In the second group session—for mothers of children between 0-24 months—I was greeted by the smiling, mischievous faces of children playing while their mothers listened to a role model mother talk about topics ranging from hygiene and healthy eating to the benefits of mosquito nets and making sure their children got stimulation through play—in sum, all the healthy behavior that goes into making healthy mothers and healthy children.
This program started as a pilot project in selected areas of Djibouti as a result of a grant from the Japan Social Development Fund (JSDF) in 2010, administered by the World Bank. It had put in place a system to prevent vulnerable sections of the population from plummeting further down the spiral of poverty. After positive results, and proof of behavior change early on, the pilot project was scaled-up through another project covering a larger number of beneficiaries, this time funded by the Bank’s International Development Association (IDA) in the Balballa, Obock, and Dikhil areas of Djibouti. This is an excellent example of the important role the JSDF has played in the Bank’s engagement in Djibouti.
The program was a response to the severe drought that affected the region in 2007/2008 and the impact of the global financial crisis. The Bank mobilized substantial funding through IDA’s Crisis Response Window to complement the Djiboutian government’s efforts to boost economic growth through new investments in urban infrastructure, rural development, and human capital. The scaling up of the Social Safety Net program was among those interventions.
Djibouti’s Social Safety Net program differs from many more traditional Social Safety Nets because it mainstreams nutrition-sensitive interventions into a cash-for-work program, seeking to harness the effect of additional household income on children’s nutritional status. The program focuses on poor and vulnerable households with pregnant women and children less than two years old.
The “first 1000 days approach” is based on evidence that malnutrition starts during pregnancy, and that early damage caused by it is irreversible after the child reaches 24 months. Global statistics have also shown that income controlled by women has a greater effect on child nutrition and household food security, than income controlled by men. Communicating behavior change during monthly group sessions and individual home visits aims to effect behavior change to promote health-seeking habits.
The project is managed by the Djiboutian Agency for Social Development under the Secretariat d’Etat chargé de la Solidarité Nationale in close coordination with the Ministry of Health. It is implemented by local organizations at the community level. The interventions started in September 2012, and have since been rolled out geographically. By June 2014, at least 5,400 beneficiaries had attended the nutrition services, while more than 4,440 beneficiaries have been involved in the cash-for-work interventions.
Several surveys have been conducted to assess results in behavior change. We have found, for example, that over 60% of pregnant/nursing women who are program participants have a more diversified diet, or a food regimen with at least four food categories, compared with about 20% in 2011. Similarly, the proportion of women who exclusively breastfed their babies for the first six months of an infant’s life, reached 35% compared with 9% a couple of years earlier. Although this cannot solely be attributed to the program, we are in the process of conducting an impact evaluation to assess the added value of integrating the nutrition with a cash-for-work program. The results will be available early next year.
The program has demonstrated strong results on the ground, helping bring about behavior change with a long-lasting impact. I look forward to continue working with the government of Djibouti and local communities to scale-up the program. This project holds tremendous promise for those most at risk of malnutrition in Djibouti. We are off to a good start.