The Handshake Between Nutrition and Social Protection: Theory vs. Reality
Nutrition-sensitive interventions entail a sort of handshake between sectors, and to a certain degree co-dependencies for shared success. At its core, the social protection sector serves to identify (through targeting) and support at-risk and vulnerable populations. In the context of nutrition-sensitive programming, social protection can also serve as a platform to: promote community-based nutrition services; amplify nutrition messaging; infuse “resources” (e.g. hard inputs such as cash or soft “inputs” such as the knowledge and skills that drive increased empowerment and resilience) that enable behavior change; convene multisectoral and multi-level stakeholders; motivate convergence of activities among partners; and provide the foundation for a rigorous Management Information System (MIS).
For its part, nutrition (ideally) provides localized messages based on global evidence of what works combined with formative research to understand the specific barriers (e.g. taboos) and opportunities (e.g. locally available and accessible nutritious foods) in the community. In addition, nutrition supports: high quality community-based and facility-based services delivered by adequately trained and supervised community workers and/or health staff; a comprehensive and timely system of surveillance; an enabling environment including sensitized and mobilized community leaders, effective Information, Education and Communication (IEC) materials and Social Behavior Change Communication (SBCC); and a well-coordinated network of partners.
In short, effective nutrition-sensitive social protection programming relies on the existence of an effective system of nutrition service delivery.
Theory and Reality
In “theory”, a well-functioning social protection system seamlessly connects to a well-functioning nutrition system and—voila—“synergy”! The strengths of each sector are mutually reinforcing and catalytic. However, in many country contexts, and in low-capacity settings in particular, theory looks not at all like reality. The challenge of operationalizing effective nutrition-sensitive social protection programs (given that social protection interventions inherently target the most vulnerable segments of society) is that all of the required systems are almost by definition broken or very, very weak.
Ideally, the project design takes into account the nutrition landscape, including an assessment of the coverage of nutrition services and gaps, and discussion of the distinct roles of the nutrition and social protection sectors—their respective lines of responsibility and/or where there is grey area. But, what do you do when there is no community-based nutrition platform to tap into? Or when the nutrition platform is so very, very weak that promoting available nutrition services is unlikely to improve nutrition outcomes? What can be done, when working at scale, to ensure shared objectives are reached without either duplicating the nutrition system or further overburdening it?
In reality, the desired “synergy” must be manufactured. Focusing on the integration points between the social protection program and the nutrition system is essential. This is an area of operational research where more and more effective strategies (and case studies) are needed.
Opportunities and Dangers
Strategies that could be reasonably carried out by a nutrition-sensitive social protection project to strengthen a deficient nutrition system include:
- Support for augmenting and training community nutrition workers;
- Coordinating partners with shared nutrition objectives to co-locate activities;
- Deployment of M&E systems to make visible evidence of progress against nutrition targets; and
- Mobilization of stakeholders to advocate for higher quality services and delivery of results.
While safe from impinging on the realm of nutrition, this is a long path to improvement—longer, importantly, than the timeline for most development projects. Long-horizon strategies are necessary, but likely insufficient in isolation, to result in the magnitude of change in nutrition outcomes desired in the short-term. Arguably, they exceed what should be expected from a social protection intervention. Achievement of shared outcomes in low-capacity settings within a practical timeline requires commitment (political and financial) and concrete action from the nutrition sector.
The danger is that a well-designed nutrition-sensitive social protection project fails to achieve improvements in measurable nutrition outcomes because the nutrition system does not have adequate capacity. At the very least, it is important to include nutrition indicators and incorporate nutrition interventions in program process evaluations so that, regardless of whether nutrition objectives are met, we have the possibility to determine why.
Ultimately, nutrition outcomes improve when children are well nourished, healthy, safe and nurtured, especially during the first 1,000 days. The right messages need to be conveyed at the right time to the right beneficiaries, in addition to beneficiaries having adequate resources available to take action. This may mean: improved coordination across community-level and facility-level nutrition platforms; more and better trained facility and community nutrition workers; institution of effective supportive supervision and monitoring tools and systems to support it; more effective nutrition messaging that addresses specific barriers and opportunities localized to each area; a more dynamic community-based nutrition platform, including engagement of local leaders and social monitoring of nutrition data and review at all levels.
Business-as-usual is simply not enough.
Disclaimer: This blog series reflects the author’s experiences supporting nutrition-sensitive projects, primarily in Africa.
Written with key contributions from Aaron Buchsbaum, Leslie Elder, Laura Figazzolo, and Ale Marini.
See also the first blog in this series.
 Word Bank Group. Investing in the Early Years Causal Framework.