John Gachigi's (Government of Kenya) presentation at the Transfer Project Workshop in Arusha, Tanzania on 3rd April 2019.

1. Government of Kenya
JOHN GACHIGI,
HEAD, SOCIAL ASSISTANCE UNIT
EVALUATION OF NUTRITION IMPROVEMENTS
THROUGH CASH & HEALTH EDUCATION (NICHE)
PROGRAM IN KENYA

2. Background of NICHE Program
• Stunting and other forms of children’s under nutrition, like wasting and
underweight conditions, can be reduced by improving women’s nutrition
during and after pregnancy, early and exclusive breastfeeding, and timely
and appropriate complementary food (UNICEF, 2013)
• Cash transfer programmes can increase consumption and food security,
dietary diversity, and infant and young child feeding (de Groot et al., 2015;
FAO, 2015), but its direct impact on stunting, wasting and under nutrition
remains mixed.
• But interventions entailing both cash transfers and nutritional counselling
have shown a decrease in stunting, underweight and wasting among
children.
• These findings support the underlying premise of NICHE: that providing
additional cash and health information will facilitate positive behaviour
change that will reduce malnutrition, stunting and wasting among children
in targeted households.

3. Objectives of the Study
• To assess causal linkages between the programme
and expected outcomes such as improvements in
growth, food consumption, positive health,
nutrition and hygiene behaviors.
• To evaluate the effectiveness, efficiency and
relevance of CT- OVC, additional CT and
nutritional counselling in targeted households.

4. Study Area
Kitui & Machakos Counties
Arid & semi-arid lands
High levels of Stunting &
Malnutrition(45%)KITUI
MACHAKOS

5. Study Population
Drawn from existing CT-OVC Cash Beneficiary
Households with:
•Pregnant woman
•Child aged 0-24 months.
Total study population was =1500
•Treatment 1139 control 361
1199 pregnant women
1306 children

6. Study Design
Randomized Control Trial
(RCT)
Arms Intervention Strategy
Treatment arm
• CT-OVC Cash Transfer
• Additional Cash only—(USD 5
& USD 10)
• Nutritional Counselling
Control arm • CT-OVC Cash Transfer only

7. Study Methods
Methods
Quantitative
Baseline survey
(1500)
Midline survey
(592 &755)
Endline survey
(794)
Qualitative
FGDs
CFA beneficiaries
(13)
NICHE
beneficiaries (7)
IDI (7)
Knowledge quiz
(794)

8. Results
Anthropometric z-scores
• Difference in Difference results for stunting, wasting and underweight are
positive, but limited
• Children in larger households are more likely to experience underweight
and wasting
• There is an underlying inverse relationship between income and stunting
and underweight
Nutrition
• Exclusive breastfeeding: Treatment households were 7 percent more likely
to practice exclusive breastfeeding
• Complementary feeding: Treatment households were 11 percent more
likely to practice complementary feeding

9. Results
Child Health
• Complete immunization: Control households were 12 percent more likely
to have received immunization
• Routine checkups: Treatment households were 12 percent more likely to
have routine checkups
• Household illness: Control households were more likely to have
experienced malaria (6 percent) or gastrointestinal distress (7 percent)
Pregnant Women
• Dietary diversity: Improved by 32 percent among treatment households
• ANC: Likelihood increased by 41 percent among NICHE participants
• Delivery in a health facility: Treatment households increased from already-
high 88 percent to near-universal of 99.8 percent

10. Discussion
•NICHE is most effective when cash is readily available, relatively
costless and predictable to obtain.
•The biggest gains were made when smaller, more affordable
purchases, such as soap or dietary inputs, were paired with
lessons, such as on handwashing and dietary diversity,
respectively.
•There is a relationship between exposure to NICHE and a range
of healthy behaviours like diversifying diets, establishing
handwashing stations or complementary breastfeeding.
•There is value and relevance of CHV visits and acknowledged
household behaviour change favouring improved hygiene and
diet.

11. Recommendations
• Consider adding an MPESA option, which would avoid problems related to
visiting banks, which can be long distances away and incur extra costs
• Consider providing the cash transfer on a monthly basis, rather than a bi-
monthly basis, and increasing the value of the transfer to align with other such
programmes.
• Encourage CHVs to provide information regarding when they will revisit to
ensure that beneficiaries are present; establish a schedule.
• Bring the beneficiary learning forums closer to the beneficiaries, thus reducing
travel distance and transit time
• Continue to reinforce best practice activities, particularly those that are not
expensive

12. Next Steps on NICHE Program
•Expansion of existing Nutrition-Sensitive Safety Net
benefit to other counties
•Approximately 50,000 individuals in 23,500
households under the Kenya Social Economic
Inclusion Program (KSEIP) will be covered

13. Take Away Points
• Combining counseling and cash transfers improves wellbeing
and positive behavior change
•Treatment households are far more likely to practice enhanced
hygienic, dietary and infant care practices than comparison
households
•Collaboration between NICHE partners and with government
partners facilitated rollout and hence the design of the new
program

14. Acknowledgements
Government of Kenya
The Field Team
Implementing & Funding Agencies

15. Asanteni Sana
Asanteni Sana