Piloting the First Integrated Child Nutrition and "Workfare" Social Program in Djibouti

October 3, 2016

Good nutrition for pregnant women and infants is essential to lifelong health. In particular, children without proper nutrition during their first 1,000 days – roughly from conception through age two – can suffer irreversible physical, cognitive and behavioral growth damage. The intervention in Djibouti takes an innovative approach to improving nutrition and boosting growth, by twinning a workfare program for women with nutrition-related support for both them and their young children. The evaluation results will improve policymakers’ understanding of whether traditional growth monitoring and nutrition programs are more effective when women in the program also have the chance to earn money they can spend on their families.

Research area: Early Childhood Nutrition, Development, and Health

Country: Djibouti

Evaluation Sample: Pregnant women and their children up to two years of age in poor areas (urban and rural) in Djibouti.

Timeline: 2012 - 2016

Intervention: Community nutrition sessions, workfare

Researchers: Stefanie Brodmann, World Bank; Florencia Devoto, Jameel Poverty Action Lab (JPAL); Emanuela Galasso, World Bank

Partners: Djibouti Social Development Agency (ADDS)Abdul Latif Jameel Poverty Action; Government of Djibouti



In Djibouti, roughly two in five people live beneath the poverty line. The situation has been exacerbated in recent years because of the rise in global food prices and a severe drought that began in 2007 and cut annual economic growth by almost four percent through 2011. Almost a third of the country’s children aged five and under are stunted, a rate comparable to that seen in much poorer sub-Saharan countries. The Government of Djibouti is piloting a workfare program for women, in conjunction with nutrition-focused community meetings, as part of its new safety nets strategy. This evaluation will help the government decide how to scale up efforts to improve nutrition for pregnant women and young children.

World Bank

Intervention and Evaluation Details


A nutritional program targets pregnant women and children up to two years of age; while a public works program, run simultaneously, gives women a chance to earn money they can spend on their children. The program was launched as a pilot in poor areas of Djibouti’s main city, also called Djibouti, and in rural areas around the city.

Nutritional program: Once a month, women participating in the program gather for three hours in neighborhood groups of no more than 20 people. During these sessions, children’s height and weight are monitored by social workers. Discussion centers on themes relevant to health and nutrition, including feeding practices and appropriate growth. Cooking sessions are included, and nutritional supplements are distributed. Any problems detected are pursued in personal follow-up visits or clinical referrals.

Work program: Participants can qualify for public works such as garbage collection, street sweeping and a crafts program. The caregiver has priority for these positions, but can also designate a family member. The jobs last for a maximum of 50 days and pay about $6 per day, about 80 percent of the national minimum wage. A bank account is opened in the name of the participating household member.


The evaluation is non-experimental and uses matched difference-in-difference to gauge the impact of the gradual rollout of the intervention.

The program began its roll out in 2012, with some poor neighborhoods in the targeted areas receiving only the nutrition program, and others receiving the nutrition and workfare component. Because of the roll-out over a two year period – meaning that some qualifying neighborhoods didn’t receive anything that first year -- these neighborhoods were able to act as a control group. After a year, households in this third area qualified for a combined nutrition-workfare program.

The baseline survey was carried out in 2013, with the endline survey carried out in 2015, before the last neighborhoods were switched to receive the intervention.

Policy Impact

The evaluation tests the value of linking a workfare program with nutritional assistance program for women and children. It will help determine the cost effectiveness in terms of improved nutritional practices. In addition, the evaluation will provide information on the constraints, if any, of linking these two approaches and whether women participating in the program are able influence the allocation of the additional income.


World Bank

Making Nutrition Work in Djibouti