Towards advancing children's nutritional intake: Taking stock of evidence-based effective school feeding programs in the Middle East

The International Food Policy Research Institute (IFPRI) in partnership with the Consultative Group on International Agricultural Research (CGIAR) Fragility, Conflict and Migration (FCM) initiative organized a policy seminar titled "Towards Advancing Children's Nutritional Intake: Taking Stock of Evidence-based Effective School Feeding Programs in the Middle East and North Africa". The seminar presented findings from a recent randomized controlled trial, funded by partners from the private sector including HSA Group, and Tetra Pak, on the effectiveness of school feeding programs (SFPs) in emergency and humanitarian contexts.

Bringing together representatives from academia, government entities, and international organizations, the event commenced with Sikandra Kurdi's opening remarks where she highlighted the need to "understand food insecurity and its negative impact has become very noticeable in recent years". She shed light on how research in this field is considered relatively low due to how hard it is to conduct research in conflict-affected regions.

"Malnutrition during school age and adolescence has long-term consequences and for girls, it eventually impacts the survival of their children" stated Dalia El Sabbagh, IFPRI Collaborator during her keynote presentation where she presented the findings from a qualitative evaluation on the feasibility of alternative school feeding models in emergency contexts. She further explained that the main goal of the study was to assess the feasibility, costs, and perceived benefits of different SFPs by reviewing the implemented models that included the Date Bar program, High Energy Biscuits, and Healthy Kitchen in the MENA region. It is noteworthy that according to the focus group discussions conducted with the children's caregivers and stakeholders of the SFPs, the benefits are similar across the three models in terms of their diets and nutrition, health, education outcomes, household budgets, and food security as well as the overall family wellbeing. The empirical findings of the study suggested that hybrid models providing a combination of fortified snacks and healthy meals are cost-efficient, feasible, and acceptable. Finally, Dalia concluded her presentation by shedding light on the importance of improving SFPs to achieve a greater impact on children's outcomes by adding complementary nutrition and promoting a healthier food environment.

Building on the discussion, Hala Suliman, Regional Programme Policy Officer at the World Food Programme (WFP) presented the WFP School Feeding Operations in Emergency Contexts. The WFP's School Feeding Strategy 2020-2030: School Feeding in Emergencies is divided into three contexts. "The first context is implemented in crisis or humanitarian settings, during which, WFP provides operational support to ensure consistent delivery of quality school feeding aiming at increasing the number of children reached by WFP" underscored Hala. The second context is implemented in stable low and lower-middle-income countries where WFP is not only providing school feeding but also helping the government to start take over some of the work so that they can learn what they need to do. Finally, the third context is for middle-income countries where WFP relies more on the government and the organization helps advance national programmes.

"School-age population in Yemen represents 33% of the overall population, yet over 4.5 million Yemeni children of school age do not attend schools" elucidated Hala while presenting WFP's work in Yemen where they helped 35,500 students with 6 million meals in 31 schools during 2018-2023. She concluded that SFPs were a powerful tool for families, motivating them to prioritize their children's education. Hala further explained that attendance rates jumped to 87% and retention rates climbed to 97%, surpassing, therefore, the targets of 85% and 95%, respectively. Among the lessons learned, Hala explained that given the positive results, scaling up the program is important in addition to improving the monitoring and evaluation (M&E) reporting as well as strengthening the linkages with the national authorities since these programs will eventually be managed by the government solely.

HSA Group was presented by Michael Aron, IFPRI's private sector partner on this project presented the School Feeding Milk Initiative in Yemen where he explained that SFPs were a very good way to reduce malnutrition and poor education issues in Yemeni households. He explained the main goal of the study was to understand the impact of the intervention on children's daily dietary diversity and consumption of nutritious foods, school attendance and learning, and mental health, among others.

Building upon the previous insights, Lily Bliznashka, IFPRI's Research Fellow disseminated the findings of the above-mentioned initiative in Yemen. "In 2022, half a billion children under 18 years old lived in conflict-affected zones", noted Lily who explained that the literature on these affected areas are low, which was the main rationale behind conducting this study in a conflict-affected country such as Yemen. Children who took part in the study were randomly chosen to participate, while the selection process was stratified by gender. As per the results of the study, the intervention had a small to moderate positive impact on children's literacy and numeracy scores, however, the larger impact was among girls. Overall, the study had a positive impact on household food security, especially in reducing the prevalence of severe or moderate food insecurity.

In this regard, the seminar entailed a panel discussion tackling the opportunities and challenges of SFPs in the MENA region. During which, Imane Helmy, a Senior Economist at the World Bank emphasized on the importance of building a strong data infrastructure to be able to conduct rigorous impact evaluations and design nutrition-sensitive programs. She touched upon the need to partner with national statistical offices to have indicators and data that provide the information we need related to food insecurity and malnutrition issues. 'Today, the study presented very unique results, among which is the mental health and behavioral pathways which was very well tackled' explained Imane who stated that there is a lack of knowledge in this subject, which is a very interesting subject for the World Bank. Further, she suggested that future studies should include operational lessons: we need to learn more about delivery, supply chain management, institutional arrangements and how to move from production to distribution.

From the donors' perspective, Hala Suliman emphasized the good evidence provided by the RCT findings that WFP can use when they are discussing fundings with the donors, proving the effectiveness of SFPs. She highlighted that although the UHT milk was used in different countries such as Algeria and Philippines, which is safer and has a long shelf life, yet it is expensive, and the nutritional value is not very high. Furthermore, she elaborated that the latter is better than using fresh milk which has more complicated issues (i.e. hygiene, logistics, etc.) which may end in poisoning kids. 'It is good that now we have evidence for emergency settings that goes with WFP standards in terms of how easy we can deliver, and the nutritional value of UHT milk associated with dry snacks' concluded Hala.

In addition, Michael Aron confirmed the importance of collaboration between the government and the private sector while achieving the latter's own interests (i.e. increasing sales and demonstrating the importance of the latest technologies they reached. 'However, the private sector cannot sustain such huge programs and that is why it is important that the governments are fully in control', further explained Mr. Aron who explained how the results were useful during such a short period of time, hoping they could be built on in future studies.

Furthermore, Peiman Milani, the Rockefeller Foundation's Director of the Food Initiative highlighted the challenges that hinder the scale-up of SFPs. Among these challenges is the need for long-term funds, which is not usually guaranteed. From her side, Purnima Menon, IFPRI's Senior Director for Food and Nutrition Policy emphasized the importance of investing in research and the importance of identifying all potential outcomes that we aim to achieve by the end of the intervention while designing the study. She also highlighted the importance of engaging more with private sector entities in this research field and disseminating findings.

Following the panel discussion, experts on the SFPs intervened during a Q&A session, where attendees engaged in a robust discussion on the challenges of conducting RCTs in conflict-affected regions, the challenges of scaling-up, and future considerations to be taken for while implementing future studies.

Written by Ganna Hassan, Research Assistant, Development Strategies and Governance Unit, IFPRI, Cairo, Egypt.

This blog first appeared on the IFPRI Egypt blog.