Anne Bossuyt IFPRI, Ethiopia

1. The nutrition sensitive productive
safety net in Ethiopia
From Design to Implementation
Anne Bossuyt
IFPRI, Ethiopia

2. Context
Marked improvements in human
development and poverty, but challenges
remain
Pro-poor investments and programs
• Increasing financial allocation for pro-
poor sectors
• Health Extension Program (over 39,000
health extension workers)
• A multisectoral National Nutrition
Program
• Emergency relief programs
• A Rural Productive Safety Net Program
(PSNP) - since 2005

3. PSNP in a nutshell
One of largest safety net programs in sub-
Saharan Africa
• 8 million rural poor - 350 food insecure
districts
• Community targeting
• Provides transfers (food or cash) to
chronically food insecure households (6
months/year )
o In return: healthy adults carry out public
works (supporting community
infrastructures)
o Vulnerable clients and pregnant and
lactating women: unconditional
transfers
o Labor constraints households:
unconditional transfers
o Launched in 2005; gradual expansion
(geographic and programmatic)
Photo :PSNP DCT (2013)
Good results
• Well targeted to the poor
• Good results in addressing food insecurity,
reducing distress sales, improving resilience,
increasing access to services (health,
education, sanitation), improving household
level diet diversity…

4. PSNP 4 Design – enabling factors to make
the program more nutrition sensitive
Some early initiatives PSNP 3 - no nutrition objective, but some nutrition sensitive features
o Pockets of successful interventions linking PSNP clients with health services
o But little attention to defining implementation modalities and accountability structures
2012-2013 – a high level of attention to nutrition
o Understanding of high cost associated with malnutrition
o Revision of the National Nutrition Program (NNP) in 2013
• Multisectoral approach; importance of accountability
• Acknowledgment that the PSNP could become an important vehicle of nutrition sensitive
interventions

5. Design- enabling factors (2)
PSNP 4 design guided by multisectoral consultations (2013-2014)
o Move towards a system wide approach (linking PSNP clients with social, health and
livelihood services)
o Considered lessons learned of earlier phases
o MOH gradually more involved; Social Affairs: new player
New Evidence (2013-2014)
o PSNP 3 had no impact on nutrition outcomes of children; limited contacts of PSNP clients
with health extension workers (IFPRI, 2014)
o Global advocacy on the role of nutrition sensitive programs (Lancet 2013 ; the potentials
of nutrition sensitive transfer programs by H. Alderman, IFPRI )

6. The result: nutrition mainstreamed throughout
the design
PSNP 4 : considered high potential for nutrition sensitivity,
• Because of its scale, poverty focus, potential to empower women, attention to system
building, integration of livelihood interventions, gradual involvement of social sector
Nutrition : mainstreamed throughout all the PSNP components
• PSNP will address some determinants of stunting
• Vulnerable clients and communities : mobilized for improved nutrition and uptake of
health services
• Linkages between agriculture , health and social sectors to be strengthened under PSNP
– general principles of collaborative modalities defined
• Accountability: nutrition outcomes-level indicators included in results framework

7. PSNP will address some
determinants of stunting
• 2014 mini DHS and PSNP
baseline surveys: 0verall poor
nutrition indicators in PSNP
districts, accompanied by low
health seeking behavior and
caring practices
• PSNP-4 : designed to address
some of these determinants

9. Progress : slow but steady roll out
• Roll out of PSNP-4 in July 2015 (awareness raising on new provisions)
• Growing multisectoral and high level engagement at federal level
o Health and Social Affairs gradually more involved
o Political buy-in translated in various national strategic and policy documents
o Implementation processes defined
o Multisectoral process; role of pilots (MOLSA/UNICEF)
o PSNP agenda integrated in strengthened community nutrition programs of MOH
• Expanded support through NGOs
• Measuring progress
o Nutrition indicators included in overall PSNP impact assessments
o Partnerships for evidence on nutrition outcomes established (BMGF, NGO, UNICEF
pilots – role of IFPRI )
o Routine monitoring: some efforts to measure progress on selected nutrition provisions
 Interventions gradually rolled out but not yet systematically implemented

10. Challenges
• Translating political buy-in to capacities on the ground
• Size of the program (7000 kebeles ; > 15,000 frontline workers )
• Multisectoral approach at decentralized level was not well spelled out at design phase
• One program, but different contexts (e.g. regional aspects)
• Conflicting priorities : PSNP innovations; Recurrent droughts
• Ambitious design not necessary associated with adequate funding : Pulses retracted in
2017; Limited budget and attention for capacity building (hard and soft skills)
• Service delivery: Linking safety net clients to basic services vs limited availability of basic
services
• Accountability : Indicators defined at design, but modalities of reporting only identified
later in the project

11. Lessons learned
1. Focus on defining implementation
modalities and creating capacities at
decentralized levels is crucial for
implementation
• The size of the program at
grassroot level matters: limited
systematic focus on strengthening
capacities of front line workers at
design phase hampered roll out of
the multisectoral collaboration
model
• In a federal system, it is important to
build in accountability modalities at
all levels in the implementation
manuals
2. Importance of reaching out to other
sectors
 Improving service delivery: PSNP
activities being integrated in plans of
Ministry of Labor and Social Affairs
(linkages role) and Health sector
/nutrition specific interventions (and
training for frontlines workers)
 Funding for capacity building:
Ministry of finance (50 million USD)
for capacity building and
multisectoral collaboration (ESPES
program, 2017)

12. Lessons learned (2)
3. Advocacy and action requires data and evidence
• Measuring progress allows to identify bottlenecks early and to seek solutions
• There is lots of evidence and data available on PSNP which can be further
analyzed to guide implementation
 Important role for programs like Compact 2025 and the National
Information Platform for Nutrition, which aim to strengthen capacities to
better use existing data for informed decision making for nutrition -
essential to move successfully from a nutrition sensitive design to
implementation