Effectiveness and Acceptability Evaluation of Adolescent Nutrition CCT Pilot in Pakistan

Introduction Adolescent girls (15-19 years) in Pakistan are among the most vulnerable to anaemia and malnutrition, with over half (54.7%) of them being anemic and living in vulnerable contexts. Among these adolescent girls, particularly those who are out of school, are often being left out by many health interventions in the country. Additionally, a significant proportion of adolescent girls, approximately 2.1 million (9%) are out of school.

The pilot intervention focuses on delivering a package of nutrition interventions to address anaemia and nutrition in adolescent daughters of Kafalat beneficiaries. It includes weekly iron and folic acid supplementations (WIFAS), nutrition education, group counselling sessions, and the provision of Weekly Iron Folic Acid Supplementation (WIFAS). WIFAS will be delivered at quarterly visits. A girl will consume one supplement at the facilitation center and then she will be recommended to consume the remaining 12 supplements, once a week on a fixed day at home. The dose of the supplements is 60mg iron and 2.8mg folic acid and once weekly continuous supplementation is recommended. A quarterly cash transfer of PKR 1,000 will be provided to the mother of the adolescent girl and the conditionality will be based on reporting consumption of WIFAS. It will also require the attendance of adolescent girls and their mothers in the quarterly nutrition education, as well as group counselling sessions at the BISP Nashonuma facilitation centers. The girl is also expected to report on her consumption at the quarterly visit and she will be given 13 more supplements to be consumed once weekly (1st supplement will be consumed at visit). This intervention is aligned with World Health Organization (WHO) recommendations for WIFAS adolescent girls in regions where anemia prevalence among women of reproductive age exceeds 20% [3]. The intervention is being delivered by the World Food Program (WFP) on behalf of BISP at the BISP Nashonuma facilitation centers.

To evaluate the impact of this new pilot program targeting adolescent girls aged 15-19 years, an effectiveness study will be carried out using a mixed-methods evaluation approach, inclusive of qualitative and quantitative research components. This evaluation aims to determine the potential to reduce anemia and to improve adolescent nutrition and equity in access to improved nutrition through the BISP conditional cash transfer program.

Objectives of the study

The proposed baseline and endline evaluation aim to evaluate the impact of the adolescent nutrition interventions and the conditional cash transfer within the CCT pilot program. The study question employing a PICO (Population, Intervention, Comparison, Outcome) framework will comprise adolescent girls of BISP Kafaalat families as 'population', WIFAS, counselling/nutrition education sessions and CCT as 'intervention' improved nutrition status, adolescent girls in BISP Kafalat households without the adolescent WIFAS, nutrition education and additional CCT as 'comparison' and hemoglobin changes, population anaemia prevalence rate (primary), and adolescent nutrition knowledge and attitudes (secondary) as 'outcome'.