The Synergetic Effect of Cash Transfers for Families, Child Sensitive Social Protection Programs, and Capacity Building for Effective Social Protection on Children's Nutritional Status in Nepal

Objective: The aim of this study was to evaluate the effectiveness of the synergetic effect of child sensitive social protection programs, augmented by a capacity building for social protection and embedded within existing government's targeted resource transfers for families on child nutritional status. Design: A repeat cross-sectional quasi-experimental design with measures taken pre-(October-December 2009) and post-(December 2014-February 2015) intervention in the intervention and comparison district. The comparison district received standard social welfare services in the form of targeted resource transfers (TRTs) for eligible families. The intervention district received the TRTs plus a child cash payment, augmented by a capacity building for effective social protection outcomes. Propensity scores were used in difference-in-differences models to compare the changes over time between the intervention and control groups. Results: Propensity score matched/weighted models produced better results than the unmatched analyses, and hence we report findings from the radius matching. The intervention resulted in a 5.16 (95% CI: 9.55, 0.77), 7.35 (95% CI: 11.62, 3.08) and 2.84 (95% CI: 5.58, 0.10) percentage point reduction in the prevalence of stunting, underweight, and wasting among children under the age, respectively. The intervention impact was greater in boys than girls for stunting and wasting; and greater in girls than boys for underweight. The intervention also resulted in a 6.66 (95% CI: 2.13, 3.18), 11.40 (95% CI: 16.66, 6.13), and 4.0 (95% CI: 6.43, 1.78) percentage point reduction in the prevalence of stunting, underweight, and wasting among older children (>= 24 months). No impact was observed among younger children (<24 months). Conclusions: Targeted resource transfers for families, augmented with a child sensitive social protection program and capacity building for social protection can address effectively child malnutrition. To increase the intervention effectiveness on younger children, the child cash payment amount needs to be revisited and closely embedded into infant and young child feeding initiatives, but also adjusted to equate to 20% of household expenditure or more to maximize the diversity of food available to young children.