UNICEF Mozambique shows how 'cash and care' accelerate child well-being

Nampula, Mozambique - The strong November sun is shining over the field at the village center in Mecuburi Sede, Nampula Province, Mozambique. It is still early morning, but no one is sleeping in. During the past days, both early mornings and late evenings, government staff, community leaders, civil society organizations, social workers, nurses, community activists have been working hard to prepare for this day. It is the start of the Social Action Fair, an annual event organized by Mozambique’s Ministry of Gender, Children and Social Action (MGCAS) in collaboration with provincial, district and community actors. Its purpose is to showcase and promote the various social services available to citizens. But this year, the event includes an extra, very special feature. At the village center, under lush tamarind trees, 266 women are patiently waiting for the event to start. In their arms, on their hips, or on their back, they are all carrying newborns, wrapped in colourful ‘capulana’ fabrics. In a few minutes, they will be receiving their first monthly cash transfers, delivered thanks to a recent expansion of the Government of Mozambique’s Child Grant programme for children aged 0-2 years.

“With this money, I hope that I will be able to buy food and clothes for my little girl, and also to buy nutritious food for myself so that my milk is healthy and strong for the child”, says 23-year-old Sonia, who is waiting for her turn to receive the grant for her 3-month-old daughter, during the Child Grant expansion launch in Mecuburi. A government technician counts out the subsidy to which Sonia is entitled, 1080 Meticals, (~18 USD), before handing over the monthly payment.

The Child Grant, targeting children aged 0-2 years, constitutes a key part of the Government of Mozambique’s social protection strategy and a component of the Basic Social Subsidy Programme (PSSB). The PSSB is implemented at national, provincial and district levels, with the aim of strengthening Mozambique’s basic (non-contributory) social protection system, targeting vulnerable populations in the country.

Since 2017, UNICEF has supported the Ministry of Gender, Children and Social Action (MGCAS) and its operational arm, the National Institute of Social Action (INAS) in the design, implementation and evaluation of the pilot phase of this cash-plus programme, named ‘Subsidio para a Criança de 0-2 anos’ in Portuguese. The pilot phase was initiated in September 2018 and reached 15,345 children in four districts in Nampula, one of the poorest provinces in Mozambique, with the largest child population. The pilot was financed by Sweden, the UK and the Netherlands through the UN Joint Programme on Social Protection.

“This programme is unique, because of its comprehensive “Cash and Care” design. The typical ‘cash plus’ model includes behaviour change communication for stunting reduction. But this programme also has a strong case management component,” says Maki Kato, Chief of Social Policy at UNICEF Mozambique.

The programme includes three main components which together make up the “Cash & Care” model. The first component is a cash transfer of approximately 540 MZN (approx. 9 USD) per month (paid on a quarterly basis), distributed unconditionally throughout the year to primary caregivers of children between 0 and 2 years old in targeted districts. The second component of the model focuses on social behaviour change communication (SBCC) on nutrition, WASH and childcare practices, implemented by community social protection volunteers, known in Portuguese as Permanentes. The third component of the model is a case management component, offered to beneficiary households classified as most vulnerable to common protection risks, based on a rapid assessment implemented at the time of enrolment.

“By design, this is done in a way that requires strong coordination, collaboration and joint implementation with other sections. The case management component is managed by the Child Protection section, through their expertise. I think this is unique, a real integrated approach where we are using the cash transfer as a platform to reach vulnerable families with the necessary support”, says Kato.

Another key to success was to not create something new for the SBCC package, but rather to use the same approach that is already being implemented through community health workers and healthcare staff all over the country. The programme uses a community-based approach, in which a simplified information package from the Ministry of Health is disseminated by the community social protection volunteers at cash distribution points.

In addition to internal coordination, ensuring government ownership and developing capacity at the field level is essential. “There is special attention to the level of coordination at the provincial, district and community levels, and we managed to establish healthy coordination with the INAS Delegations and the whole implementation chain was aligned. I believe that this dictated the success of the implementation of the Pilot phase”, says Gerson Nhancale, Social Policy Officer based in Nampula Province.

To influence and inform expansion, the pilot was accompanied by a rigorous impact and process evaluation over 24 months (2019-2021), which measured results on target children, main caregivers (mothers), households and older children in the household.

“To be honest, I was quite concerned about what would come out of the report. I had not expected to see such positive results” says Maki Kato. “We faced so many challenges during the pilot; payments were irregular,  during the first year. The care component started only after payments had started due to delays in government approval. And of course COVID-19 on top of that... I was preparing myself for limited impacts.”

Besides a reduction in poverty, and increases in savings and household expenditures, which are common results of cash transfers, we saw several positive and more rare impacts. Some examples included a sharp increase in birth registration, an increase in dietary diversity and frequency of meals of target children, a decrease in stress, depression and experience of intimate partner violence among caregivers, and, to the surprise of most sceptics of cash transfer programmes, a reduction in pregnancies.

“During the implementation of the pilot phase of the programme, we witnessed some important decisive changes in the family environment: mothers gained self-esteem, which pushed them to take better care of their children, and through the information from the INAS staff they learned how to prepare and feed their children appropriately so that they grow up healthy and nourished”, says Gerson.

This clear evidence in the form of hard data and qualitative reports from the field level, together with strong donor support, was crucial for convincing the Government of Mozambique to expand the Cash Plus programme, representing a key moment of success for UNICEF, but most of all, for the children of the country. The programme will be expanded gradually, giving priority to provinces with high rates of poverty and malnutrition. Between 2022-2024 the government plans to reach about 250,000 families with children aged 0-2. The expansion is financed by the United Kingdom, Canada, Finland, Sweden, KfW and the World Bank, demonstrating strong donor engagement and commitment.

It is Monday morning, and at the Child Grant expansion launch in Mecuburi, the mood is festive. The catchy “Subsídio Para a Criança” song is bursting through the speakers at the village centre. Through a ceremonial moment, the Vice Minister of Gender, Children and Social Action, H.E Lucas Mangrasse, officially launch the programme and handed over the cash to the first mother in line.

As she receives her first payment, Nilsa, 18 years old, explains that in addition to food for her baby, she hopes to be able to buy a plastic sheet to cover the roof of her house to provide shelter from the rain. She considers it to be an important help in starting her life as a mother.

As the sun sets, we leave Mecuburi with a sense of relief, gratitude, and excitement about what is to come. The event truly showed the power of collaboration in social protection. Graciano Langa, Social Policy Officer at UNICEF in Maputo, explains:

“It was very rewarding to see a smile of gratitude on the faces of the mothers of children benefiting from the child grant. All the effort and dedication of all the team involved with the implementation of the program paid off and it was worth it” Graciano has been working with UNICEF since 2019 and has followed the programme development closely.

According to Kato, the event brought mixed feelings. “It was emotional. I felt a sense of satisfaction, seeing the excitement of the community and the government officials, especially INAS, being so happy and proud - it really was a happy moment. But at the same time, I felt a sense of urgency, because this must expand even more. You know, Mozambique is such a young country, with so many children and such high levels of poverty and vulnerabilities... So much more needs to be done. We are only in the initial phase. But it is an important step forward.”