Challenges

In the Dominican Republic, almost half (45 per cent) of deaths among children under the age of 5 are related to undernutrition. Not only does undernutrition kill, it also prevents children from growing up to live healthy and productive lives as adults, thus leading to an ongoing intergenerational cycle of undernutrition.

The nutrition situation in the Dominican Republic is marked by pervasive micronutrient deficiencies and low dietary diversity, combined with one of the lowest rates of exclusive breastfeeding of children under six months in the region. Poverty, and the inadequate quantity and quality or access to human, economic and institutional resources, is the most important root cause of malnutrition.

Toward a Solution

When the Government of the Dominican Republic reformed its social sector in 2009, it requested WFP support to incorporate a nutrition intervention as a sub-component of the conditional cash-based transfer in the national social protection programme called Solidaridad, based on the premise that investing in nutrition would boost the action of the programme as a whole and achieve better results. This included a blended approach to training, capacity development, promotion of growth monitoring and preventive care for children. The nutrition component is delivered through primary healthcare, as well as through the provision of micronutrient powders to all beneficiaries of the social protection programme aged 6-59 months.

The nutrition intervention component of the Progresando con Solidaridad was first targeted to all children aged 6-59 months of beneficiary families, who were identified as living in moderate or extreme poverty. In 2012, the Government revised the nutrition component of the Progresando con Solidaridad to include interventions addressing child undernutrition and the nutrition of pregnant and lactating women and the elderly by providing fortified complementary foods and primary health interventions.

Programmes like Progresando con Solidaridad demonstrate that social protection schemes with multiple nutrition components can directly contribute to improving diets. For example, they can provide food to beneficiaries through food transfers and school meals programmes. Furthermore, they can facilitate access to primary health care through conditional cash transfers, which encourage the use of health services and enable households to access items for personal and household hygiene and clean water.

Currently, Progresando con Solidaridad?s conditional cash-based transfer component for food consumption targets some 800,000 poor households. From January 2014 to August 2016, the nutrition component served 132,882 beneficiaries of these households (78,882 children, 12,000 pregnant and lactating women, and 40,000 elderly people). In addition, the nutrition component supports 20,000 Progresando con Solidaridad community employees and public health practitioners.

The nutrition intervention methodology of the Progresando con Solidaridad programme includes the following actions:

• Distribution of micronutrient powders to children aged 6-59 months to help prevent and control micronutrient deficiencies;
• Provision of nutrition education to families benefitting from the Progresando con Solidaridad programme to improve their capacity to properly select food and, therefore, improve food consumption and nutrition;
• Strengthening and extending the community volunteer network to reach beneficiaries at the household level, particularly mothers. This helps to ensure adequate consumption of micronutrient powders, fortified and complementary foods;
• Distribution of a specialized nutritious food called Progresina fortificada (Super Cereal plus) to children aged 6-59 months to prevent and control chronic and acute malnutrition;
• Distribution of a specialized nutritious food called Progresina (Super cereal) to pregnant and lactating women and the elderly; and
• Strengthening national and local capacities to carry out monitoring and evaluation activities.

This in-kind assistance component complements the conditional cash transfer part of the programme called Comer es Primero. It supports beneficiaries’ food security with a transfer of roughly USD 16 per month, conditional on the beneficiaries’ participation in preventative healthcare activities, children’s school attendance, head of household attendance at community education sessions and obtaining identification documents.

In terms of effectiveness and validation, an evaluation of the nutrition component of the Progresando con Solidaridad programme, conducted in 2013, found the following:

• 50 per cent reduction in anaemia prevalence in enrolled beneficiary children;
• Improved dietary diversity of targeted families; and,
• Enhanced national and local capacity to reduce undernutrition.

Thanks to these positive results, the Vice President of the Dominican Republic and WFP signed a Memorandum of Understanding in 2013 to implement a more comprehensive nutrition component focused on children under 5, pregnant and lactating women, and the elderly benefiting from the Progresando con Solidaridad programme.

Social protection and safety nets is WFP’s largest focus area for South-South and triangular exchanges worldwide to date. The Progresando con Solidaridad programme was selected for presentation as a successful South-South case study at the Global Forum on Nutrition-Sensitive Social Protection in September 2015. The Forum is a South- South learning platform facilitated by the WFP Centre of Excellence against Hunger in Brazil. Its key objective is to facilitate exchange of experiences and lessons learned on social protection and safety nets through South- South knowledge-sharing. Over 150 participants from 20 countries joined the Forum and learned from the Dominican Republic’s experience.

Progresando con Solidaridad is the Dominican Republic Government’s main strategy for promoting human development and combatting poverty. The nutrient component and government commitment at all levels to deliver has contributed to the programme’s sustainability and replicability. A number of key elements need to be in place to replicate this solution elsewhere: a) a successful existing social protection scheme in which nutrition- sensitive interventions can be incorporated; and, b) a good evidence base to demonstrate the impact of nutrition- sensitive interventions (in the Dominican Republic case, a four-month feasibility study was first conducted in 2009 and the success of this pilot led to national implementation starting in 2010).