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a chance to grow How social protection can tackle child malnutrition and promote economic opportunities a chance to grow How social protection can tackle child malnutrition and promote economic opportunities

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Acknowledgements This report was written by Daphne Jayasinghe with Liam Crosby and We would also like to express our gratitude to Save the Children staff Nicola Hypher at Save the Children UK. Alex Cobham and Nuria Molina for extremely useful contributions and guidance in writing the report, also to Nora O’Connell, Daniel Desai The authors would like to thank Rachel Godfrey-Wood and Deepta Martin, Alex Rees, Victoria Sibson, Maricar Garde, Maria Pizzini, Leah Chopra at the Institute for Development Studies for preparing an Kreitzman, Simon Wright, Rowan Harvey, Kristi Tabaj, Joy del Rosso, evidence review of nutrition impacts of social protection systems which Brendan Cox and Michael Klosson for their insight, advice and comments informed much of chapters 1 and 2; Richard Watts and Matthew Martin during the review process. Thanks are due to John Hoddinott at the at Development Finance International for their research into current and International Food Policy Research Institute, Terry McKinley at the projected trends in social protection expenditure; Sailesh Tiwari at the School of Oriental and African Studies, University of London and Jennifer World Bank for his methodological help in the analysis for chapter 4; Yablonski at UNICEF for helpful conversations during initial scoping and Kate Dooley, Jessica Espey, Alison Holder, and Nick Martlew at for the report. We are also grateful to Sheila Murthy and Natalia Elena Save the Children UK for their contributions. Winder-Rossi at UNICEF for providing very helpful comments on an earlier draft. A series of country specific briefings accompanies this report.

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First published 2012

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Cover photo: Alek and Ayel, age three, South Sudan. Since Alek joined a cash-for-work scheme supported by Save the Children, she and her three children now get enough to eat, and her two older children have started going to school. “The cash transfer project has changed my family’s life,” she says. (Photo: Jenn Warren/Save the Children)

Typeset by Grasshopper Design Company Printed by Stephen Austin Ltd. contents

Foreword v Executive summary vi Abbreviations viii

Introduction 1 Tackling child malnutrition 2 Overview of the report 3

1 How social transfers help tackle child hunger and malnutrition 4 Increasing poor households’ food expenditure and stimulating local markets 6 Increasing productivity and improving self-reliance among poor communities 7 Strengthening human capital 7

2 Ensuring social transfers support nutrition: five policy guidelines 10 1. Social transfer programmes should be underpinned by long-term commitment and broad coverage 10 2. Cash transfers should reflect the cost of a nutritious diet and be able to adjust in response to price increases 11 3. Delivery needs to be timely and convenient for beneficiaries 13 4. Integrate social transfers with wider nutrition packages, but conditionality should not be the default option 14 5. Ensure social protection works for women and young children 15 Summary 16

3 The impact of the financial crisis on developing countries 19 Slower growth and uncertain economic outlook 19 The economic outlook for developing countries 20 Summary 22

4 Social transfers – needed now more than ever 23 Declining investments in social transfers: a false economy 26

Conclusions and recommendations 29

Appendix 1 Estimating the effects of the eurozone crisis on hunger 31 Appendix 2 Analysis of the effect of social protection programmes on national resilience to economic shocks 34 Endnotes 36

iii foreword

The fight against poverty, hunger and malnutrition government has expanded social spending with is a primary and an imperious duty of governments newer and broader social transfer programmes like and societies all over the world, as well as a key issue Bolsa Familia. Over the last two years, even more established by the Declaration of the Millennium advanced social programmes to protect the poorest Development Goals. In such an economically wealthy have been implemented, such as Plano Brasil Sem world, encompassing technological achievements and Miséria (The Brazil without Extreme Poverty Plan) plenty of knowledge and evidence on good practices, and Brasil Carinhoso (The Caring Brazil Action). The programmes and social projects to deal with hunger first one intends to enable 16.2 million people to and its determinants, it is unacceptable that there rise above the extreme poverty line by 2014. The still are 2.6 million children dying from malnutrition latter is specially addressed to poor and potentially every year, not to mention the large amount of malnourished children, providing additional cash people affected by the consequences of this condition transfers to families with children; more vacancies for the health and the productive lives of individuals in early childhood schools; and free distribution of already affected. nutritional supplements and medications all over the country. It intends to promote 2.7 million children Despite the efforts that many countries have made within 2 million families to overcome conditions of in recent decades, we must dare, we must seek extreme poverty. new ways and strategies to combat this injustice, especially in a context of rising food and fuel prices Malnutrition takes away lives and destroys the and the remaining uncertainty about the recovery potential of millions of children. The world and of the global economy. This insightful report shows government leaders must not postpone solutions how countries such as Mexico, South Africa, Ethiopia, for that. This report presents very consistent and Bangladesh and Brazil have been exploring new ways up-to-date evidence, good practices and guidelines to to handle the fore mentioned issues design innovative social programmes and strategies to fight hunger and malnutrition and, thus, reach the In fact, over the last ten years, the Brazilian target of facing this persistent challenge. experience has shown that strategic decisions to stimulate the economy with a set of integrated social programmes may prove very effective in the reduction of poverty and hunger. Besides building a strategy to develop a domestic consumer market and Tereza Helena Gabrielli Barreto Campello taking the right decisions to enhance the economy Minister of Social Development and Fight Against during the 2008–still-going crisis, the Brazilian Hunger, Federal Government of Brazil

v Executive summary

Social protection aims to make poor people fuel prices. In this context of global economic crisis, less vulnerable and protect them from this report: extreme deprivation.1 It helps people living in • set outs the role that social protection can play in poverty to meet their basic needs, including improving nutrition and tackling hunger access to food. Social protection can tackle • outlines the importance of good nutrition in the immediate and underlying causes of relation to long term economic growth • presents five evidence-based guidelines for malnutrition, thereby avoiding the lasting policy-makers on the design of social transfers to damaging effects that malnutrition has on help tackle hunger and malnutrition, to adapt to children’s lives. country contexts Social protection also has the potential to empower • assesses the implications of economic crisis for people living in poverty to transform their livelihoods, rates of hunger and children’s nutritional status. so they can fully participate in their economies and An estimated 925 million people globally experience 2 societies. It is therefore a strategy that, properly hunger.4 Our analysis, building on World Bank applied, addresses short-term needs of people living projections and using data for 98 developing in poverty, while at the same time providing them countries, shows that an escalation of the eurozone with economic and social opportunities that can crisis could push an extra 33 million people into deliver sustainable returns for society as a whole. hunger by the end of 2013. The devastating impact Social protection plays a vital role in protecting of economic crisis is not limited to the number of vulnerable people during times of stability as well people going hungry – or to those who don’t get as in response to crisis. If introduced prior to crisis enough calories. It also increases the number who and sustained during crisis, social protection can suffer poor nutrition. play a role in preventing negative impacts on families. Families in crisis are often forced to adopt coping Given its potential to protect people from the strategies that jeopardise their nutrition, such as devastating effects of poverty, to empower them substituting healthy food for cheaper, less nutritious and to transform their livelihoods, social protection staples, or cutting the frequency of meals. Children in should be viewed as a core long-term strategy. particular suffer in this context. When the nutrition This report focuses on one component of social of young children, pregnant women or breastfeeding protection – social transfers – which are particularly mothers is neglected, the damage to children’s relevant to tackling malnutrition. Social transfers are physical growth and cognitive development can be “predictable transfers to households or individuals, lasting, and in some cases irreversible. both in-kind and cash, including public works Malnutrition is an underlying cause of the death of 3 programmes”. In other words, distributing cash, food 2.6 million children each year – one-third of or assets – sometimes in exchange for recipients’ the global total of children’s deaths.5 The effects participation in employment or other activities – in of malnutrition on the physical and cognitive order to protect those people from poverty and development of children who do survive can have promote productive livelihoods. long-term negative effects on their life chances The financial crisis that struck in 2008 continues to and the contribution they can make to society. It is have global economic ramifications. These have been estimated that adults who were malnourished as made worse by the unfolding economic crisis in the children earn at least 20% less on average than those eurozone; slowing growth in other industrialised and who were not.6 emerging markets; and increasing global food and

vi executive summary vii Social transfer programmes should be should programmes Social transfer commitment and long-term by underpinned coverage. broad a the cost of should reflect Cash transfers increases. diet and adjust to price nutritious and convenient. Delivery needs to be timely with should be integrated Social transfers but conditionality interventions, wider nutrition default option. should not be the for work programmes social transfer Ensure and children. women calling on the World Bank to prioritise social World calling on the the as one of the special themes for transfers round 17th replenishment Bank IDA World funds in the short additional term to providing Social Response trust fund managed the Rapid Bank. World the by

1. 2. 3. 4. 5. which should should which guidelines following the consider the to enhance context the national to be adapted nutrition. on social transfers impact of scaling up multi-year funding to support scaling up multi-year of social transfer the establishment by: programmes – – ensure that their programmes contain social that their programmes ensure countries low-income spending floors that allow programmes. to finance their social protection of the importance recognition of domestic – such as social contributions revenues tax base – to fund long-term and increased programmes. commitments to social transfer tax authorities strengthening This will involve and tackling international constraints to tax ensuring corporate transparency by collection, and tackling financial secrecy. expected to be established at the body, to conduct an 2012 G20 summit, June social protection assessment of urgent – including attention to their programmes outcomes – in all nutrition potential to achieve This the end of 2012. countries by low-income assessment should be done in conjunction with which is sharing Platform, the G20 Knowledge key best practices from social protection G20 countries. base. the evidence to increase on nutrition • We call on the G20, bilateral and multilateral bilateral and multilateral call on the G20, We in social transfers donors to promote countries by: developing • • Monetary calling on the International to Fund • mobilisation in supporting domestic revenue • cooperation tasking the social protection • programmes of social transfer impact evaluating

strengthen social transfer programmes as as programmes social transfer strengthen and policy tool to combat hunger a key both in times of stability and as , malnutrition tool that is easily crisis-response an effective is the best insurance for Preparedness scalable. crisis response. (including agricultural inputs) (including agricultural We call on developing country governments to: country governments call on developing We • Social transfers are an effective policy tool to combat an effective are Social transfers both in times of stability and hunger and malnutrition, in times of crisis. Recommendations In addition to national governments, there is a clear there to national governments, In addition such as the and groups international donors for role in social protection. in investing G8 and G20 to play commit to supportRicher countries must spending in order countries, in the poorest on social transfers to invest country governments developing to allow the potential Given in long-term development. hunger it is vital to prevent of social transfers and that established before are that programmes during crisis. is sustained even investment However, despite the economic benefits and the despite the economic benefits However, can have impact social protection potential positive countries even find that we on hunger and nutrition, to commitments had strong historically that have maintain spending failed to have social protection during the economic on social protection levels of 15 countries identified as having Two-thirds crisis. in social protection significantly invested historically are and several since 2008, cut expenditure have the growth-boosting, Given planning further cuts. potential and nutrition-improving poverty-alleviating a false these cuts constitute of social protection, on a global scale. economy Social protection can have a number of economic a number can have Social protection nutrition and of which also promote some benefits, example: for security through, food • and dietary expenditure diversity food increasing • assets productive in investments strengthening • markets. food demand in stimulating Given the negative effects of malnutrition on on malnutrition of effects the negative Given of potential and the development, children’s and economic to boost nutrition social transfers social transfer argues that this report opportunities, into the short- be integrated should programmes of plans development and long-term term recovery countries. developing Abbreviations

CoD Cost of the Diet CSG Child Support Grant DAC Development Assistance Committee DRC Democratic Republic of Congo FAO Food and Agriculture Organization (UN) GDP gross domestic product GER gross enrolment ratio HEA Household Economy Approach IDA International Development Association (World Bank) NREGA National Rural Employment Guarantee Act ODA official development assistance PSNP Productive Safety Net Programme PWPs public works programmes SCTP Social Cash Transfer Programme SOAG State Old Age Grant UNICEF United Nations Children’s Fund

viii Introduction

Social protection has a vital role to play in Social transfer programmes – such as cash or in-kind minimising the impact of crisis, including transfers and public works programmes – can benefit natural disasters and conflict. However, it communities in crisis and at risk of hunger in several also provides an important set of policy ways. They can increase poor households’ resilience instruments to protect those vulnerable to to shocks, while ensuring they can continue to access poverty and malnutrition during times of services essential to human development – such as health and education – and enable poor households peace and relative stability, and to improve to avoid the need to adopt coping strategies that a range of human development indicators may be harmful in the longer term.5 such as health and education. Social protection programmes also have the Social protection can have broad positive impacts, potential to benefit the wider community and, increasing the effectiveness of investments in health where coverage is broad, even the whole country. 1 and nutrition, education, and water and sanitation. By promoting consumer spending, they stimulate However, this report is predominantly focused on the local and national economies. benefits of social protection for hunger and nutrition, especially in the context of economic crisis. Social protection helps people living in poverty and vulnerability to access their basic needs, including good-quality curative and preventative health services, as well as the means to sustain a productive livelihood. It can also contribute to tackling Social protection: malnutrition by supporting families to access enough a human right food to meet full nutrient requirements and improve child care and feeding practices. Social protection Social protection is a fundamental right in and also has the potential to empower poor people to of itself, as enshrined in article 9 of the transform their livelihoods, so that they can fully International Covenant on Economic, Social and 6 participate in their economies and societies.2 It is, Cultural Rights. It is also instrumental in the therefore, a strategy that, if done right, can address provision of other essential rights, including the 7 the short-term needs of people living in poverty and rights to food, health and education. provide them with economic and social opportunities Children’s rights to social security and an that can deliver sustainable returns for themselves adequate standard of living are elaborated in and for society as a whole. articles 26 and 27 of the UN Convention on Social protection policies aim to make poor people the Rights of the Child and in the Universal less vulnerable and protect them from extreme Declaration of Human Rights. 3 deprivation. Social protection policies are broad In 2012 the Committee on World Food and can impact on a range of human development Security’s High Level Panel of Experts will 4 indicators. This report focuses on one component draw attention to the right to social protection of social protection – social transfers – since these in a forthcoming report.8 are most relevant to tackling child malnutrition.

1 2 a chance to grow malnutrition inthisreport protein. Undernutrition –whichwe refer toas macronutrientsprimary globally experiencehunger: malnutrition.An estimated925millionpeople to contributetowards reductions inhungerand Social protection programmes have beenshown T rates ofmalnutrition, shouldmake socialtransfer developing countries, thosewithhigh particularly on humandevelopment andeconomicgrowth, Given thepotentially damagingimpactofmalnutrition food, care, waterandsanitation, andhealth services. (underweight) duetoacombinationofdeficits of height-for-age (stunting)orlow weight-for-age manifested aslow weight-for-height (wasting), low ackling childmalnutrition Definitions ofkey and cash, includingpublicworks programmes”. transfers tohouseholdsorindividuals, bothin-kind Social transfers are definedas “...predictable polity orsociety”. are deemedsocially unacceptablewithinagiven levels ofvulnerability, riskanddeprivationwhich refers to “the publicactions taken inresponse to of socialprotection, but, broadly, socialprotection Social protection. There are many definitions of time. which provide transfers for amore limitedperiod emergencyorseasonalsafety nets,short-term and promote productive livelihoods. This includes activities –inorder toprotect themfrom poverty that recipientsinemployment participate orother cash, food orassets–sometimes onthecondition In otherwords, socialtransfers entaildistributing social riskssuchasdiscriminationorabuse.” shocks; andsocialequitytoprotect peopleagainst against therisksandconsequencesoflivelihood to basicservices; socialinsurance toprotect people special care orwould otherwisebedeniedaccess households; togroups whoneed socialservices social assistancetoextremely poorindividualsand all initiatives, bothformal andinformal, thatprovide: 9 Socialprotection is “the setof – carbohydrates, fatsand 17 16 –refers topoorgrowth, they lacksufficient terms 10 11

PWP, requirement. There are many different typesof food orassetsare given oncompletionofawork special typesofsocialtransfer inwhichcash, Public works programmes (PWPs)are without any suchrequirements. services, orthey canbeunconditionalandprovided health,attending certain education, ornutrition transfers canbeconditionaluponrecipients are well-administered, andhave theflexibilityand ability toreach thosevulnerable tomalnutrition, such programmes are well-established, have the malnutrition intheevent ofcrisis, itisvitalthat up toprevent increasing ratesofpoverty and to beresponsive toshocksandbeready toscale transfers –receive inadequateinvestment. Inorder social protection programmes –includingsocial andhumancapital,for economicopportunities right, andinspiteofthepotential benefitsitoffers However, althoughsocial protection isafundamental nutrition outcomes. contexts inorder tomaximiseimprovements in nutrition, for policy-makers toadapt tonational the evidence for thebenefits ofsocialtransfers for out todevelop asetoffive guidelines, based on programmes ‘nutrition-focused’. This reportsets when they fall’; suggests, safety netsare designed to ‘catch people of transientandchronic poverty.As thename of safety netsisonpreventing thenegative impacts interchangeably withsocialtransfers. The emphasis Safety netsisatermthatoftenused vulnerability andchildren’s development.” others, for thepurposesofaddressing poverty, to individualsorhouseholdsby governments or They are “predictable, regular transfers ofcash Cash transfers are onetypeofsocialtransfer. transformative impactsonlivelihoods. defined more broadly toincludepromotive and creation ofapublicgood intheform ofnew • jobsfor workers toincrease theirincomeand • infrastructure ofservices. ordelivery infrastructure orimprovements ofexisting reduce theirvulnerability 14 butthey oftenhave similarobjectives: 12 whereas socialtransfers are often 15 13 Cash introduction 3 he final chapter goes on The final chapter port e re th of ew vervi his report analyses the potential of social transfers of social transfers the potential analyses This report the implications and identifies nutrition to improve hunger outlook for global economic of the poor the It sets out countries. in developing and nutrition importance responses. of social transfer cause as an underlying 1 identifies poverty Chapter of the evidence and summarises of malnutrition, boost potential to simultaneously social transfers’ It security and nutrition. food economic growth, successfully that have particularanalyses programmes in hunger and malnutrition. contributed to decreases key to define 2 uses existing evidence Chapter that programmes social transfer characteristics of It provides outcomes. nutrition can maximise positive on the design of policy-makers for guidelines five programmes. social transfer 3 summarises the economic risks Chapter countries in light of the facing poorer currently in industrialised and crisis and downturn eurozone in which It discusses the ways emerging economies. developing affect financial and economic crises can and considers their impact on economies, countries, with a particular emphasis and children, communities, on their impact on hunger and malnutrition. on the evidence new present 4 we In Chapter downgrades economic growth impact of projected showing hungry, who are of children on the numbers at risk of hunger if people are that 33 million more It goes realised. scenarios are economic worst-case as an social transfers, on to demonstrate how than mitigate against more anti-inequality measure, this risk. key conclusions and provides The final chapter donor national governments, for recommendations institutions and the G20 on multilateral countries, and measuring needs in social transfers investing evidence- It includes five development. capacity for for based guidelines on the design of social transfers hunger to improve to employ national governments outcomes. and nutrition in social transfers, to argue that modest investments can challenging inequality, when directly especially and their lives on children’s high returns deliver chances. future O

other 21 20 the World Bank World the 26 As the World Bank’s Bank’s World As the 19 By compromising By compromising 25 n top of the direct human costs, human costs, On top of the direct

27 22 hild malnutrition has a devastating has a devastating Child malnutrition 24 he financial crisis in Europe, slowing slowing in Europe, The financial crisis human capital, malnutrition also damages the malnutrition human capital, potential of a country: growth he risk of increasing poverty may translate into may poverty The risk of increasing including worldwide, children for effects devastating incidence of hunger and malnutrition. increased that economic crisis can lead to Studies show birth-weight and low in the risk of low increases or stunting – both indicators of height-for-age malnutrition. crisis-induced malnutrition can spark a vicious circle can spark a vicious circle crisis-induced malnutrition of contracting economic potential. hief Economist said, “[d]eveloping countries need “[d]eveloping Chief Economist said, for their vulnerabilities and prepare to evaluate is still time.” while there further shocks, human impact, stunting children’s physical and physical stunting children’s human impact, development. cognitive he global economy is reeling from the impact from is reeling The global economy in industrialised and emerging of economic crisis economies. Bank and the International Monetary World The growth for projections both downgraded Fund have 2012 and 2013; in in the global economy hina, rising food prices and the impact of rising food in China, growth East on oil prices tensions in the Middle continuing in developing drastic knock-on effects having are and future lives children’s threatening countries, consequences for and with devastating chances, struggle to feed facing a daily poor people already their families. resources to adapt and increase coverage and scale and scale coverage and increase to adapt resources assessed study that Bank World A 2011 crisis. during the extent of social protection programmes in programmes of social protection the extent and capacity and their effectiveness 13 countries that only found volatility price to food to respond while response, one country basis for had a strong Of the other unprepared. were countries three and one had prepared moderately eight were nine, response. basis for a weak has estimated that “many countries lose at least “many has estimated that to domestic product of their gross 2–3 percent undernutrition.” commentators have been even more pessimistic in more been even commentators have their forecasts. 1 How social transfers help tackle child hunger and malnutrition

The malnutrition crisis is not new; it is hits chronically poor people as well as economically already an enormous problem globally, active ‘working poor’ people. Rising global and causing the deaths of 300 children every domestic food prices and increasing vulnerability to hour of every day.1 Rates of stunting (see crisis among the ‘working poor’5 are compounding Box 1), for example, have remained high in the threat of malnutrition. many countries for 20 years, declining by Economic downturns force parents to work more an average of just 0.6% each year2 during hours (up to 10 extra hours a week to feed their that period. families),6 which can in turn have negative effects on childcare practices and the ability of parents Economic conditions – including income poverty to prepare nutritious meals, increasing the risk of and low employment status – are a key underlying malnutrition for children. cause of malnutrition, as reflected in the UNICEF framework of the causes of malnutrition (see Given the importance of economic factors for Figure 1). This was borne out by a Save the Children progress against nutrition, continued global economic research study that assessed the extent to which decline in 2012 and 2013 could exacerbate the poverty is a barrier to good nutrition. Using the Cost situation for millions of children. Studies show of the Diet3 method, it measured the proportion that economic crisis can lead to increases in the of people who could not afford a minimum-cost risk of low birth-weight and stunting.7, 8 For example, nutritious diet in selected communities in Bangladesh, the Indonesian economic and financial crisis in 1998 Ethiopia and Kenya. The study found that a significant led to food insecurity spreading across the country, proportion of families could not afford a nutritious and the prevalence of underweight children aged diet, even if they spent all of their income on food.4 6–17 months increased between 1996 and 1998. Evidence shows that the impact of economic crisis By providing access to a nutritious diet and enabling poor people to invest in and develop their own production, social transfers can lead to sustainable Box 1. Measures of reductions in poverty and hunger, as well as malnutrition boosting economic growth.9 Studies show that the benefits of social transfer schemes for nutrition are Stunting: a child is too short for their age – a concentrated more on the poorest groups of society result of chronic malnutrition than on the middle-income and better-off groups.10, 11 For example, conditional cash transfers in Honduras, Wasting: a child’s weight is too low for their Mexico and Nicaragua were found to have a greater height – a result of acute malnutrition impact on poorer households.12 An early evaluation Micronutrient deficiency: a lack of one or of the Mexican Oportunidades cash transfer scheme more essential vitamins and minerals, such as found higher food expenditure among beneficiaries, vitamin A, iron or zinc. particularly among poorer people.13 In South Africa, the Child Support Grant is taken up largely by From A Life Free from Hunger: Tackling child malnutrition, Save the Children, 2012 vulnerable households in which adults are less well-educated and less likely to be employed.14

4 1 How social transfers help tackle child hunger and malnutrition 5 Immediate causes Basic causes and -term and the reducing thereby Long-term consequences Long-term economic ability, intellectual Adult size, performance, reproductive productivity, disease metabolic and cardiovascular insecurity food , of health services Disease Unhealthy household Unhealthy environment and lack environment intergenerational transmission of poverty. and stimulate local markets and stimulate poor communities This chapter reviews how social transfer social transfer how reviews This chapter can: programmes • on food poor households’ expenditure increase • among and self-reliance productivity improve • human capital, strengthen Inadequate care political context Social, economic and economic and Social, physical, social and natural physical, Income poverty: employment, employment, Income poverty: Lack of capital: financial, human, human, financial, Lack of capital: self-employment, dwelling, assets, assets, dwelling, self-employment, remittances, pensions, transfers, etc transfers, pensions, remittances, Maternal and child undernutrition Inadequate poverty between relations the dietary intake Household food insecurity food Short-term consequences disability morbidity, Mortality, Underlying Underlying causes of framework 1. Figure and its short undernutrition and child causesmaternal of other consequences long-term Given the benefits of social transfers for food for the benefits of social transfers Given it is no surprise reduction, consumption and poverty of the evidence and growing is also strong that there to tackle programmes social protection potential for in – see the examples given hunger and malnutrition 2. Box Source: UNICEF framework, presented in Black et al (2008) ‘Maternal and child undernutrition: global and regional exposures exposures global and regional ‘Maternal and child undernutrition: in Black et al (2008) presented UNICEF framework, Source: January 2008 The Lancet, and health consequences’, 6 a chance to grow with 8%onaverage for householdsintheUK the quantityandqualityoffood consumption. There isrobust evidence ofsocialtransfers improving stimulating markets local food expenditureand Increasing poorhouseholds’ of theirincome–upto80% people indeveloping countriesspendthemajority the programme onfood. Programme reportedspendingmoney earnedfrom over 99%ofbeneficiariestheCharsLivelihoods they receive on food. For example, inBangladesh, significant proportion ofany additional income Social transfer beneficiariesalsotendtospenda impact onhunger Bo • • • poverty budget. 46.5% oftheMexicangovernment’s anti- ,Oportunidades whichcurrently represents More than4millionfamiliesbenefitfrom is thecountry’s mainanti-poverty programme. (knownProgresa as Oportunidades before 2002) Mexico:The conditionalcashtransfer scheme woredas (districts)inruralEthiopia, andaims (PSNP) istargetedatthemostfood-insecure Ethiopia: The just 4.8%in2009. people inextreme poverty from 12%in2003to scheme hashelpedtoreduce theproportion of of US$8bn(orjust0.5%Brazil’s GDP), this multi-sectoral Zero Hunger strategy.At acost strandsofBrazil’sone ofthemostimportant Brazil. than 46millionofthepoorest peoplein cash transfer schemethatnow reaches more Brazil: BolsaFamilia isaninnovative conditional nutrition interventions. school attendance, healthclinicvisitsand human capital, by linkingtransfers toregular transfers ofcashandfocuses onimproving children toschool. Ittherefore provides regular the extenttowhichpoorfamiliessendtheir affordability isacriticalbarrier thatlimits x 2. Fivesocialprotection systems 18 Introduced in2003, theprogramme is Productive Safety NetProgramme 17 The schemerecognises that 29

27 –onfood (compared and nutrition: 28 26 ). ). Poor • that schemeonfood. scheme spendasmuch as88%ofthecashfrom In Brazil, ruralhouseholdsontheBolsaFamilia were shown to consume 6.4%more caloriesthan • often, diversity. greater dietary spending leadstoimproved calorieintake and, There isstrong evidence toshow thatthisincreased ensure thatchildren donotgo hungry. beneficiaries thatthey usethegrantto reporting say thatthey spend mostofitonfood, with 70%of South Grant Africa beneficiariesofthe ChildSupport beneficiaries usedthecashtobuy food. non-beneficiaries. consume therequired 1,800caloriesperday than beneficiaries were significantly more likely to the CSG. In 2009, 9millionchildren benefitedfrom caregivers earnlessthantheminimum wage. children undertheageof14whoseparents or R240 (around US$31)ispaidtofamilieswith to reduce childpoverty.A monthly grantof is oneofthegovernment’s maininitiatives Grant (CSG) South Africa:TheChildSupport 900,000 peoplehave benefited. Bangladesh. Itisestimatedthatmore than poorest householdsintheCharsregion of income-generating assetsto55,000ofthe is apublicworks programme thatprovides Bangladesh: The for sixmonthsoftheyear, food transfers to7.6millionruralEthiopians food aid. In2009itdelivered cashand/or to overcome many people’s dependencyon gardens canbeestablished. their homesare reconstructed andhomestead plinthonwhich constructing araisedearthen Chars householdsare given cashinreturn for 8.3 millionpeopleby 2015. The schemeissettobeextendedcover beneficiaries who were unableto work (15%). public works (85%)orasdirectfor support that show evidenceof 22, 23 34 BeneficiariesofOportunidades 30 Chars LivelihoodsProgrammeChars InEthiopia, 80%ofPSNP 19 21 25 33 eitherthrough

InEthiopia, PSNP 24 Membersof 32 31 Andin 20

1 How social transfers help tackle child hunger and malnutrition 7

48 49 See Box 3 for examples 3 for See Box 55 Beneficiaries of Ethiopia’s Ethiopia’s Beneficiaries of 47 In South Africa, labour force force labour Africa, In South Following the introduction of the introduction Following 52 51

53 Several studies have demonstrated studies have Several 54 Instead, several studies show that by that by studies show several Instead, 50 programme programme the Bolsa Familia example, For 46 PSNP are able to own more productive assets – productive more own able to PSNP are for money – and borrow such as tools or livestock to equipped better them making purposes, productive after economic crisis, recovery contribute to faster participation was 13–17% higher in households with with similar households not a pension compared a benefit. receiving boost consumption and stimulate the local economy. local economy. the and stimulate boost consumption employment-promoting also has Social protection people can be essential in protecting which effects, PSNP the example, for emergency needs: acute from hunger Ethiopian families from many protected of provision through price rises, during 2011 food temporary and cash provisions. employment Strengthening human capital economic crisis is reliant from Long-term recovery (see Stunting in children ‘human capital’. on strong because it constrains human capital page 4) reduces and reduces development, and cognitive both physical may stunted children earnings in adulthood: future as 20% less than their non-stunted earn as much counterparts. While some have voiced concerns regarding concerns regarding voiced While some have on the local of social transfers effects disincentive the by not borne out these are labour supply, evidence. in Brazil enables beneficiaries to protect themselves themselves to protect beneficiaries in Brazil enables with the result of shocks, effects against the adverse to participate in new likely more are that they activities. entrepreneurial from different countries of the impact of social different from indicators. on stunting and other nutritional transfers the Basic Income Grant in Namibia, employment rose rose employment the Basic Income Grant in Namibia, 44% to 55%) within (from points 11 percentage by the space of one year. to start up new businesses or invest in their in to start or invest businesses up new risk and reduce help transfers Social livelihoods. their potential to people to improve enable poor in investing term by income in the long generate assets. reducing credit and family care constraints, social constraints, care and family credit reducing economic encourage more can programmes transfer activity among adults. that social transfers can lead to significant reductions can lead to significant that social transfers scores), in height-for-age improvements in stunting (ie, beneficiaries during who are among children mainly their first 36 months of life.

43 41 44 A 36

In 45 35 The 38 This market stimulation stimulation This market 39 and productivity

40 These investments lead to longer-term increases increases lead to longer-term These investments economic growth. and micro-level in productivity Employment schemes such as NREGA in India can Employment assets such as water of productive lead to creation productivity. future which promote systems, The growth-promoting aspects of social transfers of social transfers aspects The growth-promoting in policy makers them an essential tool for make countries. and middle-income low-income provided by social transfers also supports markets in also supports social transfers markets by provided Social transfer times of seasonal or economic shocks. the means to maintain beneficiaries who have can help consumption in the face of such shocks again benefiting fluctuations in demand, reduce non-recipients. Social transfers provide a stimulus to a stimulus provide Social transfers face of economic In the entrepreneurialism. reluctant more people are uncertainty and risk, Bangladesh, the Chars programme brought about brought programme the Chars Bangladesh, nutrient- consumption of in the increases significant leafy green pulses, fish, meat, such as eggs, rich foods fruit among beneficiaries. milk and vegetables, recent review of social cash transfers found that found cash transfers of social review recent increased had they “almost without exception”, dietary diversity. By enabling poor people to spend more, social social people to spend more, By enabling poor the local economy stimulate programmes transfer economic growth. and can boost overall Social transfer programmes lead to investment by by lead to investment programmes Social transfer For example, assets. beneficiaries in productive to lead to the PSNP in Ethiopia has been shown holdings. beneficiaries in livestock by investments Increasing self-reliance among improving poor communities non-beneficiaries, and most of these ‘extra’ calories calories ‘extra’ most of these and non-beneficiaries, products. vegetable animal and from came Sustainable growth among poor people builds Sustainable growth and creates shocks to future resilience increased poverty. a permanent exit from the potential for stimulation of food markets by social transfers has social transfers by markets of food stimulation community. to benefit the wider also been shown where non-beneficiaries in villages example, For food increased Oportunidades operates have in other villages, to people compared expenditure has the scheme due to the stimulation probably to the local economy. given 8 a chance to grow tackling malnutrition. access tohealthservices, whichisalsocriticalfor water andsanitationfacilities, andtoimprove financial Social transfers are alsoproven toincrease accessto poor peopletoaccessmore andbetter-quality food. hunger andmalnutrition. Vitally, extracashenables programmes canhave effects onpoverty, important This chapter hasshown thatsocialtransfer other schemesin Africa and Asia hasshown similar America, andevidence citedinthischapter from well-evaluated cash transfer programmes from Latin The evidence for nutrition effects isstrong inthe and B other nutritionalindicators: Mexico Bo • • • Stunting • 2% tallerthannon-beneficiaries. children’s height, makingbeneficiarieson average Grant hasbeenshown toleadincreases in South Africa: The unconditionalChild Support 36–59 month-olds. stunted thannon-beneficiaries, risingto41% for Familia have a26%betterchanceofnotbeing Brazil: Children whoareoftheBolsa part corresponding toanextra10mmofheight. faster thansimilarchildren notonthescheme, have meangrowth ratesthatare upto16% schemehaveOportunidades beenshown to Mexico: Children whoareofthe part 7mm talleronaverage thannon-beneficiaries. children underfive women ofbeneficiary are public works programme hasshown that Bangladesh:A recent evaluation oftheChars growers’ earningswere badly affected. age duringacoffee priceshock, whencoffee from negative effects ontheirheight-for- beneficiaries ofthescheme were protected infants This effectyoung isnotedbothamongvery x 3. The impact ofsocial angladesh 57 andchildren uptoagethree. 69

60, 61

58 59 Child transfers onstuntingand 56

resilience tofuture shocks. food andonavarietyoffood types, andbuildtheir households’ abilitytomaintaintheirexpenditure on settings, socialprotection programmes againprotect humanitarian crises–seeBox 4. Inthoseemergency for nutrition important inthecontextof also very Social transfers andsafety netprogrammes are safety net. established asa ‘right’ ratherthanatemporary on nutrition, iftheprogrammes particularly are and publicworks programmes shows theirimpact results. Evidenceavailable for bothcashtransfers • • Other nutritional indicators • • Brazil:An evaluation ofBolsaFamilia recipients’ weight-for-height. in South Africa hasbeenshown toimprove South Africa: Grant The ChildSupport height, strong positive effects notonly onweight-for- hasbeenshown tohaveMexico: Oportunidades incidence oflow birth-weightby 4.6% levels ofanaemia. (1.39mm higher)amongbeneficiariesunderfive. heavier) andmid-upperarmcircumference both weight-for-age (beneficiariesbeing210g Bangladesh:The Charsprogramme increased of theanalytical sample). this wasnotsignificant(perhaps duetothesize a positive effect onweight-for-height, although , Brazil, SouthAfrica 65 butalsoonbirth-weight(reducing the 67 64

68 66 showed ) and 1 How social transfers help tackle child hunger and malnutrition 9 analysis, analysis, 73

rather than their own food production food rather than their own : happen they which captures how families are likely to respond to respond likely families are how which captures including: to shocks, • purchases on food the extent of reliance • families’ income is generated how • is functioning. the market how experience past and current the Children’s Save in Mali and Niger with governments in working invaluable demonstrates that the HEA can be programmes in helping target social transfer HEA helps to identify who has the effectively. be prioritised in social who should need, greatest By identifying and when. programmes, transfer consolidate, when they when families cut back, that social HEA can ensure trade, and when they complement families’ means programmes transfer sustainable. making them more of coping, they can stop crises before Social transfers in promoting a crucial role and can play happen, are They shocks. to future resilience communities’ But by not the whole solution to building resilience. of hunger effects the worst people from protecting a solid platform can provide social transfers crises, livelihoods transformative which longer term, from can build. work rise – and for the media to pick this up – social pick this up – social the media to for rise – and the can scale up when programmes protection programmes Social protection come. warning signs triggers – based on should include agreed and local understanding – established relationships security outlook and nutrition so that if the food contingency plans families becomes a concern, for funds pre-positioned involving put into action are the this kind of flexibility built in, With and stocks. of crisis can be prevented. impacts negative programmes these as possible, be as effective To families. should be targeted at the most vulnerable the this is tools for One of the best available (HEA) Approach Household Economy and malnutrition and malnutrition 70 cantransfers help

71 Against a background of long-term of long-term Against a background 72 before crises food Stopping x 4. In this context, a shock such as drought or a a shock such as drought In this context, of that slashes the availability price spike food by weakened already can mean that children food dangerously undernourishment and disease are of sudden, vulnerable to sickness and the threat of When the production acute malnutrition. 25% in the Sahel by across fell foods staple prices and food with 2011, 2012 compared means of the the beyond rose simultaneously study found the Children a Save families, poorest families in Niger that thousands of the poorest their basic survival 40% of afford needs could only the year. for is the underlying cause of 300,000 deaths in the cause of 300,000 is the underlying each year. region Food prices rocketing while your crops fail and fail and crops while your prices rocketing Food that has combination deadly this is the animals die: the Sahel and the across of people pushed millions in Even 2009–12. into crisis from Africa Horn of in the under five 50% of children non-crisis years, malnutrition, chronic Sahel suffer

In areas at risk of food crisis, social transfers social transfers crisis, at risk of food In areas response efficient a more for a platform provide Rather than wait warning signs. to the first early and mortality rates of acute malnutrition for to Social transfer programmes help protect help protect programmes Social transfer being from in high-risk areas communities and help to build their crisis, by affected adversely a basic income Ensuring families have resilience. to sell have don’t means they basket or food fees assets or sacrifice school their productive if crisis their children costs to feed or healthcare in Ethiopia in 2011 the PSNP example, For hits. an acute hunger millions of people from protected the In 2008, the region. crisis that was affecting of Niger started a pilot social transfer government the worst to help 80,000 people avoid programme price spikes. or food drought of shocks like effects chronic malnutrition, an acute nutrition crisis an acute nutrition malnutrition, chronic 6.3 million people. affecting which is now unfolded Bo social how 2 Ensuring social transfers support nutrition: five policy guidelines

As the previous chapter sets out, there are a 1. Social transfer programmes number of cases where social transfer systems should be underpinned by have been shown to improve various aspects long-term commitment and of child well-being, including reducing poverty broad coverage and hunger; and building and sustaining livelihoods, especially in crisis. There are Social protection programmes – including transfer also strong examples of the impact of social programmes – should be institutionalised as part transfers on human development indicators, of a system, within a national social protection such as health, education and nutrition, and strategy and domestic law.3 In this way the in stimulating investment in productive assets programme guarantees access to social protection and demand in local markets. for those people who require it, according to the eligibility criteria. Beneficiaries should only leave However, although these kinds of impact have the programme as a result of no longer meeting been found across a number of programmes, they the eligibility criteria – eg, no longer fitting the are not guaranteed. While the impact of social demographic criteria, such as those based on age; or transfers on food consumption and dietary diversity ‘graduating’ beyond the poverty criteria. By contrast, is reasonably robust, the evidence of its impact on short-term programmes that only operate for a nutrition indicators such as stunting is not as clear- period of months are unlikely to have sustained 1 cut. To achieve improvements in child nutrition impact on nutrition or other indicators. through social transfers, a number of design and implementation characteristics of these programmes In many developing countries, child malnutrition is must be considered. a huge challenge. Over 40% of children under the age of five are stunted in India, Pakistan, Bangladesh, The design and implementation of social protection Nigeria and Ethiopia,4 with high levels in many other programmes need to be aligned with long-term developing countries. In these countries broad national objectives and goals. In developing countries, coverage is critical to reducing national rates where coverage of social protection is generally of malnutrition. This in turn requires long-term low, governments will need to define priorities domestic financing strategies for social protection and strategies for progressive realisation of social programmes, complemented where necessary by 2 protection programmes, consistent with need and multi-year funding commitments from donors. broader policy frameworks. In order to effectively deal with crises, social transfers In countries with high burdens of malnutrition, it is need to be well-established prior to the crisis and be crucial that social protection programmes include sustained during the crisis.5 Social transfers should nutrition as one of the stated objectives and that also be flexible to provide seasonal or crisis-related programmes are designed based on a comprehensive support to shock-affected socio-economic groups analysis of the causes and context of malnutrition. to protect households and prevent loss of human This chapter draws on existing evidence to set out and productive capital. Household Economy Analysis five broad guidelines for policy-makers to use in (HEA) can be used to identify the crucial time in the developing social transfer programmes that will help year when families most need support (see Box 4). maximise improvements in nutrition, and that are appropriate for national contexts and priorities.

10 2 Ensuring social transfers support nutrition: Five policy guidelines 11

10 The inadequate 14 12 11 An evaluation of Save the of Save An evaluation 9 For example, simulations of doubling the of doubling simulations example, For 13 Evidence from a synthesis of World Vision’s cash Vision’s a synthesis of Evidence from World that cash is spent on in emergencies found transfers flexibility in how more and allows food diverse more beneficiaries spend cash. Children’s programme in Niger found that cash in Niger found programme Children’s millet, food, staple used in buying the were transfers such locally available products as other as well and cowpeas oil, groundnut meat, milk, as cow’s increased foods Spending on nutritious pancakes. after distribution of the transfer. considerably there is now a commitment to align the transfer a commitment to align the transfer is now there prices. size better with prevailing it is on nutrition, to maximise impact In order diet and the crucial that the cost of a nutritious in considered are power purchasing household’s Transfer size is critical in determining the impact of Transfer Evidence on hunger and nutrition. social transfers poverty tackling the underlying that by shows leads to young a larger cash transfer constraint, is likely which and better food, eating more children and impact on height-for-age a positive to have stunting. Beneficiaries may also use the cash transfer transfer also use the cash Beneficiaries may health and such as expenditure non-food for impact on nutrition which will increase education, the short in and long term. and child development families to prioritise The flexibility of cash allows and healthcare nutrition, between to need, according the from evidence example, For other basic needs. the households that that for PSNP in Ethiopia found majority the overwhelming transfers food received cash whereas received, they consumed all the food with way, diverse more in a much used are transfers numbers spending some cash on health, significant in farming. education or investing transfer size in Mexico’s Oportunidades programme size in Mexico’s transfer of stunting. prevalence lower found transfer size in Mozambique’s Food subsidy Food size in Mozambique’s transfer Alimentos) has de Subsídio (Programa programme challenge that has undermined impact; been a key Transfers of cash, as opposed to food to food opposed as cash, of Transfers transfers, ‘in kind’ or other distribution beneficiary, for the benefits of a range provide use of the transfer; choice of greater and allow a can allow and empowering more are they choice. of food In addition, diversity greater local able to strengthen better are cash transfers cost-effective to be more likely and are markets cash transfer the Children’s Save transfers. than food higher dietary found in Swaziland programme compared recipients cash plus food among diversity recipients. only to food 7 8 The 6 adjust in to a nutritious price increases to transfers should reflect and be able ash Many of the programmes that have had the had the have that programmes of the Many those are nutrition on impacts impressive most have that – ie, coverage significant that achieved of people – irrespective a large number reached has Brazil example, For targeted. are they of how declines impressive one of the most experienced Its world. in the developing in child undernutrition , Bolsa Familia programme, conditional cash transfer people as part 46 million of an integrated reaches The Hunger). (Zero Zero Fome strategy, nutrition playing as is recognised programme cash transfer child malnutrition, in reducing an important role to acknowledged power purchasing with increased 15% of the decline in malnutrition. account for Across the different types of social transfer types of social transfer the different Across (emergency and developmental, programmes of transfers programmes) including public works (such as as opposed to in-kind transfers cash, There in popularity. grown have and assets), food of cash consensus in favour has been a growing ‘in kind’ transfers aid or other food over transfers UN agencies with EC, in most circumstances, their use all increasing and the UK government of cash-based transfers. 2. C 2. the cost of diet response In countries with the highest burdens of In countries with the highest burdens is of social protection coverage malnutrition, Coverage is narrow. insufficient and targeting must in these countries of social protection scaled up. be urgently In summary protection Long-term commitment to social a sustained impact is essential to ensure on nutrition. In many developing countries, particularly in countries, developing In many programmes protection social Africa, sub-Saharan poor of those who are a small proportion reach These programmes and vulnerable to malnutrition. that are on selected vulnerable groups tend to focus such as orphaned and other defined, often narrowly unable to who are or people vulnerable children, or disability. sickness chronic due to old age, work South African Child Support Grant reaches around Child Support around African Grant reaches South Oportunidades and Mexico’s 9 million households; than 4 million households. more reaches programme 12 a chance to grow not available orare only available athighcost. the Dietanalysis, whichcan assess thefoods thatare informed by amarket assessment, includingCostof contexts, thedecisionontransfer modalityshouldbe food –onthemarket, andrisingfood prices. Inthese availability offoodtypes –especially ofcertain transfers may belesssuitablebecauseofthepoor areas affected by drought oranaturaldisaster, cash In somecontexts, fragilestatesandin particularly the gap accordingly. on nutrition needstoassessaffordability –andbridge nutritious diet, any cash transfer thataimstoimpact In order toincrease accesstoandaffordability ofa total estimatedcostoftheminimum nutritious diet. poor householdsisabletomeetonly 31%ofthe of malnutrition. Rather, theannual incomeofvery availability ofnutrient-rich food isnotamaincause In Pakistan, CostoftheDietanalysis found that micronutrients. better-off households, cannotafford theessential requirements;their energy mostpeople, including ‘poor’) canbarely afford adietthatmerely fulfils poorest families(thosewhoare poor’and ‘very optimal growth anddevelopment ofchildren. The than adietthatprovides therequired nutrients for for childrensufficient energy is four timescheaper for poorgroups. very InDRC, adietthatprovides nutritious dietandhouseholdincome, particularly Pakistan Diet analysis undertaken inDRC, Bangladeshand determining appropriate transfer size. Costofthe Source: Blank, LandHanda, S(2008) ‘Social Protection in EasternandSouthern Africa:A framework for UNICEF’. andstrategy Nairobi: UNICEF

Percentage of national poverty line Figure 2.

Mozambique 10 15 20 25 30 35 0 5 16 found ahugegap between thecostofa value of

Zambia transfer

Kenya

South Africa as a percentage of

Malawi

Honduras cash transfers. increasingly expressed apreference for food over was underminedby risingfood prices, beneficiaries food prices. InEthiopia, whenthecashwagerate to whichtransfer sizeisabletoadjustchanging on key aspectssuchastransfer sizeandtheextent The appropriateness ofcashversus food depends nutrient needsofhouseholds, ofchildren. particularly andmicro-should bedesignedtomeetenergy Where food transfers are provided, thesetransfers households. 10–40% ofthepercapita consumptionofrecipient than halfthepoverty line, thesevaluesrepresent target theultra-poor, whoseconsumptionisnomore poverty line. Sincethe African programmes typically provide benefitsrangingfrom 5–20%ofthenational line. amount equaltoabout20%orlessofthepoverty Cash transfer programmes typically transfer an policies tostabilisefood prices. or switching tofood transfers; orintroduce other such asvouchers, acombinationofcashandfood price inflation; consideralternative payment types may toindex-linktransfer sizetofood benecessary seasonal variationsinpricesandproduction levels. It amount shouldbeinformed by anunderstandingof In thelightofrisingfood prices, decisionsontransfer and thecostofanutritious diet. wage ratesriskwideningthegap between income Pakistan showed thatfluctuating food pricesand the poverty line 19 The five Africanprogrammes shown inFigure 2 Brazil 20 17

Jamaica The CostoftheDietanalysis for

Nicaragua 18

Mexico

Colombia 2 Ensuring social transfers support nutrition: Five policy guidelines 13 and timely be to through beneficiaries for convenient is mechanisms of social protection Timeliness may transfers Delayed ensuring impact. critical to and other asset depletion to prevent not be able harmful coping strategies. should be designed in a way The delivery of transfers accessing for the time burden to minimise cost and the who are women, particularly for the transfer, primary and tend to be overburdened recipients Security issues and the domestic responsibilities. by Cash of transport also be considered. must availability mobile through delivered increasingly are transfers including e-payment solutions, finance and digital systems. transfer and mobile phone-based money finance and digital solutions have mobile Innovative the delivery of cash the potential to transform 5). systems (see Box transfer In summary regular are It is critical that social transfers be should transfers In addition and predictable. that minimises way in a cost-effective delivered delivery Innovative on beneficiaries. the burden systems should be explored. needs Delivery 3. a bank, local agent, or mobile van) or a mobile or local agent, a bank, system (where transfer phone-based money via a mobile beneficiaries access their transfer phone with a local agent). eliminate solutions will largely These e-payment of associated with the security the problems to withdraw Beneficiaries will also not have cash. making it easier to save. at once, all their money beneficiaries to system will allow The e-payments potentially services directly, for and products pay including school fees. intended to delivery solutions are The innovative – particularly on women, the time burden reduce collecting for responsible primarily who are participating – and to introduce the transfers skills and technologies. tools, households to new training in will get regular households example, For will run and the programme management, money better campaigns to promote awareness-raising financial practices. transfers – Delivering cash alawi M x 5. Save the Children is working in partnership is working the Children Save with Opportunity Malawi International Bank in bank that targets the poor (a commercial Airtel (a mobile phone and areas) under-served e-payment operator) to pilot an innovative Beneficiaries will be able to delivery mechanism. e-payments one of two access their funds through visit they banking (where electronic systems: There are also problems with the security of cash also problems are There counted and transported. when it is physically high transport are costs and a there In addition, who administer and on district staff large burden each month. distribute the transfers The Government of Malawi’s Social Cash Transfer Transfer Social Cash of Malawi’s The Government manually delivered (SCTP) is currently Programme place to a fixed beneficiaries to travel and requires at a set time each month to collect the full value of is time-consuming and The process their transfer. ‘opportunity costs’ in terms of with high restrictive, to access the transfer. the time that it takes

Bo solutions mobile finance and digital Cash transfers should be indexed to food price to food should be indexed Cash transfers food particularly of rising in contexts inflation, modalities payment or alternative prices; prices should and policies to stabilise food be considered. Transfer sizes should be large enough to have enough to have should be large sizes Transfer nutrition sustained impact on a sufficient and should they In particular, and other outcomes. support households to meet the costs of a prices taking into account food diet, nutritious power. and purchasing Cash, rather than in-kind, transfers have a have transfers than in-kind, rather Cash, including allowing of advantages, number and of food and diversity choice greater other consumption. In summary Input or asset transfers impact on nutrition in a in on nutrition impact transfers or asset Input livelihoods improving by including of ways, number security food boosting income, thereby opportunities, interventions Particular may livelihoods and nutrition. as kitchen gardens such on nutrition, impact directly transfers livestock and food nutritious that produce foods. of protein-rich consumption increase that may 14 a chance to grow nutritional supplementsleadtobetterchildnutrition. feedingIt isknownpracticesand thatparticular links tonationalnutrition policies. programmes andbycomplementary strengthening nutrition canbemaximisedby combiningwith The potentialfor socialtransfers toimpacton nutrition componentshouldbeseeninthatlight. Social transfers must meetmultiple goals; the not be but conditionalityshould with 4. Integrate social by TheLancet. by drawing recommended onthe13interventions women, lactatingmothersandyoung children, protein supplementsfor pregnant andenergy) micronutritent ornutritional (vitamins, minerals, and promotion ofhygiene practices, aswell as ofgood nutrition,support suchasbreastfeeding integrated approach thatincludespromotion and Consequently, itiscriticaltointroduce aholisticand household environment arefactors. alsoimportant malnutrition –inadequatecare andanunhealthy poverty isnottheonly contributingfactorto in themalnutrition causalframework (seepage5), transfer programmes, and therelative contribution impact onnutrition when combinedwithsocial However, theextenttowhichtheseinterventions vice versa. haveinterventions accesstosocialtransfers and to ensure thatthosetargetedfor direct nutrition Different targetingsystemscanalsobelinked up nutrition workers topromote good nutrition. programmes acadre tosupport ofcommunity committees). There ispotentialfor publicworks in programme communication andincommunity good nutrition (for example, atpayment points, and processes topromote behaviour thatsupports can beenhancedby usingsocialtransfer structures policies inanumber ofways. For example, nutrition Social transfer policiescanbelinked tonutrition nutrient deficiencies. malnutrition, suchaspoor-quality dietsandspecific to effectively impactonthenon-incomecausesof foods. These ‘direct have interventions’ beenshown support, andprovision ofsupplementsorfortified are combinedwithbreastfeeding promotion and transfer programmes inLatin American countries, Many programmes, conditionalcash particularly wider nutritionpackages, the default option 22

transfers 21 As represented As

with educationmessages. programme,Oportunidades andutilisationincreased of nutritional supplementswasakey challengeinthe growth andlower probability ofstunting. use thesupplementsexperiencedanincrease inmean taken intoaccount, itwas found thatthosewhodid households hadnotusednutritional supplementswas impact onnutrition. However, oncethefactthatmany reportedalimited Initial findingsfrom Oportunidades promoting behaviour good nutrition. thatsupports conditionality), includingnutritional supplementsand related components(enforcing uptake through a provides awiderangeofnutrition- andhealth- of eachcomponent, isunclear. Oportunidades condition mattersmore for nutrition outcomes. There issomedebateonwhetherthecashor health workers andpromoters. nutrition promotion activitiesthrough community has linked thepublicworks componentwith and nutritional supplements, andinfection control. promotion of appropriate andsupport breastfeeding develop amore integratedapproach involving recommended thattheprogrammmeOportunidades in several Latin American countries. found there were different impactsfrom programmes have includedseveral similarcomponents. Itwas Other programmes, inLatin particularly America, programme. be complementedby astronger nationalnutrition developed programmes intheregion) isfor itto Grant(oneofthemost African ChildSupport one oftherecommendations for theSouth normally ‘stand alone’. normally ‘stand In sub-Saharan Africa, socialtransfers are transfer programme. or micronutrient supplementsalongsideacash encouraging exclusive breastfeeding andiron folate across Latin American countriesrecommended assessment ofprogramme characteristics, astudy as essentialtoenhancingimpactonnutrition. orlinkstonationalnutritionalinterventions policies nutrition points tothenecessityofcomplementary Therefore, overall, theevidence from Oportunidades unconditional programmes. saw adecrease inchildheight, compared to conditions, inpublicworks, suchasparticipation However, programmes withnon-health-related related tonutrition, increased height-for-age scores. that health-related conditionalities, includingthose nutrition didnotfindstatistically significant evidence A meta-analysis ofimpactscashtransfers on 29 Insomeareas ofEthiopia, thePSNP 28 Inarecent evaluation, 25 A further studyon Afurther 31 27 Basedonan 24 The uptake The 30 26

2 Ensuring social transfers support nutrition: Five policy guidelines 15 40 confounding confounding 39 A recent study A recent 38 Consequently, where possible, possible, where Consequently, 37 and women 41 of the impact of the Mexican social protection protection of the impact of the Mexican social since concluded that, Oportunidades, programme, of the proportion the scheme was introduced, either on food households’ budget that was spent the same or increased, remained expectations that it would fall as a proportion of an fall as a proportion expectations that it would This was attributed to the fact that budget. increased into the hands of women. the cash was put directly social transfers should be delivered in a should be delivered social transfers over control women’s manner that increases and supports their contribution resources family the family. diet for to ensuring a nutritious or that making women, evidence is positive There the primary of recipient the primary care-giver, For outcomes. nutrition can improve the transfer age pension in South the impact of the old example, when the of girls was greater Africa on nutrition to a woman. pension was given Entry to social protection programmes is often Entry programmes to social protection such as lack of birth to access, barriers impeded by of programmes, and limited awareness registration children on younger to impact more which is likely It is critical that in any social protection programme programme social protection It is critical that in any the design is outcomes, nutrition seeking to improve empowerment women’s and treats gender-sensitive also must programmes Therefore, as an objective. and children, on women impacts negative any avoid or women for burdens work such as increased One gender stereotypes. reinforcing inadvertently is the programmes public works concern around The PSNP includes specific impact on childcare. participation women’s to promote provisions to lighten with provisions time constraints, given and and lactating women, on pregnant the burden unevenly these are however, facilities; childcare implemented. In order to improve nutrition, social transfer transfer social nutrition, to improve In order the specific into account take must programmes – beneficiaries risks faced by vulnerabilities and and women particularly those that affect children. young of survival chances that a child’s has shown Research the controls 20% when the mother by increase a decisive play therefore, Women, household budget. dietary and children’s diversity security, in food role health and nutrition. protection social Ensure 5. for works children young 35 Other 33 Making transfers Making transfers 36 In spite of positive positive In spite of 32

34 conditional on attending clinics may risk further conditional on attending clinics may or poorest marginalising those people who are to be less able to likely who are most remote, with the conditions. comply Conditions will not be feasible in some Conditions will not be feasible of services supply where is contexts of the if payment example, insufficient. For is conditional upon attending a health transfer be an adequate must there or clinic, centre and affordable of clinics within a feasible number families. distance for travelling Conditions involve extra administrative administrative extra Conditions involve Mexican Oportunidades the costs. For programme, monitoring adherence it is estimated that to 26% of the to conditionality amounts cost (excluding the cost of the programme themselves). transfers Enforcing and administering the conditions and administering Enforcing institutional capacity additional require may which on the part of the implementing agencies, income countries. low in many be unrealistic may in burdens face additional Beneficiaries may risk that is greater and there meeting conditions, or stigmatised. will be disempowered they impacts from some conditional cash transfer transfer conditional cash some impacts from are there outcomes, nutrition-related on programmes to query reasons the use of conditionalities powerful that some is evidence There as a general approach. are conditionality underlying of the assumptions such as the assumption that poor questionable, and education. people neglect nutrition Given the costs, risks and challenges risks and challenges the costs, Given and the lack of associated with conditionality, conditionality of benefits, consistent evidence should not be the default option when Context- programmes. designing social transfer to required resources are specific analysis and substantial given of conditionality in any support the introduction evidence of benefits is When definitive programme. effect a combination of the disempowering absent, of conditions and the associated monitoring costs against their use. indicates a presumption In summary it is impact on nutrition, to ensure In order with nutrition essential to link social transfers policies or complementary interventions. • Conditions may make programmes more politically politically more programmes make may Conditions programme the focus may enforced, if and, acceptable, not may as non-poor people groups on poorer the conditions. with comply challenges to conditionalities include: challenges to conditionalities • • • 16 a chance to grow transfers canbeaimedat children ofagesashigh easily belaterrecovered. and thatany nutritional deficitsatthisagecannot areinterventions usually greater for young children, The evidence strong isvery thatnutritional gainsof or community-based targeting(see Table 1). poorest households, based onproxy means-testing orphaned andothervulnerablechildren, andthe those whoare unabletowork, householdswith (who struggletoaccessfood duetolivinginpoverty), Programmes targetpeoplewhoare food insecure disparities, ruralareas oradministrative factors. targeting component, eitherbased onregional income methodologies. There isoftenageographical diverse groups, oftenusingmultiple targeting sub-Saharan Africa –have tendedtotargetmore Developing countries–for example, countriesin impacts onnutrition from thistargetingmethodology. the evidence from Latin America hasfound positive women, andchildrenagegroups. incertain Muchof components targetedatpregnant andlactating or proxy means-testing(see Table 1), withspecific families inextreme poverty, basedonmeanstesting predominantly Latin American countries, target to targeting. Many middle-income countries, Different countriestake different approaches resources. and politicalwill, government prioritiesandfinancial government capacity, includingavailable datasystems; Targeting dependsonprogramme objectives; and sustainedimpactonchildren’s nutrition. the programme wasassociatedwithaneffective Grantshows thatearlyChild Support accessto and poorer families. Evidencefrom South Africa’s malnutrition are includedin Table 1opposite. advantages anddisadvantagesimplicationsfor selection. The different targetingapproaches, their (for example, basedonageorgeography) orself- individual orhouseholdassessments, categorisations prior tofirstpregnancy. anaemia andcanbenefitfrom improved nutrition adolescent girls, whoare vulnerableto particularly breastfeeding mothers, poorhouseholds, very and children undertheageoftwo, pregnant women and affected by undernutrition. These groups include criteria effectively includegroups thatare particularly Developing countriesshouldensure thateligibility that affect poorhouseholds. access totheprogramme, thosebarriers particularly programmes tominimisethebarriers thatdelay Consequently, more needstobedoneinmany 44 Targeting mechanismscanbebasedon 43 45 Therefore, whilecash 42

significant for children undertwo. measurable nutrition-relevant impactsare oftenmost en Acción,Familias andBrazil’sBolsa Familia show that South Africa’s Grant, ChildSupport Colombia’s 18 years, studiesofMexico’s Progresa-Oportunidades, most cost-effective andpolitically-acceptable option. targeting aimingatbroad coverage islikely tobethe malnutrition andlimiteddatasystems, categorical For developing countries, given highburdens of adolescent girls. children undertheage oftwo, of pregnant andbreastfeeding women and to malnutrition, suchasthecriticalwindow effectively reaches thosemostvulnerable It iscriticalthatsocialprotection reinforcing traditionalgender roles. by introducing impracticalconditions or risk ofincreasing theworkload ofwomen programmes must alsobemindfulof the nutritious dietfor thefamily. However, theirroleshould support inensuringa impact onintra-householddynamicsand Social transfers must avoid any negative In summary 1. monitored andevaluated. social transfer programmes, whichshouldinturnbe impact onnutrition shouldbeanexplicitobjective of malnutrition isakey challengeandpolicypriority, be adapted tosuitthenationalcontext. Where transfers tohelpimprove childnutrition –to evidence-based guidelinesonthedesignofsocial Save theChildren hasdeveloped asetoffive Summary respond flexibly in crisis situations. developed instabletimesandbedesignedto response, socialtransfer programmes shouldbe broad coverage. Inorder toensure effective crisis by donorsaimingatprogressive realisation of by multi-yearnecessary fundingcommitments domestic fundingstrategies, complemented where rates ofmalnutrition andtodeveloping long-term it. Broad coverage iscriticaltoreducing national should guaranteeaccessfor thosewhorequire programmes shouldbeinstitutionalisedand and broad coverage. Socialtransfer underpinned by long-termcommitment Social protection programmes shouldbe 46 47 and 2 Ensuring social transfers support nutrition: Five policy guidelines 17 Implications for for Implications malnutrition addressing The countries with highest The countries do of malnutrition burden data good not tend to have is and malnutrition systems, on income not based solely poverty needs to be taken Care that the proxies to ensure including at accurate, are identifying those vulnerable of malnutrition is not easily Malnutrition identified within communities, large are particularly if there of malnourished numbers children It is possible to select the with the highest regions of malnutrition, burdens although this will miss in malnourished children other regions be difficult to ensure May those vulnerable to effects self select, of malnutrition without overburdening these groups Allows programmes to be programmes Allows that targeted to age groups particularly vulnerable to are of malnutrition, the effects and particularly pregnant young women, breastfeeding girls adolescent children, power. Cash transfers should be adjusted to food should be adjusted to food Cash transfers power. prices increases. It is and convenient. Delivery be timely must in order predictable important are that transfers harmful coping to impact on households and avoid e-payment innovative Delivery through strategies. and costs on burden mechanisms can reduce such as for other benefits, beneficiaries and allow access to financial services and savings. Disadvantages 3. Requires a good a good Requires understanding of or characteristics of poor vulnerable households manipulation Potential limited elites, local by and transparency understanding by communities Requires strong data systems strong Requires into account Does not take other dimensions of poverty Likely high inclusion and Likely possible exclusion errors; stigma Inclusion errors, as non-poor Inclusion errors, and able to benefit; are of poor exclusion errors people who do not meet the criteria birth extensive Requires registration Inclusion and exclusion lead to tensions may errors to historically if related marginalised areas Advantages Can be relatively cost- Can be relatively increase and can effective empowerment community simple, Administratively political broad-based support and buy-in from able to target classes, middle particularly vulnerable groups Can be effective at Can be effective less determining eligibility, and therefore data intensive, than means testing less costly Relatively effective at at effective Relatively based determining eligibility (limited on income poverty exclusion and inclusion errors) No need to select beneficiaries and therefore and limited capacity required resources Administratively simple, simple, Administratively is poverty particularly where concentrated Transfers of cash, as opposed of cash, Transfers malnutrition for addressing implications and mechanisms argeting to in-kind transfers, are preferred as they provide provide as they preferred are to in-kind transfers, for the beneficiarya range of benefits (such as as stimulating choice) as well of food diversity Transfer cost-effective. and being more markets size matters and should be based on the cost of diet and households’ purchasing a nutritious Cash transfers should reflect the cost of should reflect Cash transfers to adjust to diet and be able a nutritious price increases. Self-selection Proxy means-tested – Proxy eligibility based on observable characteristics (asset housing) that are ownership, associated with poverty targeting Community-based members – community determine which households eligible are – eligibility based Categorical such as categories on broad disability and gender age, Categorisation Means-tested – eligibility Means-tested based on income levels Individual or household assessments Individual Self-selection – beneficiaries by identify themselves choosing to participate in public (eg, the programme programmes) works Geographical – selects Geographical by location beneficiaries Targeting mechanism Targeting 1. T 1. able 2. T 18 a chance to grow 4. linkingtargetingandidentificationsystems • andtrainingcommunity nutrition supporting • usingsocialtransfer structures andprocesses • policies. This canbeachieved by: strengthening linkagestonationalnutrition good nutritionand support practices, andby programmes topromotewith complementary enhancing impactby combiningsocialtransfers option. conditionality shouldnotbethedefault with widernutrition interventions, but Social transfers shouldbeintegrated need them. to socialtransfers for thosepeoplethat of direct nutritionandaccess interventions to effectively deliver anappropriate package workers through publicworks programmes practices to promote good nutrition andsupport There isconsiderablepotentialfor 5. two andadolescentgirls. breastfeeding women, children undertheageof effects ofmalnutrition, suchaspregnant and those whoare vulnerabletothelong-lasting is criticalthatsocialtransfers effectively reaches access for young children orpoorhouseholds. It should bemadetominimisethebarriers to Access for vulnerablechildren isessential; effort any negative impactsonwomen andchildren. of resources infavour ofchildnutrition andavoids way theintra-householdallocation thatsupports children. Socialtransfers shouldbedelivered ina Ensure socialtransfers work for women and should therefore notbethedefaultoption. associated withconditionality, andconditions nutrition, there are many costsandrisksthatare Although conditionsmay enhanceimpacton 3 The impact of the financial crisis on developing countries

This chapter summarises the ways in which Slower growth and uncertain economic and financial crisis in Europe and economic outlook other industrialised and emerging economies is affecting national economies and poor Following a peak in GDP growth in the third people in developing countries. It highlights quarter of 2011, growth in developing and emerging 9 threats to ‘fiscal space’ – or government’s economies slowed more than forecast. While ability to respond to shocks by adjusting tax growth prospects in developing countries are higher or spending – threats to revenue and, at the than in high-income countries, the former continue to be negatively affected by economic turmoil in community level, threats to remittances and Europe.10 Early 2012 saw projections for global, food price inflation. developed country and developing country growth Evidence shows that financial crisis can push high significantly downgraded (see Table 2). numbers of people into poverty thereby increasing Despite large bailouts for struggling European their vulnerability to malnutrition. In Indonesia, the economies, the economic outlook in Europe remains number of households vulnerable to poverty more extremely bleak: eurozone GDP is expected to 1 than doubled after the economic crisis of 1997–98. decline by 0.3% in 2012.11 Over the subsequent Vulnerability to poverty increases as families are years to 2016, enforced austerity as a result of the forced to adopt harmful coping mechanisms, such as eurozone fiscal pact will mean that recovery remains selling productive assets and reducing investments extremely weak, with predicted growth of only 0.5% 2 in health, nutrition and education. The recent global per year over those three years.12 The World Bank economic crisis and food price spike has pushed 100 predicts that, in the event of a serious deterioration 3 million more people into poverty, and made them of economic conditions in the eurozone, developing more vulnerable to any subsequent shocks than country GDP could decline by 4.2% by 2013, relative they were four years ago. Food prices remain highly to its current forecasts.13 This scale of impact would volatile, and recent analysis estimates that the 2011 be achieved in a variety of ways, largely related to food price spike alone pushed 48.6 million people changes in revenue flows to developing countries. into poverty.4 Furthermore, developing countries’ capacity to respond to a sharp downturn in global growth is more limited than before the 2008/09 global economic and financial crisis.5, 6 Many countries expended substantial fiscal resources to weather the impact of global increases in food and fuel prices, and have yet to rebuild fiscal buffers to counter the “The downturn in Europe and weaker growth impacts of further economic crisis.7 This increased vulnerability is particularly concerning given analysis in developing countries raises the risk that of the global financial and economic context, which the two developments reinforce one another, suggests that crises such as this are likely to become resulting in an even weaker outcome.” more frequent in the future.8 (World Bank, 2012)14

19 20 a chance to grow of carry trade,of carry by whichinvestors borrow atlow Quantitative easingalso led tothephenomenon and upwards trends. seeing aquickre-establishment oftheprevious levels acceleration ofcommoditypricesafterthecrisis, effects.important Onewastobolsterthe Quantitative easinginrichcountrieshadother quantitative easinghasended. may indicateaperiodoflower flows infuture if of thecrisis, asriskswere swiftly reappraised, and in developing countriesintheimmediateaftermath turn hadfollowed asharpdrop-off ininvestments half oftheyear. substantial sumsfrom thosemarkets inthesecond countries weaken sharply asinvestors withdrew affected. 2011already saw capital flows todeveloping upon themfor linesofcredit willbenegatively need recapitalisation, developing countriesreliant European banksexperience significantlossesand First, privatecapital flows will remain depressed. As for developingcountries The economicoutlook Source:World Bank2012GlobalEconomicProspects: andvulnerabilities. Uncertainties table 2. Downgrades problem ismore widely felt. rely than wasoncethecase, onfood imports sothis meansthatmoreexporters developing countries imports. Long-standingpressure tobecomecash-crop most have also suffered from higherpricesfor food have benefited from higherprices for theirexports, food markets. Sowhile somedeveloping countries economies, andsowasnotsustainable. resulted from rounds ofquantitative easinginrich investment (whichsometermeda ‘bubble’), which World trade growthcountry Developing growthcountry High income Global economy 15 This followed aperiodofhigher 6.6% 6.2% 2.7% 3.6% 2012 growth projected June 2011: 17 This includespricesinkey to economicgrowth projections 18

4.7% India andChina) (3.8% excluding 5.4% countries) eurozone (-0.3% for 1.4% 2.5% -1.1% 2012 growth projected 2012:January 16 This in This -1.9% -0.8% -1.3% projections 2012 growth Change in exports. as such, underminethecompetitiveness oftheir to upwardly valuethosecountries’currencies and, a higherrateindeveloping countries. The effect is interest ratesindeveloped countriesandlendat and regional crisis’. and improve themonitoringofearly signalsofglobal World Bank, underscores ‘the needtoremain vigilant 2011historicalpeak which,February according tothe again. InMarch 2012, they were only 6%below their of2012sawquarter globalfood pricesontherise of2011,a declineduringthelastquarter thefirst and domesticfood pricesfluctuatedramatically. After 2011 saw globalfood pricesreaching record highs banks repatriate capital toheadquarters. this hasledtoincreased vulnerabilityasEuropean Africa were European. Intimesofeconomic crisis, 2000–06, 56%offoreign-owned banksinsub-Saharan has grown significantly duringthelastdecade–from number ofEuropean banksinlow-income countries Finally, withregard toprivatecapital flows, the increases inchildmortality. unpredictable andvolatile. flows todeveloping countriesare likely to remain recession cancelordelay investments, capital investors withlessappetite for riskduring extended at risk. may have putanadditional 400,000children’s lives the Children estimatesthat2011highfood prices negative impactonchildhungerandnutrition. Save cutting down thenumber ofmeals–willhave a substituting cheaper staples for nutritious food or Many householdresponses tocrisis–suchas 21 6.3% 2.6% 3.6% 3.1% 2013 growth projected June 2011: Malnutrition isakey factorinanticipated 19

6.8% India andChina) (4.5% excluding 6% countries) eurozone (1.1% for 2% 2013 growth projected 2012:January

-0.5% -0.3% -2% projections 2013 growth Change in 22 As 3 The impact of the financial crisis on developing countries 21

32 Europe Europe 31 28 With reliable sources of income sources With reliable 29 Remittances represent on average 8% of on average Remittances represent 30 for poor families at risk, the need for social transfers social transfers the need for poor families at risk, for and destitution is stark. poverty to prevent impact on scenarios would Such labour market members living and working family from remittances role in protecting a significant which played overseas, price crisis the impact of the food poor people from in 2008/09. OECD Secretary-General Angel Gurría OECD Secretary-General “The fall of ODA is a source of great great of is a source ODA fall of “The developing when at a time coming concern, the knock-on been hit by have countries Aid is and need it most. of the crisis effect to low-income total flows a fraction of only times economic hard but these countries, and lower investment also mean lower I commend the countries that exports. in spite their commitments keeping are They consolidation plans. of tough fiscal the crisis should not be used that show development reduce as an excuse to cooperation contributions.” low-income countries’ GDP, with peaks in Tajikistan Tajikistan with peaks in countries’ GDP, low-income Nepal (22%) and the Gambia (14%). (39%), for of migrant remittances source a key remains will of remittances The level world. the developing and in Europe rising unemployment by be affected Bank estimates that a World The devaluation. euro European economic crisis – in which several severe denied the willingness of markets countries were private banks result, as a to finance their debts and, – could cause remittances engulfed were in Europe 6% or more, countries to decline by to developing impacting particularly on the 24 countries where of GDP. more 10% or represent remittances impact on already high global unemployment. The high global unemployment. impact on already that International Labour Organisation estimates an 200 million, of is global unemployment there of 27 million since the start of the crisis. increase risks materialise Their estimate is that if downside 2% falls to below and global growth as projected rise more would global unemployment in 2012, at least in 2012, than 204 million to more rapidly than under the baseline scenario (if 4 million more with a further to increase risks do not materialise), than under the 6 million more 209 million in 2013, baseline scenario. Rapid Rapid 26 Developing country exports Developing Such countries as these are Such countries as these are 23 25 27 Certain developing countries are particularly countries are Certain developing 24 At the aggregate level, international aid flows over over international aid flows level, At the aggregate the hit by been less hard have years the last three The OECD’s expected. economic crisis than originally reported Assistance Committee (DAC) Development of 0.7% in in global ODA increase a real-terms lifting it to US$119 billion (and the rise was 2009, is excluded). item, a volatile 6.8% once debt relief, is partly ODA because 2009 this increase However, the cases before in many was budgeted in 2008, the OECD-DAC April 2012, In economic crisis began. announced that major donors’ aid to developing a breaking 3% in 2011, nearly by countries fell years Disregarding increases. of annual long trend this was the first drop of exceptional debt relief, previous following of aid flows since 1997. Analysis that economic crises in a range of countries shows countries that experience such crises from aid flows to those countries as 25% relative as much can fall by as for can continue and that this effect with no crisis, long as a decade. and significant reductions in aid, therefore, have the have therefore, reductions in aid, and significant contraction in many economic potential to force and hunger. of poverty countries with a high burden extremely vulnerable to further downturn in Europe to further vulnerable in Europe downturn extremely and associated decline in demand. lower from gaps to fill the official aid for Prospects bleak. are receipts and trade flows private capital of all net Africa almost two-thirds In sub-Saharan come from inflows (public and private) capital Assistance (ODA). Official Development The picture in labour markets is no more is no more in labour markets The picture crisis could seriously The eurozone encouraging. Turning to trade, the picture is also a concern. also a concern. is the picture to trade, Turning as developing Europe has overtaken China Although crisis the eurozone main trading partner, countries’ countries’ import developing impacted on has already declined Global trade volumes and export markets. months during the three pace of 8% at an annualised 17% decline in a reflecting ending October 2011, imports. European dependent on European countries for their export their countries for dependent on European exports 61% of Mozambique’s example, For markets. the for exports were and 56% of Madagascar’s in 2011. eurozone declined at a 1.3% annualised pace in the third in the third pace annualised declined at a 1.3% quarter through to decline continued of 2011 and Asia (where in south particularly sharply November, of the pre-crisis This is a reversal 9.7%). by fell they country by exports2007 developing in grew trend: 10.7%. 22 a chance to grow in responding toeconomiccrisis(seeBox 6). social protection –includingsocialtransfers –plays the more vital. Globalleadersrecognise therole makes therole ofsocialtransfers mechanismsall coping withearliercrisesandhighfood prices, this most. distributed, affecting theincomesofpoorest the effects ofcrisessuchasthisare unequally Bangladesh andthePhilippineshasshown that of households. Inaddition, evidence from Mexico, developing countriesatthelevel ofthestateand in Europe willbetoreduce available resources in Overall, thecontinuing effects ofthefinancialcrisis Summary Bo Nicolas Sarkozy, former President ofFrance, May 2011 balanced andsustainablegrowth.” improve worker productivity andpromote social protection schemes, becausethey help “Economies fare betterwhenthere are efficient 2011 Ban KiMoon, UnitedNationsSecretary-General, October necessary, feasible andeffective.” uncertainty, investment insocialprotection is “At atimeofglobaleconomicturmoiland Social Transfers inBrasilia, December2011 Director ofUN Women, atthePresentationon oftheReport Michelle Bachelet, Under-Secretary GeneralandExecutive inclusive andsustainable.” creating pathsfor development thatare more shocks, helpingtoacceleratethisprocess and the capacity ofrecovery inthefaceofeconomic aggregated demandintimesofcrisisandincreasing “Social transfers contributetostabilizing 2012 Felipe Calderón, President ofMexicoand2012G20President, .” .” known asOportunidades through theconditional cashtransfer program and increased poverty. InMexico, we managedthis poorest. We must break thelinkbetween crisis by aggressive socialprograms toprotect the “Any adjustmentprogram must beaccompanied 33 x 6. leadersfocusincreasingly Global onsocialprotection With depletedhouseholdreserves from the beginningoffinancialand food pricecrisis. malnutrition were already extremely seriousbefore delivered through thehealthsystem. Globallevels of and toinvest inmore direct nutritional interventions countries’ ‘fiscal space’toprovide socialtransfers poverty. Second, itweakens thenationaldefences – exacerbates underlying householdandcommunity reducing malnutrition intwo key ways. First, it Global economicdeclinethreatens progress in as amatterofpriority. Any worsening ofthissituationmust beaddressed foster socialcohesionandstability.” inequalities, toimprove livingstandards, andto extremely effective way tofightpoverty, to reduce in Brazil, thatinvesting insocialprotection isan “We know from experience, developed since2003 Juan Somavia, ILODirector General, 2011 developing anddeveloped countries.” overcome poverty andsocialexclusionin fuelling demandandenabledpeopletobetter population, asamacroeconomic served stabilizer the impactofcrisisamongvulnerable “Social protection measures have cushioned Council onEmployment andSocial Transfers, 2012 January Kemal Dervis, Chair, andJohn Evans, Vice-Chair, Global Agenda the future.” crisis andneedtobeinvested inandwidened have shockabsorbersinthe actedasimportant “…well-designed systemsofsocialprotection Vice President for Development 2012 Economics,January Justin Yifu Lin, the World Bank’s ChiefEconomist andSenior there isstilltime.” vulnerabilities andprepare shocks, for further while “Developing countriesneedtoevaluate their Dilma Rousseff, President ofBrazil, December2011 34

4 Social transfers – needed now more than ever

Given the negative outlook of the global of eurozone crisis be realised, we estimate that the economy, and the economic threats to number of additional people hungry globally will households and communities in developing leap by a staggering 33 million by the end of 2013, countries, children are faced with the very as discussed in Box 7.2 Evidence from Mexico and real threats of increasing poverty, hunger elsewhere has shown that the effects of crises such as and mortality. this are unequally distributed, affecting the incomes of the poorest most.3 At times of crisis, social transfers As noted in Chapter 3, the most recent food price are more essential than ever to address the threat of spike in 2011 is estimated to have pushed 48.6 million hunger, poverty and inequality. people into poverty.1 Such shocks have devastating Overall, the results in Box 7 demonstrate two effects on the ability of families to afford the amount key points. First, that the interconnectedness of of food that they need: for example, it has been economies and societies means that a sharp return estimated that the 2008/09 food price crisis pushed to financial crisis in Europe will have a direct impact an additional 63 million people into hunger, making on the developing world, driving up the numbers of them unable to afford the minimum necessary people in hunger by an estimated 33 million by 2013. amount of calories. This chapter updates that Second, however, we have seen that social transfers analysis to estimate the direct human costs of recent aimed at reducing extreme inequality provide a highly downgrades to economic growth, and of the risks of potent weapon – so transfers to provide just a 10% a further slowdown. increase in the incomes of the poorest two quintiles We estimate that 6.3 million extra people are at give rise to a 55 million reduction in the numbers of risk of hunger worldwide as a result of the growth people living in hunger, if enacted in the worst-case downgrades made in January 2012, compared to scenario. The total cost of such a scheme stands at what would be the case had growth continued as 1.5% of the GDP of countries included in our model, had previously been projected. Furthermore, should so should be seen as a feasible option. the World Bank’s worst case scenario of the impact

23 24 a chance to grow hunger global Bo income distribution(from the World Development relationship alongwithdataonaverage incomeand research. crisis onhunger, we extended World Bank In order toestimatetheeffect oftheeurozone 4.2%by 2013.a further would betoreduce developing growth country by Bank estimatesthattheimpactofsuchashock banks andotherfinancialinstitutions. The World wider financialcrisiscould result, engulfingprivate Italy, forcing themintounregulated defaults, amuch for majorEuropean countriessuchasSpainor is estimatedthatifmarkets were torefuse finance and 6.3%in2012, to5.4%and6.0%. Furthermore, it growth hasbeendowngraded from 6.2%in2012 For developing countriesasawhole, predicted downgraded between June2012. 2011andJanuary rates ofgrowth for 2012and2013have been pointfor thisanalysisOur starting isthatprojected * 2013 developing T Source: FAO able 3. Impact of2012Growth downgrades on Region

Total Sub-Saharan Africa Middle Eastand North Africa Latin America andCaribbean Asia andPacific x 7. Estimating 5 The approach usesanincome–calorie world hunger the effectof 5,997,125 926,000 Population

(2013, thousands)

4,045,868 876,081 465,681 609,495 Population

in hunger

(2010, thousands) 239,000 578,000 37,000 53,000 4 the eurozone crisison

Indicators pre-downgrade growth scenario. 32.8m more peoplein ‘hunger’, relative tothe shock totheeurozone would beanadditional been projected. The potentialimpactofasevere the casehadgrowth continued ashadpreviously ‘hunger’ by theendof2013thanwould have been expected tolead6.3millionmore peoplein to economicgrowth indeveloping countriesis Table 3.Ascanbeseen, therecent downgrade The results from theseanalyses are shown in use isdetailedin Appendix 1. energy requirementsenergy here asunabletomeettheirminimum dietary impacts ofgrowth scenariosonhunger(defined scenarios. We usethisapproach toestimatethe their calorierequirements, underdifferent growth globally livingwithinsufficientincometomeet * 6

) toestimatethenumber ofpeople Most recent number inhunger Increased Increased downgrade (2013, thousands) 6,266.0 1,690.2 3,655.7 338.6 581.4 7 ). thatweThe methodology 32,836.0 in Europe Worst-case number inhunger scenario (2013, thousands) 19,165.0 8,849.5 1,774.9 3,046.1 4 S ocial Box 7 continued

Estimating the effect of social transfers to of some 56 million people lifted out of hunger, with transfers – needed now more reduce inequality reductions by region of between 5.6% and 9.0%. We now use the same model to consider the This shows the importance of income inequality effects of a programme of social transfers to in determining this measure of hunger, and the increase the share of income going to each of the importance of policy responses that address such poorest two quintiles. In several African countries, poverty in ensuring that the poorest are protected social transfer schemes have been shown to from economic shocks and remain able to afford increase the incomes of their beneficiaries by their minimum dietary energy requirements. between 10% and 40%.8 We take the bottom of The total cost of the social transfers averages this range, and envisage a programme of transfers within our sample at 1.51% of GDP, ranging from that increases the income share of the bottom two 1.15% in Latin America and the Caribbean to 1.67% quintiles by 10%. We explore the extent to which in Asia. In India, for example, the cost is 1.94%, addressing inequality in this way could counter the and in Niger 2.03%; in Angola 0.77% and in Brazil effects of the worst-case scenario. 1.05%. These costs are reasonable and, indeed, are than ever Table 4 shows that in this case, the number of not dramatically more than is already spent on people globally unable to afford their minimum social protection systems by a number of states. dietary energy requirements would in fact fall, Brazil’s Bolsa Familia programme, for example, cost 9 by approximately 23 million. This represents a approximately 0.5% of GDP in 2006. reversal from the underlying worst-case scenario

Table 4. Impact of 2012 European Growth downgrades on 2013 developing world hunger

Region Population Population Worst-case scenario, Total swing due to (2013) in hunger with social transfers social transfers (2010, thousands)* Additional Percent People out Percent people in change in of hunger change hunger numbers in hunger

Asia and Pacific 4,045,868 578,000 -14,404.9 -3.72% 33,569.90 8.63%

Latin America 609,495 53,000 -2,150.4 -3.17% 5,196.50 7.69%

Middle East and 465,681 37,000 -1,334.0 -3.85% 3,108.90 9.00% North Africa

Sub-Saharan 876,081 239,000 -5,061.6 -2.04% 13,911.10 5.60% Africa

Total 5,997,125 926,000 -22,951 55,786.40

* Source: FAO

25 26 a chance to grow GDP) sincethefinancialcrisis(see Table 5). to spendonsocialprotection (asaproportion of selected, seven have reduced theamountthey planned countries (Rwandaand Vietnam) thatincreased social If we lookonly since2009, thisfigure rises, astwo the basisofpolicycommitments. information.budgetary Countrieswere selectedon historic commitmenttosocialprotection andavailable of 15IDA-lending countries, eachofwhichhave an crisis. Save theChildren investigated thebudgets oftheglobaleconomic been decliningsincethestart despite this, investments insocialprotection have However, Save theChildren analysis shows that downturn becomesareality (seeBox 6onpage22). social transfers asthethreat ofcontinuing economic leaders are drawing attentiontothevitalneedfor effects ofsocialtransfers isstrong.A number of The evidence for thepro-poor growth-promoting transfers: Declining investmentsinsocial T able 5. Government expenditureonsocialprotection Zambia Vietnam Senegal Rwanda Papua New Guinea Nigeria Nicaragua Nepal Mozambique Malawi Kenya India Ghana Cape Verde Bangladesh a false economy (billions –localcurrency; constantprices) 137.82 11.97k 71.15 11.73 16.65 15.64 22.24 82.62 2008 10 0.16 8.69 1.37 8.58 1.01 0.03 0.58 Ofthe15countries Absolute expenditure 11

111.30 0.13 225.88 0.25 15.14k 0.81 2012 2008 25.72 0.65 10.45 0.04 11.36 2.60 26.58 1.07 91.25 1.42 6.15 0.18 0.27 1.07 1.11 8.01 0.98 2.19 0.42 0.02 0.09 0.35 these 15countrieshave beencuttingexpenditure. cut itineachsubsequentyear, meaningtwo-thirds of transfers spendingdramatically in2009have both economy onaglobalscale. Ratherthanresponding social transfers investments couldrepresent afalse strengthen humancapital. Therefore, thedeclinein transfers cancontributetopro-poor growth and from theimpactofshocks; asdiscussedabove, social Not only cansocialtransfers protect poorpeople Table 6). had budgetedintheyears following thecrisis(see failed todeliver onspendingtheamountthatthey with dataonactual(aswell asplanned)expenditure Perhaps more worryingly, sixoutofseven countries cut expenditure onsocialtransfers. available, andallofthosecountriesare planningto Four ofthesecountrieshave budgetdatafor 2013 damaging results for children andpoorhouseholds. undertake austeritymeasures in2012withpotentially which have found 70%ofcountriesare setto in linewithotheranalyses ofgovernment spending, 15

0.74 0.46 percentage ofGDP Expenditure asa 13 This analysis is 2012 0.17 0.80 0.09 0.78 1.00 0.04 0.78 0.79 0.70 1.60 1.09 0.34 0.06 0.26 1.27 12 14

4 Social transfers – needed now more than ever 27 in 18 Low-SPI High-SPI – – – – – – -8.43% 17 rise on average rise on average 19 2009 to 7.77% -8.88% -2.16% according , , expenditure on actual to 2006 (ie, before the economic crisis hit) saw their crisis hit) saw the economic before 2006 (ie, primary rates school enrolment In addition, Save the Children analysis suggests analysis the Children Save In addition, social protection with a strong Asian countries that better able into the crisis were going performance impacts of against potential negative to defend such as a decline in school economic crisis, Asian countries (see 28 from Evidence enrolment. methodology) that those Appendix 2 for shows on the scores above-average countries which had Social Bank’s Index Protection Asian Development Similarly in Indonesia, evidence suggests that social that social suggests evidence in Indonesia, Similarly following established that were programmes transfer important cushioning were in financial crisis the 1997 of the 2009 downturn. the effects 2011 2009 2010 -2.16% -4.38% -0.69% -5.18% -4.30% -1.94% -0.33% -19.31% -45.43% Year – with the result that with the result 16 -3.93% -17.62% -4.56% -21.65% 2008 11.69% 40.17% -10.75% 119.31% 2005 2006 2007 2008

1.00 0.50 -0.50 -1.00 -1.50 Percentage change Percentage change in school enrolment percentage Figure 3. index score being high or low social protection Zambia Rwanda Papua New Guinea New Papua Nepal Kenya Mozambique Bangladesh

difference between planned Percentage able 6. T social protection the number of recipients of unemployment benefits of unemployment of recipients the number a million in 1998. 50,000 in 1997 to half from rose There is evidence that those countries with pre- that those countries evidence is There able more were programmes transfer existing social to afford in order during crisis years to scale up as economic to their populations, better transfers example, For into poverty. shocks pushed millions Asian financial the following during and immediately use its was able to South Korea crisis of 1998, a base from scheme as existing social transfers and the scale up social transfers which to rapidly schemes, insurance employment to economic downturn by cutting social transfers, transfers, social cutting by downturn to economic boosting from benefit would countries developing programmes. 28 a chance to grow medium term. large increases inpoverty andinequalityinthe response tothatcrisiswastooweak toprevent case studiesshow thattheoverall socialtransfers crises andthatcountriesprepare themselves, by thatlessonsareIt isimportant learnedfrom previous them toscaleupduringthe2008/09crisis. any socialprotection systemsinplacethatallowed the World Bank’s IndependentEvaluationGroup had Unfortunately, only 16%ofcountriesreviewed by average scores saw theirenrolment ratesdecline. during theeconomiccrisis. Countrieswithbelow- 21 20 Detailed of socialtransfers. risks,further despiteevidence oftheimportance scenario for European andglobalgrowth poses just whenthey are neededmost.Aworsening unable toresist pressure tocutsocialtransfers – exacerbated.And yet we finddeveloping countries food prices, theglobalproblem ofmalnutrition is In themidstofacrisis, andfacingrenewed high the level andpredictability oftheiraid. to shocks; donorsmust considertheimplicationsfor possible, sothatthey are abletoscaleupinresponse developing strong socialtransfers systemsasearly as Conclusions and recommendations

Social transfer programmes can have from countries such as Mexico has shown that the important effects on poverty, hunger and effects of crises such as this are unequally distributed, nutrition. These effects occur through various affecting the incomes of poorest most.1 Given the channels; an essential one is increased cash via depleted household reserves from coping with earlier social transfers that enables poor people to crises and high food prices, the role of social transfers access more and better-quality food. is even more crucial. Our evidence shows that a sharp return to financial While evidence for nutrition effects is strongest in crisis in Europe would drive up the numbers of the well-evaluated cash transfer programmes from people in hunger by an estimated 33 million by 2013. Latin America, evidence from other schemes in Africa But there is also a positive message. Social transfer and Asia, such as that presented in this report, are policies to reduce inequality would not only negate increasingly showing similar results. Social transfers but even reverse this threat. In the event of the are also very important for nutrition in the context ‘worst case scenario’ in the eurozone, social transfers of humanitarian crises, as discussed in Box 4 on that provide a 10% increase in the income share of page 9, and the effects in those settings again occur the poorest two quintiles could – if implemented in by protecting the ability of households to maintain advance of such a crisis – lead to a net reduction of their expenditure on food, including a variety of food 55 million people living in situations of hunger. The types, and to build their resilience to future shocks. total cost of such a scheme stands at just 1.5% of the There are a number of threats to effective GDP of countries included in our model, so should social transfer schemes. In the midst of a crisis, be seen as a broadly feasible option. and facing renewed high food prices, the global In order to scale up rapidly in times of crisis, a social problem of hunger and malnutrition is currently transfer system needs to be well-established. But being exacerbated. And yet we find evidence that social protection coverage in developing countries governments have been unable to resist pressure to remains low. The World Bank estimates that only 20% cut social protection, just when it is needed most. of households in sub-Saharan Africa and just over Of 15 countries with a historic commitment to 30% in south Asia have access to social protection2 social protection policies, seven have made cuts as and this includes social insurance that is likely to a percentage of GDP since the 2008/09 crisis, and be targeted to better-off formal sector employees. two more joined the ranks of countries cutting social Therefore, developing country governments should protection in the years after 2009. Furthermore, all develop national social protection strategies, based four countries for which there are data for 2013 have on an inclusive national dialogue. This should aim for budgeted to make cuts next year. the progressive scale-up of broad and comprehensive Cuts to social protection in response to economic social protection programmes, determined by crisis constitute a false economy. This report national priorities. This requires long-term domestic highlights the growth-boosting potential of social financing strategies, complemented by multi-year transfers and the long term benefits for children and funding commitments from donors. ultimately the labour force. It finds, for example, that The World Bank’s Rapid Social Response program is school enrolment rates suffer less in Asian countries specifically designed to help low-income countries with higher scores on the Asian Development Bank’s to design social protection systems. However, it is Social Protection Index. oversubscribed and, without more resourcing, unable A worsening scenario for European and global to help additional countries. Support to build the growth poses further risks, reducing available foundations for timely response when a crisis hits resources in developing countries at the level of is being neglected in favour of setting aside funds to the state and of households. In addition, evidence scale up programmes during a crisis.

29 30 a chance to grow • We call ondeveloping governments country to: in timesofcrisis. hunger andmalnutrition, bothintimesofstabilityand Social transfers are aneffective policytool tocombat Recommendations urgent priority. in globalknowledge ofsocialtransfers must bean such as1–3%ofGDP, andsoon. This stepforward countries shouldaimfor aminimum scaleinarange recommendations about, for example, whether practice globally, itisdifficulttodraw powerful data, however, andwithoutthepromotion ofbest Without thecollationandanalysis ofthatsystematic done by poverty andinequality. malnutrition andmany otherelementsofthe damage design, socialtransfers offer asetoftoolstocombat At sufficientscale,people. andwith appropriate sometimes tothepoorest andmostmarginalised the enormousbenefitsthatsocialtransfers canbring, schemes around the world. This review hasshown on thecoverage, scaleandimpacts ofsocialtransfer At present, thereofsystematicdata isashortage the World Bank, IDA, thatwillbeginin2013. the process ofreplenishing theconcessionalarmof to prioritisesocialtransfers better, includingthrough seek recommendations from the World Bankonhow transfers for low-income countries. The G20should greater share oftheBank’s netincometosocial assistancestrategies;within country anddirect a Social ResponseProgram; prioritisesocialtransfers Bank canseektoreallocate fundingtotheRapid allocationsare pre-defined,Although country the be addressed withinexisting World Bankresources. There isalsoarangeofways thisfundingneedcan corporate transparency andtacklingfinancialsecrecy. international constraintstotaxcollectionby promoting involve strengthening taxauthoritiesandtacklingthe social transfer programmes inthelongterm. This will countries indomesticrevenue mobilisationtofund mustefforts beredoubled toassistlow-income establish socialtransfers systemsnow. Inaddition, Trust Fund, low-income countriesto tosupport provide top-upfundingfor theRapid SocialResponse the widereconomy from shocks, we callondonorsto of socialtransfers inprotecting vulnerablegroups and Given theevidence inthisreportontheeffectiveness as key policytoolstocombat hunger and strengthen socialtransfer programmes evaluating impactofsocial transfers onnutrition • taskingthesocialprotection cooperation • prioritisingtheneedtotackleinternational • Fundto callingontheInternationalMonetary • • developing countriesby: donors topromote socialtransfers in We callontheG20, bilateralandmultilateral considerthefollowing guidelines, • to increase theevidence. practices from key G20countries. Platform thatissharingsocial protection best be doneinconjunctionwithG20Knowledge by theendof2012. This assessmentshould nutrition outcomes–inalllow-income countries of socialprotection –includingattentionto G20 summit, toconductanurgent assessment body, expectedtobeestablishedat theJune 2012 commitments tosocialtransfer programmes. and increased taxbase–tofundlong-term revenues –such associalcontributions in recognitionofdomestic oftheimportance obstacles todomesticrevenue mobilisation to financetheirsocialprotection programmes. spending floorsthatallow low-income countries ensure thattheirprogrammes containsocial – – programmes by: the establishment ofsocialtransfer scaling upmulti-year fundingtosupport for crisisresponse. scalable. Preparedness isthebestinsurance effective crisisresponse toolthatiseasily malnutrition, intimesofstabilityandasan 5. 4. 3. 2. 1. impact ofsocialtransfers onnutrition: be adapted tothenationalcontextenhance

by the World Bank. the Rapid SocialResponsetrustfundmanaged providing termto additional fundsintheshort World BankIDA 17threplenishment round transfers asoneofthespecialthemesfor the calling onthe World Banktoprioritisesocial women andchildren. Ensure socialtransfer programmes work for should notbethedefaultoption. wider nutrition interventions, butconditionality Social transfers shouldbeintegratedwith needstobetimelyDelivery andconvenient. nutritious dietandadjusttopriceincreases. Cash transfers shouldreflect thecostofa broad coverage. underpinned by long-termcommitmentand Social protection programmes shouldbe whichshould Appendix 1

Estimating the effects of the eurozone crisis on hunger

In order to estimate the effect of the Methodology eurozone crisis on hunger, we extended World Bank research.1 This approach uses We used the income–calorie relationship that was an income–calorie relationship along calculated by Tiwari and Zaman (2010), according to with data on average income and income the model below: distribution (from the World Development Cit = J + dlog(Yit) + mi + eit Indicators) to estimate the number of Where: people globally living with insufficient C = the per capita calorie consumption in income to meet their calorie requirements, it under different growth scenarios. country i in year t, Y = the per capita income for country We use this approach to estimate the impact on it hunger of recent downgrades and potential future mi is the time invariant country fixed-effect downgrades to growth in developing countries is the random error. (defined here as the inability to afford the minimum eit requirements of calories2). It is estimated that as The coefficients in the model q( and d) were many as 32 million people could be pushed into calculated by Tiwari and Zaman as 201.2 and 330.0, hunger if the eurozone crisis was to worsen. respectively, on the basis of a fixed-effects regression of 83 countries and 742 country years. Based on this relationship, and the minimum energy requirements per person from FAOSTAT,3 we calculate an estimation of the minimum income that would be needed to acquire the minimum required number of calories, as shown in Table 7.

Table 7. minimum income requirements for caloric intake, by continent

Region Minimum income required to meet Number of countries with minimum caloric requirements income distribution data (US$, annual)

Asia and Pacific 153.5 24

Latin America 172.1 20

Middle East and North Africa 161.9 12

Sub-Saharan Africa 131.0 40

Total 96

31 32 a chance to grow but as Tiwari andZamannote, FAO’s people, estimatesofthenumber ofhungry baseline estimatesare somewhat lower thanthe to give totalnumbers ofpeoplewhoare hungry. Our to thetotalpopulationofthosesub-regions inorder of peoplewhoare hungry.These are inturnapplied averages (weighted by populationsize)ofthenumber income distribution, we calculatesubregion-specific as ‘hungry’. Basedonthecountrieswithdata canleadtolargenumbers defined within acountry low–average incomesandlargeincomeinequality and Zaman. impliesthatboth This methodology baseline (2010),Tiwari followingof themethodology population whoseincomeisbelow thislevel at Indicators, we thencalculatetheproportion ofthe data are available inthe World Development For the96countriesfor whichincomedistribution and January 2012. and January years have beendowngraded between June 2011 The projected ratesof growth over thenexttwo people. hungry this baseline, ratherthaninthetotalnumbers of between two growth scenariosthatbothuse aswenot important are interested inthedifference T developing growth 4.2% by country by2013. afurther that theimpactofsuchashockwould betoreduce Atlantic couldresult. The World Bankestimates and otherfinancialinstitutionsonbothsidesofthe wider financialcrisisthatcouldengulfprivatebanks forcing themintounregulated defaults, amuch to refuse finance for several European countries, Furthermore, itisestimatedthatifmarkets were 6.2% in2012and6.3%2012, to5.4%and6.0%. whole, predicted growth hasbeendowngraded from able 8. impact onhungerofdifferenteconomicscenarios

Total Africa Sub-Saharan Africa North Middle Eastand Latin America Asia andPacific

Region 5,997,125 6,266

(2013) Population 6 4,045,868 For developing countriesasa 876,081 465,681 609,495 5 thisdiscrepancy is Number Percentage downgrade Most recent 1,690.2 3,655.7 338.6 581.4 change 0.68% 0.98% 0.86% 0.94% 4

equivalent amount). (and thetopincomequintile’s share fallingby an income shares ofthetwo lowest quintileby 10% within eachcountry, totheeffect ofraisingthe policy measures responded by redistributing income World Bank’s ‘serious scenario’wasrealised, but Finally, we estimatedwhatwould happen ifthe 2012willbeonglobalhunger.January impact ofthedowngrade oneconomicgrowth in these two estimatesisanestimateofwhatthe estimates from 2012. January The difference between and repeated thesameestimationsusingrevised previous trends, ifincomewasdistributedsoas to of asevere eurozone crisiswould berelative to trends. The finalcolumnsestimatewhattheimpact scenario, relative tothepre-downgrade growth the impactofahypothetical severe eurozone crisis the baseline. The following two columnspresent downgrades; andthepercentage changerelative to requirements)energy by themostrecent growth (ie, becomeunabletoafford theirminimum dietary the number ofpeoplewhohave beenmade ‘hungry’ of eachregion in2013. The nexttwo columnsshow The firstcolumnshows theprojected population The results from theseanalyses are shown in Table 8. Results requirements remain unabletoafford theirminimum calorie we re-estimated thenumber ofpeoplewho would projections globally, onthenumber ofpeoplehungry To estimatetheeffects ofthesevariousgrowth 32,836 Number Percentage in Europe Worst-case scenario 19,165.0 8,849.5 1,774.9 3,046.1 7 iftheoldestimateswere realised, change 3.6% 5.1% 4.5% 5.0% -22,951 Number but reduced inequality Worst-case scenario, -14,404.9 -5,061.6 -1,334.0 -3.85% -2,150.4 Percentage change -2.04% -3.17% -3.72% Appendix 1: Estimating the effects of the eurozone crisis on hunger 33 Finally, if the eurozone crisis were to severely worsen, worsen, to severely were crisis the eurozone if Finally, in redistributing succeeded responses but policy income the to increase as such a way income in the number 10%, quintiles by lowest the two of share their minimum afford unable to globally of people by fall, in fact dietary would energy requirements importance the This shows 23 million. approximately of in determining this measure of income inequality that and the importance of policy responses hunger, are in ensuring that the poorest such poverty address able to and remain economic shocks from protected dietary their minimum energyafford requirements. The potential impact of a severe shock to the shock to of a severe The potential impact more 32.8m additional be an would eurozone to the pre-downgrade relative ‘hunger’, people in scenario. growth As can be seen, the recent downgrade to economic to economic downgrade recent the seen, As can be to lead countries is expected in developing growth the end by ‘hunger’ in people more to 6.3 million the case had growth been have would of 2013 than The been projected. as had previously continued of people is number most affected with the region people unable to (3.7m more Asia and the Pacific dietary their minimum energyafford requirements), people). Africa (1.7m more sub-Saharan by followed increase the income share of the two lowest quintiles quintiles lowest the two of share income the increase 10%. by Appendix 2

Analysis of the effect of social protection programmes on national resilience to economic shocks

Here we investigate the importance of groups, based on whether their overall social having a social protection system in place, by protection index score was above or below the plotting the extent to which such schemes average for Asia. We then calculated the average can protect countries’ school enrolment change in primary school enrolment within each rates from negative effects of the 2008/09 of these groupings, and plotted that separately economic crisis. for the two groups.

Methods Results The resulting chart is shown in Figure 3 on page 27. We assess the extent to which countries were affected by the global economic crisis by looking at As can be seen, the dramatic reduction in GDP in changes in their school enrolment rates, an important 2008/09 was associated with a reduction in school indicator for children’s well-being. We used data on enrolment figures in those Asian countries that Asian countries’ social protection systems from the have below-average social protection index scores. Asian Development Bank’s Social Protection Index as However, the darker bars show that in countries the main measure of 33 countries’ social protection that scored in the top half of the social systems. The index was constructed using data from protection index, the 2008/09 crisis in fact 2006–07, and as such can be taken as a reasonable saw an increase in school enrolment. estimate of the social protection policies of these That is to say, for countries with poor social countries in the lead-up to the economic crisis. protection systems in the run-up to the crisis, school These variables are detailed below. enrolment fell during crisis years. However, being in We had both enrolment data and social protection the top half of the social protection index strongly index data for 28 Asian countries. We divided reduced this effect, suggesting a protective effect countries into ‘low’ or ‘high’ social protection against the effects of economic crisis.

Variable Description

Annual percentage change in This was calculated from UNESCO primary gross enrolment ratio (GER) figures. GER refers to primary school enrolment the number of pupils enrolled in a given level of education regardless of age, expressed as a percentage of the population in the theoretical age group for that level of education. Where data were missing they were imputed by linear interpolation if there were data for other surrounding years. Percentage change in enrolment was calculated based on these figures.

Social protection index: These variables were taken from the Asian Development Bank’s Social Protection index for Committed overall indicator made up Poverty Reduction. These indicators were coded into binary variables depicting whether countries of four sub-indices: were above or below the mean for Asia as a whole. The overall score ranges from 0.01 (Papua New • expenditure Guinea) to 0.96 (Japan). The index is provided for 33 countries. • coverage • distribution • impact

34 endnotes

Executive summary 10 S Devereux, R Sabates-Wheeler (2004) Transformative Social Protection, IDS Working Paper, 232, Brighton: Institute of Development Studies 1 Save the Children (2009) Lasting Benefits: The role of cash transfers in 11 tackling child mortality. London: Save the Children (UK) United Nations Children’s Fund (2012). Integrated Social Protection Systems: Enhancing Equity for Children. UNICEF social protection strategic 2 A Barrientos and J Scott (2008) Social Transfers and Growth: A Review. framework. New York: UNICEF Manchester: Brooks World Poverty Institute 12 K Subbarao, A Ahmed, T Teklu (1996) ‘Selected Social Safety Net 3 United Nations Children’s Fund (2012). Integrated Social Protection Programs in the Philippines: Targeting, Cost-Effectiveness and Options for Systems: Enhancing Equity for Children. UNICEF social protection strategic Reform, World Bank Discussion Paper, 317. Washington: The World Bank framework. New York: UNICEF 13 Save the Children (2009) Lasting Benefits: The role of cash transfers in 4 Food and Agriculture Organisation (2010) Global hunger declining, but still tackling child mortality. London: Save the Children (UK) unacceptably high. Briefing from the Economic and Social Development 14 Department, January 2010. Available at: http://www.fao.org/docrep/012/ A McCord, R Slater (2009) Overview of Public Works Programmes in al390e/al390e00.pdf sub-Saharan Africa. London: Overseas Development Institute 15 5 RE Black, LH Allen, ZA Bhutta, et al (2008) Maternal and child United Nations Children’s Fund (2012). Integrated Social Protection undernutrition: global an regional exposures and health consequences. The Systems: Enhancing Equity for Children. UNICEF social protection strategic Lancet 2008, Jan 19, 371(9608). UN Inter-Agency Group for Child framework. New York: UNICEF Mortality Estimation (2011). Levels and Trends in Child Mortality: Report 16 Food and Agriculture Organisation (2010) Global hunger declining, but 2011. New York: UNICEF still unacceptably high. Briefing from the Economic and Social Development 6 S Grantham-McGregor et al (2007) Development potential in the first Department, January 2010. Available at: http://www.fao.org/docrep/012/ 5 years for children in developing countries. The Lancet 369:60-70 al390e/al390e00.pdf 17 Malnutrition is a broad term commonly used as an alternative to undernutrition but technically it also refers to overnutrition. People are Introduction malnourished if their diet does not provide adequate calories and protein 1 DFID, and others (2009) Joint statement on Advancing Child-Sensitive for growth and maintenance or they are unable to fully utilize the food Social Protection Social Protection. For information, see www.unicef.org/ they eat due to illness (undernutrition). They are also malnourished if socialpolicy they consume too many calories (overnutrition) 2 A Barrientos and J Scott (2008) Social Transfers and Growth: A Review. 18 Foresight (2011). The Future of Food and Farming: Final Project Report. Manchester: Brooks World Poverty Institute London: Government Office for Science. 3 Save the Children (2009) Lasting Benefits: The role of cash transfers in Throughout this report we use the widely used term malnutrition to tackling child mortality. London: Save the Children (UK) refer to the technical term undernutrition 4 DFID, and others (2009) Joint statement on Advancing Child-Sensitive 19 M Grosch, C Andrews, R Quintana and C Rodriguez-Alas (2011) Social Protection Social Protection. For information, see www.unicef.org/ Assessing Safety Net Readiness in response to Food Price Volatility. 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Available at http://www.imf.org/external/np/pp/ insurance.’ Available from http://www2.ohchr.org/english/law/cescr.htm eng/2011/092111.pdf 7 General Comment 12 of the UN Committee on Economic, Social and World Bank (2012). Global Economic Prospects: Uncertainties and Cultural Rights states (in clarification of the right relating to food) that: Vulnerabilities. Washington: The World Bank. Available at http:// “Economic accessibility implies that personal or household financial costs go.worldbank.org/WI8LCZ6PT0 associated with the acquisition of food for an adequate diet should be at 22 Institut fur Macrookonomie und Konjukturvorschung, OFCE, WIFO a level such that the attainment and satisfaction of other basic needs are (2012). Report: Fiscal Pact Deepens Euro Area Crisis. Dusseldorf: IMK. not threatened or compromised. Economic accessibility applies to any Available at: http://www.boeckler.de/pdf/p_imk_report_71e_2012.pdf acquisition pattern or entitlement through which people procure their 23 food and is a measure of the extent to which it is satisfactory for the 925 million people experience hunger: they lack access to sufficient enjoyment of the right to adequate food. Socially vulnerable groups such of the major macronutrients (carbohydrates, fats and protein). as landless persons and other particularly impoverished segments of the Undernutrition refers to poor growth, manifested as low weight for population may need attention through special programmes.” Available height (wasting), low height for age (stunting) or low weight for age at http://www.unhchr.ch/tbs/doc.nsf/0/3d02758c707031d58025677f003b (underweight) due to a combination of deficits of food, care, water and 73b9 sanitation and health services. Throughout this report we use the widely used term malnutrition to refer to the technical term undernutrition. 8 Committee on World Food Security: High Level Panel of Experts (2012, See Foresight (2011). The Future of Food and Farming: Final Project Report. forthcoming). Social Protection for Food Security. For details see http://www. London: Government Office for Science. fao.org/cfs/cfs-hlpe/en/ 24 J Friedman and J Sturdy The Influence of Economic Crisis on Early 9 A Norton, T Conway, M Foster. (2000) Social Protection Concepts and Childhood development: A Review of Pathways and Measured Impact. In: No Approaches – Implications for Policy and Practice in International Development. Small Matter: The Impact of Poverty, Shocks and Human Capital Investments in London: Overseas Development Institute (ODI) Early Childhood Development. Washington: The World Bank

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Social protection growth: Pro-poor Promoting growth, pro-poor Linkages between H Son (2010) – MC Neri, N Kakwani, Brazilian experience. the recent and labor market: social programmes 881–894 pp. 6, No. 38, Vol. Development World (2011) – Social A Barrientos 40:1 pp 11-20 Development Vol to find out? World need What do we Vol 40:1 pp 11-20 Development Vol to find out? World need What do we 38 a chance to grow within targetedhouseholds. Brighton: IDS T Summary.pdf docs/reducingpoverty/case/119/summary/Mexico-Oportunidades%20 Programme.Available at:Oportunidades http://info.worldbank.org/etools/ World Bank; casestudyfor ShanghaiPoverty Conference. Mexico’s T 15 14 13 12 11 London: Save theChildren (UK) the poorest children. Evaluationofapilotsafety netproject insouthern Niger. 10 9 8 7 6 5 4 3 2 1 nutriion: Fivepolicyguidelines ensuringsocial transfers uppo 2 vulnerable familiesandchildren these toolsitisnow possibletotargeteffective aidtowards themost ofthepopulationarewhich parts mostatrisk. With acombination of thatfamiliesfaceinorder toaffordof theshortfall anutritious diet, and of theDiettoolinorder togive solidinformation bothaboutthesize Data from theHEAcanbeeffectively combinedwithdatafrom theCost food orincomeisscarce. food, how they obtainincomeandhow they are likely tobehave when programmes: whatthedifferent populationgroups are, how they obtain the householdeconomy thatisessentialfor good designofsocialtransfer with several householdmembersandothers. Itprovides information on live andmake endsmeet. ranging information onhouseholdsinruralareas, tounderstandhow they Approach isarigorous butflexibleway ofcollectingand analysing wide 73 Mozambique. Research Brief17 Impact EvaluationoftheexpansionFood SubsidyProgramme in brief 14andInternationalPolicy Centerfor Inclusive Growth (2010) Subsidio de Alimentos in Mozambique: BaselineEvaluation. Research analysis ofMexico’s Oportunidades. Lancet. 2008Mar8;371(9615):828-37 cash transfer programmes for childhealth, growth, anddevelopment: an Lancet 2009; 374: 1997–2005 growth, cognition, language, andbehaviour: alongitudinalfollow-up study, Oportunidades, Mexico’s conditionalcashtransfer programme, onchild LCH Fernald, PJGertler, LMNeufeld (2009)10-year effect of nutrition, suchasmicro-nutrient deficiencyoranaemia, islessclear Productive SafetyNet programme (PSNP) World Vision. ODIHPG Emergencies – A synthesisof World Vision’s experienceandlearning Available athttp://www.savethechildren.org.uk/resources/online-library/ and Food transfers inSwaziland. London: Save theChildren andIDS. 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UNICEF2011 14 protection asaproportion ofGDPin2013 13 following largeincreases immediately post-crisis 12 Cape Verde, Ghana, Malawi, Nepal, Nicaragua, Senegal. that have planneddecreases asaproportion ofGDPare: Bangladesh, Finance Initiative for Save theChildren UK, March 2012. The countries 2013.An Analysis of15committedcountries. by Development Report 11 as well asproven implementationofsocialprotection commitments tointernationalagreements suchasILOconvention 102– 10 9 8 7 6 5 4 3 2 1 than ever 4 malnutrition 34 Premise 7:1 income distribution: Insightsfrom. simulations inselectedcountries Economic 33 Pacific Islands, UNICEF, 6–7January Financial Crisis’. Paper presented attheConference onEast Asia andthe Washington, DCandILO, Geneva) markets andtheeconomiccrisis: Impacts, responses andlessons(World Bank, responses afterthecrisis”, inGBetcherman, RIslam(eds):labor EastAsian social protection protection in2010. allocationfor Only Bangladeshmetitsbudgetary ofspendingtheamountthattheyfell hadcommittedtosocial short 1Brazil-BolsaFamilia.pdf Transfers for thePoor.Available athttp://www.mfdr.org/sourcebook/6- Africa:A framework for UNICEF. andstrategy Nairobi: UNICEF crisis on ‘hunger’ andsothisdefinitionhadtobetaken etc. However, there are limitedways toestimatetheeffects ofglobal diversity, ofdietary to accountfor theimportance micronutrient intake, worldbank.org/data-catalog/world-development-indicators Washington:Bank The World undernourishment. World Bank: Policy Research briefingnote. go.worldbank.org/WI8LCZ6PT0 Vulnerabilities. Washington:The World Bank.Available athttp:// Premise 7:1 income distribution: Insightsfrom. simulations inselectedcountries Economic Bank Development Goals, GlobalMonitoringReport. Washington:The World K Lindert (2006) Brazil: KLindert BolsaFamiliaProgram –Scaling-upCash LBlank, SHanda(2008)SocialProtection inEasternandSouthern This definitionofhungerhasseveral shortcomings, includingitsfailure World Bank;World Development Indicators.Available athttp://data. S Tiwari, HZaman, 2010:The impactofeconomicshocksonglobal World Bank(2012)GlobalEconomicProspects: and Uncertainties and onpoverty BHabibetal(2010)Theimpactofthefinancialcrisis See Annex A for methodology World Bank(2012)Food Prices, NutritionandtheMillennium Ortiz, Chai, Cummings(2011).Austeritymeasures threaten children Bangladesh, Kenya, NepalandRwandawillallcutspendingonsocial Rwandaand Vietnam have bothcutsocialprotection since2009, MMartin, R Watts (2012). Socialprotection expenditure trends 2008– Includinghaving anationalsocialprotection inplaceand strategy Save theChildren (2012)ALife Free from Hunger:Tackling child and onpoverty BHabibetal(2010)Theimpactofthefinancialcrisis SMehrotra (2009) ‘The Poor inEastandSouth Asia inthe Time of SHKangetal. 2001. Korea: Labor market outcomesandpolicy Kenya, Mozambique, Nepal, Papua New Guinea, Rwanda, Zambiaall Social transfers –needednow more 2 1 the eurozone crisisonhunger Appendix 1: Estimating 2 1 Conclusions andrecommendations London: ODI Poverty andsocialprotection casestudies. –Evidencefrom 10country 21 2000–2010SocialSafety Nets.Support Washington:The World Bank 20 calculated basedonthesefigures data for othersurrounding years. Percentage changeinenrolment was data were missingthey were imputedby linearinterpolationifthere were population inthetheoretical agegroup for thatlevel ofeducation. Where level ofeducationregardless ofageexpressed asapercentage ofthe figures (GER). GER refers tothe number ofpupilsenrolled inagiven 19 Committed Poverty Reduction.AsianDevelopment Bank 18 7 6 5 4 3 crisis on ‘hunger’ andsothisdefinitionhadtobetaken etc. However, there are limitedways toestimatetheeffects ofglobal diversity, ofdietary to accountfor theimportance micronutrient intake, Bank TheWorldWashington: undernourishment. World Bank: Policy Research briefingnote. fragile situations’, SocialProtection andLabourDiscussionPaper 1209 Premise 7:1 income distribution: Insightsfrom. simulations inselectedcountries Economic cut-off point, makingtheMDERahighly sensitive parameter. levels energy closetothe of thepopulationtypically consumesdietary countries withahighprevalence ofundernourishment, alargeproportion expressed inkilocalories(kcal)perpersonday. in Particularly MDERs ofthedifferent gender–agegroups inthepopulation. Itis For anentire population, theMDERisweighted average ofthe year toyear dependingonthegenderandagestructure of thepopulation. minimum acceptableweight for attainedheight, andfrom by country vary Accordingly, MDERs, neededfor activityanda theamountofenergy differ by genderandage. for differentThey alsovary levels ofactivity. Requirements are definedas follows: energy requirements Dietary go.worldbank.org/WI8LCZ6PT0 Vulnerabilities. Washington:The World Bank.Available athttp:// Bank TheWorldWashington: undernourishment. World Bank: Policy Research briefingnote. al390e/al390e00.pdf Department, 2010.Available January at: http://www.fao.org/docrep/012/ unacceptably high. Briefingfrom theEconomicandSocialDevelopment Bank TheWorldWashington:note. shocks onglobalundernourishment. World Bank: Policy Research briefing This definitionofhungerhasseveral shortcomings, includingitsfailure S Tiwari, HZaman, 2010:The impactofeconomicshocksonglobal Andrews Cetal(2012) ‘Social protection inlow-income countriesand and onpoverty BHabibetal(2010)Theimpactofthefinancialcrisis FAO StateofFood Insecurity2008. Energy Minimum Dietary World Bank(2012)GlobalEconomicProspects: and Uncertainties S Tiwari, HZaman, 2010:The impactofeconomicshocksonglobal Food and Agriculture Organisation(2010)Globalhunger declining, butstill FAOSTAT, citedinS Tiwari, HZaman, 2010:The impactofeconomic Overseas Development Institute(2009) The globalfinancialcrisis: IndependentEvaluationGroup (2011) An Evaluationof World Bank grossThis wascalculatedfrom enrolment UNESCOprimary ratio BBauch,A Weber,J Wood (2008). SocialProtection IndexFor the effectsof a chance to grow COVERPh oto J enn W :

How social protection can tackle child malnutrition arren /S aveChild ren t h e and promote economic opportunities

An estimated 925 million people are facing hunger. This widespread hunger feeds into the hidden crisis of malnutrition, which is an underlying cause of 2.6 million children’s deaths a year. Now, global economic and financial crisis threatens to leave millions more people in developing countries hungry and malnourished. As A Chance to Grow demonstrates, social protection programmes are a vital tool in tackling hunger and malnutrition – in times of crisis and of relative stability. Social protection can address both the immediate and the underlying causes of malnutrition – and prevent lasting damage to children’s lives. Focusing on social transfers, this report: • set outs the role social protection can play in tackling hunger and improving nutrition • outlines the importance of good nutrition for long-term economic growth • presents five evidence-based guidelines on the design of social transfers to tackle hunger and malnutrition – to be adapted by policy-makers to their country contexts • assesses the implications of the economic crisis for rates of hunger and children’s nutritional status. This report closes with a series of recommendations calling on developing country governments and donors to promote and strengthen social protection programmes – and thereby reduce child hunger and malnutrition. cover photo: hildren

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