Meta-evaluation o ACF’s Emergency Fresh Food Voucher Programmes
ACF commissioned a meta-evaluation o 5 o its resh ood voucherprogrammes implemented between 2009-2011 during emergenciesin Bolivia, Dadaab reugee camps in Kenya, Haiti, Pakistan and theoccupied Palestinian Territories (oPT). The programmes were allpaper cash-vouchers exchanged or resh oods
in local markets. Inthe case o Bolivia, Dadaab and Haiti, the resh ood voucher wasdesigned to complement a general ood distribution. In Pakistan,the voucher replaced general ood distribution ater marketsdemonstrated some degree o recovery. In oPT, the voucher initially targeted those vulnerable to ood insecurity who presumably hadsucient economic resources to meet staple ood needs. Objectivesranged primarily rom increasing dietary diversity and ensuring anadequate diet to reducing micronutrient malnutrition, preventingmortality or malnutrition, and other ood security and livelihoodsobjectives, e.g. reducing negative coping mechanisms. The primary ndings are as ollows:Fresh ood vouchers increased dietary diversity in all programmes, butwith mixed degree o result largely resulting rom aults in design andimplementation that can be better managed in the uture. In the caseo Haiti, dietary diversity only increased marginally (to pre-earthquakelevels which were already poor) in part due to the lack o a generalration which may have led a signicant portion o beneciaries to usesome o their voucher or staple oods. The importance o guaranteeinga staple ood supply either through cash-based interventions and/orin-kind distributions is essential, and lack thereo may have resultedin an increase in acute malnutrition in some project areas during theFFV programme in Bolivia. That said, in three o the 5 countries studieswhere comparisons are possible, the relative cost eectiveness (changein ood consumption) was signicantly higher or FFV compared to in-kind staple ood distribution only. FFV also correlated with lower rateso anaemia (Bolivia), increase in nutritional programme attendance(Dadaab), declines in acute malnutrition (Dadaab and Haiti), andincome replacement and thereore reallocation o income to otherlivelihoods needs and protection o assets (oPT and Pakistan). As thecause (and cure) o acute malnutrition is complex, attribution remainsa challenge. Furthermore, none o the programmes systematically measured beneciaries’ knowledge, attitude and practice (KAP) oa healthy diet. Thereore it is not clear that i simply cash had beenprovided, the programmes could have achieved the same impact aswell as saeguarding the other advantages o CBIs, e.g. fexibility andchoice, dignity and cost-eciency.By-in-large, needs assessments identied poor dietary diversity as aproblem, largely caused by lack o access to resh oods. Whereascausal analysis o acute and micronutrient malnutrition was usually poor with the exception o Bolivia. Where market assessments wererigorous (Haiti, Pakistan, and oPT) and market monitoring systemseective, ACF was much more ecient (and eective) at monitoringsupply, adjusting the value o the voucher, and assessing the impacto the voucher on local markets. Baselines and monitoring remain akey challenge where both process and impact monitoring indicators,tools and systems need to refect a programme’s objectives, and shouldinclude both individual and household indicators o a healthy diet,particularly when the outcome indicator is the child’s nutritional status.The lack o this important inormation makes it dicult to interpretunexpected outcomes such as when pre-FFV household dietary diversity increases presumably due to increased supply, whereaschildren o the same household remain acutely malnourished (Dadaab)and how complementary programmes, such as grants to small shopspost-crisis (Pakistan) can contribute to recovery and income generation.Fresh ood vouchers also demonstrated their utility as a marketsupport mechanism with increase in vendor incomes in all country programmes, particularly benetting women vendors in Haiti andDadaab, recovering shops post-food Pakistan, and the dairy sectorin oPT. Market assessments need to determine not only i markets canrespond to an increase in demand but also how can humanitarianinterventions support markets to recover. To do so equally rigorousmonitoring systems including baselines and appropriate indicatorssuch as monthly revenue, debt levels and/or recourse to credit needto be developed and systematically implemented. The lack o suchvaluable inormation made it dicult to veriy anecdotal reportsin Dadaab, Haiti and Pakistan. Particularly interesting is how anincrease in demand can result in an increase in supply and thereoreimproved ood consumption among non-beneciaries (Dadaab).Other ndings not specic to resh ood vouchers are included in thedetailed report, and consist o the importance o adequate planning,stang, monitoring, and nancial systems that ensure promptpayment o participating vendors. With experience and advancesin technologies these areas are improving. Accountability systemsneed to allow or beneciary eedback and ensure responsivenesso programmes to beneciary and vendor needs. The greatercollaboration between nancial institutions and humanitarianagencies can increase accountability and reduce costs.Fresh ood vouchers appear to be proving their utility as one tool toimprove ood consumption in emergencies, either as a complementto general ood distribution and/or when the voucher includes stapleoods. Fresh ood vouchers also show potential as a complement to,and importantly - when coordinated with - other nutrition-relatedactivities, e.g. supplementary and therapeutic eeding, nutritioneducation and other public health promotion activities, in line with ACF’s Maximising the Nutritional Impacts o Food Security andLivelihoods Interventions. However more analysis based on greaterrigor in nutritional causal analysis, dening objectives and programmelogic (the role o the voucher) as well as monitoring and evaluation isneeded in programmes implemented by ACF and other agencies. Moreexperience with and evaluation o voucher programmes will provideinsight into their appropriateness and their cost-eectiveness as acomplementary means o preventing, reducing or treating acute andmicronutrient malnutrition.
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With the exception o Pakistanvoucher which included staple oods.