7. Proportion of eligible population reached by nutrition preventive programme (coverage)

7. Proportion of eligible population reached by nutrition preventive programme (coverage)

VERSION

V5.0 - 2026.03 — Existing

INDICATOR CODE

7

TECHNICAL OWNER

PRG-S Nutrition

INDICATOR TYPE

Country Level Outcome Indicator

INDICATOR CLASSIFICATION

Mandatory

INDICATOR SCOPE

Programme specific

APPLICABILITY

The selection of this indicator is mandatory against the following sub-activities in CSPs logframes. Selection of the below sub-activities will trigger in COMET the mandatory selection of this indicator:

1. Prevention of micronutrient deficiencies (PMD)

2. Prevention of acute malnutrition (PREV)

3. Prevention of stunting (STUN)

   
   

UNIT OF MEASUREMENT & ANALYSIS

Percentage of children under 5 and pregnant and breastfeeding women and girls

DEFINITION

This indicator measures the proportion of eligible individuals (tier 1) who are enrolled in and receiving nutrition prevention interventions aimed at reducing the risk of wasting, micronutrient deficiencies, or stunting.

The following terms are important for this indicator:

Prevention of wasting: WFP’s prevention package is a set of: integrated nutrition‑specific and nutrition‑sensitive interventions that aim to stop children and PBWG from becoming wasted/undernourished by addressing the immediate and underlying causes of malnutrition before it occurs. It focuses on pregnant and breastfeeding women, young children, and vulnerable households, improving access to nutritious foods (through cash, vouchers or specialized nutritious foods) alongside social and behaviour change support to protect diets and care practices and malnutrition screening.

Prevention of stunting: WFP’s approach to preventing stunting focuses on improving diets and nutrition during the most critical periods of growth, particularly during pregnancy and early childhood, while addressing the food system and household factors that drive malnutrition. This approach prioritizes maternal and child nutrition, increased access to diverse and nutritious diets, and social and behaviour change to support optimal infant and young child feeding, alongside strengthening food systems and national nutrition capacities so that healthy diets are affordable and sustainable over time.

Prevention of micronutrient deficiencies: refers to ensuring that vulnerable populations consistently consume diets that provide adequate essential vitamins and minerals needed for health, growth and development. WFP prevents micronutrient deficiencies primarily by improving the quality of diets, including through the provision of fortified foods, micronutrient‑rich specialized nutritious foods, and support to food fortification, with a particular focus on pregnant and breastfeeding women, infants and young children, who are most at risk of “hidden hunger.” A preventive approach to addressing malnutrition requires robust, context-specific analysis that identifies drivers of malnutrition. Knowing that more than one type of malnutrition can be, and often is, experienced at the same time, analyses must account for various types of malnutrition.

Definition of Eligible Populations

Eligible individuals are those from targeted food‑insecure households, particularly those experiencing severe levels of food insecurity such as populations living in areas classified as IPC/AFI or Cadre Harmonise (CH) Phase 3 or higher who receive GFA during the reporting period and whose members (children 6-23 months/6-59 months/PBWG) face an elevated risk of acute malnutrition or wasting.

In specific high‑risk contexts such as extreme malnutrition situations (IPC AFI/CH or AMN Phase 5 “Catastrophe”) or refugee camps eligibility criteria may be broadened due to heightened vulnerability. In these cases, all children aged 6–59 months and pregnant and breastfeeding women and girls (PBWG) in targeted locations may become eligible during the reporting period as part of a blanket intervention to prevent mortality.

For any preventive nutrition intervention:

• Numerator: Number of individuals in the target population who received the full intended preventive intervention within a defined period.

• Denominator: Total number of individuals who should have received the intervention, based on eligibility criteria (age, gender, physiological status, geography, additional nutritional vulnerability).

The denominator must reflect the actual objective of the intervention (prevent wasting, prevent stunting, prevent micronutrient deficiency), and not simply “all children” or “all PBWG” unless in exceptional circumstances (please see below).

Prevention of wasting:

• Numerator: Children 6–23 months (or 6–59 months, depending on programme design) and/or pregnant and breastfeeding women and girls (PBWG) from targeted food insecure households

• Denominator: All eligible children 6–23 months (or 6–59 months, depending on programme design) and or all eligible pregnant and breastfeeding women and girls (PBWG) living in targeted food insecure households receiving GFA during the reporting period.

Prevention of stunting

• Children

  • Numerator: Children 6–23 months who received the stunting prevention package.

  • Denominator: All eligible children 6–23 in the targeted area.

• PBWG

  • Numerator: Pregnant and breastfeeding women and girls who received the recommended minimum ration/dose/package (e.g., BEP) to prevent low birthweight and stunting in children

  • Denominator: All eligible Pregnant and Breastfeeding women and girls in target area during implementation period.

Prevention of Micronutrient Deficiencies

• Children

  • Numerator: Children 6–23 /6-59 months receiving specialized nutritious foods (micronutrient powder, LNS, etc.), fortified food and/or nutritious foods + minimum SBC package)

  • Denominator: All eligible children in that age group in the targeted area.

• PBWG

  • Numerator: Pregnant and breastfeeding women and girls receiving specialized nutritious foods (SC, LNS, etc.), fortified food and/or nutritious foods + minimum SBC package)

  • Denominator: All eligible pregnant and breastfeeding women and girls in the target area during the implementation period.

RATIONALE

Prevention coverage measures the proportion of at‑risk individuals who are receiving prevention support compared to those identified as needing it. The indicator assesses whether enrolment levels are sufficient in relation to the estimated needs of the target population and therefore reflects progress toward the commitment to leave no one behind in the prevention of wasting, micronutrient deficiencies, and stunting.

Through showing how many eligible individuals receive prevention services, coverage provides an important proxy for the effectiveness of programme outreach, the accessibility of services, and the quality of programme delivery. It also complements the adherence indicator by providing a fuller picture of programme performance from initial reach to sustained participation.

This indicator is essential for guiding operational decision making, optimizing resource allocation, and ensuring accountability to affected populations. It supports corporate commitments to prevent undernutrition, invest in the first 1,000 days, and reduce the burden of malnutrition in all its forms, in alignment with global nutrition targets and policy priorities.

DATA COLLECTION TOOL

Data source:

1) Desk Review (Routine Programme and Secondary Data)

• Estimating the eligible population:
  This is done using the most recent census data, population projections, and other context‑relevant datasets. Where eligibility is based on targeted food‑insecure households, particularly those experiencing severe levels of food insecurity such as populations living in areas classified as IPC/AFI or Cadre Harmonise (CH) Phase 3 or higher who receive GFA during the reporting period and whose members (children 6-23 months/6-59 months/PBWG) face an elevated risk of acute malnutrition or wasting.

• Estimating the population reached:
  Routine programme monitoring data, including Cooperating Partner (CP) reports and corporate reporting systems, provide the verified number of individuals who received prevention assistance.

2) Probabilistic Cross‑Sectional Survey

A probabilistic survey samples households across the entire catchment area using statistically representative methods, making this approach the most reliable for estimating coverage. Surveys generate direct, population‑based estimates of both eligibility and programme reach.

It is recommended that at least one probabilistic survey be conducted during the CSP cycle ideally near the beginning to strengthen the accuracy of coverage measurement and mitigate limitations inherent in routine data systems.

SAMPLING REQUIREMENTS

1. Desk Review

A desk review does not require sampling because it draws on complete programme and secondary datasets. All available information on programme reach and eligibility for the entire targeted population should be used. The total number of individuals who are eligible is established using the latest census and other relevant data based on criteria for eligibility described above. Program data such as Cooperating Partners (CP) reports and other corporate tools can be used to identify how many were reached.

2. Probabilistic Survey

Probabilistic cross-sectional surveys have the highest reliability as they use statistical sampling techniques to ensure reliability and representativeness in the population being surveyed. When a probabilistic cross‑sectional survey is used to estimate coverage, a statistically representative sample must be drawn. The following parameters should guide sample size calculation for this indicator:

• Population size:
  The sampling frame is the total number of individuals eligible for the programme at the time of the survey (e.g., children 6-23 months/6-59 months/ PBWG)

• Expected coverage (prevalence of the indicator):
  A minimum expected coverage of 70% may be used as a starting point; however, the expected value should be adjusted based on:

• previous programme results

• anticipated constraints such as limited outreach or access challenges.

• Lower expected coverage should be used when substantial barriers are known.

• Non-response rate:
  A 10% non-response adjustment is recommended to account for households or individuals who cannot be reached or decline to participate.

• Design effect (DEFF):
  If cluster sampling is applied, the design effect must be incorporated.

• When previous data is available, DEFF should reflect observed variability.

• If no prior information exists, a default value of 1.5 may be used.

• The design effect should be increased or decreased depending on the homogeneity or heterogeneity of the surveyed population, following standard sampling guidance.

• Confidence level:
  A 95% confidence interval is strongly recommended to ensure statistical reliability.

INDICATOR CALCULATION FOR REPORTING

For any preventive nutrition intervention, the following parameters are used to calculate the indicator:

Survey Calculation:

Scripts in R, STATA and SPSS and sample data are available on Github for the survey version of this indicator.

Desk Review Calculation:

Desk review calculations depend on registration and programme data availability. The different options are given below in order of preference. Both are relevant for continuous or short-term emergency programming.

1. Targeted individuals are registered, and monthly reporting available, including admissions and discharge

   

   Take note that registered does not mean that the individual received a transfer, and this should not be a requirement as attendance is rarely 100%. If this data is not available, this methodology cannot be used.

2. Targeted individuals are registered, but monthly reporting on admissions and discharge is not available OR Individuals are not registered.

   

   Note: The maximum number of individuals that received a transfer represents the month with the highest attendance.

This will be an underestimation depending on the adherence of beneficiaries within the program (see adherence indicator). Absence within a nutrition prevention programme is not uncommon, with a minimum of 66% of the beneficiaries receiving 66% of the transfers. This means that this method always entails a risk of underreporting.

DATA ENTRY AND DISAGGREGATION IN CORPORATE SYSTEMS

Values are recorded in the logframe. Each value has a reporting combination which is created based on:

• Sub-activity

• Country

• Target Group

Mandatory disaggregation (for follow-up value only):

• Sex

BASELINE

Baselines remain fixed for the entire CSP period and are not recalculated annually, unless applicable as above.

For a new programme, the baseline should be set as zero for the first year. The baseline for continuing programmes for more than one year should be based on the previous year’s coverage rate.

TARGET SETTING

Annual targets:

The minimum coverage of 70% needs to be set as a target. However, under very special circumstances, the annual targets can be set higher if there are strong indication that this is realistic and achievable.

End of CSP target:

WFP is committed to having a minimum coverage of 70% for its programming therefore targets need to be set at 70% (or under very special circumstances above if there are strong indications that this is realistic and achievable).

FREQUENCY OF DATA COLLECTION

Desk review: Data collection from the programme related data sources is conducted once per month if admission and discharge data are available. Data should be entered monthly and reported quarterly.

Cross-sectional surveys: Data collection should be undertaken at least once a year. A minimum of one survey needs to be conducted during the implementation of a CSP, within three months of the start of the programme.

There may be a need to collect data more frequently if there is a massive change in the operating environment or a need to monitor unusual performance data or areas of poor coverage more closely.

INTERPRETATION

Coverage reflects the programme’s ability to reach the population that is eligible and intended to benefit from nutrition prevention services. Higher coverage indicates stronger programme reach and alignment with needs, while lower coverage signals potential barriers to access or issues in programme design or implementation.

Interpreting this indicator requires examining coverage from the perspective of nutrition prevention service delivery. Key questions to guide interpretation include:

• Why are eligible individuals not benefiting from the programme?
  Consider barriers that may prevent people from accessing services, such as limited awareness, social norms, competing priorities, or exclusion errors.

• Are service delivery or programme design factors affecting coverage?
  Review issues such as distance to distribution sites or health facilities, transfer modality, targeting criteria, operating days/hours, supply consistency, outreach effectiveness, or constraints related to staffing or partners.

• Are there contextual or operational constraints?
  For example, insecurity, displacement, seasonality, access restrictions, or rapid population movements that may reduce the ability of eligible households to participate.

Coverage should therefore be interpreted not only as a number, but as an insight into how well the programme is reaching at‑risk groups and where improvements may be needed to strengthen prevention outcomes.

REPORTING EXAMPLE(S)

In 2025, prevention coverage for children 6–23 months in food‑insecure households in IPC 3+ areas reached 62%. Of the 48,000 children estimated to be eligible under the programme criteria, 29,760 were reached with at least one prevention transfer or service during the reporting period.

Coverage remains below the desired 70% benchmark, indicating that a substantial proportion of eligible children were not benefiting from prevention services. Programme review and field consultations suggest that reduced coverage is primarily linked to:

• Access constraints, particularly in hard‑to‑reach areas during the rainy season, limiting the ability of caregivers to attend distribution points.

• Distance to service sites, with several communities located more than 5 km from the nearest facility.

• Outreach gaps, including insufficient community‑level communication to ensure that newly food‑insecure households were aware of their eligibility.

No major issues with service quality or supply chain continuity were reported, suggesting that the observed gap is largely due to physical and information barriers, rather than modality or transfer design.

Targeted actions to improve coverage include:

1. Expanding mobile distribution days in the most remote clusters.

2. Increasing community sensitisation through local volunteers.

3. Revising micro‑planning to better align distribution days with seasonal access patterns.

INDICATORS COLLECTED & ANALYSED AT THE SAME TIME

The following indicators may be reported along with this indicator:

• 8. Proportion of target population who participate in an adequate number of distributions (adherence)

COMPLEMENTARY QUALITATIVE RESEARCH

Qualitative approaches including Focus Group Discussions and Key Informant Interviews to complement quantitative data and establish reasons for performance should be utilized. Qualitative data can also inform required actions and recommendations for improvement.

DECISIONS DATA CAN INFORM

Coverage is a proxy measurement of the quality of the prevention programme and an estimate of whether the programme’s reach is sufficient to achieve its intended results. The data can inform corrective action and determine beneficiaries’ scale up or follow-up. The coverage, in addition, informs decisions on improving the design of prevention programmes for the achievement of intended results. This can include changes to the types of delivery approaches, programme locations, and types of prevention services provided.

VISUALIZATION

Example:

LIMITATIONS

Desk reviews carry inherent limitations in accurately estimating both the number of individuals eligible and the number reached. These limitations stem from potential issues such as outdated or unreliable population data, incomplete or imprecise food insecurity figures, and challenges in ensuring correct targeting during programme implementation. As a result, coverage derived from a desk review should be interpreted as a proxy estimate, rather than a definitive measurement.

Desk reviews also do not provide insight into why individuals are or are not accessing services and therefore cannot identify barriers, enablers, or behavioural and contextual factors influencing coverage.

A coverage survey is strongly recommended to enhance accuracy and understanding. Conducting the survey as a joint exercise between WFP, nutrition partners, and government counterparts increases methodological robustness, strengthens ownership, and builds national and local capacity.

FURTHER INFORMATION

• Coverage Guidelines

• Nutrition M&E guidelines