Improving access to nutritious food through CVA to address Moderate Acute Malnutrition

Cash and vouchers for nutrition: what do we know about access to local foods?

How can families better access nutritious food in fragile and crisis contexts? And what role can cash and vouchers play in addressing child malnutrition? A new evidence review by Action Against Hunger explores these questions by looking specifically at how cash and voucher assistance (CVA) can help households access and consume local, nutritious foods—what is referred to as the “food route.” By focusing on this pathway, the review contributes to a growing conversation on how humanitarian assistance can better support nutrition through markets and local food systems.

Focusing on access to food

Cash and voucher assistance is widely used in humanitarian settings and can influence nutrition in several ways. It can, for instance, improve access to healthcare services, support livelihoods, or reduce economic stress within households. These different pathways all contribute, directly or indirectly, to better nutrition outcomes.

This review, however, takes a clear and deliberate focus on one pathway only: how CVA can improve nutrition through food itself, by enabling families to purchase and consume nutrient-dense, locally available foods.

This distinction is important. By concentrating on the “food route,” the study isolates the role of food access—what people are able to buy, cook, and eat—and how this affects nutrition outcomes. It also highlights the role of local markets, food availability, and household decision-making. In doing so, the review helps unpack a complex issue that is often influenced by many overlapping factors.

Why this matters

Ensuring access to nutritious food is central to preventing wasting and supporting recovery from malnutrition. Recent WHO guidance emphasizes the importance of locally available, nutrient-dense diets for both preventing and managing acute malnutrition. These recommendations stress that children, as well as pregnant and breastfeeding women, need regular access to diverse, safe, and nutrient-rich foods to support healthy growth, development, and survival.

At the same time, cash and vouchers are increasingly used in humanitarian responses. They provide families with flexibility and dignity, allowing them to prioritize their needs and make their own choices. They also support local economies by strengthening demand in markets, which can benefit producers, traders, and communities more broadly. Because of this flexibility, CVA has become a key tool across many contexts—from development settings to acute emergencies. However, despite their widespread use, the specific contribution of cash and vouchers to nutrition outcomes—especially through improving access to local foods, in line with global recommendations—has not always been clearly understood. This review responds to that need by bringing together existing evidence and highlighting what we know, as well as what remains uncertain.

What does the evidence tell us?

The review draws on a large body of evidence, combining findings from more than 50 studies as well as insights from practitioners working in the field. It offers a comprehensive overview of how CVA for food interventions have been designed and implemented across different contexts, and what effects they have had on nutrition-related outcomes.

Overall, the findings suggest that cash and voucher assistance used for food can play a meaningful role in improving nutrition, particularly by supporting access to diverse diets. At the same time, the review makes clear that results are not uniform. Outcomes vary significantly depending on context, the type of intervention, and the way programmes are implemented.

Rather than providing simple or definitive answers, the study offers a balanced and nuanced perspective. It highlights where evidence is strong and consistent, where it is still emerging, and where gaps remain. It also underlines the importance of programme design choices—such as transfer size, timing, or whether additional support is included—in shaping outcomes.

Importantly, the review points to areas where further learning is needed, including the role of CVA in treating malnutrition, differences between types of assistance (cash versus vouchers), and the specific needs of certain population groups.

Beyond the headlines: why you should read the full review

This article provides only a high-level overview of a much more detailed analysis. The full report goes significantly further, offering a rigorous synthesis of global evidence alongside practical insights drawn from field experience.

Readers will find a deeper exploration of how programmes work in practice, how different design choices influence outcomes, and how interventions can be adapted to specific contexts. The report also outlines operational recommendations for practitioners, as well as a clear agenda for future research.

For humanitarian organisations, donors, policymakers, and technical experts working to strengthen nutrition outcomes, particularly through market-based approaches, the full review is an essential resource. It not only compiles existing knowledge but also helps guide future efforts.

Moving forward

As humanitarian needs continue to grow and contexts become more complex, there is increasing demand for approaches that are both effective and adaptable. Cash and voucher assistance represents one of these approaches, offering flexibility while also connecting people to local markets.

This review highlights that improving access to local, nutritious foods through CVA to prevent or manage MAM is a promising pathway, but also one that requires careful consideration. Understanding local food systems, market dynamics, and household practices is essential to ensure that assistance translates into meaningful improvements in nutrition.

It also reinforces the importance of integrating CVA with other forms of support where needed, and of continuing to build the evidence base. Learning from experience, adapting programmes, and investing in better data will be key to maximising impact.

To explore the findings, recommendations, and evidence in depth, read the full report :