Delegation of the European Union to Armenia

PNSP 4: an overview of the nutrition sensitive interventions

02/04/2018 - 14:03
Annexes

PSNP4 (2015-2010) was designed with the objective to support the transition towards a social protection system.  It will do so by ensuring that poor and vulnerable households benefit from an essential suite of services including safety net transfers, livelihood interventions, key health and nutrition services, community assets constructed through public works and support to households up to, during and beyond safety net graduation. As part of the system building approach, PSNP4 includes a set of nutrition sensitive interventions which address some determinants of malnutrition, including maternal and child health, vaccination, infant and young child feeding practices, dietary diversity, women empowerment and water, sanitation, and hygiene. Besides linking its public work clients to behavior change communication (BCC) sessions on health, nutrition and sanitation, PSNP now implements a “linkages to social services” component which promotes health seeking behavior for pregnant and lactating women (PLW) and their young children through soft conditionalities or co-responsibilities .

Mainstreaming of nutrition throughout PSNP is obtained through the following interventions:

PNSP3

PSNP 4

Targeting

Targeting criteria: food security and poverty

Increasing nutrition sensitive targeting:  targeting will continue to be based on poverty and food insecurity but

  • Communities will be mobilized to target poor HH with vulnerable PLW  or malnourished children during annual retargeting process (all things being equal)
  • Non PSNP HH who are seeking health services for treatment of moderately malnourished children (under TSFP or OTP/CMAM) can be referred by the HEW to the DA for transitory inclusion in PSNP. IF sufficient contingency funding is available, these HH can be accommodated under the  PSNP for temporary inclusion in the program (during  the ongoing transfer season) and if the contingency budget allows for this)

Transfers

Focus on calories; Food transfer consisted of cereals

  • Increased nutrition value: Cereals and pulses
  • Implementation of actions which enhance women’s control over the use of cash or food transfers
  • Transfers can be scaled up in response to shocks (transitory needs, reduce risks of acute malnutrition )
  • PNSP will  work with MoH and DP to develop specific BCC tools to encourage safety net clients to optimize use of both local and transferred resources for improved nutrition of children >2 and PLW

Public works

Focus on building community assets. No special attention to nutrition sensitive public works Community based Public works , although PW allowed for the construction of  HP and started with child care provisions

  • Focus on building community assets remains, but communities will be mobilized to identify and plan nutrition sensitive public works. Nutrition sensitive PW (latrine construction; Health post construction School room construction;  Development of homestead/kitchen gardens on the land of female-headed households with severe labour shortages (public works contribution can include land preparation, irrigation development, and production of nursery products, vegetable and legume seeds, and fruit tree seedlings) to these households;  Establishment of child care centres at public work sites and/or villages;   Caring of the children in these child care centers will also be considered as an eligible public work). Additionally, crop and livestock oriented PW projects will increase access to an increased food diet. This might include also  planting of vitamin rich fruit trees where applicable

Transition of pregnant women to direct support a provision but not well implemented

Duration was from 4th months of pregnancy until 10 months after birth

  • Early transition of pregnant women from public work to direct support . The transition of a woman when she is pregnant to temporary direct support based on referral from the health sector (or proof of first ANC visit or  on confirmation from the health worker of her pregnancy ) and in the absence of this, from the 4th month of pregnancy); and her continued receipt of direct support until her child is 12 months old.
  • The transition of primary care-givers of malnourished children (under five) under treatment to temporary direct support until the child is assessed as no longer requiring special treatment by the health care worker.
  • Duration of direct support for PLW is extended: from the moment a mother is referred by the health sector until one year after birth

PSNP 3 PIM  allowed for some nutrition related behavior change communication during PSNP gatherings, but  implementation arrangement were not defined in the PSNP PIM and this  did not go beyond some pilots

  • Participation in monthly nutrition, health and sanitation community  behavior change communication sessions (BCC)  is now considered as a substitute to public works -for male and female PW clients; 
  • Monthly participation – which is considered mandatory- will be tracked in the client card and monitored.  BCC participation of PW clients will be counted as part of a working day for public works (3 monthly sessions counts for 1 PW-day) . 
  • PW BCC sessions will be organized by HEW/HDA in consultation with DA and supported by the social worker (where available). When not yet organized in the community, the HEW can use PSNP gatherings  to provide PSNP specific BCC

Linkages with Health and social services

The Community Based Nutrition program were  gradually  rolled out  in all PSNP woredas , but PNSP  households were not specifically targeted under CBN. Participation of PSNP HH in CBN was not monitored

  • A new subcomponent the “Linkages to social services” , introduces the concept of soft conditionalities or co-responsibilities for women receiving direct support with regards to their uptake of health and nutrition services for them and for their young child. This intervention aims to link vulnerable clients with existing health services and to increase health-seeking behaviour of PNSP clients[1].
  • These co-responsibilities will be considered as soft conditionalities, which means that - while households are informed of their co-responsibilities and basic monitoring is undertaken-  no penalties are enforced (nothing is deducted from the transfer if they do not fulfil their co-responsibilities). These soft conditionalities will be phased in gradually as services are available.  Compliance with co-responsibilities will be monitored and promoted - social workers, HEW  and DA will encourage HH to comply with  their respective co-responsibilities.

No linkages between HAPB and NNP

Linkages with nutrition sensitive livelihoods will be promoted.

  • Increased focus on livelihood might increase household income which can lead to improved caring practices if combined with the nutrition and health care BCC.  Nutrition Community BCC will be organized as part of the PW requirements. 
  • Livelihoods transfers will target poor women and  female-headed households 
  • Nutrition sensitive income generation activities can be promoted. For example, in areas where critical nutrition-related services (e.g. milk marketing or processing of complementary foods for young children) are identified as a potential income generation activity, PSNP 4 may support their inclusion as off-farm enterprises eligible for program support.
  • Livelihoods will create an entry point or nutrition and health related BCC: under its livelihood interventions, PSNP4 will facilitate the formation of Development Groups comprising 20-30 village members to participate in livelihood interventions.  Besides the livelihood interventions, these groups will also provide an entry point for supporting active linkages to health and nutrition awareness raising and training provided by HEWs.      

Involvement of health sector  in PNSP processes and planning

HEW were supposed to be part of PSNP’s administrative structure and to play a role in community targeting & appeal systems,  but no training tools were provided and implementation was not monitored

  • As a  member of the Kebele and community food security task forces , the HEW will support the targeting and the graduation process.
  • As a member of the Kebele appeals committee – the HEW will provide input where needed –
  • HEW will ensure referral for timely transition from public work to temporary direct support (DS) of vulnerable PSNP clients
  • the HEW will also identify non PSNP HH with  malnourished children which should be referred to PSNP for transitory direct support
  • the HEW will conduct awareness raising with public works clients on the improved Gender and Social Development (GSD) provisions
  • HEW will plan and implement monthly behaviour change communication sessions for public work clients: HEW is a key actor for the implementation of “linkages to social services co-responsibilities for direct support clients
  • HEW is responsible for promoting compliance with co-responsibilities; where available, social workers will support her in this task

 

PSNP4 is also accountable for nutrition related outcomes and nutrition related indicators are now included in its results framework. PSNP will assess impact on the minimum acceptable diet of children 6-23 months in PSNP households and will review the extend in which client households apply an adequate nutrition KAP (Knowledge, Attitude and Practices). Access to nutrition education services by PSNP clients will also be monitored (such as participation in  CBN of  PSNP clients and proportion of PSNP clients who attend BCC sessions ).

 

[1] Including 4 Antenatal care clinics, post natal care , growth monitoring and promotion,  vaccination of children and regular health check up