Cash ‘Plus’ for Improved Child Nutrition and Parenting: Systematic Evidence Review

Background

Save the Children is a rights-based organization, which delivers both humanitarian and development programming including influencing and supporting duty-bearers such as governments to ensure children’s rights are upheld and needs are met.

Save the Children has a long history of delivering high quality programmes. Through this experience, we have been able to identify and develop solutions to some of the biggest and most common problems children face today. By elevating these solutions, which represent our best work and best thinking, Save the Children has created organisation-wide “Common Approaches,” that ensure we achieve more for children in more places across the world.

The Save the Children definition of a Common Approach is;

“Our best understanding of how to address a particular problem facing children. It is based on evidence; it can be adapted to work in multiple contexts; and it can be replicated in different countries.”

Put more simply, Common Approaches are our best programmatic work. They have been developed by Save the Children, and/or our technical experts, and programme experience have been key contributors to their development. In all cases, our technical experts have agreed that they are the best-known, evidence-based solutions to common problems children face around the world. As such, each Common Approach has documented guidance to inform programme design and guide staff through implementation. Significantly, Common Approaches are not static. They should continue to evolve and improve as new evidence is generated (whether internally or externally), and our experience and learning from implementing each one deepens.

One of Save the Children’s 19 Common Approaches is focused on Cash ‘Plus’ for improving child nutrition, which Save the Children calls, ‘Resourcing Families for Better Nutrition’ (RF4BN).​ RF4BN focuses on the First 1,000 Days of a child’s life to reducing maternal and child undernutrition, in particular stunting and wasting, in development and humanitarian contexts. The approach combines regular cash transfers that are designed and implemented to maximise impacts on nutrition, with a contextually-informed package of social behaviour change communication (SBCC), linkages to basic maternal and child health and nutrition services, and additional context-appropriate, nutrition-specific interventions.

In addition to the RF4BN, Save the Children has been working on developing an approach internally referred to as Child Sensitive Social Protection (CSSP) parenting or cash plus parenting. This approach seeks to strengthen parenting skills that support children’s development along with improving family budgeting practices in households that receive social protection. Additional sessions are added to the package depending on the objective of the CSSP initiative, for example, nutrition awareness, the importance of education and illeffects of child labour. This approach is currently implemented in 6 countries. Given the positive findings that are emerging on child development and the interest shown by governments to adopt this package to make social protection more child sensitive, there is an interest to promote this to become a Common Approach. While a basic evidence review has been carried out, there is a need for a more thorough review and also to summarise this into an Evidence Synthesis Narrative.

We are seeking consultant’s support for systematic review of the evidence and learning related to the RF4BN approach along with systematic review of evidence in the cash plus parenting approach, component based on SCI’s Common Approaches Evidence Framework.

Objective

In order to ensure that Save the Children Common Approaches remain the best understanding of how to address particular problems facing children, each Common Approaches undergoes routine evidence reviews. At a minimum, the review and update process takes place every fourth year of implementation, and;

1. Reviews the evidence and learning related to the approach, both internal and external. This covers both development and humanitarian context.
2. Determines whether or not the Common Approach needs to be updated, based on this review,
3. Updates the Common Approach, if needed.

The last evidence review for RF4BN Common Approach took place in 2018.

Evidence Review Focus

The focus of the evidence review process should be on new evidence, and the lessons learned from that evidence, which have emerged over the preceding three years, 2019 – 2022. The review should consider use of multiple appropriate methods to be the “gold standard” for rigorous evidence. Therefore, evidence related to Common Approaches can be obtained from a multitude of sources, such as

• Peer-reviewed journals
• Non-peer reviewed articles
• Reports and evaluations (aka ‘grey literature’) and experiential evidence
• Professional conference papers
• Experiential evidence
• As well as reports and small-N case studies

The consultant should use the SCI’s “Common Approaches Evidence Framework: Systematic Review Guidance”. This review process should be guided by the six Common Approaches Evidence Framework (CAEF) criteria:

• Effectiveness: the effect for the target population on the primary outcome(s) – strongly positive, mildly positive, no effect, mildly negative or strongly negative (the determination of what is strong/mild will need to be tailored to each intervention, and should be defined relative to what is considered achievable in the relevant field;[1] the rationale for the determination should be made clear in the narrative synthesis document)
• Acceptability: whether there is evidence of objections, resistance to or disengagement from the intervention from some or all of the population that have not been mitigated, such that the intervention could not be implemented as planned
• Safety/risk: whether, after mitigating measures have been undertaken, the intervention directly or indirectly causes harm or places at risk some or all of the affected population or implementers, including local staff
• Equity: positive evidence of key dimensions of equity and their implications being considered in intervention design or no evidence of key dimensions of equity being considered in design
• Scalability: delivered at scale effectively or not delivered at scale or not delivered effectively at scale
• Cost-effectiveness: cost per outcome or cost-benefit analysis should be recorded, rather than judgements on cost-effectiveness (which will primarily be comparative)

Using the Evidence Matrix Template or specific software such as Mendeley, each study should be tagged in relation to findings against each CAEF evaluation criteria, with additional notes or explanations as necessary (the same study may be mentioned for multiple criteria). In addition, the sources (i.e. peer-reviewed published literature, grey literature and), methods used, context covered, quality of evidence and type of outcomes assessed should be tagged for completeness. To be considered rigorous, each design, approach and method used to obtain evidence should adhere to recognized research and evaluation, as well as ethical standards, and the evidence should be triangulated. Once the body of evidence has been assessed against the rubrics for the six criteria, the level of existing evidence in support of the approach is updated using the Common Approach Assessment Rubric.

• The Common Approaches Evidence Framework is guided by the following principles: Rigour
• Triangulation
• Voice and Inclusion
• Contextual Relevance

Review and Update Process

The review and update process is comprised of three broad stages:

1. Review: The review of the evidence and learning from the past three years, 2019 – 2021.
2. Decision: A decision, based on the findings of the review, about whether the Common Approach needs to be updated or not.
3. Update (if needed): Updating of the Common Approach and/or the relevant Common Approach materials and guidance to reflect the new evidence and learning.

[1] For example, it is recognised that only small changes in stunting prevalence are achievable in typical 3-5 year nutrition projects, so a “strong” effect would match strong results found in the best programmes in this field.

Review Stage Key Steps

1. A search of the published literature for new/emerging evidence. The extent of this search will depend on the Common Approach and the extent to which a systematic review of the evidence has been done previously.
2. In case it does not show up in the above search, a review of any new learning and/or guidance notes relevant to the Common Approach issued over the past three years by global bodies (e.g. WHO, UNICEF).
3. (If relevant) A scan of the results achieved by other organizations using the Common Approach or a similar approach, and how these compare to the results Save the Children is achieving.
4. A review of the relevant Save the Children evaluations, including those in Save the Children’s internal Evaluation Repository.
5. A review of other relevant internal research studies, especially any related to the Common Approach learning agenda, as well as conference papers, reports etc.
6. A review of learning from the implementation of the Learning Programme Silver course.
7. A survey and/or key stakeholder interviews of country office staff who have/are implementing the Common Approach, in order to get their learning from their use of the Common Approach, and/or to validate any new emerging evidence.
8. Consideration of other potential gaps in the Common Approach guidance, given any shift in agency priorities over the past three years (e.g. related to cross-cutters).
9. Documentation of the key findings from the review, including what the implications are for the design and delivery of the Common Approach.
10. Validation of the review findings with Save the Children’s Child Sensitive Social Protection Techincl Working Group, if a different group conducted the review.

Decision Stage

• Once the findings of the review have been shared with and discussed by the relevant TWG, it is the TWG co-leads and/or the Head of Programmes that decides whether or not the Common Approach and/or the relevant guidance and materials should be updated as a result of the findings.
• This decision, and the findings of the review, should be shared and discussed with the relevant TLG.

Update Stage

Decision not to update

If the decision is made not to update the Common Approach and/or the Common Approach materials, the following are the expected outputs:

• A summary of the main findings from the review to be shared with key stakeholders (e.g. via Communities of Practice) and posted to the Common Approach OneNet page.
• An updated Evidence Matrix and Evaluation Criteria Rubric and Tool for Common Approaches endorsed after 2020. An updated Light Touch Review Assessment Tool, with citations of the new evidence found (as appropriate), for Common Approaches endorsed prior to 2020.
• An updated Evidence (heat) Map if the new evidence is such that the strength of evidence for any of the six criteria has changed.

Outputs and Deliverables

1. A narrative summary synthesis of the evidence and main findings from the review, and the updates made as a result. This summary must be included in the Comprehensive Overview as an annex (e.g. “Key findings and updates made to the Common Approach as a result of the 2022 review process”). A separate evidence synthesis narrative is to be produced for the proposed CSSP/Cash plus parenting Common Approach (based on the CA templete)
2. An updated Evidence Matrix, Evaluation Criteria Rubric and Tool or an updated Light Touch Review Assessment Tool with citations of the new evidence.
3. An updated Evidence (heat) Map, if the new evidence is such that the strength of evidence for any of the six criteria has changed.

If the decision is made to update the Common Approach and/or the Common Approach guidance, the following resources should to be updated;

1. Update Common Approaches materials, as appropriate:
   • RF4BN Comprehensive Overview document
   • RF4BN 2-page Overview

Team and Selection Criteria

The review can be conducted by an individual consultant or by a team of consultants with a lead consultant. To be considered, the team member(s) must have demonstrated skills, expertise, and experience in:

• Conducting strategy reviews on topics related to children’s wellbeing
• Sound understanding of the different methods of impact evaluation
• Demonstrated familiarity with social protection/CSSP, Nutrition and ECD
• Conducting ethical and inclusive studies involving marginalised, deprived and/or vulnerable groups in culturally appropriate and sensitive ways
• Managing and coordinating a range of government, non-government, community groups and academic stakeholders