The “Plus” in the Ep Fet Po Cash-Plus Program and its Role in Building Human Capital for Early Years in Sierra Leone1 1. Introduction While there has been some economic progress (pre COVID-19), Sierra Leone still has some of the lowest human capital outcomes in the world. Since emerging from a decade long civil war in 2002, the economy has been on a challenging recovery path with multiple shocks. Between 2016 and 2019, Sierra Leone experienced an average economic growth of 4.7 percent. However, per capita income growth continued to lag behind GDP growth as a result of low investments in physical and human capital and high population growth of 2.1 percent per annum.2 The above have also impacted poverty reduction with over half of its population still living below the poverty line and the poverty rate in rural Sierra Leone is more than double that in urban areas.3 Development indicators in the areas of education, health and nutrition are amongst the lowest in the world. For example, the World Bank’s Human Capital Index shows that a child born in Sierra Leone has lower chances of surviving to the age of five, worse test scores in school, and poorer health outcomes and survival in adulthood compared to a child born in an average low-income country or an average country in the Sub-Saharan African Region.4 There is also large inequality in health outcomes among wealth groups. More than 30 percent of children under 5 years in the two lowest consumption quintiles are stunted compared to 18 percent in the richest quintile.5 Similarly, the population residing in rural areas and areas outside of the Western Region have achieved lower human capital outcomes. The Government of Sierra Leone (GoSL) prioritizes building human capital, including through social protection interventions. “Human Capital Development” is the first Policy Cluster in GoSL’s Medium-term National Development Plan (MTNDP) 2019–2023. Under this cluster, GoSL focuses on Ensuring free quality basic and senior secondary education; Strengthening tertiary and higher education; Accelerating health- care delivery; Enhancing environmental sanitation and hygiene; Increasing social protection; and Advancing housing and land management. Through these policies, the country aims to sustainably transform its economy and achieve middle income status by 2039. In line with this prioritization, together with its development partners, GoSL is implementing interventions aimed at reducing poverty and building human capital. Notable among these interventions, is the flagship social protection (SP) program, Ep Fet Po6 cash transfer program, financed through the Social Safety Net (SSN) Project. Through the SSN Project, Sierra Leone has established the key building blocks for a national SP system with the aim to respond to the challenges in human capital development. The SSN Project, launched in 1 This note was prepared in the period of February to May 2021, by Steisianasari Mileiva (Social Protection Specialist, World Bank) and Rashida Ibrahim (Early Years Fellow, World Bank) with inputs from Hannah Buya Kamara and Tumainiel Ngowi (Social Protection Consultants, World Bank), under the overall supervision of Junko Onishi and Abu Kargbo (co-Task Team Leaders of the SSN Project and Sr. Social Protection Specialists). The content of this final version was presented and discussed among SSN Project stakeholders during project implementation support mission on May 12, 2021. 2 World Bank, Sierra Leone PER 2021, forthcoming. 3 Statistics Sierra Leone/World Bank. 2019. “Methodology for Consumption-Poverty Estimation, 2018 and Poverty Trends, 2011- 2018, in Sierra Leone.” 4 World Bank Human Capital Project: Sierra Leone, 2020 retrieved from http://databank.worldbank.org/data/download/hci/HCI_1pager_SLE.pdf?cid=GGH_e_hcpexternal_en_ext 5 Insert reference; check Project Paper 2019. 6 Local language, Krio, for (Krio for “help to fight poverty”) . Page 1 of 21 2014, has established a basic national safety net system7 and as of December 2020 close to 200,000 persons from approximately 32,000 extremely poor households across 10 districts have benefited from the cash transfers. Over 90 percent of the cash recipients are women and since 2019, it has an additional focus on reaching Persons with Disabilities (PWDs). Since its inception, the Ep Fet Po cash transfer program has positioned itself in the cash-plus program category, complementing its unconditional cash benefits with beneficiaries’ participation in information sessions, among others, on health and nutrition. The project is implemented by the National Commission for Social Action (NaCSA) in partnership with the Anti- Corruption Commission and Statistics Sierra Leone. In addition to GoSL resources, the project has received financial and technical support from the World Bank, United Nations International Children’s Emergency Fund (UNICEF), Foreign, Commonwealth and Development Office (FCDO) and the European Union. See more details of the SSN Project in Annex 1. Around the world, including Sierra Leone, governments are leveraging cash transfer programs to reach the poorest by complementing cash benefits with additional services (“cash-plus”8) to boost human capital outcomes. Cash transfers have been an effective tool for addressing poverty.9 Typically, targeted cash transfer programs provide governments with a platform to reach the poorest and most vulnerable in the country. The impact of cash transfer programs alone extend well beyond improving consumption outcomes and include increasing beneficiaries’ uptake of health services, school enrolment and dietary diversity.10 Nevertheless, having these cash transfer programs as cash-plus can enhance impact on human capital outcomes by addressing constraints such as inadequate access to human capital messages/ information and access to public services and often by promoting inter-agency collaborations.11 Cash-plus programs can be characterized as SP interventions whereby regular cash transfers are provided with provision of information (e.g. behavioral change communication or sensitization meetings), additional inputs and services (e.g. asset transfer, micronutrient supplement, coaching/training) or linkages to other sectors (e.g. agriculture, education, finance, health, etc.) that seek to augment income effects realized by the cash benefits.12 Despite often challenging implementing contexts, countries in Sub-Saharan Africa are successfully implementing cash-plus programs at varying scope. Many countries such as Madagascar, Mali, Niger and Senegal have implemented “plus” components focused on supporting maternal and children’s wellbeing through multiple delivery platforms, frontline workers and with wide range of impacts. For example, in Madagascar, some cash transfer beneficiaries lead monthly group sessions on parenting practices while in Senegal the cash transfer program linked up with outreach workers from a nutrition program to provide 7 A basic national safety net system consists of, among others: targeting mechanism to select beneficiaries, management information system (MIS), payment mechanism (typically a third-party payment service provider), monitoring and evaluation and grievance-redress mechanism. 8 These additional services are also commonly referred to as “accompanying measures”, “co-responsibilities” or “soft-conditions” and more often for unconditional cash transfers whereby provision of cash is not conditional to fulfilment of specific verified actions such as children’s enrolment in school or pre-natal visits to health center. 9 Bastagli, F., Hagen-Zanker, J., Harman, L., Barca, V., Sturge, G. and Schmidt, T. 2016. Cash Transfers: What does the evidence say? A rigorous review of programme impact and the role of design and implementation features. London: Overseas Development Institute. 10 Baird et al. 2014. Conditional, unconditional and everything in between: a systematic review of the effects of cash transfer programmes on schooling outcomes; Bastagli et al. 2016. Cash Transfers: What does the Evidence say? 11 Arriagada et al., 2018. 12 World Bank, State of Economic Inclusion Report 2021; Rawlings 2020 discussion paper; Grosh, Margaret, Julieta Trias, Ruslan Yemstov, and Ian Walker. 2018. “The Contribution of Social Protection and Jobs to Human Capital Formation”. Washington, DC: World Bank; Roelen, K., S. Deveureux, A. Abdulai, B. Martorano, T. Palermo, and L. Ragno. 2017. “How to Make ‘Cash Plus’ Work: Linking Cash Transfers to Services and Sectors.” Innocenti Working Paper 2017-10, UNICEF Office of Research, Florence. Page 2 of 21 beneficiaries with individual and group-based counseling (see more details in Annex 2). The “plus” component in Ep Fet Po program provides information on beneficiaries’ rights and responsibilities as well as health and nutrition through group-based sensitization meetings during payment days, led by trained community workers. Most recently, driven by GoSL’s focus on human capital development during the early years, Ep Fet Po added a focus on early childhood development into its range of sensitization topics and plan to provide take-home behavioral change posters to its beneficiaries. 2. Objectives This note aims to compile emerging anecdotal evidence and operational lessons of the “plus” component of Ep Fet Po, to propel more evidence building in this area. Throughout the years, implementation modalities and a range of topics of the “plus” component have evolved alongside emerging anecdotal evidence and operational lessons. However, there is yet an exercise to bring them all together and discuss the progress to date coherently. This note will be expected to serve as key additional knowledge on this front and by doing so illustrate the extent to which Ep Fet Po conforms with other cash- plus programs in the effort of building human capital, especially in the early years. Furthermore, through the review, this note will draw recommendations to strengthen the “plus” component of the Ep Fet Po Program and further enhance the impacts of the Program. 3. Methodology This note is based on a desk review of relevant reports and project documents that discuss the Ep Fet Po’s “plus” component, analyzing them against select literature. Over the years, pieces of data and information have been generated on the “plus” component as part of SSN project monitoring and assessments. A timeline assessment led to the proposed framework consisting of three distinct phases of the evolution of the “plus” component. Then, key design features in these three phases were mapped following what has been done for other countries in Rawlings, et al. 2020 and other relevant elements. In the absence of impact assessments, anecdotal evidence of results from existing reports13 were captured. In order to understand the level of focus on the early years (0-5 years old), another mapping exercise was conducted for all human capital messages that build the “plus” component in Ep Fet Po. 4. Three Phases of the “Plus” Component in Ep Fet Po The Ep Fet Po cash-plus program has been a key part of the SSN Project since its inception in 2014. The Ep Fet Po is an unconditional cash transfer program, providing quarterly cash transfers to its targeted beneficiaries. Since its launched, it was designed as a cash-plus program with provision of educational information alongside the cash benefits. In the SSN project appraisal document (2014), the provision of information was referred to as “soft-conditions”14 in the form of attendance to workshops to reinforce human capital investments. The provision of information aimed to further encourage beneficiary households to invest in human capital and adopt good practices (e.g. on health and nutrition, child care, water, sanitation and hygiene, as well as other topics including the importance of starting schooling at the 13 Among others, the SSN Project Aide Memoires, Post-Payment Monitoring Report (2019), and Draft Implementation Completion Report for 2014-2019 period of the SSN Project. 14 As in many other unconditional cash transfer programs, soft conditions mean that the transfers of quarterly cash benefits will not be dependent on fulfilment of these conditions and there will not be any punishment or dropping of beneficiaries who do not meet these conditions. Page 3 of 21 appropriate age).15 This design follows the cash-plus programs’ theory of change that establishes a pathway combining income support and the “plus” components toward achieving multiple human capital outcomes, as depicted in Figure 1. Figure 1. Theory of Change for Cash-Plus Programs Source: Grosh, Margaret, Julieta Trias, Ruslan Yemstov, and Ian Walker. 2018. “The Contribution of Social Protection and Jobs to Human Capital Formation”. Washington, DC: World Bank Throughout the years, the “plus” component in Ep Fet Po has remained in the form of provision of educational information, with developments, among others, in the delivery modalities and the range of topics. There are three distinct phases of the evolution and developments of the “plus” component. The first phase focused on the development and delivery of the beneficiary workshops during the quarterly cash payments between 2016 and 2019. The second phase started during the preparation of the second additional financing for the SSN Project in 2019, whereby two additional topics, namely on early childhood development and sexual and gender-based violence, were added to the beneficiary workshop reflecting increasing priority of the GoSL in these areas. Also, there was a commitment to increase the frequency of the delivery of workshops not only during quarterly payments but also in each of the months between payments. The third phase started in mid-2020 with the COVID-19 pandemic. Social distancing and other health prevention measures led to a decision to minimize group-based gatherings and to re-package key messages across the different topics of the “plus” component into a behavioural change communication campaign. See more details in Table 1. 15 Sierra Leone Social Safety Net Project Appraisal Document, 2014. Page 4 of 21 Table 1. Three Phases of the “Plus” Component in Ep Fet Po and Their Key Design Features Phase 1 Phase 2 Phase 3 Year 2016-2019* 2019-2020 2020 onward Name Beneficiary Workshop Behavioral Change Workshop Behavioral Change Communication Campaign Target All cash transfer recipients All cash transfer recipients All cash transfer recipients as well as population communities at large Topics/ Module 1: Program Information & Module 1: Program Information & All five modules as mentioned in Modules Beneficiaries’ Co-Responsibilities16, Beneficiaries’ Co-Responsibilities, Phase 2 as well as some COVID-19 Module 2: Health, Nutrition and Module 2: Health, Nutrition and information. WASH, Module 3: Financial Literacy WASH, Module 3: Financial Literacy and Income Generation, Module 4: Early Childhood Development, and Module 5: Sexual & Gender-based Violence Delivery Group-based, during quarterly cash Group-based, monthly, with Take-home poster summarizing key modality payments sessions during cash payments and behavioral change messages, walk- outside payments through of the topical posters during quarterly cash payments; and delivery of the messages through other communication channels such as radio jingles and radio/TV discussions Trainers/Frontli Trained Community Identification NaCSA District Ep Fet Po payment teams for the ne Workers Committees (CICs)17 and Community Coordinators/Officers for topic (i) walk-through of the posters Health Workers (CHWs) above and Contracted Implementing Partner for the rest of the topics/modules Training/facilitat Pictorial flip chart (called “job aide”) Pictorial flip chart with guiding texts Behavioral change poster ion tools without guiding texts on the side facing frontline workers SBCC strategies Discussions and demonstrations Discussions, demonstrations, group Discussions, potential recall through exercises (games, role play), peer- take-home posters and radio learning messages Trainer’s SLL 50,000 for CICs and SLL 150,000 To be part of implementing Not applicable incentives for CHWs18 per delivery to each partner’s cost assigned beneficiary group M&E approach M&E strategy developed in To be developed by implementing Tracking of take-home posters to be Handbooks with reporting template partner; M&E strategy developed in included in payment tool for trainers; key questions included Handbook; draft monitoring tool (integrating the tracking of both cash in oversight monitoring and post- developed for oversight monitoring and “plus” benefits), key questions payment monitoring surveys and team included in oversight monitoring and SSN rapid assessment post-payment monitoring surveys 16 The co-responsibilities were introduced as the following: (a) children under 5 years old to have full immunization/vaccination, (b) children to attend basic schooling, (c) pregnant women and new mothers should go to clinic, (d) provide at least basic nutrition for the family, and (e) household representatives to attend complementary workshops. 17 Community Identification Committees are community representatives (e.g. teachers, health workers, mammy queen, religious leaders, youth leaders, etc.) who supported the community-level targeting mechanism in the selection of Ep Fet Po beneficiaries. 18 Or US$4.89 and US$14.68 respectively, using exchange rate as of June 9, 2021. Page 5 of 21 Relevant No indicator Proportion of beneficiaries Proportion of beneficiaries receiving indicator in attending the behavioral change the behavioral change project results workshop communication materials framework Progress and (a) All beneficiaries received Module Key documents already developed, (a) First poster summarizing key challenges 1 that includes information on including: TOR for implementing messages from Module 2 and 3 beneficiaries’ co-responsibilities of partner; pictorial flip charts with already developed and walked supporting children’s and maternal guiding texts for Module 1 and 2; through in locations where payment health; (b) Not all (only around 74 key messages developed and has been completed; (b) Second percent) beneficiaries received validated with partners for Module poster and radio jingles on early Module 2 that provides deep dive on 3 to 5. However, the lengthy childhood development drafted and health, nutrition and WASH19; (c) procurement dovetailed to the field tested; (c) a pilot concept financial literacy module was not COVID-19 crisis and developed to engage new CICs to implemented; (d) Retainment of implementation had to be adjusted deliver behavioral change modules knowledge on how to use cash mindful of COVID-19 social developed in Phase 2 through small benefits to improve wellbeing; (e) distancing measures and other group gathering. Spillover effect whereby the restrictions. information provided was reported to be beneficial also for non- beneficiaries and CICs. Source: authors’ summary from available documents *Phase 1 coincides with the “SSN Project Phase 1” implemented from 2014 to 2019 that includes the original project and its first additional financing. Following its preparatory stage, the beneficiary workshops started in 2016. Despite implementation challenges, Phase 1 gathered some positive results among beneficiaries and non-beneficiaries. NaCSA trained community workers (both CICs and CHWs) to deliver educational information to Ep Fet Po beneficiaries in the form of beneficiary workshops. CICs were responsible for Module 1 and CHWs for Module 2. As seen in Table 1, the beneficiary workshops were well attended. A post-payment survey in 2019 reported that 77 percent of surveyed beneficiaries confirmed that they participated in such workshops. Phase 1 showed positive results in knowledge retention with regard to messages delivered in Module 1 and 2. For example, beneficiaries correctly recalled the importance of sending children to school, eating well/good food and using the cash transfers to do (small) business, when asked about top three messages learned at the beneficiary workshops, even over 6 months after participating in the workshops.20 This suggests some level of effectiveness with the use of pictorial flip charts to deliver the educational information sessions during payment days, despite a large proportion of participating beneficiaries being illiterate. Furthermore, interviews with CICs who live in the same communities with beneficiaries affirmed increased knowledge (e.g. investment and proper care of children, importance of hygiene practices at home, use of health care services) and sharing this knowledge to non-beneficiaries. CICs also reported that through facilitating the workshops, they gained knowledge on how to better care and provide nutritious food for their families as well as making their children a priority.21 Implementation challenges in Phase 1 included some inconsistencies in the roll-out and inter-agency coordination. Some communities reported that they did not benefit from the beneficiary workshops,22 especially on Module 2 (see Table 1). This could be due to either exclusion of some communities (to be 19 SSN Project Aide Memoire from Implementation Supervision Mission, May 2019. 20 NaCSA oversight monitoring during Ep Fet Po exit payment in September 2019, pending final data cleaning. 21 2018 Sierra Leone Social Safety Net Rapid Assessment (Interviews with project stakeholders). 22 ibid Page 6 of 21 part of the control group “deliberately not receiving beneficiary workshops” during a planned impact evaluation in 2017) or absence of the CICs or CHWs during the workshops. It was reported during one of the SSN Project supervision mission that some CHWs were not delivering the beneficiary workshops as per training guidelines and that monitoring and coordination with the Ministry of Health and Sanitation and the District Health Management Team will need to be strengthened.23 Another inconsistency in the roll out was that the recommended 1:30 trainer to beneficiary ratio was exceeded up to 1:100 in some crowded payment locations where non-beneficiaries in the community also participated in the session.24 Furthermore, the draft job aide developed for Module 3 was neither tested nor delivered to beneficiaries due to competing demands, particularly to conduct targeting and enrolment of beneficiaries and maintaining the regular delivery of the quarterly cash transfers. Phase 2 planned to be implemented between 2020-2023 and was expected to build on the experiences in Phase 1 and strengthen the delivery of the “plus” component of Ep Fet Po. In Phase 2, the name of the “plus” component was changed to behavioral change workshops to bolster its effort in encouraging beneficiaries to put the cash transfers toward investments in human capital and adopt specific practices. Given the expanded scope and ambition (see Table 1), NaCSA added staff support in addition to the beneficiary workshop focal point for Phase 1 who in fact doubled the role with another assignment in the project. NaCSA conducted an in-house mapping exercise of current and ideal behaviors among Ep Fet Po beneficiaries, what can be influenced or changed through information sessions, and their corresponding messages to be part of Modules 3 to 5. A validation meeting was held in September 2019 with relevant partners resulting in a set of key behavioral change messages as outlined in Annex 3. With the richness of these new sets of messages, the plan was to engage an implementing partner (i.e. an experienced non- governmental or civil society organization) to deliver Modules 2 to 5, while Module 1 was to be delivered by NaCSA Coordinators in each of its District Offices.25 To increase visibility of this activity in regular monitoring and reporting, the project’s results framework was revised to include an indicator on the proportion of beneficiaries attending the behavioral change workshops..26 The procurement of the implementing partner had yet to be completed at the time the COVID-19 pandemic hit the country. Phase 3 followed from the declaration of COVID-19 public health emergency by President Bio in March 2020. The Government put in place protocols to reduce the spread of COVID-19, these included ban on intercity travel and large group gatherings. In order to minimize large group gatherings in the Ep Fet Po program, the “plus” component was transformed into an innovative provision of the behavioral change messages through a combination of delivery modalities. This is considered as Phase 3. The readily available behavioral change messages developed in Phase 2 have been included into the Information, Education and Communication (IEC) efforts of the SSN Project and rebranded to form a behavioral change communication campaign.27 NaCSA partnered with a local multimedia agency with experience in social and behavioral change communication to translate messages in Module 4 into take-home posters (with catchphrases) and radio jingles.28 To date, the poster and jingles have been completed, ready for dissemination to beneficiaries. During pre-testing, sampled beneficiaries preferred posters with visuals of real people (instead of pictorial illustrations as were done in Phase 1 and 2) that are perceived to be more 23 SSN Project Aide Memoire from Implementation Supervision Mission, May 2019; Post-Payment Monitoring Report, 2019; Draft Implementation Completion Report for 2014-2019 period of the SSN Project. 24 SSN Project Aide Memoire from Implementation Supervision Mission, May 2019. 25 The job aides for Module 1 and 2 were revised, including guiding texts at the back of the pictorial side to strengthen uniformity of messages to beneficiaries. 26 SSN Project Paper, Second Additional Financing, 2019. 27 SSN Project Paper, Third Additional Financing, 2020. 28 In addition, NaCSA also received technical inputs from an international organization specializing in behavioral science. Page 7 of 21 relatable to the beneficiaries. Furthermore, in preparation to a post-COVID-19 pandemic period when the ban on large group gatherings is lifted, NaCSA has put together a plan to pilot test the engagement of the newly recruited CICs to deliver the behavioral change modules developed in Phase 2. Moving forward, the Ep Fet Po “plus” component is expected to go beyond provision of information, such as establishing a referral system to existing services. Information is key in inducing demand for services and behavioural change, but as outlined in the introduction section and the theory of change in Figure 1 the “plus” can range from information to asset transfers to linkages to available services. As program implementation scales up on both the regular cash transfers and the safety net system building blocks, experiences from other countries show that the initial platform of information provision could be expanded to other inputs, services, and/or linkages. In fact, in the Ep Fet Po, initial engagement has been forged to link PWDs in the beneficiary households to relevant services such as medical support and assessment for appropriate assistive devices and therapies. In 2020, as part of the development of its targeting strategy to reach households with PWDs, NaCSA collaborated with the National Commission for Persons with Disabilities (NCPD) and Sierra Leone Union for Disability Inclusion (SLUDI). NaCSA initiated a mapping of government and non-government agencies working on disability with regard to where they are located and types of services provided, with the aim to link them with the Ep Fet Po beneficiary database. 5. Ep Fet Po’s “Plus” Component’s Increasing Focus on Early Years Ep Fet Po’s behavioral change messages are responding to several development priorities of the GoSL with increasing focus on the early years. Ep Fet Po includes both nutrition-focused and parenting-focused topics as is often the case in many cash transfer programs around the world.29. Ep Fet Po started sensitizing beneficiaries on nutrition and health, such as to put the cash transfers toward nutritious food, timely access to health services especially for children, and protecting health of the family such as through use of bed nets and good hygiene practices around the dwellings.30 This is also well aligned with the country’s efforts to improve its health outcomes. Some Ep Fet Po’s messages already put emphasis on children development outcomes, such as those on antenatal health check-ups, exclusive breastfeeding and full immunization for children under 5 years old. These behaviors could help reduce maternal and child mortality of which the rates in Sierra Leone are among the highest in the world31. The addition of Module 4 on early childhood development bolstered social, emotional and cognitive development in the early years with a focus on positive parenting practices and supporting early schooling for children. Module 5 on sexual and gender-based violence emphasizes the prevention of teenage pregnancy, which also supports children’s development outcomes as there is a higher likelihood of child mortality among teenage mothers.32 Thus, Module 2 and Module 4 (see Table 2) deliver key messages specifically targeting the early years and as such, are termed as early years focused messages. 29 Rawlings et al. 2020. 30 The full set of messages in Module 2 on Nutrition, Health and WASH are aligned with the Ministry of Health and Sanitation’s Message Guide for Reproductive, Maternal, Neonatal, and Child Health. 31 Sierra Leone Demographic and Health Survey 2019. 32 Sierra Leone Demographic and Health Survey 2019. Page 8 of 21 Table 2. Level of Child-sensitive Messages/“Focus on Early Years” in the Ep Fet Po Behavioral Change Communication Modules Key Messages under each Module Early Years Family-Focused Other Focused Messages Messages Module 1: Program Overview Project Information: Beneficiaries √ Project Information: Benefit amount √ Anti-Corruption √ Payment Schedule √ Beneficiaries should obey their co-responsibilities √ √ Module 2: Health, Nutrition and WASH Eat a variety of foods daily √ Drink only clean and safe water √ √ Wash hands with soap and clean running water √ √ Breast milk is the best food for baby √ √ Use available health services √ √ Prevent Malaria √ Module 3: Financial Literacy & Income Generation Be financially inclusive through savings √ Make good financial decision (wise spending, spend on “needs” √ not “wants”) Adopt a budgeting habit or make a money plan √ Identify the business that is in demand and profitable in your √ community Good record keeping makes a successful business √ Module 4: Early Childhood Development Make time to play with your children √ Do no harm to your children √ Physical abuse cannot change children ‘bad’ behavior √ Children should go to school at an early age √ Children should be given space in discussions for decision making √ Module 5: Sexual and Gender-based Violence (SGBV) Violence in the home is never OK! √ Say no to child marriage and teenage pregnancy √ √ No one has the right to force you to have sex 33 √ Report any form of violence, sexual exploitation and abuse in the √ SSN project through the grievance redress mechanism Source: authors’ mapping based on analysis of key messages Program overview focuses on general information about the Ep Fet Po; Promotion of breastfeeding also focuses on the lactating mother. The added focus on early years is considered timely as it has been shown that there are higher returns on investments during the early years. The GoSL through the 2019 -2023 MTNDP, commits to increasing investment in children and women to build the country’s human capital. The Plan recognizes the need to ensure that children receive adequate health care, quality early childhood education, and be protected from harm, danger and abuse. While Ep Fet Po beneficiary households are likely to have higher number 33 Sexual offences act of 2019. Page 9 of 21 of children above 5 years old,34 with an overall population fertility rate of 4.3 and a high rate of teenage pregnancy,35 sensitization on the importance of investing during the early years is beneficial not only to current parents but also to parents-to-be. The Ep Fet Po’s messages on early years are on the right track. The key messages in the health, nutrition and WASH and early childhood development modules are well aligned with the nurturing care framework36 and the UNICEF Key Family Practices as also referred by other countries (see table in Annex 2). The modules will provide information on healthcare during pregnancy, immunization, exclusive breastfeeding, childcare during and after illness, dietary diversity, malaria prevention, early stimulation, early learning responsive caregiving and positive discipline approaches. 6. Lessons and Recommendations The main goal of the “plus” component in Ep Fet Po is to empower beneficiaries to enable them build human capital. The implementation has resulted into some successes but has also experienced some challenges. Below are some recommendations for NacSA to consider in the short, medium and long term to help strengthen the implementation of the Ep Fet Po “plus” component. Short-term: Consistent and timely delivery: Due to the ‘low intensity’37 nature of the “plus” component under the Ep Fet Po, delivery must be consistent in order to provide the needed impact on improved behavioral change for building human capital. To ensure that beneficiaries are continually reached with messages for improved behavior change, it is highly recommended that in the short term, NaCSA continue to deliver the behavioral change messages through the agreed communication campaign such as television, radio discussions, and prints/posters in a timely and consistent manner. It would be critical to avoid any production delays, especially with regard to the take-home posters, since these posters will need to be presented during payment days and distributed to the 70,000 Ep Fet Po beneficiaries across all 16 districts of the country. There is a need to mitigate any risk of delays due to: prolonged procurement processes, competing demands with other project activities, and setting up a complex distribution mechanism; for example, through advance procurement processing and meticulous planning. Consider expansion of “plus” to include linking beneficiaries with services: With the upcoming one-time cash benefit top-up for beneficiary households with PWDs, it may be feasible and beneficial to have NCDP/SLUDI representatives join Ep Fet Po payment days. They could advocate how to best allocate the top-up to support household members who are PWDs and to link beneficiaries with available services for PWDs in the area and share relevant contacts. Strengthening training/capacity building: It is highly important to have well-trained frontline workers for the delivery of the “plus” component. In low- and middle-income countries, the frontline workers of “plus” components are mostly community workers and volunteers with limited literacy or a few years of 34 An average of 2.5 children between 6-18 years old in an average household size of 5.8 (SSN Rapid Assessment, 2018). 35 About a third of girls aged 15-19 years old are pregnant or already having given birth at least once (World Bank Open Data, 2016). 36 The five (5) components of the framework: good health, adequate nutrition, responsive caregiving, security and safety and opportunities for early learning. 37 As captured in Rawlings et al. 2020, ‘low intensity’ included posters, radio, health talks, food demonstrations, and pre - recorded SMS or voice messages, while ‘high-intensity’ included small group parenting sessions and one-on-one home visits. Page 10 of 21 education rather than professionals. Hence, they need to be trained and equipped with the right field tools to build their capacity for delivery. The importance and the need of such training was highlighted by some of the CICs.38 The training built their knowledge in the content of the beneficiary workshops as well as their facilitation skills for effective delivery. In terms of effectiveness, reviews of parenting programs have found that the quality of the relationship between the parent and the facilitator influence the results of the intervention.39 Therefore, sufficient trainings are important to ensure that CICs and CHWs have their capacities built in how to establish rapport and build relationships with the beneficiaries. Monitoring and supervision: For effective delivery of a cash-plus program, a systematic monitoring and supervision system needs to be put in place. This is to assess the degree to which the program is being implemented as intended and whether it is conforming to established quality standards, most especially, the quality of the interaction between facilitators and beneficiaries/sessions’ participants. NaCSA has developed monitoring tools for the behavioral change workshops. Given the change to the behavioral change communication campaign approach, there is a need to adjust the monitoring tools accordingly- among others, to ensure that the take-home posters are being presented at each payment point and that beneficiaries receive the posters in addition to the cash transfers. Timely results from monitoring and supervision visits are crucial to allow course correction while the Ep Fet Po program is still active. Medium-term: Strengthened partnership with other institutions: As NaCSA plan to pilot the return to group-based behavioral change workshops (as planned in Phase 2), it may be beneficial to consider partnership with relevant government or non-government institutions, especially with institutions who have the core mandate to deliver community counseling/training/services as outlined in the various modules. For example, there may be some Ep Fet Po communities where the CHWs are already well trained (by the District Management Health Team or by other development partners’ programming, e.g. UNICEF) and delivering, either all or partially, the messages in Module 2 “Nutrition, Health and WASH.” If so, then they could be linked to the Ep Fet Po beneficiaries. The Ministry of Social Welfare and the Ministry of Gender and Children’s Affairs play a key role in advocating for the rights of women, children, the aged, persons with disability, and other vulnerable groups. As such, they could be a key partner in the delivery of Modules 4 and 5. Strengthened partnership with these institutions can broaden delivery platforms and ensure sustainability of human capital gains made even after the SSN Project ends. Increased dosage and delivery modalities: The dosage of a program is a combination of the frequency of the contacts (weekly, fortnightly, monthly), the duration of each contact (minutes/hours), and the duration of the program (number of months). Given quarterly delivery of the beneficiary workshops during cash payments for a duration of one to two hours in Phase 1 and planned monthly delivery in Phase 2, there is the need for the delivery dosage to be reviewed for more contact times with beneficiaries to have the desired impact of building human capital as seen in Annex 2. Phase 1 showed some retention of knowledge by participants of the beneficiary workshops; however, less is known about actual behavioral 38SSN Rapid Assessment. 2018. 39Moran, P., D. Ghate, and A. van der Merwe. 2004. “What works in parenting support? A review of the international evidence.” Retrieved from http://dera.ioe.ac.uk/5024/1/RR574.pdf; Nowak, C., and N. Heinrichs. 2008. A comprehensive meta‐analysis of Triple P‐Positive Parenting Program using hierarchical linear modeling: Effectiveness and moderating variables. Clinical Child and Family Psychology Review, 11, 114–144.; Sweet, M.A., and M.I. Appelbaum. 2004. “Is home visiting an effective strategy? A meta‐analytic review of home visiting programs for families with young children.” Child Development, 75, 1435–1456. Page 11 of 21 changes. Complementarities between delivery modalities of the cash-plus component help to reinforce messaging and create feedback loops that promote behavior change. When circumstances allow for a safe group gathering, behavioral change workshop, as in Phase 2, may be complemented with take-home posters as in Phase 3 to support knowledge recall and practice at home. As tabulated in Annex 2, another option to be explored are home visits to hone key practices such as on good parenting. The frequency of home visits would also play a key role. For example, a study in Jamaica concluded that as frequency of visiting increases from none to monthly, fortnightly, and weekly, benefits on children’s development increased.40 Learning and evaluation: Phase 1 showed good attendance and resulted in knowledge retention with regard to messages delivered in Module 1 and 2. Less is known about whether beneficiaries practiced the knowledge gained. This is one area where monitoring and evaluation could play a bigger role. Furthermore, impact evaluation would be best placed to understand whether beneficiaries use the cash for human capital investments because of the delivery of the “plus” (i.e. beneficiary workshop) or regardless of the “plus.” This is a knowledge gap that could be explored in future programming. The Programs in Madagascar and Niger (see Annex 2) can inform on the design of such impact evaluation. Long-term: Financial and non‐financial incentives for facilitators: Volunteers are increasingly asking for stipends and payments for facilitating community activities. This was observed during interviews conducted as part of the 2018 SSN Rapid Assessment where the CICs requested stipends. An assessment of the lessons from Peru’s parenting program (Cuna más)41 showed that providing volunteers with uniforms and other materials serve as incentives and keep volunteers motivated enough to carry out responsibilities assigned to them. It also found that compensating/reimbursing travel expenses of volunteers motivates them and helps to reduce attrition. NaCSA may consider other forms of non-financial incentives for volunteers to ensure they are motivated enough to continue delivering the “plus” component of the program. Going beyond provision of information and linkages: Cash-plus programs are increasingly going beyond the provision of information to training/capacity building and provision of lump sum for business startups as noted in the case of Niger.42 Once the implementation of the “plus” in the form of provision of educational information is regularized, NaCSA with its partners, may consider expanding to a more comprehensive support to the beneficiaries. Ep Fet Po beneficiaries could receive training in economic activities/ventures including on how to assess market demands that may be quite different for rural and urban contexts and how to fill the demand either through individual or group-based businesses. As with the experience in Niger, this could be complemented, among others, with the provision of startup business capital, linkage to markets and regular coaching. Nevertheless, with the comprehensiveness of such support, also comes complexities of roll-out that would typically require cash transfer implementing agency to partner with other institutions with the right experience and capacity. 40 Powell, Christine, and Sally Grantham-McGregor. 1989. “Home Visiting of Varying Frequency and Child Development.” Pediatrics 84 (1): 157–64. 41 Josephson, K., G. Guerrero, and C. Coddington. 2017. “Supporting the Early Childhood Workforce at Scale: The Cun a Más home visiting program in Peru.” Results for Development, Washington, DC. 42 State of Economic Inclusion Report. 2021. Case Study 1 Productive Inclusion Measures and Adaptive Social Protection in the Sahel. Page 12 of 21 7. Conclusion Globally, cash transfer programs have undoubtedly been proven to build human capital especially during the early years. The contribution of cash-plus programs and specifically the “plus” component (i.e. ranging from provision of information, linkages to other sectors, to additional inputs and services) to these achievements cannot be understated as seen in countries such as Niger, Madagascar, and Senegal. The “plus” component in the Sierra Leone Ep Fet Po cash-plus program has remained in the form of provision of educational information, with developments, among others, in the delivery modalities and the range of topics. Since its launched in 2014 there are three distinct phases of the “plus” as outlined in this note. The first phase was the provision of beneficiary workshops during payment days, the second phase covered the development period of the behavioral change workshops with additional topics and dosage, and the third phase is the behavioral change communication campaign. Moving forward, the “plus” component is expected to go beyond provision of information such as referral system to existing services. Ep Fet Po’s behavioral change messages are responding to several development priorities of the GoSL with increasing focus on early years. The added focus on early years is well aligned with GoSL commitment in its MTNDP to increasing investment in children and women to build the country’s human capital. The early years topics are concentrated in Ep Fet Po’s Module 2 “Health, Nutrition and WASH” and Module 4 “Early Childhood Development.” In addition, the emphasis on prevention of teenage pregnancy in Module 5 “Sexual and Gender-based Violence” also supports children’s development outcomes with the higher likelihood of child mortality among teenage mothers in Sierra Leone. It also supports the provision of safe and secure environments for young children. The overall implementation of the Ep Fet Po “plus” component has shown some positive results among beneficiaries and non-beneficiaries despite some implementation challenges encountered. This note outlines recommendations to strengthen the delivery of the “plus” component and ultimately to achieve improvements in child wellbeing and human capital accumulation in the long run. These recommendations, ranging from what can be done in the short- to long- term, were drawn from emerging lessons within the Ep Fet Po as well as from implementation of cash-plus programs in other countries Page 13 of 21 Bibliography Adato, M., & Bassett, L. 2009. Social protection to support orphans and vulnerable children and families: the potential of cash transfers to protect education, health and nutrition. AIDS Care, 21, 60e75 Baird et al. 2014. Conditional, unconditional and everything in between: a systematic review of the effects of cash transfer programmes on schooling outcomes; Bastagli et al. 2016. Cash Transfers: What does the Evidence say? Bastagli, F., Hagen-Zanker, J., Harman, L., Barca, V., Sturge, G. and Schmidt, T. 2016. Cash Transfers: What does the evidence say? A rigorous review of programme impact and the role of design and implementation features. London: Overseas Development Institute. De Walque, Damien, Lia Fernald, Paul Gertler, and Melissa Hidrobo. 2017. “Cash Transfers and Child and Adolescent Development” in D.A.P. Bundy, N. de Silva, S. Horton, D.T. Jamison, and G.C. Patton (eds), Disease Control Priorities: Volume 8, Child and Adolescent Health and Development, Third Edition, 325– 41. World Bank, Washington DC. http://dcpv 3.org/chapter/2472/cash-transfers-and-child-and- adolescent-development. Government of Sierra Leone. 2019. Sierra Leone 2019-2023 Medium Term Nation Development Plan (MTNDP). Grosh, Margaret, Julieta Trias, Ruslan Yemstov, and Ian Walker. 2018. “The Contribution of Social Protection and Jobs to Human Capital Formation”. Washington, DC: World Bank Josephson, K., G. Guerrero, and C. Coddington. 2017. “Supporting the Early Childhood Workforce at Scale: The Cuna Más home visiting program in Peru.” Results for Development, Washington, DC. Moran, P., D. Ghate, and A. van der Merwe. 2004. “What works in parenting support? A review of the international evidence.” Retrieved from http://dera.ioe.ac.uk/5024/1/RR574.pdf; Nowak, C., and N. Heinrichs. 2008. A comprehensive meta‐analysis of Triple P‐Positive Parenting Program using hierarchical linear modeling: Effectiveness and moderating variables. Clinical Child and Family Psychology Review, 11, 114–144.; Sweet, M.A., and M.I. Appelbaum. 2004. “Is home visiting an effective strategy? A meta‐analytic review of home visiting programs for families with young children.” Child Development, 75, 1435–1456. National Commission for Social Action, Statistics Sierra Leone, World Bank. 2019. Ep Fet Po: Sierra Leone Social Safety Nets Program Rapid Assessment. National Commission for Social Action. 2020. Report from Oversight Monitoring for September 2019 SSN exit-payment (pending). National Commission for Social Action. 2021. Report from Post Payment Monitoring in 2019. Submitted draft version. National Commission for Social Action. 2021. Implementation Completion Report for Sierra Leone Social Safety Net Project 2014-2019 period. Submitted draft version. Page 14 of 21 Powell, Christine, and Sally Grantham-McGregor. 1989. “Home Visiting of Varying Frequency and Child Development.” Pediatrics 84 (1): 157–64. Rawlings et al. Boosting the Benefits of Cash Transfer Programs during the Early Years: A Case Study Review of Accompanying Measures. 2020. Social Protection and Jobs Discussion Paper. Roelen, K., S. Deveureux, A. Abdulai, B. Martorano, T. Palermo, and L. Ragno. 2017. “How to Make ‘Cash Plus’ Work: Linking Cash Transfers to Services and Sectors.” Innocenti Working Paper 2017-10, UNICEF Office of Research, Florence. Sall, Mohamadou; Dramani, Latif Armel Guy; Prevel, Yves Martin; Kameli, Yves; Fall, Abdou Salam. 2012. Évaluation de l’impact du transfert en espèces dans le cadre du projet nutrition ciblée sur l’enfant et transferts sociaux (NETS). Dakar, Senegal: LARTES-IFAN, Cheikh Anta Diop de Dakar. Sierra Leone Integrated Household Survey (SLIHS), 2018. Sierra Leone Demographic and Health Survey, 2019. Statistics Sierra Leone/World Bank. 2019. “Methodology for Consumption-Poverty Estimation, 2018 and Poverty Trends, 2011-2018, in Sierra Leone.” World Bank Human Capital Project: Sierra Leone, 2020 retrieved from http://databank.worldbank.org/data/download/hci/HCI_1pager_SLE.pdf?cid=GGH_e_hcpexternal_en_e xt World Bank, Sierra Leone Public Expenditure Review. Forthcoming, 2021. Physical Policy for a Sustainable Recovery. World Bank. Sierra Leone Social Safety Net Project Appraisal Document, 2014. World Bank. Sierra Leone Social Safety Net Project Aide Memoire from Implementation Supervision Mission, May 2019. World Bank. Sierra Leone Social Safety Net Project Paper, Second Additional Financing, 2019. World Bank. Sierra Leone Social Safety Net Project Paper, Third Additional Financing, 2020. World Bank State of Economic Inclusion Report. 2021. Case Study 1 Productive Inclusion Measures and Adaptive Social Protection in the Sahel. World Health Organization retrieved from https://apps.who.int/iris/bitstream/handle/10665/272603/9789241514064-eng.pdf?ua=1 Page 15 of 21 Annex 1: Summary of the SSN Project The SSN project aims to establish the key building blocks for a basic national safety net system and to provide income support to extremely poor households in Sierra Leone. The project includes three components: (a) Development of Systems for Implementation of Social Safety Net Interventions, (b) Cash Transfers to Extremely Poor Households, and (c) Project Management and Capacity Building. The project is implemented by the National Commission for Social Action (NaCSA), in partnership with the Anti-Corruption Commission (ACC) and Statistics Sierra Leone. The project is currently scheduled to close on June 30, 2023. The project was launched in 2014 and it has received multiple additional financing. It is funded through a grant from the International Development Associations (IDA) of US$47 million, US$4.3 million from the Ebola Recovery and Reconstruction Trust Fund, US$1 million from the Global Risk Financing Facility, US$5 million from the European Union and a counterpart contribution of the GoSL of US$3.419 million. Innovatively, the second additional financing also included US$4 million in contingent financing, set aside to finance emergency cash transfers in the event of an eligible emergency or crisis, providing the means to respond quickly to the COVID-19 crisis. To date, a basic national safety net system has been established and a total of 196,332 persons from approximately 32,000 households across 10 districts of the country have benefited from the SSN cash transfers since its inception in 2014 and 92 percent of the household representatives, who received the cash, were women. As of November 2019, these households have “graduated/exited” from the SSN cash transfers. Since 2020, the Project has supported a new set of extremely poor households in all 16 districts of the country with an additional focus on reaching Persons with Disabilities. The targeting exercise to identify 35,000 extreme poor households nationwide was completed in July 2020. As the COVID-19 pandemic began to unfold in the country, the World Bank disbursed the US$4 million contingency financing in mid-2020 to fund the COVID-19 Emergency Cash Transfer (ECT), which has provided income support to approximately 29,000 households in the cities of Freetown, Bo, Kenema, Port Loko, and Makeni. The Ep Fet Po program has adopted a rigorous, three-stage targeting process (geographical targeting, community- based targeting, and verification through a proxy means test [PMT]), which has been shown to effectively reach extremely poor households in rural Sierra Leone. 43 The data collected on households through the SSN targeting process have been the basis for establishing the Social Protection Registry for Integrated National Targeting (SPRINT). Other programs are increasingly sharing beneficiary data through SPRINT,44 thus enabling SPRINT to evolve into a national social registry. Ep Fet Po is a cash-plus program whereby the “plus” component, in addition to the cash benefits, provide a range of educational information, among others on health, nutrition, the importance of the early years, either through group-based sensitization meetings or behavioral change communication campaign. Throughout the project implementation, a number of innovations have been made to ensure strong fiduciary oversight around the payment of beneficiaries, such as the use of smartphone data collection, including photos for payment identification and verification, beneficiary identification (ID) cards with quick response codes, issuance of electronic payment vouchers (for the ECT) and payment reconciliation tools. To complement the targeting and payment systems, a grievance redress mechanism (GRM) and anti-corruption measures for the Ep Fet Po have been established with the ACC to help ensure that the cash transfers reach the intended beneficiaries. The government is also beginning to expand the use of these key building blocks to include other projects and programs related to social protection, poverty reduction and human capital accumulation. 43Lertsuridej, M, and M. Spivack. 2017. Sierra Leone Social Safety Nets Project: Targeting Assessment Report. 44This occurred during the Ebola response and more formalized data sharing arrangements will be established to enable regular sharing of data. The SPRINT is managed by the National Social Protection Secretariat (NSPS) at NaCSA. Page 16 of 21 Annex 2: Nutrition and Parenting Focused Cash Transfer’s “Accompanying Measures” in Selected Countries in Sub-Saharan Africa Region45 Delivery Modality Target Front-line Country Group- Individual Other Topics Curriculum SBCC Strategies Impacts Population Workers based visits Madagascar Mothers of Monthly -- Pay-day Parenting UNICEF KFP; Discussions, Mother Leaders: Grade advancement, children ‘Nudges’ practices, child WB and Demonstrations, No minimum uptake of parenting under 6 development, self- ideas42 Play, Feedback to education; behaviors, improved child years old affirmation, behavioral Parents, Payday Voluntary language and cognitive financial planning elements Nudges skills; reduced food insecurity* (World Bank, 2018) Mali Pregnant Twice per -- Preventive Maternal and child Government Peer-to-Peer, NGO Staff: Increased food women, month Nutrition health and of Mali; NGO Information on Paid monthly consumption, dietary mothers of (open to Packages nutrition, family staff and Payday, Media diversity; PNP reduced children all) (PNP) planning, hygiene doctors adapt child undernutrition** under 5 to local (Hidrobo et al., 2019) years old context Niger Poor Monthly Home visits; Village Parenting for Adapted from Feedback to Community Improved parenting women with Monthly assembly health, nutrition, UNICEF KFP Parents, Media, educators: practices, child socio- children hygiene, family Peer-to-Peer No minimum emotional skills; reduced under 3 planning, psycho- education; harsh discipline* years old social development monthly stipend (Premand et al., 2020) Senegal Pregnant Monthly Health clinic Village Maternal and child Government Discussions, Play, Nutrition Increased dietary women, visits and assembly; health and of Senegal Feedback to Enhancement diversity, food mothers of counseling; Local nutrition, access to (NEP Parents, Peer-to- Program (NEP) consumption, vaccination; children as needed authority ECD and health structures), Peer, (nutrition aides, reduced diarrheal under 5 meetings services support from Grandmother outreach workers, disease** years old UNICEF Groups mother leaders) (Sall et al., 2012) Sources: compiled by Rawlings et al 2020 based on the detailed case studies. *Indicates impact of the accompanying measure only (impact evaluation measured differentiated impacts of the accompanying measure, above and beyond the cash transfer) **Indicates combined impact of the accompanying measure and cash transfer (impact evaluation did not differentiate between impacts of accompanying measure and cash transfer) ª Indicates the reported results are from a previous variation of the program. 45 Selected from Rawlings et al., 2020 Page 17 of 21 Annex 3: Key Messages to be delivered through the SSN Behavioral Change Workshop MODULE 1 : PROGRAM OVERVIEW The content of this module has been delivered to the SSN beneficiaries. Moving forward, some of the program information will be updated to reflect any new details as part of the SSN expansion. 1. Project Information: Beneficiaries ✓ Objective of ‘Ep Fet Po’ is to provide income support to extreme poor households ✓ Recipient of the transfers is the most responsible female in the household (The one with most knowledge and responsible for household spending, and for decisions related to maternal & child health). ✓ Target is selected extremely poor households in ‘Ep Fet Po’ localities ✓ Target areas are the 16 districts in Sierra Leone 2. Project Information: Benefit amount ✓ Benefit size for beneficiaries is $135 for the first transfer and $45 for subsequent three transfers; and households with persons with disabilities as per enrolment database, will receive additional one-time $4546 ✓ Reasons for change in benefit amount is due to increase in the cost of living 3. Anti-Corruption ✓ Say No to extortion ✓ Always call ACC toll free line (515) for any corruption attempt by community stakeholders. 4. Payment Schedule ✓ Beneficiaries should come for payment at the pay point after every three months (Quarterly) 5. Beneficiaries should obey their co-responsibilities ✓ Household representatives, typically the recipient of the cash transfers, to attend behavioral change workshops both during payment days and outside payment days. ✓ Children under the age of 5 years fully immunized/vaccinated ✓ Children attend basic schooling ✓ Pregnant women and new mothers should go to clinic ✓ Provide at least basic nutrition for the family ✓ Although parents are busy, they need to make time to play and communicate with children: early learning goes a long way ✓ The Ep fet Po money will not last forever: manage the money well, consider saving and doing good business. ✓ Women and children need more protection especially from violence: they play important roles to shape the future generations of your village and country. ✓ Beneficiaries who know how to count their money, should do so in the presence of the payment team; If you cannot count your money, ask for help. MODULE 2 : HEALTH, N UTRITION AND WASH The content of this module has been delivered to some SSN beneficiaries and will continue to be delivered to the new SSN beneficiaries. 46 Updated in December 2020 during the third additional financing to the SSN Project. Page 18 of 21 1. Eat a variety of foods daily ✓ Eat a variety of foods every day at each meal, including body-building foods (protein, meat, eggs, beans, peanut), protective foods (fruit and vegetables) and energy foods (staples: rice, maize, corn, yam). ✓ Ensure that children and pregnant and breastfeeding women regularly eat iron rich foods such as meat, dark leafy vegetables, and eggs. ✓ During and after illness, breastfeed children more frequently than usual and give extra meals 2. Drink only clean and safe water ✓ Chlorinate your well and stream water before drinking ✓ Boil untreated water to kill germs ✓ Drink available tap water 3. Wash hands with soap and clean running water ✓ Wash hands thoroughly after using the toilet ✓ Wash hands after take care of your child ✓ Wash hands before cooking, eating and feeding your child 4. Use available health services ✓ Husbands should take their pregnant women to the nearest PHU for anti-natal care ✓ Children under-5 should be immunized ✓ Always go the nearest PHU to seek medical attention when sick 5. Breast milk is the best food for a baby 6. Prevent Malaria ✓ Sleep under an insecticide treated net ✓ Always clean your environment properly to clear mosquito breeding site. MODULE 3 : FINANCIAL LITERACY & INCOME GENERATION This is new module as part of the SSN expansion. The draft messages were discussed and revised at a validation workshop that was conducted on the 29th October 2019. 1. Be financially inclusive through savings: ✓ Learn to save money for the rainy days ✓ Deal with all obstacles to savings (Lan lesson from di anch) 2. Make good financial decision (wise spending, spend on “needs” not “wants”) ✓ Plan before spending money. ✓ Use money when it is absolutely necessarily (take tem use money) ✓ Provision of basic necessities for the family saves you more money. ✓ Avoid unnecessary expenses (Take tem use money for you benefit bambai’) ✓ Do not spend money on things you already have. ✓ Stop buying in credit, be a smart buyer 3. Adopt a budgeting habit or make a money plan. ✓ Plan your household spending (Sharp your cutlass before the day for battle) ✓ Identify various household income sources 4. Identify the business that is in demand and profitable in your community. ✓ Clean seller, clean products, more customers (customer service skills) ✓ Have good marketing skills Page 19 of 21 ✓ ‘Plant tik wae go gi you money tumara’ 5. Good record keeping makes a successful business ✓ learn to know how much you invest in your business to know your profit MODULE 4 : EARLY C HI LDHOOD DEVELOPMENT This is new module as part of the SSN expansion. The draft messages were discussed and revised at a validation workshop that was conducted on the 29th October 2019. 1. Make time to play with your children, they need you ✓ Love your kids ✓ Your child is your best friend ✓ Spend time with your kids ✓ Play with your kids ✓ Do homework with your kids ✓ Your child is your ‘best safety net’ ✓ Support you Pikin for you tumara bambai. ✓ Do not value your business than your child 2. Do no harm to children ✓ Supervise children at play ✓ Protect your children at all times ✓ Do not leave your children with strangers ✓ Do not allow adults (men) to call your child- “My Wife/husband” ✓ Do not engage children in Labour (Street selling (hawking), Running ‘adult errands’ Providing farm labor 3. Physical violence cannot change children’s bad behavior ✓ Beating and slapping children only makes them stubborn ✓ Use 3Fs for your children (Fair, Firm, Friendly) ▪ F- Fair (justice, listening, communicate, etc) ▪ F- Firm (child should know when it is business; take a safe position, take appropriate action in the best interest of the child). ▪ F- Friendly (discipline with love, smiling, etc.) ✓ Say no to all forms of physical disciplinary actions ✓ Disciplinary action should be age appropriate to children 4. Children should go to school at a very early age ✓ Invest in your children for your old age to be good ✓ More of your income should go to caring for your children (education, health, welfare, food, etc) ✓ ‘Put you money pan pikin im-book learning, you go enjoy you old age’ 5. Children should be given space in discussions for decision making ✓ Listen to your children- ▪ active listening ▪ ‘Pikin sef na mortal-man’ ✓ Talk to your children- ▪ sign, simple words, ✓ Children are important in the family ✓ Consult your children when taking key family decisions that may affect them Page 20 of 21 MODULE 5 : SEXUAL & GENDER BASED VIOLENCE This is new module as part of the SSN expansion. The draft messages were discussed and revised at a validation workshop that was conducted on the 29th October 2019 and updated on August 10 following the Gender-based Violence communication materials (as endorsed by the GoSL’s Ministry of Gender and Children’s Affairs) shared by UNICEF to NaCSA IEC on July 30, 2020. 1. Violence in the home is never OK! ✓ Never use physical, sexual or emotional violence in the home ✓ Women are good economists and integral to the livelihoods of the family ✓ Men to support women for socio-economic empowerment ✓ If you experience violence, tell someone you trust and go to the nearest Family Support Unit or call 116 for help 2. Say No to child marriage and teenage pregnancy ✓ Child marriage and teenage pregnancy (under 18 years old) is a crime punishable by Law ✓ There are harmful effects of under-aged marriage ✓ There are benefits of avoiding child marriage and teenage pregnancy 3. No one has the right to force you to have sex47 ✓ Be bold for change! Report sexual violence in your community – rape is a crime in Sierra Leone! ✓ ‘15ys or life imprisonment for sexual penetration of a child’ ✓ Settlement of sexual offence such as rape outside of courts is also a crime ✓ If you are a victim of sexual assault or any form of violence please tell someone you trust or go to the nearest Family Support Unit or hospital or call 116 for help 4. You can also report any form of violence, sexual exploitation and abuse through the Ep Fet Po/SSN grievance redress mechanism (call 515 toll free) ✓ Help protect girls and women, especially those with disabilities as they are at greater risk of violence ✓ Do not break the law, there is a moratorium on initiation into secret societies of children under the age of 18 ✓ ‘Wuna nor put small pekin pan Bondo biznes’ 47 Sexual offences act of 2019. Page 21 of 21