Accessing local foods through cash or voucher assistance to preventing wasting & managing moderate acute malnutrition
This document is a concise and simplified version of the full report based on an extensive evidence review of how Cash and Voucher Assistance (CVA) can improve access to locally available nutritious foods to prevent wasting and support the management of Moderate Acute Malnutrition (MAM). It provides a high level overview designed primarily for Action Against Hunger (ACF) technical partners, and therefore does not present the full depth of analysis included in the comprehensive report. A longer, fully detailed version—covering complete methodology, findings, in depth analyses and references—is available upon request only. Scientific partners or any stakeholders requiring a thorough understanding of the evidence base and methodological details may request access to the full version from the Action Against Hunger team.
1st January 2024
Action Against Hunger
Given the scale of global malnutrition and the increasing use of Cash and Voucher Assistance (CVA) in aid programming, it was important to evaluate the evidence base to guide future program design, ensure effective resource allocation, and support the development of context-specific strategies that can improve nutritional outcomes for vulnerable populations. This review was conducted to assess how CVA can be leveraged to prevent wasting and manage MAM in children 0-5 months, children 6-59 months, and PBWGs by improving access to and utilization of local, nutritious foods, through what we refer to as “the food route”. This route contrasts with non-food pathways, such as improving access to health services or childcare, and focuses specifically on interventions that enable the purchase or consumption of nutrient-dense foods through market-based mechanisms.
To conduct the review, the authors employed a dual-method approach combining a structured literature review and key informant consultations. The literature review was guided by the PICO framework, focusing on populations at risk of or recovering from MAM, interventions involving CVA for food access, and outcomes related to nutritional status and dietary diversity. Studies focusing only on outcomes related to access to health services, childcare, etc. (referred to as the “non-food route”) were excluded. From an initial pool of 204 records, 55 studies and 7 Literature Reviews were selected based on inclusion criteria such as relevance to the food route, geographic diversity, and publication language. These studies spanned humanitarian and development contexts. Additionally, six key informant interviews and two focus group discussions were conducted with practitioners from international and local NGOs and UN agencies. These consultations helped fill gaps identified in the literature and provided operational insights. However, limitations included a scarcity of studies on MAM management, limited data on PBWGs, and underrepresentation of certain regions (Central and South America, the Middle East, and the Pacific).
The review finds that CVA can positively impact the prevention of wasting and poor growth among children under five. While many studies report improvements in anthropometric indicators and dietary diversity, some others failed to find positive effects. The evidence suggests that effectiveness of CVA varies depending on the modality used—cash, vouchers, or a combination—and whether complementary components, on top of Social and Behavior Change (SBC) interventions are included. There is emerging evidence on the impact of CVA for food on PBWGs nutritional status, with only a few studies addressing their nutritional outcomes. Similarly, the role of CVA in managing MAM is under-researched, with only three studies (including only one study published in a peer-reviewed scientific journal) exploring its use during the management of MAM among children or in preventing relapse.