Leveraging Social Protection platforms for improved nutrition in the Dominican Republic

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Social protection and safety nets is WFP’s largest focus area for South-South and triangular exchanges worldwide.

The Dominican Republic’s Progresando con Solidaridad programme represents an excellent and innovative example of how to optimize an existing national social protection scheme and make it highly nutrition-sensitive.

While a number of social protection schemes around the world may have a single nutrition component, Progresando con Solidaridad is innovative for the comprehensive range of nutrition components that are embedded in the programme. For example, the programme includes nutrition education; community nutrition networks and distribution of micronutrient powders and specialized nutritious food to children under the age of 5, to pregnant and lactating women and to the elderly.

Its nutrition intervention component was first targeted to all children aged 6-59 months of beneficiary families, who were identified as living in moderate and extreme poverty. After 2013, the nutrition intervention was extended to children under the age of five, pregnant and lactating women and the elderly benefitting from the programme.

An evaluation of the nutrition component of the Progresando con Solidaridad programme (2013), highlighted a 50 percent reduction in anaemia prevalence in children enrolled in the programme. Progresando con Solidaridad programme was selected as a successful case study at the Global Forum on Nutrition-Sensitive Social Protection in September 2015. The Forum is a South-South learning platform facilitated by the WFP Centre of Excellence against Hunger in Brazil, which promotes South-South and triangular cooperation and aims to facilitate exchanges of lessons learned on social protection programmes across the developing world. Over 150 participants from 20 countries joined the Forum and learnt from the Dominican Republic’s experience.

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Zero Hunger , Good Health and Well-Being , Partnerships for the Goals

Almost half (45 percent) of child deaths under the age of five are related to undernutrition. Not only does undernutrition kill, it also prevents children from growing up to live healthy and productive lives as adults, thus leading to an ongoing intergenerational cycle of undernutrition. Adequate nutrition is particularly important during the first 1,000 days of life, from the start of a woman's pregnancy to the child's second birthday, when both mother and child have increased nutritional needs. Poverty, and the inadequate quantity and quality or access to human, economic and institutional resources, is the most important root cause of malnutrition.

Nutrition-sensitive social protection targets the most vulnerable, and can be an important strategy to address the underlying causes of malnutrition. Targeting strategies of social protection programmes tend to be based on socio-economic criteria, such as poverty, asset ownership, etc., which apply at the household level. However, applying a nutrition lens to targeting is an invitation to consider the nutritional vulnerability of individuals within households in addition to household-level criteria . In fact, social safety nets with nutrition components can help tackle both the immediate and underlying causes of malnutrition. They do so by reducing vulnerability; protecting incomes, crops and assets; ensuring basic needs can be met; securing access to a nutritious diet and supporting access to health services and safe drinking water and better sanitation .

When the Government of the Dominican Republic reformed its social sector in 2009, The United Nations World Food Programme (WFP) supported the Government to incorporate a nutrition intervention as a sub-component of the conditional cash-based transfer in the national social protection program, Progresando con Solidaridad. This included a blended approach to training, capacity development, promotion of growth monitoring and preventative care for children. The nutrition component was delivered through primary healthcare, as well as the provision of micronutrient powders to all beneficiaries of the social protection programme aged 6-59 months.

Programs like Progresando con Solidaridad highlight that social protection schemes with multiple nutrition components can directly contribute to improving diets. For example, they can provide food to beneficiaries through food transfers and school meals programmes. Furthermore, they can facilitate access to health care through conditional cash transfers that encourage the use of health services and/or enable households to access items for personal and household hygiene and clean water.
Currently, Progresando con Solidaridad’s conditional cash-based transfer component for food consumption targets over 700,000 poor households. From January 2014 to August 2016, the nutrition component serves 121,706 beneficiaries of these households (88,348 children; 23,665 pregnant and lactating women and 9.693 elderly). In addition, the nutrition component supports 20,000 Progresando con Solidaridad community employees and public health practitioners.

Methodology
The nutrition intervention of the Progresando con Solidaridad programme is composed of the following acitons:

1) Distribution of micronutrient powders to children aged 6-59 months to help prevent and control micronutrient deficiencies;

2) Provision of nutrition education to families benefitting from the Solidaridad programme to improve their capacity to properly select food and, therefore, improve food consumption and nutrition;

3) Strengthen and extend the community volunteer network to reach beneficiaries at household level, particularly mothers. This helps to ensure an adequate consumption of micronutrient powders and fortified and complementary food. Additionally, it contributes to improved healthcare services to mothers and their children;

4) Distribution of a specialized nutritious food called Progresina fortificada (Super Cereal plus) to children aged 6-59 months to prevent and control chronic and acute malnutrition;

5) Distribution of a specialized nutritious food called Progresina (Super cereal) to pregnant and lactating women and the elderly;

6) Strengthen national and local capacities to carry out monitoring and evaluation activities.

This in-kind assistance complements the conditional cash transfer part of the program, called “Comer es Primero”. It supports beneficiaries’ food security with a transfer of roughly US$16 per month, conditional on the participation of beneficiaries to preventative healthcare activities; children’s school attendance; head of household attendance at community education sessions, and obtaining of identification documents.

Photo credit to WFP/Ramon Charlyn Tineo

Dominican Republic

The Social Policy Cabinet of the Vice-President of the Dominican Republic , Ministry of Health of the Dominican Republic

WFP

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