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Linking Social Protection and Nutrition Outcomes: Best Practices and Opportunities in Somalia

Kyallo Florence*, Farah Mohamed, Rithaa Gilbert, Mohamed Hassan, Abdullahi Leila, Ngina Clementina

Jomo Kenyatta University of Agriculture & Technology, Department of Human Nutrition Sciences, P.O Box 62000-00200, Nairobi

Abstract: Social protection is one of the nutrition-sensitive interventions that if well targeted can be an effective means to reach marginalised, poor, and nutritionally vulnerable populations. This study aimed to document key linkages, best practices, and synergies between social protection programming and nutrition in Somalia and similar fragile contexts. Data was collected using key informant interviews. The enablers to the linkage of social protection and nutrition in Somalia include Government commitment and goodwill, donor awareness, and presence of the first-ever long-term and Government-led social protection program known as Safety Nets and Human Capacity Project. However, sustainability, inadequate coordination, targetting, and the lack of nutrition indicators and objectives, among others, are the challenges facing the efforts by government and stakeholders. There is need for Government, through leadership of the office of the National Coordination for Scaling Up Nutrition (SUN), to strengthen systems for integrating social protection and nutrition. This entails fostering coordination among stakeholders in the social protection and nutrition sectors and adequate funding.

Keywords: social protection, SUN, Somalia, nutrition, cash transfer, nutrition-sensitive interventions

Received July 12, 2021; Revised August 17, 2021; Accepted August 25, 2021

Citation: Kyallo Florence, Farah Mohamed, Rithaa Gilbert, Mohamed Hassan, Abdullahi Leila, Ngina Clementina, Linking Social Protection and Nutrition Outcomes: Best Practices and Opportunities in Somalia. Journal of Food and Nutrition Research, 9 (8). 430-433. January 2021. doi:10.12691/jfnr-9-8-5

1. Introduction

In recent years, social protection has increasingly gained attention as a powerful tool in the battle against poverty, vulnerability, and inequality. It is one of the nutrition-sensitive interventions that if well targeted can be an effective means to reach marginalised, resource-poor, and nutritionally vulnerable populations. The Second International Conference on Nutrition (ICN2) Framework for Action strongly emphasises the importance of social protection. Recommendations 22 and 23 encourage member states to "incorporate explicit nutrition objectives into social protection and humanitarian assistance safety net programmes", and "use cash and food transfers, including school feeding programmes and other forms of social protection for vulnerable populations, to improve diets through better access to food".

Social protection is one of the interventions recognised by the Somalia government in fighting poverty. The Somalia Multi-Sectoral Nutrition Strategy (SMSNS) 2019-2024 identifies social protection as one of the nutrition-sensitive interventions key in achieving the objectives of the strategy. In addition, improved health and nutrition services and outcomes, as well as improved social protection services and outcomes, are embedded in the Social and Human Development Strategy of the Somalia National Development Plan (NDP) 2020-2024 [1] and the Costed Common Results Framework 2019-2024. The office of the National Coordination for Scaling Up Nutrition (SUN) Somalia has been spearheading cross-sectoral advocacy aimed at strengthening of nutrition specific and sensitive interventions for optimal nutrition outcomes. This includes strenthening social protection linkages, a core and heavely invested interventions targeting most vulnerable and at risk populations, with nutrition outcomes. Generating local evidence on inter-linkages between social protection and nutrition outcomes is fundamental in improving programme designs, implementation, and scale-up for improved nutrition outcomes and impact. The goal of this study was to document key linkages, best practices, and synergies between social protection programming and nutrition in Somalia and similar fragile contexts.

2. Methodology

Primary data was collected through Key Informant Interviews (KIIs). Key informants from various stakeholders in Somalia were identified through a consultative process with technical and logistical support from the office of the National Coordination for Scaling Up Nutrition (SUN) housed in the Office of the Prime Minister (OPM), Federal Government of Somalia (FGS). Interviews were conducted virtually and face to face using an interview guide.

3. Results and Discussion

3.1. Social Protection Programmes in Somalia

The predominant social protection (SP) programs in Somalia were cash transfer and medium-term safety net programmes, delivered mainly by international partners in partnership with NGOs and local administrations, almost exclusively with a humanitarian lens. They included Conditional Cash Transfers (CCT) and Unconditional Cash Transfers (UCT), public works, and a School Feeding Programme (SFP). The inherent challenges in these programmes included inadequate funding, low coverage, short-term implementation periods, and inadequate involvement of the Federal Government of Somalia (FGS) and Federal Member States (FMS) actors.

FGS and FMS were mainly involved in two social protection (SP) programmes. These are:

i. The Safety Nets and Human Capacity Project (SNHCP), otherwise known as Baxnaano Project (2019-2022), funded by the World Bank and implemented by WFP and UNICEF on behalf of the FGS; and

ii. The WFP-run School Feeding Programme, which is implemented in partnership with the Ministries of Education of FMS.

3.2. Linking Social Protection Interventions and Nutrition Outcomes

Almost all SP interventions in Somalia targeted the vulnerable households, mainly with cash transfers to improve household income. However, nutrition objectives and indicators were not included in the project designs, although improved nutrition was assumed to result from the improved income from the cash transfers. In addition, most SP interventions were short term (upto six months), and may not have significant impact on nutrition indicators. Some level of integration of SP and health and sanitation was reported, although not always included in project designs. Cash distribution centers were used as a platform for health and nutrition awareness creation, mainly delivered in form of nutrition, hygiene and sanitation messages. While cash tranfers was the routine intervention, almost all institutions interviewed reported a scale-up of the safety net package for recipient households during the COVID-19 pandemic.

3.3. Enabling the Linkage of Social Protection and Nutrition

The interviews indicated increased government commitment to supporting integrated social protection programmes as evidenced by the development and domestication of the Somalia Social Protection Policy-2019. There was also increased donor awareness on the importance of linking social protection and nutrition. The government-led Baxnaano program (2019-2022) is the first ever longer-term social protection project (beyond two years), with wide coverage, which by design is linked to human capital and targets districts with or at risk of food insecurity. The project design includes nutrition linked cash transfers, thus presenting an opportunity to improve nutrition outcomes. The existence of coordination meetings at agency level, notably the ECHO for the UN agencies and the Inter-Agency Cluster Coordination Group (ICCG), which brings together the clusters, was also cited as a platform for donors and partners to discuss linking social protection and nutrition.

3.4. Challenges to Linking Social Protection and Nutrition

• Sustainability: The social protection programmes in Somalia were funded by donors, with limited capacity for funding from the FGS and FMS. In addition, most of them were short term, usually lasting less than six months, with the exception of the new Baxnaano Project

• Inadequate integration of social protection with other sectors. Beneficiaries of SP are usually the poor and vulnerable, who are also usually in need of nutrition support and often lack access to clean water, proper hygiene, and sanitation, yet these programmes are implemented alsmost exclusive of each other.

• Targeting: Community-based targeting and nutrition-based targeting were used, but both had challenges which include influence by the ever-changing local power dynamics, as well as abuse by non-qualifying households. In the case of Baxnaano, although geographical targeting is based on food insecurity, the selection of beneficiary households is not linked to the nutrition status of children (or adults).

• Lack of nutrition indicators/objectives in project designs. This was noted in almost all projects and where nutrition was included, there was inadequate funding for the implementation of nutrition activities within SP.

• Inadequate partnership, collaboration, and coordination. Cluster were operating in silos, and the nutrition cluster and the social protection coordination forums were not planning or working together.

• The ability of communities to mitigate or cope with adversity may influence how cash-based assistance was used and the likeliness of achieving intended objectives.

• Lack of evidence on the impact of social protection on nutrition outcomes in Somalia. Since no studies had been concudted, this evidence was mising.

• Demand and supply challenges: Respodents cited the limited supply of nutrition services close to where the target families are located, since SP programmes were not responsible for the supply of nutrition services.

3.5. Opportunities

The opportunities for linking social protection and nutrition in Somalia included:

Political commitment: The government-led Baxnaano project is a unique platform for the Somali population to identify with the FGS, demonstrating goodwill from both sides. It is a notable step in building the capacity of the government to manage social protection programs in line with the vision of the Somalia Social Protection Policy 2019. The nutrition sector can use the Baxnaano as the backbone for linking to the provision of complementary nutrition services.

Targeting: The Baxnaano project has expanded targeting to areas that experience food insecurity chronically. A further opportunity to explore within Baxnaano and other SP programmes would be to target the first 1000 days of life, target youth with CTs and adolescents, especially girls within the SFP.

Coordination: Several forums for coordination exist including the Social protection Steering Committee, the Government and Development Partners working group, the Somali Cash Consortium, the Inter-Agency Cluster Coordination Group (ICCG). The Unified Social Registry (USR) is also an opportunity for coordinated identification of vulnerable families and supporting coordination between SP & nutrition.

Increased project duration: The Baxnaano is a longer-term project (2019-2022). Evidence from global literature points to several potential improvements in outcomes arising from increased duration of exposure to cash transfers, including, for example, some improvements in health behaviors and child growth outcomes [2].

Accompanying measures (AMs): Potential AMs could include nutrition education, Social Behaviour Change Communication (SBCC), food demonstrations, dietary supplementation, and activities to diversify livelihoods.

Integration of SBCC into SP programmes: There is evidence that perceptions of conditions and messaging of prescribed behaviors associated with transfer receipt can influence programme outcomes, contributing to progress in achieving intended outcomes, including nutrition outcomes [3].

Integration of SP with community capacity building: Supplementing cash transfers with appropriate training opportunities or other services can play a key role in strengthening the intended impacts of a cash transfer programme [4].

3.6. Best Practices

Several items emerge as best practices for social protection in fragile contexts and social protection interventions in general. First, is increasing the awareness on good health, nutrition, and childcare practices among social protection beneficiaries using community-based nutrition-focused approaches and adequately equipping both frontline providers of SP and nutrition service providers. Others include the utilization of mass and social media, a platform which was successfully utilised in Somalia during the COVID-19 pandemic period, to create awareness and promote preventive measures; establishing mother-to-mother support groups among beneficiaries of cash transfers; utilizing the well-established school feeding programmes for nutrition education, promotion of healthy diets especially in light of the increasing prevalence of overweight and obesity among adolescent in Somalia (16.6% and 7.8% among adolescent females and males, respectively [5].

Finally, targeting girls with integrated social protection (including nutrition and health) interventions would break the intergenerational cycle of malnutrition. The recent Somalia Fill the Nutrient Gap (FNG, 2019) study found that the girl is the most expensive member of the household to feed [6]. Pre-pregnancy nutrition is just as important as pregnancy nutrition, especially in Somalia where early marriages and self-starvation during pregnancy are common. In addition, targeting girls may also positively influence future childcare practices.

4. Conclusions

i. The Platforms for linking social protection and nutrition outcomes exist in Somalia but are not fully exploited. There is is little or no coordination among stakeholders in SP and nutrition in Somalia.

ii. Short term social protection programs may not impact nutrition. However, with increased financial and technical capacity building, the government-led longer-term Baxnaano project has the potential to impact nutrition outcomes. To make a noticeable impact on nutrition, future social protection programmes should be designed with a longer-term perspective.

iii. The capacity for linking nutrition to social protection and vice versa is limited due to inadequate institutional support and capacity.

iv. The policy environment is conducive to linking SP and nutrition. The Somalia Social Protection Policy 2019 is a milestone in embedding social protection into the development agenda in Somalia.

v. None of the social protection programmes targetted girls, a key developmental stage that if well targeted could break the cycle of malnutrition, better achieve women empowerment, improve child care practices and address harmful cultural practices such as voluntary undernutrition by pregnant women/girls to have a low birth-weight baby so that delivery is less painful.

5. Recommendations

i. Increased agencies' investment in strengthening government systems at national and state levels including development of a Common Results Framework and Monitoring and Evaluation Framework for integrating SP and nutrition, where nutrition indicators are articulated. This can be achieved by utilizing the coordination structures that have been identified in the SP policy and implementation framework that was recently endorsed by the government.

ii. Design and pilot a model that integrates targeting of first 1000 days of life, children under 2 years, pregnant & lactating mothers, and targeting of adolescent girls, given their role in nutrition outcomes in the first 1000 days of life.

iii. Coordination of social protection programmes with other programmes such as WASH, reproductive health, school feeding, and cash support for young girls, all of which have the potential to address the multiple determinants of nutrition outcomes. Establishing of institutional mechanisms to integrate nutrition and social protection within and across relevant sectors including health, social protection agriculture, education, labor, trade, and environment. In addition, OPM should lead in joint identification of minimum nutrition objectives and indicators for inclusion in SP interventions.

iv. Conduct a baseline study of the Baxnaano project and future SP projects to document baseline situation (nutritional status, household food security, WASH, and socioeconomic situation) and enable evaluation of its direct and indirect impact on nutrition outcomes, among others. This will also facilitate the monitoring of nutrition indicators.

v. Increased funding to strengthen government institutional capacity in implementing the Baxnaano project. This includes training of staff, targeting, technical support as well as monitoring and evaluation, especially at the FMS and district levels. This will promote the internal sustainability of the project and building the confidence of beneficiaries in internal structures. There is also a need for additional funds to monitor nutrition indicators and activities in social protection programmes.

vi. Need to strengthen partnership, collaboration, and coordination among stakeholders in SP and nutrition sectors and relevant government departments for policy support of SP programs, especially where there are conflicting objectives between development and social protection.

Acknowledgments

The authors acknowledge the technical and logistical support from the office of the National Coordination for Scaling Up Nutrition (SUN), Somalia, under the Office of the Prime Minister, with particular thanks to Dr. Mohamed Abdi Farah, Country SUN-Focal Person (FP) and Dr. Mohammed Abdi Hassan. Sincere appreciation to the different SUN stakeholders including UN, Private Sector, CSOs, Donors, Academia and other actors who contributed their in-valuable expertise, views and experiences, directly or indirectly, to this study. Special thanks to all other participants of Inception discussions, stakeholder engagement, primary data collection, and validation workshop who enriched the study with their valuable inputs and in-country context and insights.

Data Availability

The data used and analyzed during the current study is available from the corresponding author on reasonable request.

Funding

This study was conducted by office of the National Coordination for Scaling Up Nutrition (SUN), with financial support from UNICEF and WFP. The funder had no role in the design of the study, analysis or writing of this manuscript.

Competing Interests

The authors declare that they have no competing interests.

Ethics Approval and Consent to Participate

This study was approved by the Office of the Prime Minister, Somalia. Informed verbal consent was sought and obtained from all key informants.

References

[1]   | Federal Government of Somalia (FGS) (2020). Somalia National Development Plan 2020-2024. Internet: https://mop.gov.so/wp-content/uploads/2019/12/NDP-9-2020-2024.pdf [Accessed 6 February 2021].
[2]   | Ranganathan, M., & Lagarde, M. (2012). Promoting healthy behaviours and improving health outcomes in low and middle income countries: a review of the impact of conditional cash transfer programmes. Preventive medicine, 55, S95-S105.
[3]   | Bastagli, F., Hagen-Zanker, J., Harman, L., Barca, V., Sturge, G., Schmidt, T., & Pellerano, L. (2016). Cash transfers: What does the evidence say? A rigorous review of programme impact and the role of design and implementation features. London: ODI, 1(7).
[4]   | Hagen-Zanker, J., Bastagli, F., Harman, L., Barca, V., Sturge, G., & Schmidt, T. (2016). Understanding the impact of cash transfers: the evidence. ODI Briefing. London: Overseas Development Institute.
[5]   | Scaling up Nutrition (SUN) (2019). Nutrition situation. Internet: https://scalingupnutrition.org/wp-content/uploads/2019/10/SUN_Report_EN_2019_Country_Somalia.pdf [Accessed 6 February 2021].
[6]   | World Food Program (2019). Fill the Nutrient Gap and Cost of the Diet Assessment. Somalia. Internet: https://docs.wfp.org/api/documents/WFP-0000120661/download/ [Accessed 6 February 2021].