Strengthening Rural Food Systems through the UN World Food Program’s Fresh Food Voucher in Ethiopia’s Somali Region: An Evaluation of Nutritional and Market Impacts

Abstract

Background and Objective: Malnutrition remains a major global health issue. Ethiopia experiences high rates of child undernutrition, with 39% stunting, 11% wasting, and 22% underweight, contributing to a significant economic burden that costs 16.5% of gross domestic product (GDP) annually. Nearly half (47%) of Ethiopian children face severe food poverty, consuming two or fewer food groups daily. The study aimed to assess the impact of the community-supported Fresh Food Voucher (FFV) project on the nutritional status of children under five and women, evaluate the effectiveness of Social Behavior Change Communication (SBCC) in improving mothers’ nutritional knowledge, and examine the project’s role in strengthening local markets.

Methods: We used a quasi-experimental design and targeted 6200 households with children under 5 years and pregnant and lactating women. Statistical analyses were conducted using MS Excel, Emergency Nutrition Assessment (ENA) for Standardized Monitoring and Assessment of Relief and Transitions (SMART), and Statistical Package for the Social Sciences (SPSS). Descriptive statistics were used to examine variations in mean values at a 5% level of significance (α = 0.05).

Results: The results demonstrated significant reductions in both moderate and severe wasting. Weight-forheight z-scores showed an overall decline in wasting from 25.5% to 20.8% (p < 0.05), while Mid Upper Arm Circumference (MUAC)-based wasting dropped from 18.6% to 10.6% (p < 0.05). Dietary improvements among children aged 6–23 months were also observed, with the proportion meeting Minimum Dietary Diversity (MDD) rising from 9.5% to 20.9% (p = 0.04) and Minimum Acceptable Diet (MAD) from 5.6% to 8.9%. Food Consumption Scores (FCS) improved significantly, with households in the acceptable range increasing from 10.4% to 43.0%, and those in the poor category decreasing from 68.6% to 9.8% (p < 0.05). Household Dietary Diversity Scores (HDDS) improved significantly, with high diversity increasing from 6.3% to 91.2%. Significant improvements were also observed in maternal knowledge and practices related to infant and young child feeding (IYCF), maternal nutrition, and hygiene.

Conclusions and Implications for Translation: The community-supported FFV programs can reduce child wasting, improve dietary diversity, and enhance maternal nutrition knowledge. The findings show strong potential for scaling in resource-limited settings to boost nutrition and strengthen the local food systems. By stimulating poultry production and empowering women economically, the FFV program builds nutritional and economic resilience, though addressing food quality and supply chain challenges remains essential for sustainability.