Skip to main content

Impact of two policy interventions on dietary diversity in Ecuador

  • Juan Ponce (a1) and Jesus Ramos-Martin (a1)

To differentiate the effects of food vouchers and training in health and nutrition on consumption and dietary diversity in Ecuador by using an experimental design.


Interventions involved enrolling three groups of approximately 200 randomly selected households per group in three provinces in Ecuador. Power estimates and sample size were computed using the Optimal Design software, with a power of 80 %, at 5 % of significance and with a minimum detectable effect of 0·25 (sd). The first group was assigned to receive a monthly food voucher of $US 40. The second group was assigned to receive the same $US 40 voucher, plus training on health and nutrition issues. The third group served as the control. Weekly household values of food consumption were converted into energy intake per person per day. A simple proxy indicator was constructed for dietary diversity, based on the Food Consumption Score. Finally, an econometric model with three specifications was used for analysing the differential effect of the interventions.


Three provinces in Ecuador, two from the Sierra region (Carchi and Chimborazo) and one from the Coastal region (Santa Elena).


Members of 773 households randomly selected (n 4343).


No significant impact on consumption for any of the interventions was found. However, there was evidence that voucher systems had a positive impact on dietary diversity. No differentiated effects were found for the training intervention.


The most cost-effective intervention to improve dietary diversity in Ecuador is the use of vouchers to support family choice in food options.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Impact of two policy interventions on dietary diversity in Ecuador
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Impact of two policy interventions on dietary diversity in Ecuador
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Impact of two policy interventions on dietary diversity in Ecuador
      Available formats
Corresponding author
* Corresponding author: Email
Hide All
1. van den Bold, M, Quisumbing, AR & Gillespie, S (2013) Women’s Empowerment and Nutrition. An Evidence Review. IFPRI Discussion Paper no. 01294. Washington, DC: International Food Policy Research Institute.
2. Fiszbein, A & Schady, N (2009) Conditional Cash Transfers. Reducing Present and Future Poverty. Washington, DC: The World Bank.
3. Torres, I (2016) Policy windows for school-based health education about nutrition in Ecuador. Health Promot Int (Epublication ahead of print version).
4. Freire, WB, Silva-Jaramillo, KM, Ramirez-Luzuriaga, MJ et al. (2014) The double burden of undernutrition and excess body weight in Ecuador. Am J Clin Nutr 100, issue 6, 1636S1643S.
5. Popkin, BM, Adair, LS & Ng, SW (2012) Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70, 321.
6. Freire, WB, Ramírez, MJ, Belmont, P et al. (2014) Tomo I: Encuesta Nacional de Salud y Nutrición de la población ecuatoriana de cero a 59 años. ENSANUT-ECU 2012. Quito: Ministerio de Salud Pública.
7. Ecuadorian Ministry of Education (2010) Actualización y Fortalecimiento Curricular de la Educación General Básica (Curriculum Update and Strengthening for Basic Education). Quito: Ministry of Education.
8. Ecuadorian Ministry of Education (2012) Estándares de Calidad Educativa (Education Quality Standards). Quito: Ministry of Education.
9. Ecuadorian Ministry of Education (2012) Proyecto Programa de Alimentación Escolar (School Feeding Program). Quito: Ministry of Education.
10. Yablonski, J & O’Donnell, M (2009) Lasting Benefits. The Role of Cash Transfers in Tackling Child Mortality. London: Save the Children.
11. An, R (2013) Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public Health Nutr 16, 12151228.
12. Dimitri, C, Oberholtzer, L, Zive, M et al. (2015) Enhancing food security of low-income consumers: an investigation of financial incentives for use at farmers’ markets. Food Policy 52, 6470.
13. Herman, DR, Harrison, GG & Jenks, E (2006) Choices made by low-income women provided with an economic supplement for fresh fruit and vegetable purchase. J Am Diet Assoc 106, 740744.
14. Herman, DR, Harrison, GG, Afifi, AA et al. (2008) Effect of a targeted subsidy on intake of fruits and vegetables among low-income women in the Special Supplemental Nutrition Program for Women, Infants, and Children. Am J Public Health 98, 98105.
15. Buyuktuncer, Z, Kearney, M, Ryan, CL et al. (2014) Fruit and vegetables on prescription: a brief intervention in primary care. J Hum Nutr Diet 27, 186193.
16. Burr, ML, Trembeth, J, Jones, KB et al. (2007) The effects of dietary advice and vouchers on the intake of fruit and fruit juice by pregnant women in a deprived area: a controlled trial. Public Health Nutr 10, 559565.
17. McFadden, A, Green, JM, Williams, V et al. (2014) Can food vouchers improve nutrition and reduce health inequalities in low-income mothers and young children: a multi-method evaluation of the experiences of beneficiaries and practitioners of the Healthy Start programme in England. BMC Public Health 14, 148.
18. Anderson, JV, Bybee, DI, Brown, RM et al. (2001) 5 a day fruit and vegetable intervention improves consumption in a low income population. J Am Diet Assoc 101, 195202.
19. Bihan, H, Castetbon, K, Mejean, C et al. (2010) Sociodemographic factors and attitudes toward food affordability and health are associated with fruit and vegetable consumption in a low-income French population. J Nutr 140, 823830.
20. Bihan, H, Méjean, C, Castetbon, K et al. (2012) Impact of fruit and vegetable vouchers and dietary advice on fruit and vegetable intake in a low-income population. Eur J Clin Nutr 66, 369375.
21. Blakely, T, Ni Mhurchu, C, Jiang, Y et al. (2011) Do effects of price discounts and nutrition education on food purchases vary by ethnicity, income and education? Results from a randomised, controlled trial. J Epidemiol Community Health 65, 902908.
22. Ni Mhurchu, C, Blakely, T, Jiang, Y et al. (2010) Effects of price discounts and tailored nutrition education on supermarket purchases: a randomized controlled trial. Am J Clin Nutr 91, 736747.
23. Gentilini, U (2015) Revisiting the ‘cash versus food’ debate: new evidence for an old puzzle? World Bank Res Obs 31, 135167.
24. Gertler, P (2004) Do conditional cash transfers improve child health? Evidence from PROGRESA’s control randomized experiment. Am Econ Rev 94, 336341.
25. Behrman, JR & Hoddinott, J (2005) Programme evaluation with unobserved heterogeneity and selective implementation: the Mexican PROGRESA impact on child nutrition. Oxf Bull Econ Stat 67, 547569.
26. Maluccio, JA & Flores, R (2005) Impact Evaluation of a Conditional Cash Transfer Program: The Nicaraguan Red de Protección Social. FNCD Discussion Paper no. 184. Washington, DC: International Food Policy Research Institute.
27. Siega-Riz, AM, Estrada Del Campo, Y, Kinlaw, A et al. (2014) Effect of supplementation with a lipid-based nutrient supplement on the micronutrient status of children aged 6–18 months living in the rural region of Intibucá, Honduras. Paediatr Perinat Epidemiol 28, 245254.
28. Attanasio, O, Gómez, LC, Heredia, P et al. (2005) The Short-term Impact of a Conditional Cash Subsidy on Child Health and Nutrition in Colombia. Report Summary: Familias 03. London: Institute for Fiscal Studies.
29 Morris, SS, Flores, R, Olinto, P et al. (2004) Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial. Lancet 364, 20302037.
30. Morris, SS, Olinto, P, Flores, R et al. (2004) Conditional cash transfers are associated with a small reduction in the rate of weight gain of preschool children in northeast Brazil. J Nutr 134, 23362341.
31. Paxson, C & Schady, N (2010) Does money matter? The effects of cash transfers on child development in rural Ecuador. Econ Dev Cult Change 59, 187229.
32. Hidrobo, M, Hoddinott, J, Peterman, A et al. (2014) Cash, food, or vouchers? Evidence from a randomized experiment in northern Ecuador. J Dev Econ 107, 144156.
33. Ministerio de Salud Pública del Ecuador (2010) Tabla Compilada de Composición Química de Alimentos Ecuatorianos, revisión de 2010. Quito: Ministerio de Salud Pública.
34. World Food Programme (2008) Food Consumption Analysis. Calculation and Use of the Food Consumption Score in Food Security Analysis. Rome: World Food Programme.
35. Ministerio de Inclusión Económica y Social (2013) Informe de Gestión. Quito: Ministerio de Inclusión Económica y Social.
36. León, M & Younger, SD (2007) Transfer payments, mothers’ income and child health in Ecuador. J Dev Stud 43, 11261143.
37. National Secretariat of Planning and Development (2013) National Plan for Good Living 2013–2017. Quito: SENPLADES.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed