Fresh Food Vouchers: Tapping Local Markets to Fight Malnutrition

8th January 2010 - The sprawling Dadaab refugee camps of northeastern Kenya are the world’s largest. Hundreds of people arrive every day, seeking safe haven from neighboring Somalia, a country torn apart by decades of violence, as well as Sudan, the Democratic Republic of Congo, and other nearby nations in conflict.

Like many refugees, Dadaab residents rely on dry food rations, comprised mainly of cereals, oil and corn-soy meal, for survival. But while these rations just about meet daily caloric requirements, they fall short of the population’s nutritional needs.

Young children, whose bodies need micronutrients to thrive, are extremely vulnerable to life-threatening malnutrition. Recognising that the condition was rampant throughout the camps, Action Against Hunger launched a ground-breaking pilot programme to provide nearly 18,000 children and their families with the means to consume nutritious fresh foods, ultimately improving their health and reducing their risk of mortality.

The lack of fresh foods in refugees’ diets is not a problem of availability: all three camps in Dadaab contain functioning marketplaces full of vendors, themselves refugees, specialising in the sale of fresh fruits and vegetables, eggs, milk and other fare. (Many of the vendors purchase the food from Garissa, Kenya, where ACF provides local farmers with vegetable seeds and technical support for improved agricultural cultivation.) Rather, the problem lies in the refugees’ lack of income to purchase these highly sought-after products.

Given the proximity of the markets and the availability of local produce, Action Against Hunger saw a clear opportunity to introduce a novel solution: provide eligible families with up to 600 Kenyan Shillings per month (the equivalent of about 21 U.S. dollars) distributed as bi-weekly vouchers, to buy items of their choosing from a predetermined list of fresh foods. After receiving the vouchers, families could redeem them with designated local vendors, who in turn would receive payments from ACF through the Kenyan postal service, PostaPay.

Action Against Hunger found vouchers to be the most cost-effective approach because they require relatively little overhead. And, providing a voucher with monetary value also allows households to free up scarce cash resources for other basic necessities.

“This way, refugees could make their own choices about how to spend the vouchers from among the fresh and nutritious products, which reinforced their self-reliance and sense of dignity,” said Silke Pietzsch, Food Security & Livelihoods Advisor for Action Against Hunger. “And, unlike simply distributing fresh fruits and vegetables to refugees, which can trigger local food prices to drop, this model tapped into existing markets, thereby jolting the local economy by increasing vendors’ profits, supply and customer base.”

Through the programme, Dadaab refugee residents also participated in educational activities on topics ranging from safe food handling and breastfeeding practices to cooking balanced meals for young children.

Still, a key question remained: how to reach the families most at risk of malnutrition among the hundreds of thousands of refugees? Action Against Hunger chose to target families with severely and moderately malnourished children, and mothers with babies between the ages of six months and five years.

“Having such straightforward criteria for inclusion in our voucher programme was critical,” said Lani Trenouth, the Programme Manager implementing the initiative in the Dadaab camps. “Not only did it increase the transparency of the programme, but it also generated a high level of interest among mothers with malnourished children, who voluntarily brought them to nutrition screenings in the hope of receiving fresh food vouchers. This decreased the amount of time we needed to spend searching for children most at risk in the camps.”

“This was the first fresh food voucher programme ever to be established in a refugee camp setting, so we were thrilled to see the positive results,” Trenouth said.

Vouchers contributed to an overall decrease in malnutrition rates in the Dadaab camps and an increase in refugees’ consumption of vegetables, fruits, eggs and other fresh foods.

“Many households adopted a new, more diverse diet consisting of an average of 10 food groups, up from only five to seven before the programme,” she added. “Our health education and cooking demonstrations were wildly successful and helped contribute to this change.”

The voucher programme also provided a measurable boost to the local economy: vendors involved in the programme increased their business profits by up to 45 percent and their stock of fresh produce by up to 60 percent.

While the project was designed to facilitate refugees’ access to fresh foods, it also had the unintended impact of increasing the availability of many fresh fruits and vegetables to the camp community. For example, as a result of the heightened demand for cabbage and kale, for the first time both vegetables are now regularly sold in the local markets.

“We’re now looking for ways to replicate this innovative approach in similar settings,” said Pietzsch. “Ultimately, it’s about empowering people to improve their own health.”