July 2023 — Kenya has taken great strides in improving the health and nutritional status of its population. However, progress is not even across the country and in recent years has been hampered by high multi-dimensional poverty rates, made worse by prolonged droughts and the COVID-19 pandemic. Nationally, around 10 million Kenyans suffer from malnutrition and chronic food insecurity.

In order to address the uneven progress made and move the country forward in meeting its health and nutrition goals, the Government of Kenya (GoK) is focusing efforts on the counties which have the highest burden of malnutrition: Kilifi, Kitui, Marsabit, Turkana, and West Pokot.  Based on promising evidence around the use of cash-based transfers for nutrition, an innovative approach is being taken which integrates social protection with nutrition and child protection services, the Nutrition Improvement through Cash and Health Education (NICHE) programme.  NICHE was introduced to specifically promote the nutrition status of pregnant and lactating women and children under two years of age, a formative time for brain and physical development.

The NICHE programme provides a top-up cash transfer payment of KShs 500 to qualifying households. These are households that have a pregnant or lactating woman with a child under 36 months and are also in receipt of one of the social protection payments that are made through the existing Inua Jamii programme. The top-up payments are complemented by the provision of services, as well as social and behaviour change (SBC) designed to address ten key behavioural priorities which have been identified as having the highest potential to impact health and nutrition outcomes for women and children.  SBC has been shown to be a critical component of these types of programmes because knowledge constraints about healthy nutrition practices can be a key barrier to nutritional health, while cash transfers address resource constraints related to accessing adequate foods and services.

The Government of Kenya, together with UNICEF and civil society partners, co-created an evidence-based Social and Behaviour Change (SBC) Strategy to complement a cash transfer programme for maternal and child nutrition, through a highly participatory and iterative approach. The co-creation process involved five steps, each of which built upon the learnings from the previous steps and brought in various voices and perspectives: 1) desk review and consultative forum, 2) primary research with beneficiary communities, 3) co-creation workshop and strategy development, 4) creation of SBC materials and pretesting, and 5) guidance documentation for implementation. The strategy addresses the ten priority issues identified as having the greatest impact on maternal and child health and nutrition and social protection among cash transfer recipients and their communities. The formative research further refined the priority issue topics and identified cross-cutting factors which contribute to vulnerabilities among the key populations. 

The co-creation workshop was an opportunity to engage stakeholders across multiple sectors and levels of government, in order to build buy-in and incorporate different perspectives and priorities. This paper outlines the participatory approach which was followed to create a culturally relevant, evidence-based national SBC strategy, and prepare counties to adapt and implement within the programme communities. The approach provides a roadmap for designing future communication strategies which address a range of social and public health issues and align toward a common goal to improve the wellbeing of the most marginalized populations.