Targeting for Nutrition Improvement

Transcription

1 R e f e re c e Gu ide Targetig for Nutritio Improvemet RESOURCES FOR ADVANCING NUTRITIONAL WELL-BEING Nutritio Plaig, Assessmet ad Evaluatio Service Food ad Nutritio Divisio Food ad Agriculture Orgaizatio of the Uited Natios ROME 2001

2 Experieces i Targetig Nutritio Programmes Targeted relief food aid E T H I O P I A ad TARGETING FOR NUTRITION IMPROVEMENT 81

3 w e r e d a s 82 ANNEX: Experieces i Targetig Nutritio Programmes

4 K E N YA TARGETING FOR NUTRITION IMPROVEMENT 83

5 Targeted food stamp programmes HONDURAS 84 ANNEX: Experieces i Targetig Nutritio Programmes

6 JAMAICA VENEZUELA TARGETING FOR NUTRITION IMPROVEMENT 85

7 Targeted school feedig programmes BANGLADESH CHILE 86 ANNEX: Experieces i Targetig Nutritio Programmes

8 TARGETING FOR NUTRITION IMPROVEMENT 87

9 C O S TA RICA JAMAICA U R U G UAY 88 ANNEX: Experieces i Targetig Nutritio Programmes

10 TARGETING FOR NUTRITION IMPROVEMENT 89

11 Targeted itegrated utritio programmes BA N G L A D E S H 90 ANNEX: Experieces i Targetig Nutritio Programmes

12 Wome. Childre. Adolescet girls. TARGETING FOR NUTRITION IMPROVEMENT 91

13 Targeted supplemetary feedig programmes CHILE Wome. 92 ANNEX: Experieces i Targetig Nutritio Programmes

14 Childre. TARGETING FOR NUTRITION IMPROVEMENT 93

15 C O S TA RICA DOMINICAN REPUBLIC 94 ANNEX: Experieces i Targetig Nutritio Programmes

16 PERU Targeted food subsidies E G Y P T TARGETING FOR NUTRITION IMPROVEMENT 95

17 96 ANNEX: Experieces i Targetig Nutritio Programmes

18 ISLAMIC REPUBLIC OF IRAN TUNISIA TARGETING FOR NUTRITION IMPROVEMENT 97

19 98 ANNEX: Experieces i Targetig Nutritio Programmes

20 Summary of self-targetig efforts i Tuisia INFERIOR FOOD APPROACH SUPERIOR FOODS APPROACH Durum wheat pro d u c t s M a i tai subsidies o semolia Elimiate direct subsidies o ( c o t i uo us ) c o us c o us ad pasta (1993) B read wheat pro d u c t s Re p l ace subsidies o gros pai Elimiate subsidies o baguettes (1993) with subsidies o a sig le Elimiate subsidy o pastry flour (1991) subsidized bre ad (pai uique) L i b e ralize pro d uctio of other m ade from a distict high-ex t ractio b re ads that attract the de m a d of highra t e f lour ( ) i c o me cos u me rs (1991-pre s e t ) Cookig oils Elimiate olive oil from subsidized L i b e ralize imports of pure grai oils huile de melag e re s u l t i g i the p ac k aged i glass bottles ad sold c reatio of a subsidized ge eric at cost to attract high-ic o me g rai oil (1989) c o s u me rs ad re d uce cos u m p t i o Shift subsidy towa rds ge eric oil, of subsidized oils (1992) s o ld mostly to the poor i small C reate fixed mixed cookig oil q u a tities from large drums with 40% olive oil ad 60% grai (e vra c ), a d away from bottled oil to dive rsify ra ge of pro d uc ts oil which is maily purchased o market ad re d uce uit by the rich (oil type differe t i a ls : subsidies per litre (1993) s i ce 1989; pac k ag i g differe t i a ls : O l i ve oil also serves as a superior p ro p o s e d ) good (cot i uo us ) S u g a r Shift subsidy towa rds le s s - re f i ed Elimiate subsidies o cube sugar, b row sugar which is ot pre f e r red which is cos u med virtually by upper-ic o me groups (1990) exc l us i vely by the rich (1991) M i l k Shift subsidies to pasteurized- Apply a small, temporary pro mo t i o a l re c o stituted milk (le a s t - p re f e r red subsidy to fresh, locally pro d uc e d type of milk) pac k aged i cheaper sterilized milk (a luxury) which c a r to s that are less attrac t i ve to is cos u med primarily by the we a l t hy cos u me rs, such as rich (1992) b e r l i got c a r to s ad c o u s s i milk pouc hes ( ) TARGETING FOR NUTRITION IMPROVEMENT 99

21 Targeted food fortificatio programmes PA K I S TAN 100 ANNEX: Experieces i Targetig Nutritio Programmes

22 Bibliography AHMED, A.U., BOUID, H.E. & ALI, S.M. ALI, S.M. & ADAMS, R.H. AUSTIN, J.E. BAKER, J. & GROSH, M. BAKER, J. & GROSH, M. BRAUN, J. VON, BOUIS, H., KUMAR, S. & PANDYA-LORCH, R. BROWNIE C., HABICHT, J.P. & COGILL, B. CAMPBELL, C.C. CHAMBERS, R CHAUDHURI, S. & RAVALLION, M. CHAWDHURY, M.A. CHUNG, K. ET AL. 102 Bibliography

23 FAO. FAO. FAO. FAO. GILLESPIE, S. GLEWWE, P. GLEWWE, P. & KANAAN, O. GROSH, M.E. HABICHT, J.-P., & PELLETIER, D.L. HABICHT, J.-P., MEYERS, L.D. & BROWNIE, C. HADDAD, L. & KANBUR, R. HADDAD, L. & KANBUR, R. HADDAD, L., SULLIVAN, J. & KENNEDY, E. TARGETING FOR NUTRITION IMPROVEMENT 103

24 Bibliography HADDAD, L., CHUNG, K. & YASODA DEVI, P. HODDINOTT, J. JHA, S. KAIN, J. & UAUY, R. KHAN, M. & RIELY, F. LIPTON, M. & VAN DER GAAG. J., EDS. LUNDBERG, M. & DISKIN, P. MAXWELL, S. & FRANKENBERGER, T. ONIANG O, R. PINSTRUP-ANDERSEN, P. PINSTRUP-ANDERSEN, P. & GARCIA, M. 104 Bibliography

25 RADIMER, K.L., OLSON, C.M. & CAMPBELL, C. RAVALLION, M. RAVALLION, M. & SEN, B. RILEY, F. RUEL, M.T., RIVERA, J. & HABICHT, J.-P. SHARP, K SHOHAM, J. & BORTON, J. TUCK, L. & LINDERT, K. VALADEZ, J. & BAMBERGER, M., EDS. VAN DE WALLE, D. & NEAD, EDS. WEBB, P., RICHARDSON, E., SEYOUM, S. & YOHANNES, Y. TARGETING FOR NUTRITION IMPROVEMENT 105

26 Bibliography WFP. WHO/EMRO. 106 Bibliography

27 Coclusios ad Necessary Actios Ratioale for targetig TARGETING FOR NUTRITION IMPROVEMENT 73

28 Targetig effectiveess Targetig costs 74 CHAPTER 6: Coclusios ad Necessary Actios

29 I may coutries, targeted food subsidies or food fortificatio programmes for basic food items are implemeted to ehace food security ad utritio. TARGETING FOR NUTRITION IMPROVEMENT 75

30 Healthy, well-ourished people have a higher quality life, ad ca cotribute actively to their families, commuities ad their coutries. Areas for actio 76 CHAPTER 6: Coclusios ad Necessary Actios

31 I N S T I T U T IONAL CAPACITY BUILDING S T R E N GTHENING INFORMAT ION SY S T E MS TARGETING FOR NUTRITION IMPROVEMENT 77

32 I N T E R - I N S T I T U T IONAL PARTNERSHIPS COMMUNITY PA R T IC I PAT ION AND EMPOWERMENT 78 CHAPTER 6: Coclusios ad Necessary Actios

33 TARGETING FOR NUTRITION IMPROVEMENT 79

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35 Types of Targeted Food ad Nutritio Programmes Supplemetary feedig programmes TARGETING FOR NUTRITION IMPROVEMENT 63

36 Food fortificatio programmes 64 CHAPTER 5: Types of Targeted Food ad Nutritio Programmes

37 TARGETING FOR NUTRITION IMPROVEMENT 65

38 I the Netherlads, people did ot accept the uiversal distributio of iodized salt, as it was felt that it deied cosumers the right of choice. This led to the presece of both o-iodized ad iodized salt i the market. I Motevideo, Uruguay, three kids of fortified salt o-iodized salt, salt fortified with iodie, ad salt fortified with iodie ad fluoride are available ad sold at the same uit price. I the Islamic Republic of Ira, however, the uiversal distributio of iodized salt was accepted by the populatio ad eve led to a price icrease of this product i some istaces, idicatig that it was cosidered a superior good. 66 CHAPTER 5: Types of Targeted Food ad Nutritio Programmes

39 Supplemetatio programmes TARGETING FOR NUTRITION IMPROVEMENT 67

40 School feedig programmes 68 CHAPTER 5: Types of Targeted Food ad Nutritio Programmes

41 Food-for-work programmes TARGETING FOR NUTRITION IMPROVEMENT 69

42 Nutritio educatio ad cosumer awareess programmes 70 CHAPTER 5: Types of Targeted Food ad Nutritio Programmes

43 TARGETING FOR NUTRITION IMPROVEMENT 71

44 Targetig effectiveess ad programme efficiecy should be major cocers for plaers ad political decisio-makers, as well as for society as a whole.

45 Assessig ad Moitorig Targetig Effectiveess Uderstadig targetig effectiveess TARGETING FOR NUTRITION IMPROVEMENT 55

46 FOOD-INSECURE FOOD-SECURE TOTAL Participatig A C A + C No-participatig B D B + D Total A + B C + D 56 CHAPTER 4: Assessig ad Moitorig Targetig Effectiveess

47 Correctig targetig errors TARGETING FOR NUTRITION IMPROVEMENT 57

48 58 CHAPTER 4: Assessig ad Moitorig Targetig Effectiveess

49 Improvig targetig cost-effectiveess SITUATION IMPROVING TARGETING COST-EFFECTIVENESS High malutritio prevalece, miimal logistical ifrastructure Rigorous targetig is iappropriate. Gradual expasio of the programmes through itesive supervisio ad careful budgetig is suggested. The expert opiio of kowledgeable officials may be used i the selectio of small areas. The data collectio cost for targetig should be kept miimal. Selective targetig based o programme objectives ca be cosidered over time. Ay geographic expasio should oly take place whe the logistical problems of the area already covered are solved. High malutritio prevalece, substatial logistical ifrastructure Rigorous targetig is ot ecessary. The judgemet of medical persoel is cosidered the best source of data available. Empowermet of o-site ifrastructure i potetial areas should be cosidered as part of the itervetio. I the urba poverty zoe, where strog o-site ifrastructure is also available, a stricter targetig scheme (e.g. based o athropometric criteria) is more effective. High-low malutritio prevalece, miimal logistical ifrastructure A highly targeted scheme is advised. Prelimiary efforts to gather data (or use existig data) for targetig are essetial (e.g. coductig a athropometric survey to idetify the high prevalece of malutritio i areas throughout the programme regio). I high prevalece areas, focusig o strict targetig is uecessary. Slow-paced geographic expasio based o developig adequate ifrastructure should be emphasized. High-low malutritio prevalece, substatial logistical ifrastructure Emphasis should be give to idetifyig the high prevalece zoes. If the high prevalece areas are located far from the programme cetre, supportig the o-site ifrastructure i those areas should be cosidered as part of the programme. Rapid geographic expasio of the programme, stressig strict targetig schemes, is advised whe high prevalet zoes are distributed uiformly across the etire programme regio. Where strog o-site ifrastructure exists, highly targeted service delivery systems usig various targetig idicators through these o-site orgaizatios are recommeded. TARGETING FOR NUTRITION IMPROVEMENT 59

50 The urba poor ofte lack the physical ad ecoomic access to good quality, safe ad utritioally adequate food supplies. 60 CHAPTER 4: Assessig ad Moitorig Targetig Effectiveess

51 Participatory evaluatio of targetig effectiveess: a example from Ethiopia I 1994, a evaluatio of a World Food Programme food-for-work activity used a participatory vulerability rakig exercise to evaluate targetig effectiveess. The evaluatio ivolved a three-stage process with discussios amog two separate sets of participats i each commuity ivolved. The first stage comprised discussios with a group of local commuity-level officials. Durig the discussios, households were simply raked ito four categories of vulerability accordig to the resources they cotrolled, icludig household labour availability ad their owership of lad, draft oxe ad other livestock. Durig the secod phase of the evaluatio, a group of household members from the most vulerable group i the commuity were asked to categorize households further usig similar criteria, but givig more attetio to labour fitess ad access to emergecy support from relatives ad frieds. Respodets were also asked to idetify who had participated i the foodfor-work activity. I the third phase, the ames of participats provided by respodets were compared with paymet lists kept by the project to produce a fial list of beeficiaries. Usig the list of ames ad the fial vulerability rakigs produced durig discussios with commuity members, the project icidece was calculated as the percetage of households participatig i food-for-work i each of the four vulerability categories. TARGETING FOR NUTRITION IMPROVEMENT 61

52 Supplemetary feedig programmes, food fortificatio, supplemetatio, school feedig, food-for-work ad utritio educatio ad cosumer awareess programmes are the types of targeted programmes most commoly used to improve utritio.

53 Plaig ad Desigig for a Targetig Scheme Desigig a targetig scheme TARGETING FOR NUTRITION IMPROVEMENT 35

54 1 Who desigs, implemets ad moitors the targetig scheme? 36 CHAPTER 3: Plaig ad Desigig a Targetig Scheme

55 2 Who is to be targeted? 3 How will targetig be doe? TARGETING FOR NUTRITION IMPROVEMENT 37

56 A importat cocept i the assessmet of targetig schemes is that ay strategy will exclude some eedy idividuals while icludig others who would do well eve without the programme s support. May targetig strategies that have a small exclusio error have a large iclusio error, ad vice versa. Thus, a trade-off betwee these two errors ofte has to be cosidered. Normally, whe the mai cocer is reducig food ad utritio isecurity, miimizig udercoverage rates is more importat tha lowerig leakage rates. If a limited programme budget is the mai cocer, reducig leakage should be give greater weight. Assessig resources 38 CHAPTER 3: Plaig ad Desigig a Targetig Scheme

57 Cost comparisos across targetig schemes Admiistratively targeted programmes Self-targetig mechaisms, Market-based targetig TARGETING FOR NUTRITION IMPROVEMENT 39

58 Commuity-based targetig Geographic ad regioal targetig, Household/idividual targetig, Target populatios are ofte small childre, wome, iterally displaced persos i specific areas, food isecure households i urba areas ad the ladless rural poor. 40 CHAPTER 3: Plaig ad Desigig a Targetig Scheme

59 Selectig idicators for targetig R E L E VANCE AN D VAL ID ITY The importace of the relevace ad validity of a idicator ca be illustrated i the case of Guatemala, where a NGO providig food assistace used weight-for-height to scree for potetial beeficiaries. The very small umber of childre idetified by this screeig test prompted the NGO to coclude that malutritio was ot a problem i Guatemala ad that food aid should be discotiued. However, while the level of wastig was very low, Guatemala, at that time, had the highest rates of stutig i all of Lati America. TARGETING FOR NUTRITION IMPROVEMENT 41

60 AC C U R ACY AND RELIABILITY 42 CHAPTER 3: Plaig ad Desigig a Targetig Scheme

61 TIMELINESS AC C E S S I B I L I T Y COST OF DATA COLLECTION, PROCESSING AND ANALY S IS TARGETING FOR NUTRITION IMPROVEMENT 43

62 I geeral, whe screeig idividuals or estimatig the proportio of the eedy i a populatio for regioal targetig purposes, it is ecessary to classify idividuals accordig to their utritioal status o the basis of a cut-off value. Typically, populatio-specific cut-off poits eed to be defied for targetig purposes i each case where they are to be used. The choice of cut-off poit may have importat implicatios for the iterpretatio of a idicator ad the uderstadig of food security coditios. While food-isecure households are ofte defied as those cosumig less tha 80 percet of the recommeded miimum calorie itake, a reductio i the percetage of households cosumig less tha 70 percet of that recommeded miimum may idicate importat advaces i reducig extreme food isecurity that would ot be fully captured by a assessmet based o the 80 percet cut-off. I Guatemala, the cut-off poit below which childre showed a greater respose to supplemetatio was actually much higher tha the stadard -2 SD below the media of the NCHS levels. Had the traditioal cut-off bee used, oly a small proportio of childre would have bee cosidered at-risk ad eligible for supplemetatio, ad a large proportio of eedy childre would have bee missed by the test. I a operatioal cotext, the choice of the optimal idicator is ofte best made at a fixed cut-off defied o the basis of programme objectives ad resource availability. Eve where techically defied cut-offs exist for certai bechmark idicators, programme maagers may wish to target a particular subsegmet of the populatio which is the most food-isecure or malourished, or the most likely to beefit from a itervetio. This is likely to be the case i programmes where the budget is isufficiet to address the etire populatio sufferig from food isecurity or malutritio. Where programme resources are limited, the best cut-off for targetig is oe that will deliver exactly the umber of participats for which programme resources are available. I other words, the idicator cut-off used i the evaluatio of proxies would be selected at a value that correspods to the percetage of the populatio that ca be served give available programme resources. 44 CHAPTER 3: Plaig ad Desigig a Targetig Scheme

63 Eligibility ad exit criteria eed to be well-uderstood by recipiets ad programme staff, ad cosistetly applied. Usig proxy idicators W H AT IS A PROXY INDIC ATO R? TARGETING FOR NUTRITION IMPROVEMENT 45

64 Proxy idicators of household icome iclude: geder or age of the head of household; presece of workig-age idividuals withi the household (depedecy ratio); ethic backgroud, social class or caste; size of family dwellig or umber of rooms; type of costructio materials used for the roof, floor ad walls of the dwellig; owership of key assets such as lad, livestock ad luxury goods; geographic locatio of the household. TESTING PROXY INDIC ATO R S Quatitative methods. Qualitative methods. 46 CHAPTER 3: Plaig ad Desigig a Targetig Scheme

65 Usig geder of household head as a proxy for poverty status A study i Peru examied the validity of usig the geder of household head, as commoly defied, as a reliable way of idetifyig poor households. Usig reported data from a atioal survey, 17 percet of all households i Peru were classified as woma-headed. However, woma-headed households were ot sigificatly over-represeted amog the poorest households, accoutig for oly 20 percet of the poorest segmet (quitile) of the populatio. Targetig the poorest quitile of the populatio solely o the basis of woma- headship would, therefore, result i a sigificat level of udercoverage, equivalet to 80 percet of the households i the poorest segmet of the populatio. It would also result i sigificat leakage, sice 76 percet of woma-headed households are ot icluded i the poorest segmet of the populatio. The study otes that headship as reported by respodets fails to accout for importat elemets of the typical headship cocept, which iclude idetifyig the idividual with the most regular presece i the household, the idividual with overridig authority i household decisio-makig, or the idividual primarily resposible for the ecoomic support of the household. To be relevat for policy-makig, the defiitio of headship must be relevat to the policy issue at had. I the case of poverty targetig, the cocept of headship should be defied to idetify the primary source of ecoomic support of the household. Istead of usig reported headship, researchers costructed a idicator of workig headship based o the total proportio of hours worked i the labour market ad o the productio of home goods (ot icludig housework). Woma-headship defied i this way is more likely to idetify poor households, give a rage of evidece from across developig coutries: a b c wome s work outside the home teds to icrease with the level of poverty; i the poorest households, wome ted to work loger hours tha me; i poorer coutries, wome sped more time i icome-geeratig activities tha i coutries where poverty is less of a problem. Uder the defiitio of workig headship, 29 percet of households i Peru were determied to be woma-headed. However, amog the poorest quitile of the populatio, 34 percet were woma-headed. I such cases, the prospect of targetig o the basis of workig headship, while better tha relyig o reported headship, is still likely to result i high levels of udercoverage ad leakage. The study cocludes that, for targetig purposes, more direct idicators of poverty status may be more useful tha reliace solely o geder of household head. TARGETING FOR NUTRITION IMPROVEMENT 47

66 Selectig eligibility criteria 48 CHAPTER 3: Plaig ad Desigig a Targetig Scheme

67 Idetifyig ad screeig programme beeficiaries E L IGIBILITY DETERMINAT ION passive idetificatio active idetificatio Passive idetificatio TARGETING FOR NUTRITION IMPROVEMENT 49

68 Active idetificatio FREQUENCY OF INFORMAT ION GATHERING FOR E L IGIBILITY MO N I TORING 50 CHAPTER 3: Plaig ad Desigig a Targetig Scheme

69 HOW TO ALLOCATE PROGRAMME RESOURCES I the Jamaica food stamp programme, social workers coduct home visits i bimothly cycles, collectig iformatio from all eligible households durig the first moth of the cycle ad distributig food stamps durig the secod. The ordered collectio of iformatio prior to the distributio of beefits provides some scope for prioritizatio i the evet of resources provig isufficiet to the eeds of all those who meet the eligibility criteria. I Idia s ICDS Programme, which provides supplemetary ratios o the basis of o-goig, cliic-based growth moitorig iformatio, ratios are distributed o a first-come-first-served basis. I this case, prioritizatio occurs oly iformally, whe the supplies at cetres are limited ad staff reserve ratios for oly the most severe cases of malutritio. TARGETING FOR NUTRITION IMPROVEMENT 51

70 TABLE 1 Optios for obtaiig iformatio through household- or idividual-level scre OPTION ADVANTAGES DISADVANTAGES PASSIVE IDENTIFICAT I O N Collectig iformatio o-site, with o verificatio Simple ad low-cost Udercoverage may be high Proe to iaccuracies ad false resposes by applicats Collectig iformatio o-site, with direct measuremet by programme staff More accurate ad still low-cost Objective verificatio ad opportuity for immediate itervetio Udercoverage may be high Not always appropriate Collectig iformatio o-site, with required verifyig documets More accurate ad still low-cost Verificatio burde o applicat, with miimal additioal staff time Udercoverage may be high Not always appropriate ACTIVE IDENTIFICAT I O N Household visits for screeig Allows subjective verificatio of livig stadards ad other iformatio High-cost Outreach to idetify those ot participatig Improves accuracy of targetig Lowers udercoverage rate Improves aggregate social beefit of activity High-cost 52 CHAPTER 3: Plaig ad Desigig a Targetig Scheme

71 evel screeig COST COMPONENTS APPROPRIATE CIRCUMSTANCES Miimal staff time Oe-time, small beefits that eed immediate decisios, such as hospital fee waivers Iterviewer is based withi a commuity ad kows applicats well eough to detect false resposes Miimal staff time Cost of equipmet ad staff traiig Multiple screeig of small to moderate beefits Limited to activities where the biophysical attributes of cadidates are used as targetig criteria Miimal staff time Iformatio system to track verificatio documets Large beefit Applicat pool literate ad part of formal sector likely to have access to verificatio documets Sigificat staff time Trasport ad logistics costs O-goig or large beefit Programme staff do ot kow applicats No possibility of writte verificatio Sigificat staff time Additioal budgetary resources to provide beefits to eligible cadidates Adequate budget Likely cadidates clustered geographically or readily idetifiable through their use of specific social services TARGETING FOR NUTRITION IMPROVEMENT 53

72 The success of a targeted programme depeds o detailed plaig, efficiet maagemet ad cotiuous moitorig ad evaluatio, with the results feedig back ito improved plaig ad implemetatio of the programme.

73 Targetig Practices TARGETING FOR NUTRITION IMPROVEMENT 11

74 admiistratively targeted self-targetig. (geographic targetig) (commuity-based targetig) marketbased targetig 12 CHAPTER 2: Targetig Practices

75 Admiistrative targetig The applicatio of admiistrative targetig schemes may become complicated i coutries where there is o clearly articulated atioal food ad utritio policy ad where differet levels of admiistrative decisio-makig (e.g. atioal-, regioal- ad local-level) may lead to differet sets of eligibility criteria at each regio or locality. Locally determied eligibility criteria may have greater validity tha uiform criteria that are atioally applied. TARGETING FOR NUTRITION IMPROVEMENT 13

76 Advatages 1 Disadvatages 1 outsiders CHAPTER 2: Targetig Practices

77 4 5 Iformatio costs deped largely o the deploymet of programme staff ad ifrastructure i relatio to the locatio of the beeficiary populatio, as well as o the iformatio collectig mechaisms used. Whe staff are located close to the iteded target populatio, such as whe cliic or school staff collect targetig iformatio, data collectio costs may be margial. Similarly, whe the service delivery mode requires cadidate participats to preset themselves at a cetral locatio to apply for beefits (e.g. a MCH cetre), data collectio costs may agai be low, although this system ca also lead to a large exclusio error i targetig if o additioal efforts are made to locate eligible households or idividuals. I cotrast, where programme staff have limited ad o-costat access to the iteded target populatio ad must icur substatial time ad trasportatio costs to collect targetig iformatio, admiistrative targetig is likely to be costly. Commuity-based targetig TARGETING FOR NUTRITION IMPROVEMENT 15

78 Assessmet of commuity decisio-makig structures l l l l l The aalysis of existig commuity support mechaisms 16 CHAPTER 2: Targetig Practices

79 Public participatio ad educatio Advatages 1 isiders 2 TARGETING FOR NUTRITION IMPROVEMENT 17

80 3 4 Disadvatages CHAPTER 2: Targetig Practices

81 Commuity-based targetig is ofte iflueced by a few local leaders ad admiistrators, ad this ca result i the subjective selectio of beeficiaries that is ot based o a eeds assessmet. I local settigs, people ofte follow their leaders ad do ot have a real space i which to express their hoest opiios. At the same time, programme staff caot approach a commuity without directly ivolvig its leaders ad political decisio-makers. Their best way of dealig with this situatio is to promote ad facilitate the creatio of a more participatory decisio-makig eviromet, startig perhaps with a participatory eeds assessmet i the commuity. Self-targetig TARGETING FOR NUTRITION IMPROVEMENT 19

82 20 CHAPTER 2: Targetig Practices

83 A good example of the importace of cosumer acceptace occurred i Tuisia, where the itroductio of a heavily-subsidized ad less refied brow sugar was usuccessful. Despite the fact that the ew subsidized sugar was almost half the price of commoly used white sugar, it was ot readily accepted by cosumers at ay icome level, apparetly because darker sugar was assumed to be dirty. The failure of this itervetio was maily associated with programme desigers lack of prior uderstadig of cosumer acceptace, ad the absece of accompayig efforts to raise cosumer awareess ad provide utritio educatio. l TARGETING FOR NUTRITION IMPROVEMENT 21

84 Advatages Disadvatages CHAPTER 2: Targetig Practices

85 Market-based targetig TARGETING FOR NUTRITION IMPROVEMENT 23

86 Market-based itervetios aim to icrease the demad or supply of a particular food amog the target populatio. d e m a d 24 CHAPTER 2: Targetig Practices

87 Advatages Disadvatages TARGETING FOR NUTRITION IMPROVEMENT 25

88 Geographic ad regioal targetig I some istaces, targetig broadly defied geographic areas has bee foud to offer oly miimal gais i programme efficiecy compared with cases where o targetig is used. Studies usig household survey data idicate that the use of smaller geographic uits i geographic targetig ca reduce programme leakage ad improve the coverage of the target populatio as the uit targeted becomes smaller. 26 CHAPTER 2: Targetig Practices

89 I Burkia Faso, food aid that was targeted o the basis of the regios dif f e ret a g r i c u l t u ral potetials resulted i the distributio of large amouts of food aid re s o u rc e s to re l a t i vely better-off households. I fact, because households i areas of low agricultural potetial had developed dive rs ified icome stra t e g i e s, their access to food was less s eve rely affected by adve rse agroclimatic coditios tha that of households i areas of higher agricultural potetial which we re more depedet o agriculture as their mai s o u rce of icome ad food. Advatages TARGETING FOR NUTRITION IMPROVEMENT 27

90 4 5 Disadvatages 1 2 I most circumstaces, small area estimatio techiques have bee show to produce statistically reliable estimates of variables for small geographic uits. While already used frequetly i the Uited States ad other developed coutries, small area estimatio methods are ow beig applied with greater frequecy i developig coutries as well. By providig statistically rigorous estimates of targetig idicators at the local level, these methods ca substatially improve the efficiecy gais from regioal targetig. 28 CHAPTER 2: Targetig Practices

91 Geographic targetig for drought relief i Ethiopia I Ethiopia, a map showig chroically vulerable ad food-isecure areas has bee costructed o the basis of a composite idex of ie idicators. The map rates weredas (districts) as very highly vulerable, highly vulerable, moderately vulerable, slightly vulerable ad very slightly vulerable. No data are available for two departmets (Afar ad Somali). The idicators used as iputs to costruct the idex are: staple crop productio per capita; livestock assets aimals per capita; pasture quality ad quatity; road ifrastructure/access; food prices the averages for maize ad sorghum; assessed emergecy eeds for recet years; drought risk; variability i staple crop productio; ad probability of extreme weather shocks shortage or excess of rais. Each of the ie idicators was weighted, first idividually by a umber of collaboratig agecies (Drought Prevetio ad Preparedess Commissio [Early Warig Uit], Miistry of Agriculture, CIDA, SCF UK, the Uited States Agecy for Iteratioal Developmet [USAID], the Europea Commuity [EC] ad the Vulerability Aalysis ad Mappig Uit of the World Food Programme [VAM/WFP]) ad the by applyig a average group weight to each idicator. The idex is curretly beig validated i the field i selected weredas. Household ad idividual targetig TARGETING FOR NUTRITION IMPROVEMENT 29

92 Ifats ad youg childre are particularly at-risk of ot gettig the food they eed for good health, growth ad developmet. 30 CHAPTER 2: Targetig Practices

93 A cross-coutry study demostrated that a umber of simple idicators (each measured by oly two or three differet values) performed quite well, sigly or i combiatio, i idetifyig households ad childre uder five years of age at risk of food ad utritioal isecurity. These idicators iclude: umber of idividual foods cosumed; household size; household depedecy ratio; umber of rooms per perso; icidece of illess; vacciatio status; age at weaig of childre uder five years of age; ad drikig-water ad saitatio facilities. TARGETING FOR NUTRITION IMPROVEMENT 31

94 Geerally, utritioal criteria may be appropriate for targetig idividuals, while socioecoomic factors may prove more useful whe selectig households for targetig. Advatages Disadvatages 1 2 It is importat ot to exclude a particular programme objective or targetig criterio simply because it seems to have low cost-effectiveess. While screeig each idividual accordig to the give criteria may seem costly i the short term, the programme will beefit from such screeig i the log term because it miimizes exclusio ad iclusio errors. 32 CHAPTER 2: Targetig Practices

95 The use of athropometric idicators i targeted group feedig programmes (GFPs) ANTHROPOMETRIC INDICATORS ARE USED TO: assess the utritioal status of a populatio or group i order to decide whether to start a GFP, ad where to locate it; select idividual recipiets for feedig; moitor the growth of idividual recipiets; measure treds ad chages i utritioal status of the populatio or recipiet group, i order to decide whether to cotiue, expad or ed the GFP. SELECTED INDICATORS IN EMERGENCY SUPPLEMENTARY FEEDING PROGRAMMES Apply weight-for-height (or weight-for-legth) i childre. The priority is to select wasted childre because they are at most risk of serious illess ad death. If there are may childre, a prelimiary screeig usig mid-upper arm circumferece (MUAC) ca be used. The cut-off levels used to select childre vary accordig to the resources available, but oe recommedatio (ACC/SCN, 1990b ad UNICEF, 1986) is: Supplemetary ratios to childre whose weight-for-legth is less tha 80 percet or who have a MUAC of less tha 13.5 cm. Therapeutic feedig to childre whose weight-for-legth is less tha 80 percet or who have a MUAC of less tha 12.5 cm. Childre whose growth charts show poor weight gai ca also be selected. SELECTED INDICATORS IN NON-EMERGENCY SUPPLEMENTARY FEEDING PROGRAMMES Sice there are likely to be fewer wasted childre i o-emergecy tha i emergecy situatios, if resources permit, some stuted childre ca also be selected. The followig idicators ad cut-off levels are recommeded: For childre aged up to two years: weight-for-height of less tha 80 percet; height-forage of less tha 90 percet; poor weight gai. For childre aged two to five years: weight-for-height of less tha 80 percet; poor weight gai (stuted childre of this age are ot a high priority group because stutig is likely to have occurred earlier ad is ot likely to be a result of curret uderfeedig). If height caot be measured, use weight-for-age of less tha 80 percet or, for oe- to fiveyear-olds oly, MUAC of less tha 13.5 cm. TARGETING FOR NUTRITION IMPROVEMENT 33

96 The wide variatio of social cotexts i which differet activities are udertake will ofte lead to wide differeces i the fial choice of targetig method.

97

98 Foreword G TARGETING FOR NUTRITION IMPROVEMENT iii

99 Kraisid Totisiri Director, Food ad Nutritio Divisio iv Foreword

100 Itroductio N TARGETING FOR NUTRITION IMPROVEMENT v

101 whe how whom vi Itroductio

102 TARGETING FOR NUTRITION IMPROVEMENT vii

103 Table of cotets CHAPTER 1 Targetig for Nutritio Improvemet 1 CHAPTER 2 Targetig Practices 11 CHAPTER 3 Plaig ad Desigig a Targetig Scheme 35 viii Table of cotets

104 CHAPTER 4 Assessig ad Moitorig Targetig Effectiveess 55 CHAPTER 5 Types of Targeted Food ad Nutritio Programmes 63 CHAPTER 6 Coclusios ad Necessary Actios 73 ANNEX Experieces i Targetig Nutritio Programmes 81 TARGETING FOR NUTRITION IMPROVEMENT ix

105 A well-selected ad implemeted targetig method will maximize the social returs from a food ad utritio programme by excludig o-eedy idividuals, while miimizig the cost by icludig oly the most eedy.

106 Targetig for Nutritio Improvemet What is targetig? 1 assessmet 2 3 idetificatio prioritizatio 4 plaig developmet TARGETING FOR NUTRITION IMPROVEMENT 1

107 5 6 implemetatio moitorig 7 8 evaluatio phasig out What are the beefits of targetig? ecoomic beefits. Potetial egative effects utritioal, social 2 CHAPTER 1: Targetig for utritio improvemet

108 DIRECT NUTRITIONAL BENEFITS SOCIAL BENEFITS TARGETING FOR NUTRITION IMPROVEMENT 3

109 E C O NO M IC BEN EFITS A review of utritio programmes i 19 Lati America coutries foud that more tha 20 percet of the populatio or approximately 83 millio people out of a estimated 414 millio i the study coutries receive some level of beefits through utritiorelated programmes. However, i these same coutries, the estimated total umber of malourished childre is about 10 millio. Overall, with improved targetig of beefits to the most eedy, it would be possible to more tha double the per capita expeditures of these programmes ad cover almost five times the preset umber of malourished childre i the regio, without icreasig total programme expeditures. I coutries where curret spedig o utritio-related activities oly partially covers childre i immediate eed, targetig ca esure optimal impact by directig limited resources oly to the most eedy. I coutries where such activities cover may times as may beeficiaries as there are malourished childre, improved targetig could lead to substatial reductios i public expeditures o utritio-related programmes without seriously udermiig their impact o the most eedy. 4 CHAPTER 1: Targetig for utritio improvemet

110 Potetial egative effects of targeted programmes TARGETING FOR NUTRITION IMPROVEMENT 5

111 I the Suda, i both the food aid assistace emergecy relief programme ad the school feedig programme, wheat was itroduced to replace the locally cosumed sorghum. This led to a ew food habit of cosumig wheat i the form of bread; the demad was further icreased by a high urbaizatio rate. Local productio could ot meet the ewly created demad for wheat, ad cosequetly the coutry had to deped o imported wheat. I additio, local farmers were uable to sell their sorghum crops at reasoable prices. I Somalia, the distributio of food supplemets through the MCH services was used as a icetive for mothers to atted those services. Yet, owig to the lack of adequate supervisio ad traied staff, food distributio was ot itegrated with other routie MCH services such as growth moitorig ad utritio educatio because staff were fully occupied with the food distributio ad could ot provide other services at the same time. I practice, the health cetre was operatig as a food-distributio cetre where, i may istaces, wome came oly to receive food ratios. The cost of targetig Up-frot costs 6 CHAPTER 1: Targetig for utritio improvemet

112 Ogoig iformatio or screeig costs TARGETING FOR NUTRITION IMPROVEMENT 7

113 I additio to the explicit costs associated with a particular targetig method, some implicit costs, which are critical to esurig good coverage ad programme success, may be icurred. These implicit targetig costs may iclude the cost of expadig the ifrastructure of a service delivery system to esure greater access for the target populatio. For example, i the Bagladesh food-for-educatio activity, the participatio (coverage) of school-age girls was expaded by icreasig the size of the food ratio provided, so that it sufficietly compesated the girls families for the opportuity costs of time spet at school. Although ot ecessarily regarded as such, these larger ratios could be cosidered a importat elemet of the programme s targetig mechaism. 8 CHAPTER 1: Targetig for utritio improvemet

114 TARGETING TERMS Targetig Target populatio A me t hod of de l i ve r i g goods ad/or services to a select group of id i v i d u a ls or ho us e ho ld s, ra t her tha to every idividual or ho us e ho ld i the populat i o. Those idividuals or households iteded to receive goods, services or beefits uder a particular programme or activity. Participat/beeficiary Those idividuals or households who actually receive goods, populatio services or beefits uder a particular programme or activity. Screeig Target idicator Proxy idicator Bechmark idicator Coverage or participatio rate Udercoverage Leakage Errors of exclusio Errors of iclusio Targetig efficiecy Food isecurity Vulerability The idetificatio ad iclusio of eligible idividuals or households for programme participatio, ad the exclusio of the o-eligible. A direct measure of a particular characteristic of the target populatio that is used to idetify members of the target group. A alterative or substitute idicator that is closely associated with a target idicator, ad that ca also be applied to idetify members of a target populatio. A key idicator that is directly related to the stated targetig objectives, ad that is used to moitor the implemetatio of the targetig scheme. The percetage of the target populatio that is actually icluded amog the beeficiaries of a programme or activity. The proportio of the target group that is excluded from participatio i the activity. The proportio of the beeficiary populatio that does ot belog to the iteded target group. Leakage ca also refer to the proportio of total beefits that accrue to idividuals or households who are ot icluded i the target group. The umber of idividuals or households who are eligible for participatio but do ot participate. The umber of idividuals or households who are ot eligible to participate but who do participate. The ratio of icluded target populatio to the total target populatio mius the ratio of the icluded o-target populatio to the total populatio icluded (+1 = perfect targetig; -1 = targetig that is completely wrog; 0 = radom programme participatio). Iadequately low itake levels of utritious ad safe food. It ca be a trasitory, seasoal or chroic coditio. The presece of factors that place idividuals or households at risk of becomig temporarily or permaetly food-isecure or malourished. TARGETING FOR NUTRITION IMPROVEMENT 9

115 The wide variatio of social cotexts i which differet activities are udertake will ofte lead to wide differeces i the fial choice of targetig method.