Credit Alert for Good Food: Cash Transfer Programmes Are Boosting Maternal and Child Nutrition in Nigeria
Safiya Shuaibu Isa (Lead writer)
Globally, cash transfer programmes have emerged as a vital tool for enhancing nutrition outcomes, especially for pregnant women, lactating mothers, and children under 5. By directly providing financial resources to these vulnerable groups, these programmes address immediate nutritional needs and the underlying socio-economic factors contributing to malnutrition.
Cash transfers can be conditional or unconditional. The former usually targets a specific objective. Many countries have provided conditional cash transfers to enhance maternal health and nutrition outcomes for children, like in Brazil with the Bolsa Família Programmes, which offers financial aid to low-income families, conditional upon school attendance and health check-ups. In Mexico, Oportunidades (now Prospera) offers cash transfers to families in exchange for regular school attendance, health clinic visits, and nutrition support.
In Nigeria, The Subsidy Reinvestment and Empowerment Programme on Maternal and Child Health (SURE-P MCH) also implemented conditional cash transfers to encourage the utilisation of maternal health services. This initiative increased attendance at health facilities, where women received nutritional counselling and support, contributing to improved nutrition outcomes for mothers and children.
Cash transfers have also been effective in incentivising pregnant women to attend antenatal care (ANC) sessions, deliver their babies in health facilities, and participate in postnatal care. Regular ANC visits offer nutritional assessments, supplementation, and counselling opportunities, leading to improved maternal nutrition and birth outcomes.
In contrast, an unconditional cash transfer programme gives money without any conditions attached, allowing recipients to use it as they see fit.
An example of an unconditional cash transfer programme that targeted pregnant women and women with children under 2 was the Child Development Grant Programme CDGP funded by the UK Government through the Foreign Commonwealth & Development Office FCDO and implemented by Save the Children International SCI and Action Against Hunger Nigeria ACF.
Of cash transfers and improved nutrition outcomes
The nutrition-sensitive social protection programme tackled the economic causes of inadequate dietary intake. It deployed a counselling and behaviour change campaign to influence maternal and childcare practices in Jigawa and Zamfara states between 2013 and 2019. Evaluations of the CDGP indicated a reduction in stunting rates among children by 5.4%, and by 4.8% among children who were severely stunted.
At the time, the 2018 Nigeria Demographic and Health Survey (NDHS)’s key indicators of child malnutrition in Nigeria were 37% for stunting, 7% for wasting, and 22% for underweight all for children under the age of 5. Although malnutrition indices vary across the country, the northwestern region had the highest prevalence of stunting at 57%, while the southeast region had the lowest at 18%. The 2018 NDHS also recorded the stunting rate for children under 5 in Jigawa State at 68%.
The CDGP evaluation demonstrated positive outcomes after its implementation. Presented with this evidence, the Jigawa State government adopted and implemented a Maternal and Child Cash Transfer (MCCT) programme.
Between November 2021 and June 2022, the Jigawa State government allocated approximately N192.96 billion to this programme. The MCCT targeted 5,740 beneficiaries, including pregnant women and lactating mothers, across the state’s 287 political wards.
Each beneficiary received a monthly cash transfer of N4,000, totalling to N32,000 over the eight-month period. The primary goal of this initiative was to address stunting among children under 5 by providing financial support to mothers during critical periods of child development.
Currently in its third phase, the Jigawa MCCT Programme is targeting 8,610 beneficiaries, with each political ward enrolling 30 beneficiaries in a bid to address stunting in children under 5 by focusing on the following activities:
1. Conditional cash transfers.
2. Social behavioural change communication.
3. Infant Young Child Feeding (IYCF) sensitisation at health facilities.
4. Maternal Infant and Young Child Nutrition (MIYN) sensitisation at the ward level.
5. Sensitisation of religious, traditional, and community leaders on Moringa planting and utilisation.
Studies have shown that cash transfer programmes often increase household expenditure on food, particularly nutrient-rich foods like fruits, vegetables, and animal protein. This can improve the dietary diversity and nutrient intake of pregnant women and young children, addressing micronutrient deficiencies and promoting healthy growth and development. The CDGP also reported increased household economic autonomy for women to decide how to spend cash transfers and increased livelihood activities.
Strengthening accountability and impact through legislation
A social protection law backs the Jigawa MCCT programme. This legislation has made it possible for funds to be allocated to the Jigawa MCCT along with other social assistance programmes targeting persons with disability and the other vulnerable groups in the state.
With the enactment of the National Social Protection Policy in 2017, Nigeria has established and coordinated the activities of institutions such as the Federal Ministry of Humanitarian Affairs, Disaster Management and Social Development; the National Social Safety-Net Coordinating Office; and the National Cash Transfer Office.
However, more needs to be done regarding enrolment on the National Social Register targeting beneficiaries and the design and conditionality of cash transfer programmes. Rigorous monitoring and evaluation of cash transfer programmes are necessary to cultivate trust and ensure accountability and transparency of the process.
The ideal situation
Nutrition counselling and education must be included in the design of nutrition-sensitive cash transfer programmes to be effective. Participation in health services due to cash incentives often includes education on optimal infant and young child feeding practices. This education promotes early initiation of exclusive breastfeeding for the first six months and appropriate complementary feeding, which are crucial for preventing malnutrition in infants.
Likewise, studies have shown that combining cash transfers with Social and Behavioural Change Communication (SBCC) significantly reduces child stunting and wasting. The SBCC component educates mothers on nutrition, health-seeking behaviours, and hygiene practices, amplifying the positive effects of cash transfers on child nutrition.
Overall, cash transfer programmes serve as a lifeline for improving nutrition among pregnant women, lactating mothers, and young children. By addressing economic and educational barriers, these programmes contribute to better health outcomes and break the cycle of poverty and malnutrition.
Incorporating cash transfers within comprehensive social protection frameworks, supported by strong policy and multisectoral collaboration, can lead to sustainable improvements in maternal and child nutrition in Nigeria.
