risks”.

Olga Lucía Acosta and Juan Carlos Ramírez: Social Safety Networks: incomplete model, ECLAC, Development Financing Series, No. 141, Santiago , Chile, February 2004, pp. 50-51.

Thank you!