Egypt's “First 1000 Days” program provides nutritional support for mothers and children (2017–ongoing)

First established in 2017, the First 1,000 Days program is a nutritional and health program that targets pregnant women and children up to the age of two. Beneficiaries are recipients of welfare programs such as Takaful and Karama (a set of cash transfer programs managed by the Ministry of Social Solidarity). The program provides additional cash transfers and nutritional awareness sessions and aims to reduce anemia in women of reproductive age and prevent stunted growth in children under five. Considering the importance of the first 1,000 days in a child’s psycho-social development, the program aims to reduce inequality in outcomes that manifest in a child’s first years.

In 2011, 40 percent of Egyptians faced food insecurity. According to the Household Expenditure, Income and Consumption Survey (HEICS: 2012–2013), the lowest income decile spent 49 percent of their income on food and drink, were forced to adopt negative coping mechanisms, and relied on food with lower nutrients.¹ 35 percent of people were found to have low-quality diets, mainly consisting of cheap, low-quality cereals and food. 

Due to limited access to nutritious food, particularly for women aged 15–49, Egypt reported a 30 percent anemia rate in 2014, negatively affecting both mothers and babies.² Anemic mothers are much more likely to give birth to underweight babies, which can increase the likelihood of “wasting or stunting,” which can have a lifetime impact on the child’s physical development. In 2014, 22 percent of children under five years old experienced stunting (or, a below-average height for their age), while 10 percent suffered wasting (insufficient weight for their height).³

The first 1,000 days of a child’s life are crucial. During this period, their brain, body, and immune system undergo significant development. Malnutrition in this phase often results in stunting, which has irreversible, detrimental impacts on children’s health, academic performance, and future productivity as adults. Hence, in 2017, to mitigate the potentially lifelong impact of poor nutrition on young children, the Egyptian government launched the “First 1,000 Days” program, targeting pregnant and lactating women (PLW) and infants up to two years old. The program contains two components:

1. First, women receive financial support distributed as monthly food vouchers worth EGP 80 (USD 6), which was later reviewed and increased to EGP 111  (USD 8) to PLW enrolled in the Takaful and Karama program in the form of food subsidy ration cards. The ration cards could be retrieved at appointed retailers.
2. Second, mothers receive educational support aimed at emphasizing the importance of providing nutritious meals for their families and equipping them with the knowledge to do so. This component aims to reverse local dietary habits that contribute to poor dietary diversity.

Implementation

The First 1,000 Days program was launched in October 2017, initially in three governorates: Sohag, Assiut, and Qena. Simultaneously, an awareness campaign was initiated. Trained Community Health Workers (CHWs) conducted house visits to Takaful and Karama beneficiaries, promoting the project and encouraging PLWs to register at local Health Centers (HCUs).

When the program was first implemented, the food vouchers were made conditional upon PLW attending regular health check-ups and nutritional awareness sessions. However, in 2019, constrained financing suspended the distribution of food vouchers and limited the program to nutritional awareness sessions. By 2020, the program was integrated into the COVID-19 emergency response, funding was restored and payments were allocated electronically as part of a wider reform to adopt e-payments into the Takaful and Karama program. Additionally, the conditionality was canceled to reduce the risk of spreading COVID-19 in health centers, and food vouchers were replaced with direct cash transfers. Furthermore, the value of the cash transfers was increased to EGP 200 (USD 13), and the program coverage was extended to all 27 governorates.

In 2021, the World Food Programme (WFP) provided training for 400 healthcare workers from the Ministry of Health and Population (MOHP) to improve growth monitoring, micronutrient supplementation, antenatal care, and nutrition counseling services. A further 1,000 community workers from the Ministry of Social Solidarity (MOSS) were trained in health and nutrition counseling in 2022 to promote the use of primary health care services. ⁴ 

In the first year of the First 1,000 Days Program (2018), there were 29,673 food voucher beneficiaries. There were no beneficiaries due to funding constraints in 2019.⁵ When the program re-emerged in 2020, there were 40,548 cash transfer beneficiaries as part of a wider emergency response to COVID-19. In 2021, there were 26,253 cash transfer beneficiaries,⁶ growing to 29,000 beneficiaries by 2022.⁷ Furthermore, between 2018 and 2022, 4.8 million PLW have been given health and nutrition counseling by trained community workers.⁸ 

Cost

In 2018 and 2019, the German-Egyptian Debt Swap financed the First 1,000 Days program, amounting to USD 592,175. The German Egyptian Debt Swap is an arrangement that spares Egypt from paying EUR 54 million in debts, which will be used to finance Egypt’s switch to green energy.

In 2020 and 2021, USAID and Sawiris Foundation financed the program to a total value of USD 9,676,246.⁹ 

Assessment

In a WFP evaluation of the program in 2022, interviewed beneficiaries confirmed that the assistance met their needs and that the health awareness and nutrition sessions were relevant as they taught them how to consume nutritious food and take care of their children’s hygiene.¹⁰ 

While the policy may be effective, there are still major challenges in reaching all PLW women due to a general lack of disaggregated data about pregnant women and children under two years old. Also, as the Takaful and Karama program (through which the First 1,000 Days program is operated) has a lengthy registration process, there is a chance it can miss PLW and newborn children simply through delays in recognizing them. As such, the goal of reducing anemia is not as effective as it could be. Even then, the proportion of women of reproductive age who are anemic has fallen from 30 percent in 2014 to 28 percent in 2019 (latest available data). At the same time, World Bank and UNICEF estimates show that child stunting has steadily decreased from 23 percent in 2014 to 20 percent by 2022.

The integration of the program into the Takaful and Karama social protection scheme has led to the longevity of the program.¹¹ 

The adoption of the First 1,000 Days program by the Egyptian government as an extension to the existing social assistance net is an important step towards reducing inequalities, though it specifically targets mothers and young children. The program fosters sustainable socio-economic development, as healthier and well-nurtured children grow up to become more productive members of society, who in turn, can break the poverty cycle.

Vegetable Market in Luxor, Egypt. ©Adobe Stock/Astrid

Tags

• Children & Youth
• Future Generations
• Gender
• Health
• Middle East & North Africa
• Middle-Income Country
• Morocco
• Social Protection