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Good nutrition for pregnant women and infants is essential to lifelong health. In particular, children without proper nutrition during their first 1,000 days ¨C roughly from conception through age two ¨C can suffer irreversible physical, cognitive and behavioral growth damage. The intervention in Djibouti took an innovative approach to improving nutrition and boosting growth, by twinning a workfare program for women with nutrition-related support for both them and their young children. The evaluation results are helping improve policymakers¡¯ understanding of whether traditional growth monitoring and nutrition programs are more effective when women in the program also have the chance to earn money they can spend on their families.

Problem

Extreme poverty defines life for many families in Djibouti. Government data from 2013 indicates that more than one-fifth of the population in Djibouti lives in extreme poverty and cannot cover basic food needs; rates are much higher in rural areas, where some 44 percent of people live in extreme poverty. The impact is especially harsh on young children.  About one-third of children under the age of five suffer from chronic malnutrition and are stuntion¡£

Intervention

The Govern?ment of Djibouti started piloting growth monitoring for children with monthly nutrition classes for mother in 2012, adding a temporary employment component in 2014 for pregnant women and mothers of young children. Women learned about the importance of good nutrition and they had the opportunity to earn money that could be used for food or other necessities. Workfare runs for 50 days; nutrition meetings are monthly for three hours each time.

Evaluation design

The evaluation was non-experimental and used matched difference-in-difference to gauge the impact of the gradual rollout of the workfare intervention. By the time it started, all households in the sample had been exposed to the nutrition program.

Eligibility

Pregnant women and mothers of children up to two years of age.

Results

The evaluation showed that women were eager to work, and when they did, their children ate more nutritious food. Rates of exclusive breastfeeding increased. However, there were no changes in rates of malnutrition.

Policy impact

The Government of Djibouti has expanded the program to more parts of the country.

Next steps

The results are helping the Government of Djibouti determine what changes may be needed to refine and improve the program, while providing important evidence on the cost-effectiveness of integrating these two approaches.

Additional impacts on policy decisions and program design

• The nutrition program is now being delivered through cooperation between the social and health sectors.
• To expand help for the poorest, a national cash transfer program is being introduced nationwide. The transfer will be equivalent to 75 days of workfare.