Programme Recipients Research Articles

A post-diagnosis information and support programme for dyads-People living with dementia or mild cognitive impairment and family carers: A feasibility study.

The aim of the study was to establish the feasibility of delivering a structured post-diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings. A two-phase explanatory mixed-method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five-part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self-efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility. Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post-programme and 3-month follow-up. Post-programme semi-structured interviews were conducted with dyads and programme facilitators. Twenty-nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members. Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow-up time to 6 months. This study established the feasibility of registered nurses delivering a post-diagnosis information and support programme for people living with early-stage dementia or mild cognitive impairment and their informal carers in primary care settings. The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time. Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance. Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting. The authors have adhered to the EQUATOR STROBE Statement. A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation.

Mental health and psychosocial support programmes for displaced populations in low- and middle-income countries (LMICs): A systematic review of process, perspectives and experiences

Abstract Displacement exerts an ongoing negative impact on people’s mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of evidence synthesis on the implementation of mental health and psychosocial support (MHPSS) programmes in those contexts. We undertook a systematic review of factors influencing the delivery and receipt of MHPSS programmes for displaced populations in low- and middle-income countries to address this gap. A comprehensive search of 12 bibliographic databases, 25 websites and citation checking were undertaken. Studies published in English from 2013 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in, or programmes providers involved in delivering, MHPSS programmes. Fifteen studies were critically appraised and synthesised. Studies considered programme safety as a proxy for acceptability. Other acceptability themes included stigma, culture and gender. Barriers to the accessibility of MHPSS programmes included language, lack of literacy of programme recipients and location of services. To enhance success, future delivery of MHPSS programmes should address gender and cultural norms to limit mental health stigma. Attention should also be given to designing flexible programmes that take into consideration location and language barriers to ensure they maximise accessibility.

The Impact of Financial Aid Programmes on Access to Higher Education in Ugandan Universities

In Uganda, limited financial resources often obstruct higher education opportunities, particularly for those with modest incomes. Various financial aid initiatives have been introduced in an attempt to rectify this issue for equitable access. This study aimed to investigate the impact of financial aid initiatives on higher education accessibility, guided by two main research questions: (1) To what extent do financial aid programmes bolster access to higher education? (2) What challenges do students face in accessing financial aid for higher education? Employing a mixed-methods approach, data on enrollment into higher education institutions in Uganda were extracted from a National Council for Higher Education (NCHE) 2020 report for an overview into impacts of financial aid on access to higher education. For contextual and in-depth insight into the impacts of financial aid programmes on access to higher education, secondary data on loan schemes in two public universities and the Kabaka Education Fund in a private university were obtained and analysed using descriptive statistics. To understand the experiences and perspectives of financial aid programme recipients, qualitative interviews were conducted with a sample of 138 beneficiaries, including 12 individual recipients and 13 focus group discussions (FGDs) that involved 126 progressing recipients with about 9–10 persons per group from the three selected universities, whose responses were analysed using thematic content analysis. The results revealed that much as financial aid programmes have improved access to higher education in Ugandan universities, most financial services remain accessible primarily to wealthier individuals owing to barriers including application procedures, expenditure, discriminatory practices, limited information, a negative attitude towards aid and demotivation. The study recommends prioritising strategies that address the needs of a diverse student population to ensure equitable access to higher education, thereby promoting human progress, economic development, and the achievement of sustainable development goals.

The Impact of Financial Aid Programmes on Access to Higher Education in Ugandan Universities

In Uganda, limited financial resources often obstruct higher education opportunities, particularly for those with modest incomes. Various financial aid initiatives have been introduced in an attempt to rectify this issue for equitable access. This study aimed to investigate the impact of financial aid initiatives on higher education accessibility, guided by two main research questions: (1) To what extent do financial aid programmes bolster access to higher education? (2) What challenges do students face in accessing financial aid for higher education? Employing a mixed-methods approach, data on enrolment into higher education institutions in Uganda were extracted from a National Council for Higher Education (NCHE) 2020 report for an overview into impacts of financial aid on access to higher education. For contextual and in-depth insight into the impacts of financial aid programmes on access to higher education, secondary data on loan schemes in two public universities and the Kabaka Education Fund in a private university were obtained and analysed using descriptive statistics. To understand the experiences and perspectives of financial aid programme recipients, qualitative interviews were conducted with a sample of 138 beneficiaries, including 12 individual recipients and 13 focus group discussions (FGDs) that involved 126 progressing recipients with about 9–10 persons per group from the three selected universities, whose responses were analysed using thematic content analysis. The results revealed that much as financial aid programmes have improved access to higher education in Ugandan universities, most financial services remain accessible primarily to wealthier individuals owing to barriers including application procedures, expenditure, discriminatory practices, limited information, a negative attitude towards aid and demotivation. The study recommends prioritising strategies that address the needs of a diverse student population to ensure equitable access to higher education, thereby promoting human progress, economic development, and the achievement of sustainable development goals.

Experiences and perceived outcomes of a grocery gift card programme for households at risk of food insecurity.

This study explored programme recipients' and deliverers' experiences and perceived outcomes of accessing or facilitating a grocery gift card (GGC) programme from I Can for Kids (iCAN), a community-based programme that provides GGC to low-income families with children. This qualitative descriptive study used Freedman et al's framework of nutritious food access to guide data generation and analysis. Semi-structured interviews were conducted between August and November 2020. Data were analysed using directed content analysis with a deductive-inductive approach. Fifty-four participants were purposively recruited, including thirty-seven programme recipients who accessed iCAN's GGC programme and seventeen programme deliverers who facilitated it. Calgary, Alberta, Canada. Three themes were generated from the data. First, iCAN's GGC programme promoted a sense of autonomy and dignity among programme recipients as they appreciated receiving financial support, the flexibility and convenience of using GGC, and the freedom to select foods they desired. Recipients perceived these benefits improved their social and emotional well-being. Second, recipients reported that the use of GGC improved their households' dietary patterns and food skills. Third, both participant groups identified programmatic strengths and limitations. Programme recipients reported that iCAN's GGC programme provided them with dignified access to nutritious food and improved their households' finances, dietary patterns, and social and emotional well-being. Increasing the number of GGC provided to households on each occasion, establishing clear and consistent criteria for distributing GGC to recipients, and increasing potential donors' awareness of iCAN's GGC programme may augment the amount of support iCAN could provide to households.

Considering the youth voice: needs and asset assessment in sport for development using photovoice

With the growth of sport for development (SFD), it is increasingly important to ensure that programmes are intentionally designed to meet the needs of the communities they serve, in a way that helps build community capacity. Still, many programmes have been criticised for not considering the voices of marginalised individuals, specifically youth programme recipients, in the planning and development of SFDprogrammes. Additionally, programmes are developed from a deficit approach where only the needs or negative aspects of the community are being considered in the planning and development of programming. With these issues in mind, the purpose of this study was to assess the usefulness of photovoice as a strategic tool to give youth a voice in SFD needs and asset assessment. Additionally, it examined how practitioners can utilize the outcomes of a needs and asset assessment in planning and implementing SFD programming. The results highlight the assets and challenges that the youth participants identified and the practical use of the assessment from the perspective of programme administrators. The results suggest that photovoice can allow youth programme participants to have a genuine voice in programme development.

The Perspectives of Programme Staff and Recipients on the Acceptability and Benefits of the Ward-Based Outreach Teams in a South African Province.

The re-engineering of primary health care (PHC) called for the establishment of ward-based outreach teams as a reform strategy to bridge the gap between health facilities and communities. The Nkangala district established ward-based outreach teams in 2012. We used process evaluation to assess the acceptability of the outreach teams from the perspectives of those involved in the implementation as well as the clients who are the recipients of the outreach services in order to describe how the programme benefits the recipients, the staff, and the health system. Data were collected through interviews with multiple data sources. A thematic analysis was done using NVivo 11. The outreach programme is acceptable to the recipients and staff. The acceptability translated into measurable benefits for the recipients and the health system. Health benefits included increased access to services, support for treatment adherence, and linkages to various sector departments for social support. Since the inception of outreach teams, the district has recorded low utilisation of PHC services and improved priority indicators such as immunisation coverage, early antenatal bookings, treatment adherence, TB cure rates, and decreased default rates. The positive effects of the outreach teams on indicators underscore the need to roll the programme out to all sub-districts.

Importance of congruence between communicating and executing implementation programmes: a qualitative study of focus group interviews

BackgroundThe Ostrobothnia Depression Programme (ODP) in Finland was intended to implement two evidence-based brief psychotherapy interventions, namely motivational interview and behavioural activation, in several regional psychiatric teams. A simultaneous effectiveness study was conducted. Considerable tension was encountered between these two arms, causing resistance to change. We conducted a qualitative case study to better understand this tension and to discuss how managerial and executive practices may ensure the successful running of a hybrid design programme.MethodsWe conducted focus group interviews to evaluate the phases of preparation and practical execution of the ODP from the perspectives of management and the programme executives. To gather the data, we applied the revised Socratic approach for health technology assessment and focus group interviews. We analysed the data deductively according to the Normalization Process Theory.ResultsWe identified two main critical issues: (1) The ODP programme plan ignored the team leaders’ crucial role in influencing the implementation climate and mobilizing organizational strategies. The ODP had a simplistic top-down design with minimal and delayed collaboration with its target groups in the preparation phase. (2) Incongruence occurred between what the project group had explicitly communicated about being the spearhead of the ODP and what they then actually enacted. These two issues caused tension between the implementation efforts and the effectiveness study as well as resistance to change among the staff.ConclusionEarly, open collaboration with all prospective stakeholders towards a shared understanding about the programme is the first action the programme administrators should take. Agreement on goals and the means to achieve them would lower tension between the two arms of a hybrid design programme, thereby reducing resistance to change. Congruence between the goals communicated and the actual managerial and executive actions is of paramount importance in getting the programme recipients on board.

Recipient and instructor perspectives of an adapted exercise-based fall prevention programme for adults aged 50+ years with vision impairment: a qualitative study nested within a randomised controlled trial.

ObjectiveOlder adults with vision impairment currently have no access to tailored fall prevention programmes. Therefore, the purpose of this study, nested within an ongoing randomised controlled trial (RCT), is to document the adaptation of an existing fall prevention programme and investigate the perspectives of instructors involved in delivery and the older adults with vision impairment receiving the programme (recipients).DesignWe documented programme adaptations and training requirements, and conducted semistructured, individual interviews with both the instructors and the recipients of the programme from 2017 to 2019. The content of each interview was analysed using behaviour change theory through deductive qualitative analysis.SettingNew South Wales and Australian Capital Territory, Australia.ParticipantsThe 11 trained instructors interviewed were employees of a vision rehabilitation organisation and had delivered at least one programme session as part of the RCT. The 154 recipients interviewed were community-dwelling adults aged ≥50 years with vision impairment and no diagnosis of dementia, and had completed their participation in the programme as part of the intervention group of the RCT.ResultsSix key themes were identified relating to recipient (delivery aptitude, social norms, habit formation) and instructor (individualised adaptation, complimentary to scope of practice, challenges to delivery) perspectives. With initial training, instructors required minimal ongoing support to deliver the programme and made dynamic adaptations to suit the individual circumstances of each recipient, but cited challenges delivering the number of programme activities required. Recipient perspectives varied; however, most appreciated the delivery of the programme by instructors who understood the impact of vision impairment.Conclusions and implicationsThis novel qualitative study demonstrates that the adapted programme, delivered by instructors, who already have expertise delivering individualised programmes to older people with vision impairment, may fill the gap for a fall prevention programme in this population.Trial registration numberACTRN12616001186448.

Youth Experiences with Social Norms Feedback: Qualitative Findings from The Drug Prevention Trial the GOOD Life.

Background: Normative feedback is an intervention strategy commonly used in drug prevention programmes. This study collected process evaluation data about how programme recipients engage with social norms (SN) feedback in The GOOD Life intervention and how they experience it. Methods: Eight focus group interviews were conducted with a total of 44 adolescents (pupils aged 14–16 years) who have participated in the social-norms-based intervention The GOOD Life. The interviews focused on three topics: (1) interest in and impact of the intervention; (2) perception of the intervention elements; and (3) suggestions for improvement of The GOOD Life. They were transcribed and analysed with content analysis. Results: The analysis revealed that The GOOD Life motivated pupils to re-evaluate their own drug use behaviour and overall met their interest regarding receiving engaging and non-moral forms of drug prevention programmes. While pupils perceived the normative feedback session in the classroom and the posters with SN messages as positive, stimulating and surprising, the web-based application with SN feedback was rarely used and less positively evaluated. Anonymity and confidentiality were regarded as essential to provide honest answers in the poll. The pupils suggested even more variety in ways to engage them and to use more gaming elements. Conclusions: SN feedback was well perceived by adolescents. The intervention met their interest and needs and was able to achieve the intended impact of challenging norm perceptions. Anonymity and confidentiality are key in order to build trust and engage adolescents in the intervention.

Obesity treatment: a role for occupational therapists?

Background Half of the Danish population is overweight or obese. Obesity can negatively impact health and daily life. The Danish National Board of Health´s guidelines for weight loss programmes to the Danish municipalities, recommends multidisciplinary teams, including occupational therapy, and interventions targeting diet, exercise, psychosocial coping, and everyday life. Aim To describe the structure and content of obesity programmes offered by the 98 municipalities in Denmark, including details such as the health professionals, programme recipients, dose, structure, content, and the role of occupational therapists. Method A quantitative content analysis was conducted on 234 published Danish municipal weight loss programmes. Programme descriptions were identified through internet searches using both sundhed.dk and Google.com. Results Various health professionals conducted the programmes, and five involved occupational therapists. Programmes targeted children, adolescent and adults. Dose, structure and content were heterogeneous. Conclusion The majority of the programmes were neither evidence-based, nor did they follow recommendations from Danish National Board of Health. Few programmes addressed the role of habits or social participation. Occupational therapists appear to be under-utilized as providers of the programmes. Significance Occupational therapists have a role to play in weight loss programmes, because of their training in activity analysis and their consideration of people, environments, and occupations. These components are included in the recommendations about psychosocial aspects and everyday life from the Danish National Board of Health.

The importance of relationships in adolescent risk behaviour prevention

Abstract Health risk behaviours are a key contributing factor to adolescent morbidity and mortality. Furthermore, evidence shows that health behaviours begun in adolescence can impact on wellbeing across the lifespan. Current evidence suggests it is advantageous to target multiple health risk behaviours simultaneously, however efficacy testing remains the key focal point for research, with few studies exploring common underlying causal and contextual factors which may contribute to the success or failure of a programme. Methods This review used a customised realist approach, to explore how, why, for whom, and in what circumstances programmes are most successful in preventing multiple health risk behaviours in adolescents. The review synthesised evidence from published literature, along with qualitative data from stakeholders collected through focus groups with young people (n = 28) and school nurses (n = 22), and interviews with adolescent health and wellbeing practitioners (n = 8). Findings: Across all the realist programme theories developed, the role of relationships was the most commonly occurring theme. This theme goes beyond the expected impact of the relationship between programme deliverers and recipients, and familial and peer attachments, also taking in to consideration the relationships between programme and school leaders and staff, support networks and collaborative relationships between staff, and wider social connectedness within the community. These in turn were impacted upon by wider contextual factors, such as family, community, culture, socioeconomic status, intersectionality, and health inequalities. Conclusions These findings provide important insight in to understanding how, why, for whom, and in what circumstances multiple risk behaviour prevention programmes succeed or fail. Further to this they highlight key areas for consideration in the development of future adolescent public health interventions. Key messages Relationships built on trust and genuine care can improve adolescent risk behaviour prevention outcomes. Broader sociocultural context provide key explanations for variations in programme outcomes.

Improving wellbeing for pupils in early secondary education with Pyramid Club: A qualitative study investigating behaviour change drivers

Background:Children’s and young people’s emotional wellbeing is in decline and models of good practice are needed to help schools address the needs of vulnerable pupils. Effectiveness studies have provided empirical evidence for school-based socio-emotional interventions but few examine process issues to explain procedures and mechanisms underlying behavioural change.Aims:This paper explores behaviour change drivers elicited from a qualitative study of the Pyramid Club socio-emotional intervention; to gain an understanding of underlying processes and, thereby, determine the factors that contribute to behaviour change in programme recipients. Behaviour change drivers represents one of five global themes yielded from the complete dataset.Participants:Participants comprised a total of 65 young people aged 11–14 years (24 males; 41 females) who had attended one of eight Pyramid clubs at their respective school and 23 club leaders who had helped to run a club.Methods:Focus groups (in each school) were used to collect data from participants; groups for Pyramid attendees and club leaders were run separately. Data were thematically analysed jointly.Findings:Behaviour change drivers were organised into two thematic categories: Behaviour change procedures, which comprise contextual elements favourable to programme effectiveness and Behaviour change techniques, specific mechanisms prompting behaviour change.Conclusion:Findings extend Pyramid Club’s existing evidence base and can be used to better inform decision-makers in schools making implementation choices. More qualitative studies are needed to augment findings from effectiveness studies and to enable future programme development.

Non-tuition Costs, School Access and Student Performance: Evidence from the Gambia

Non-tuition costs—for uniforms, books and other supplies—are substantial in developing countries, often several times formal tuition. We evaluate a scholarship programme that alleviated non-tuition costs for girls in a subset of Gambian secondary schools. The programme is unique because it overlapped with a government policy that had already eliminated school fees for girls, allowing for a comparison between programme recipients and students who paid no tuition but were responsible for other expenses. We identify the effect of the programme by comparing outcomes for treated and untreated cohorts within programme schools. We find that non-tuition cost alleviation increased female enrolment by 13% and the share of enrolled students who took the ninth grade exit exam by 11 percentage points. These results highlight the importance of non-tuition costs in secondary school outcomes, even in settings where formal fees have been lifted.

Reintegrating former fighters in the Congo: ambitious objectives, limited results

ABSTRACTCurrent scholarly works in International Relations grew increasingly preoccupied over the effectiveness and programmatic failure of international assistance, especially with regard to issues pertaining to the ‘security–development’ nexus and the post-9/11 ‘securitization’ agenda. Complex Disarmament, Demobilization and Reintegration (DDR) programmes implemented worldwide since the late 1980s became a key component of international post-conflict intervention. With the extension of UN peacebuilding operations, DDR packages, which initially embraced short-term security goals in mere support of negotiated peace settlements, now entail significantly broader development objectives. Located at the interface of security and development approaches, DDR’s third phase, reintegration, has yielded limited outcomes despite growing efforts to implement long-term economic and social recovery activities. Using micro-level data derived from extensive fieldwork conducted in the Democratic Republic of Congo, this article argues that the challenges encountered in implementing reintegration might originate from high politicization of programme outcomes and recurrent neglect of local programme recipients and the socio-economic context in which they evolve. Despite formal endorsement of broad development objectives, this affected reintegration processes and their outcomes since what was really implemented consisted mainly of minimal activities prioritizing immediate security gains.

Perceptions of a short-term medical programme in the Dominican Republic: Voices of care recipients

Participation in short-term global health programmes for low-income countries is increasing amongst practising clinicians and trainees from high-income countries. However, few studies explicitly examine the perceptions of programme recipients. In July 2012, we conducted semi-structured interviews with a purposive sample of 47 adults receiving care from Medical Ministry International, an international non-governmental organisation providing short-term medical programmes in the Dominican Republic. Thirty interviews met criteria for inclusion. Transcripts were independently coded using a descriptive approach. After thematic saturation, 20 interviews were included in the final analysis. Nine major themes were identified: misidentification, access, identified needs, social determinants, faith, language, student involvement, areas for improvement and respect. Recipients were reluctant to discuss programme improvement directly and frequently misidentified the researcher as a caregiver, suggesting a need to separate clearly programme evaluation from care provision. They viewed student involvement positively in a setting where supervision is emphasised, suggesting a potential to develop measures of supervision's adequacy. Finally, recipients' perceptions of respect as an important but intangible programme element encourage broadening the ethical discourse around short-term programmes beyond only tangible goods and services. Our findings support the usefulness of qualitative methods for short-term programme evaluation and generate important hypotheses for future research.

Public health skills for a lay workforce: findings on skills and attributes from a qualitative study of lay health worker roles

To present a typology of attributes associated with lay health worker (LHW) roles drawn from a qualitative study of lay roles in the delivery of public health programmes. Qualitative research study of case studies of public health projects. Five case studies of public health projects were undertaken, reflecting diverse roles, public health issues and populations. Semi-structured interviews and focus groups were carried out with a sample of 136 stakeholders, including commissioners, practitioners, LHWs and service users. Thematic analysis was conducted within and across cases. Findings on the pre-eminence of social skills associated with LHW roles were consistent across all five projects. Being approachable, non-judgemental and responsive to community needs were critical attributes that enabled LHWs to undertake outreach and communicate successfully with programme recipients. Experiential knowledge and cultural understanding were also important qualities. A typology of attributes associated with LHW roles is presented. Social skills, the ability to connect with a community, and the ability to develop respectful relationships are fundamental qualities for LHW roles. Further research would be required to produce a comprehensive map of LHW skills; however, the paper questions assumptions that lay skills are necessarily of a lower order than the professional skill set.

A formative evaluation of a staff reward and recognition programme

Orientation: It is generally assumed that reward and recognition programmes have increased staff motivation and reduced staff turnover.Research purpose: The main aim of this evaluation was to test the plausibility of the programme theory underlying a staff reward and recognition programme within a retail setting. Secondary aims were to assess whether or not the programme was implemented as intended and whether or not its outcomes were well defined.Motivation for the study: Different groups of people may have different assumptions about whether a reward and recognition programme works or not. This evaluation was motivated by the different assumptions held by programme stakeholders, programme recipients and social science researchers regarding the programme.Research design, approach and method: This formative evaluation used a descriptive design. Primary qualitative data were collected by means of structured interviews with the Human Resource Development (HRD) Facilitator and ten programme participants.Main findings: The results showed that the programme theory was not plausible and that the programme was not implemented as intended. Although the HRD Facilitator and the participants agreed that the programme led to improved customer service, they disagreed about the other programme outcomes.Practical/managerial implications: This evaluation contains practical suggestions for improving the programme theory, the programme implementation process and the redefinition of the outcomes of the programme as standard performance indicators.Contribution/value-add: This evaluation contributed to the limited literature on the effect of reward and recognition programmes. Whilst there is a vast amount of literature pertaining to such programmes, very few formal evaluations exist about them.

Towards an evidence base of theory-driven evaluations: Some questions for proponents of theory-driven evaluation

This article discusses the further development of theory-driven evaluation approaches that are informed by contribution analysis. Using an illustrative example of an ongoing dance/physical activity programme for health promotion, a number of challenges are identified when applying a theory-driven evaluation approach. These challenges are reformulated as questions that need to be answered to make further progress with theory-driven evaluation including contribution analysis. Questions include: What is a ‘good enough’ programme theory? How does one arrive at expectations of programme impacts? How does the programme theory incorporate heterogeneous mechanisms that programme recipients might need? What does causality mean for complex interventions? What are structures that can facilitate learning from evaluations? How does the application of theory-driven evaluation approaches help generate an ‘ecology of evidence’? Discussion of these questions leads to a ‘roadmap’ for how contribution analysis might be further tested and refined.

The impact of the Kenya Cash Transfer Program for Orphans and Vulnerable Children on household spending

The Kenya Cash Transfer Program for Orphans and Vulnerable Children (CT-OVC) is the government's flagship social protection programme, reaching over 130,000 households and 260,000 orphans and vulnerable children across the country as of late 2011. The objective of this paper is to investigate whether the CT-OVC has changed the preferences of households in terms of their consumption behaviour. We compare standard difference-in-differences programme effects with ex-ante expected effects given baseline expenditure elasticities. As a result of the programme, participating households had significantly higher expenditures than control households on food, health, and clothing and significantly less spending on alcohol and tobacco. Programme impacts were also seen on spending in four of seven food groups. To test whether the programme simply moves households along their total expenditure Engel curve or in fact shifts that curve, we compare ex-ante expected behaviours with the ex-post actual response of households to the programme. We find in fact that in about one-half of the consumption categories ex-ante predicted and ex-post actual effects are significantly different, implying that preferences may have changed among programme recipients. We then directly test whether the programme has induced significant changes in expenditure elasticities (as implied by their associated marginal propensities to consume) and find evidence of this for alcohol and tobacco, and to a lesser extent for food, health and transportation and communication.