The Impact of Dosage Variability of Multi-Purpose Cash Assistance on Food Security in Syrian Refugees in Lebanon

Abstract

Abstract Objectives While food and cash-assistance have been shown to improve food security in Syrian refugees living in Lebanon, no studies have investigated dosage variability of cash transfers on food security in this setting. We assessed the impact of short- (≤12 months) and long-term (>12 months) multi-purpose cash assistance (MPC) provided by the World Food Programme (WFP) and the United Nations High Commissioner for Refugees (UNHCR), over and above food assistance, and the impact of discontinuation from MPC, on food security of Syrian refugees. Methods We used a quasi-experimental fuzzy Regression Discontinuity Design (RDD). A multi-dimensional household survey collected data in three-waves, at 6-month intervals. Households were sampled from a listing of registered Syrian refugees with WFP/UNHCR Vulnerability scores +/−10 points around the eligibility cut-off for MPC. Of 17,740 households approached, 11,457 completed the survey (65%). We assessed household food insecurity using the Food Insecurity Experience Scale and Livelihood Coping Strategies Index and diet quality using Food Consumption Score (FCS), and Household Dietary Diversity Score (HDDS). We estimated the treatment effect of MPC using two-stage least squares regression controlling for demographic characteristics (age, sex, head of household education) and receipt of other cash assistance. Results Food insecurity experience in those receiving long-term MPC decreased (P < 0.05), with a concomitant 7.7 percentage point decrease in reliance on emergency coping strategies (P < 0.01). Long-term MPC recipients had a 6 point increase in FCS (P < 0.01) along with an increase in diet diversity (P < 0.05), with higher consumption of vegetables, fish, chicken, and eggs found in both short-term and long-term MPC recipients. Conclusions There was a significant improvement in food security and diet quality among households receiving long-term MPC but not among those receiving short-term MPC (except for a small increase in diet diversity) or who were discontinued. Positive impact was observed above and beyond food assistance. Stability of assistance is therefore key in achieving impact from MPC n food security in this population. Funding Sources European Civil Protection and Humanitarian Aid Operations, German Federal Foreign Office, Norwegian Ministry of Foreign Affairs, and UK Aid, through CAMEALEON.