Child Grant Programme and the Health and Nutritional Well-being of Under-five Children in the Karnali Zone of Nepal: Assessing the Impact of Integrated Social Protection Services and Trend Analysis in Five Districts: Reanalysis of Secondary Data

The aim of this report is to unearth the effects of linking social cash transfer with capacity building for nutrition on key nutrition outcomes, immediate and underlying causes of malnutrition. As we are in the UN decade for Nutrition, the SDG era and the focus on Nutrition WHA targets there is urgent need to understand from evaluations what is working in order to harness these success stories to increase chances to achieve global targets. The following is at stake due to high levels of malnutrition in Nepal: i) It is estimated that malnutrition in Nepal contributes to about 50% of child deaths which is currently at 38 deaths per 1,000 births and translates to about 25,000 deaths per year. Further reduction in child mortality will be compromised without reducing malnutrition in all its forms; ii) For Nepal to graduate from a Least Development Country, there are three criteria namely i) Income, ii) Human Asset and iii) Economic Vulnerability. Nutrition is central and a key contributor to all the three components of the Human Asset Index; iii) Nepal will become an aging population in the next 30 years with greater than 7% of the population over the age of 65 years. In order for Nepal to reap the its demographic divided, Nepal has to urgently invest in reducing malnutrition and increasing its investment in social and human capital development focusing on; i) children under five years of age and ii) adolescents. The report is unique in its definition of intervention, as integrated social protection services instead of only cash grant. It's important to remember that in this report cash grant programme is part of the integrated social protection which includes i) government social cash transfer, ii) capacity building and behavior change communication for nutrition, iii) systems strengthening for cash grant. This distinguishes is important given that cash grant was only NRs 200. Thus the report is evaluation impact of integrated services and not just of NRs 200. The report has two main themes namely; i) findings from a robust evaluation analysis using diffrence-in-difference to compare changes in outcomes over time between one intervention district (Kalikot) and one control district (Bajhang) and ii) the trend analysis of 5 districts (Jumla, Humla, Dolpa, Mugu, and Kalikot) comparing baseline and endline. The report explores both positive changes and negative consequences of the integrated services focusing on nutrition and health outcomes, immediate and underlying that either improved or deteriorated.