Exploring pathways for increasing

the nutrition returns of Egypt’s

investment in social protection

programmes

Habiba Hassan-Wassef, MD

National Research Center, Cairo

Former Director, Inter-Agency Affairs Division, WHO HQ

ROADMAP

• The Egyptian context and its challenges.• Overview of social protection programmes (SPP) and social

safety net (SSN) schemes. • Nutrition specific and nutrition sensitive social assistance • Applying a nutrition lens to social protection programmes.• Principles governing strategic approaches to increase

nutrition returns • Importance of the life course approach.• Enabling environments in support of nutrition goals• Suggestions for increasing the nutrition returns of SPP• Policy and strategy implications • Concluding remarks

The Egyptian context and its challenges (1)

• Egypt is fully engaged in making the move to a targeted social protection system and safety net schemes that protect poor households and reduce the cost of economic reforms to be borne by the vulnerable segments of the population.

• The Ministry of Health and Population (MOHP) is presently working with all sectors and partners for formulation of the new National Nutrition Policy and Strategy 2018-2030. Prevention and control of the impact on the health and nutrition of Egyptians of the economic crisis and economic reforms is a shared objective.

The Egyptian context and its challenges (2)Challenges include:

• More than half a century of dependence on a generous subsidy system

• Currency devaluation

• High inflation rates

• Spiking of food prices and increase in cost of living

• High level of unemployment

• Growing number of vulnerable households

• Presence of other determinants impacting on the nutritional status of Egyptians

• Health care and nutrition system undergoing reform

• Diminished capacity to access a balanced and safe diet

Addressing the ChallengesMeasures accompanying the expansion of the social protection system and safety net schemes aim at: • Tackling the high complexity of long standing problems • Accelerating the pace of service expansion• Improving the system’s governance and raising the

efficiency and quality of services • Rigorous verification of eligibility and reform of the

targeting system • Strengthening the working partnership with civil

society and the private sector • Automation of the system • Completion of a unified database, accessible to all

partners, for all social and other services received by Egyptians

Overview of the magnitude of the main social

assistance services and their coverage*• Food subsidies (69 mn.)• Cash transfers to identified vulnerable groups (9.5 mn.)• Social Solidarity pensions (8 mn.)• Compensations from SIF** in cases of crises (in times of need) • Nurseries (14 000 registered nurseries)• Free school meals to 11 million pupils at preschool and primary

education levels, and 114 939*** pupils in community schools• Health insurance to beneficiaries of social solidarity pension• Energy subsidies (benefits general public)• Public transport subsidies (benefits general public)

*Source: Live personal communication by Assistant-Minister, Ministry of Social Solidarity, on 5 Dec 2011Coverage figures continue to increase as work is still in progress.**SIF: Social Insurance Fund*** Ministry of Education Statistical Yearbook 2015-2016

Source: IMF Country Report No.: 17/290, July 2017

Components of the Food Subsidy System, Ministry of Supplies and Internal Trade (MOSIT)

• The subsidized “baladi” bread scheme

• Subsidized wheat flour distribution to remote communities

• Food ration smart cards for purchasing of subsidized food items allow access to a more diverse list of foods through substitution of the unused bread allowance credit . Benefiting about 69* million beneficiaries, the system is currently refining its targeting criteria and expanding the national coverage by the distribution outlets.

*Source: IMF Country report 17/290 of 6 July 2017

Ministry of Social Solidarity, (MOSS 1)Overview of services, programmes and schemes

• Social care of vulnerable segments of the population: women, children, youth, families/households, elderly, individuals with special needs, and minors.

• Social protection in form of: monthly solidarity pensions to targeted beneficiaries; time-bound assistance during crises and emergencies; assistance to veterans and their families; extra-ordinary financial solidarity assistance in special cases; assistance to victims of desertification and water scarcity in locations at risk; child pensions for eligible cases.

Source: Egypt Government Portal: Ministry of Social Solidarity official website

Ministry of Social Solidarity (MOSS 2)Summary of services, programmes and schemes

• Assistance for social development includes, the ‘productive families’ scheme; technical training and guidance services to ‘productive families’; marketing and exhibitions for products of supported communities; development of local communities; professional training centers for youth and women; engagement of public service manpower in support of MOSS social development work.

• Civil society support for realization of their mission and the development of a working partnerships in areas with shared objectives.

• Maintaining open channels of communication with the public at large.

Source: Egypt Government Portal: Ministry of Social Solidarity official website

Some recent initiatives for protection and assistance schemes

• “FORSA”فرصة scheme, offering training offering

training and work opportunities for those who can work to border cases not qualifying for financial transfer schemes.

• “Decent Housing” سكن كريم, scheme for rehabilitation

of homes in the identified poorest villages, and connecting them to water and sanitation services.

• A limited pilot program is underway whereby continuation of social protection benefits to pregnant women is conditioned by the attendance of nutrition education sessions. Evaluation of outcomes is awaited.

Connecting the dots in favor of nutrition outcomes

• The caring and protecting work of MOSS already extends across the human life course from preconception to old age.

• Much of MOSS work aims at protecting the quality of Egypt’s human capital, a shared objective with the health and nutrition goals.

• This opens up valuable opportunities for MOSS to contribute to nutrition specific/sensitive actions throughout the life course.

• The period with greatest potential for enhancing nutritional outcomes is the First 1000 Days where MOSS is already engaged.

• The inter-ministerial national programme for nurseries to be managed by MOSS, now in the final stages of preparation, can become one of the most valuable nutrition specific contributions for MOSS.

Rappel of the Global Nutrition Targets

Applying a nutrition lens to social protection programmes

The various programmes, activities and interventions of MOSS can be grouped into 3 groups in function of their contribution, actual or potential, to nutrition goals:

1- Nutrition specific

2- Nutrition sensitive

3- Can potentially increase nutrition returns

Examples of nutrition specific/sensitive MOSS actions

Nutrition specific

• The national food and bread subsidy program

• Emergency food aid

• Food distribution in crisis situations

• In kind food aid to families

• In kind food aid associated with school feeding schemes

• Institutional catering benefiting inmates of the various types of MOSS homes

• School meals and snacks

• Nursery snacks

• Nutrition awareness and education of pregnant mothers

Nutrition sensitive

• Conditional Cash Transfer scheme (Takaful, social safety net scheme for mothers of 1ry level school children)

• Solidarity pension schemes benefiting different groups of the population

• Support to income generation through social protection schemes such as ‘Productive Families’ scheme.

• Home rehabilitation in poorest villages (healthy environment) and connecting them to clean water supply and sanitation systems (‘Sakan Kareem’ home rehab scheme)

•

Some actions that can raise the nutrition returns of SPP*

• The important initial step is for MOSS to brief all its staff on the importance of nutrition to the health, well being of the human capital.

• All food and meal distribution to be accompanied by nutrition literacy and nutrition education and personal hygiene messages.

• To change the significant investment made in school feeding from a simple procurement and distribution of energy rich snacks to a well conceived comprehensive program combining school feeding and school health.

• A comprehensive school feeding program with local procurement from smallholder producers can contribute to local improvement of the food and nutrition security situation in the long run.

• To keep the Nursery Services program within the integrated approach to early childhood development(First 1000 Days)and not to isolate it as a separate social service.

*SPP: Social Protection Programs

Importance of adoption of a life course approach

The integration of nutrition specific and/or nutrition sensitive dimension in the social protection and safety

net system in Egypt through the application of a life course approach is not expected to pose any difficulty for

MOSS as its scope of work in fulfilment of its mandate spans the entire life course.

Observing such a commitment through joint coordinated action with the Ministry of Health and Population within the framework of the respective program in this area can

produce rewarding outcomes for protecting Egypt’s human capital in the long term.

Source: An Investment Framework for Nutrition: Reaching the Global Targets for Stunting, Anemia, Breastfeeding, and Wasting Shekar M, Kakietek J, Dayton J, Eberwein, and Walters D.World Bank, 2017

Enabling environments in support of nutrition goals• Accessibility to the unified database and classified registry for social

services and social protection schemes.

• Automation of service delivery/management for all social sectors, (special case of the health sector) contributing to transparency and trust.

• Alignment of social protection programs with national program that serve shared objectives, ex. the MOSS Nursery services with the First 1000 Days.

• Integration of MOSS inputs in the new national nutrition policy and strategy (NNPS).

• Rehabilitation of the governance of the national nutrition system and re-instatement of the national food security committee to accompany the new NNPS. Availability of updated nutrition system tools such as the food analysis tables, the food based dietary guidelines, the alignment of old nutrition education materials with the realities of the present situation.

Examples of types of action to increase nutrition returns of social protection programs

• Ensuring the relevance of the nutritional quality of distributed food and meals to the nutrition status of the recipient community.

• Mobilization of agronomic technical support to help cases receiving emergency food aid in communities suffering from natural disasters, desertification and climate change.

• Mobilization of competent/concerned authorities or development partners in all cases receiving emergency food aid to help overcome, in the long run, the causes of the sudden food insecurity.

• To adopt and apply measures as required to ensure the environmental hygiene of the distribution locale and the recipient community, including access to potable water and safe sanitation facilities.

Some general policy and strategy implications • Enabling the bridging of the MOSS resource gap for

financing of social protection schemes through institutionalizing a working relation with CSOs and the private sector.

• Adopt measures to improve the performance of cash transfer programs, integrating nutrition specific and/or sensitive inputs as relevant.

• Adopt measures to ensure data availability for sharing by all partners, including the health sector.

• The health sector to adopt a policy for the MOHP to use the ID card in delivery of its services so as to integrate the unified database for social services.

Concluding remarks

There is great scope for increasing the nutrition returns of the extensive and broad range of programs and interventions handled by the Ministry of Social Solidarity (MOSS). This is reinforced through the active participation of MOSS in the planning of the new National Nutrition Policy and Strategy.

THANK YOU