Transfer Program Research Articles

Child Well-Being, Family Functioning, and Contextual Strain: A Study of Multi-Assisted Low-Income Families

Objectives: This study aimed to examine the effects of poverty on child well-being and family functioning among low-income families. Specifically, it explored the role of parental stress, family dynamics, and contextual strain on children’s behavioral and emotional outcomes. Using a sample of families receiving welfare support, the research sought to assess the impact of conditional cash transfer programs and the involvement of Child Protective Services on child development and family well-being. Methods: This cross-sectional study involved 99 children aged 8–12 from low-income, welfare-assisted families recruited from the Porto Metropolitan Area. Parental stress, parenting attitudes, family functioning, and child outcomes were assessed using standardized questionnaires. Families with and without Child Protective Services involvement were compared, and a cumulative index of contextual strain was developed to measure the multidimensional impact of stressors on child outcomes. Results: The results revealed that 53% of children exhibited clinical or borderline internalizing behaviors, 47% showed externalizing behaviors, and 39% experienced low psychological well-being. High levels of parental stress, low parenting competence, and significant contextual strain were associated with poorer child outcomes. Families involved with Child Protective Services showed no significant differences in parent or family characteristics, but children from these families exhibited fewer behavioral problems. Conclusions: The study highlights the pervasive impact of poverty and contextual strain on child development, emphasizing the need for more comprehensive interventions. Family functioning and parental stress are critical factors influencing child well-being, pointing to the importance of addressing these areas through targeted welfare and support programs to reduce the intergenerational transmission of poverty and improve child outcomes.

National innovation system for resilience, transformation and sustainable development in Uganda: contextual analysis of the factors, actors and associated linkages

Purpose While the role of the National Innovation System (NIS) in promoting economic growth is well recognized, there remains a significant knowledge gap concerning how interactions among actors and learning processes within these systems facilitate innovation commercialization in Uganda. This gap hinders the effective design and implementation of policies aimed at boosting innovation-driven development in emerging economies. This study aims to explore the linkages and interrelationships among NIS actors in Uganda. Design/methodology/approach This study used systematic document reviews and case-study techniques. A systematic review based on the SPAR-4-SLR protocol evaluated the literature on Uganda’s NIS, including policy and strategy documents, development frameworks, journal articles and working papers. This dual approach allowed for an in-depth analysis of policy documents and empirical examples, revealing complex mechanisms within Uganda’s NIS. A content analysis tool facilitated the reduction of qualitative data through codification, theme development and the reporting of results. Findings This study explored the relationships among NIS actors, offering insights into using Uganda’s unique institutional and economic landscape for sustainable growth. It identifies key drivers, such as improved collaboration between the government, industry and academia and strategic policy measures in technology transfer and innovation funding, which are essential for revitalizing Uganda’s innovation ecosystem. Research limitations/implications This study presents a preliminary analysis of Uganda’s NIS. Future studies should adopt a longitudinal approach to examine the evolution of NIS over time, including the impact of global technological advancements and policy changes on Uganda’s innovation ecosystem. To elucidate the complex interrelationships within an NIS, subsequent research could employ network analysis or systems thinking methodology. These approaches would facilitate a more nuanced understanding of the interconnections and reciprocal influences among various NIS stakeholders. Practical implications The inclusion of the innovation, technology development and transfer (ITDT) program in National Development Plan III demonstrates that National Innovation System (NIS) incorporation into the country’s development process is possible through a combination of policy/regulatory, market/economic and technical/technological factors. Originality/value This study significantly advances the understanding of innovation systems by detailing the intricate network of relationships within Uganda’s NIS. This highlights the unexplored dimensions of learning and cooperation and offers a thorough analysis of the factors that enable innovation, which are crucial for promoting innovation in a developing country.

Cash transfers and voting among young women in Malawi

ABSTRACT We investigate the effects of cash transfer programs on adolescent females’ likelihood to vote in Malawi using data from a randomized control experiment. We find that cash transfers reduce adolescent females’ likelihood to vote. Our finding is consistent with existing evidence, which indicates an inverse relationship between income and voting in developing democracies. We also find suggestive evidence that cash transfers reduce the likelihood of voting through an income effect. By increasing the income of recipients, cash transfers could reduce the marginal utility of immediate financial gains that individuals might obtain from voting (in the form of vote buying) in developing democracies. In doing so, they might lower the incentive to participate in voting.

Role of NEP 2020 in Encouraging Global Partnerships in Indian Higher Education

The Government of India's National Education Policy (NEP) 2020 places a strong emphasis on internationalization and foreign collaborations in higher education. NEP 2020 is a powerful instrument for building worldwide collaborations because of its innovative approach to internationalization. The policy encourages cooperation through initiatives including combined degree programs, academic mobility, and research alliances with respectable foreign universities. It facilitates the process for foreign universities to establish campuses in India and encourages Indian institutions to increase their global presence. By promoting credit transfer programs and reciprocal qualification recognition, NEP 2020 aligns Indian education with global standards. This research examines the ways in which NEP 2020 has enabled these collaborations, pinpoints obstacles, and assesses their consequences for higher education in India. Both quantitative and qualitative techniques were used to assess a sample of 117 academic institution respondents. To guarantee thorough results, statistical testing and hypothesis validation were carried out. This study also examined the effects of NEP 2020 on international partnerships in Indian higher education, assessed the results, and pinpointed solutions to problems. The results advance knowledge of how policy frameworks improve HEIs' internationalization and competitiveness in the global market.

Implementing INTERACT in Veterans Health Administration Community Living Centers: A pragmatic randomized trial.

Hospital transfers from VA Community Living Centers (CLCs) are common. The objective of this study was to evaluate the effect of introducing the Intervention to Reduce Acute Care Transfers (INTERACT) program into VA CLCs. Cluster randomized trial involving 16 pair-matched VA CLCs. Intervention CLC nursing staff were trained in the use of INTERACT tools designed to identify early signs of a clinical change in condition and improve communication and documentation. One tool was embedded into the VA Electronic Medical Record. Intervention staff were supported by bi-weekly calls over 18 months to reinforce INTERACT tool use. The primary outcome for intent-to-treat analyses was the rate of all-cause hospitalizations per 1000 person days. Secondary outcomes, assessed through structured record reviews and algorithms, were intervention CLCs change in 1) potentially inappropriate transfer decisions and 2) potentially preventable transfers. CLC staff implementation and engagement in INTERACT were documented. Only five of the eight intervention CLCs substantially engaged in the intervention. Using a negative-binomial regression with random effects, adjusting for month, intervention, and the interaction of time and the intervention, we observed no statistically significant difference between intervention and control facilities in all-cause hospitalizations. This was confirmed with matched resident-level, as-treated, analyses among residents in the five engaged CLCs and their matched controls. Structured implicit review of intervention CLC's medical records revealed low rates of inappropriate transfer decisions both before and after the intervention. Introducing INTERACT into volunteer VA CLCs did not reduce the rates of all-cause hospitalizations. In both the pre- and post-intervention periods, all-cause hospitalization rates were relatively higher, and inappropriate transfers lower in VA CLCs than commonly observed in community NHs. Low rates of potentially inappropriate transfers and higher nurse and physician staffing in CLCs may explain why INTERACT was not implemented as fully as planned.

Cash transfers and women’s economic inclusion in rural Zambia

This paper investigates whether an increase in exogenous income through the Child Grants model of the Social Cash Transfer programme in Zambia fosters economic inclusion among rural women. We conceptualize economic inclusion as a transformative process comprised of four pillars: productive capacity, saving capacity, women’s empowerment, and time preferences and expectations. Using experimental data, we find strong evidence of direct impacts of the Child Grant on productive and saving capacity, and time preferences and expectations of rural women. In addition to these direct impacts, we implement a mediation analysis to explore the potential mediating role of time preferences and expectations in affecting the other pillars of economic inclusion. Through this approach, we find indicative evidence of indirect and mutually reinforcing relationships between changes in time preferences and expectations brought about through the Child Grant and improvements in the productive and saving capacity of beneficiaries. These results suggest that cash transfers might be effective in promoting women’s economic inclusion, both through the direct monetary effect and through the mediated effect of time preferences and expectations.

Conditional cash transfers and mortality in people hospitalised with psychiatric disorders: A cohort study of the Brazilian Bolsa Família Programme.

Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders. This cohort study utilised Brazilian administrative datasets, linking social and health system data from the 100 Million Brazilian Cohort, a population-representative study. We followed individuals who applied for BFP following a single hospitalisation with a psychiatric disorder between 2008 and 2015. The outcome was mortality and specific causes, defined according to International Classification of Diseases 10th Revision (ICD-10). Cox proportional hazards models estimated the hazard ratio (HR) for overall mortality and competing risks models estimated the HR for specific causes of death, both associated with being a BFP recipient, adjusted for confounders, and weighted with a propensity score. We included 69,901 psychiatric patients aged between 10 and 120, with the majority being male (60.5%), and 26,556 (37.99%) received BFP following hospitalisation. BFP was associated with reduced overall mortality (HR 0.93, 95% CI 0.87,0.98, p 0.018) and mortality due to natural causes (HR 0.89, 95% CI 0.83, 0.96, p < 0.001). Reduction in suicide (HR 0.90, 95% CI 0.68, 1.21, p = 0.514) was observed, although it was not statistically significant. The BFP's effects on overall mortality were more pronounced in females and younger individuals. In addition, 4% of deaths could have been prevented if BFP had been present (population attributable risk (PAF) = 4%, 95% CI 0.06, 7.10). BFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.

Do conditional cash transfers improve intergenerational gains in educational achievement?: Evidence from Brazil’s Bolsa Familia Program

Conditional cash transfer programs are designed to interrupt the intergenerational cycle of poverty by improving health and educational outcomes. We evaluate the efficacy of the world’s largest CCT program utilizing educational outcomes from the complete administrative records at the intra-family level of Brazil’s Bolsa Família program (PBF). Although we find that younger siblings subject to the Bolsa Família conditionalities outperform their older, untreated siblings in educational attainment within the same household, the overall effect size remains substantively small. We consider the educational attainment of 15–17 year old beneficiaries with siblings who were above the age of 18 at the time of family enrollment. Our findings show precisely estimated positive effects due to the large sample, indicating that the program yields minimal improvements in educational outcomes for ‘treated’ children compared to their ‘untreated’ siblings. Additionally, we find modest differences across boy and girl sibling pairs, but consistent regional effects, underscoring the importance of local public goods provision for enhancing program efficacy.

Exploring the impact of university-driven supplier development interventions on supplier performance: a case of the garment industry

PurposeThe purpose of this study is to investigate the effectiveness of university-driven knowledge transfer initiatives in enhancing the capabilities and performance of local suppliers in the garment industry. By focusing on the impact of UDIs in Myanmar, this research aims to provide empirical evidence on how these initiatives can foster supplier development and performance improvement through targeted capability enhancement strategies.Design/methodology/approachThis study utilizes a combination of surveys and an experimental design to evaluate the impact of university-driven supplier development interventions (UDIs) based on Lean principles in Myanmar’s garment industry. Nine garment suppliers were assessed before and after the UDI program. The research employed partial least squares structural equation modeling (PLS-SEM) to analyze the direct, indirect and mediating effects of UDIs on supplier performance, focusing on the role of supplier capability enhancement as a mediating factor.FindingsThe study found that the UDI program significantly improved supplier capabilities, which in turn led to enhanced performance. The analysis revealed partial mediation, indicating that while UDIs directly impact supplier performance, their effect is significantly amplified through the enhancement of supplier capabilities. These findings highlight the critical role of targeted capability development in achieving substantial performance improvements among local suppliers.Originality/valueThis research contributes to the literature by providing empirical evidence on the effectiveness of university-driven supplier development initiatives in a developing country context. It validates the indirect role of UDIs in boosting supplier performance via capability enhancement, emphasizing the importance of industry-specific and capability-focused development strategies. The findings underscore the value of structured knowledge transfer programs in supporting local suppliers, offering practical insights for policymakers and educational institutions aiming to enhance industrial performance through strategic interventions.

Role of Social Cash Transfers Among Children in Child-Headed Households: A Case of Jacha Area of Epworth in Harare, Zimbabwe, in the Face of Austerity Era

AbstractCash transfers are some of the social protection systems for reducing risks and vulnerabilities among children in child-headed families. There are limited academic studies that interrogate the role of social cash transfers among children in child-headed households (CHHs) in the Jacha area of Epworth, Harare, Zimbabwe, in the face of austerity era. A qualitative case study design was adopted to have an in-depth and detailed understanding of the lives of children in CHHs. The resilience theory was used to understand and analyse the realities of these children. Research findings suggest that social cash transfer programmes are very crucial in upholding the human rights of the children in child-headed households of the Jacha area in Epworth, Harare. As a result of social cash transfer programmes, some children in child-headed households enhanced their resilience in many ways. Some of them were rescued from the incidences of abuse, violence, and exploitation through cash transfers. The children in child-headed households were able to meet their basic needs such as food, education, health, clothes, having time for playing, and peer interactions. The article concludes by lobbying and advocating for more social protection programmes towards children in child-headed households in urban informal settlements of Epworth, Harare, Zimbabwe.

On marketization and public spending growth

Abstract I contribute to the literature on the growth of public spending in Western economies with a novel mechanism that ties it to the marketization process, i.e. the substitution of home with market production. I argue that a key contributor to the expansion of social spending is the replacement of family-based transfers with public pensions and other public transfer programs. I provide empirical support for this hypothesis by establishing the long-run relationship between government size and marketization, alongside other established determinants of government spending, in a panel of Western economies. I then illustrate a potential mechanism behind the results with a theoretical model in which, as a result of the productivity advantage of the market over the home sector, family-based intergenerational transfers decline unexpectedly, providing a rationale for government intervention in the form of public pensions with a poverty relief component.

Long-term effects of the targeting the ultra-poor program—a reproducibility and replicability assessment of banerjee et al. (2021)

Abstract Banerjee, Duflo, and Sharma (BDS, 2021a) conduct a ten-year follow-up of a randomized transfer program in West Bengal. BDS find large effects on consumption, food security, income, and health. We conduct a replicability assessment. First, we successfully reproduce the results, thanks to a perfectly documented reproduction package. Results are robust across alternative specifications. We furthermore assess the paper's pre-specification diligence and the reporting in terms of external and construct validity. While the paper refers to a pre-registration, it lacks a pre-analysis plan. Assessing the validity of findings for other contexts is difficult absent necessary details about the exact treatment delivery.

Performance of cash transfer program on farmers’ livelihood: evidence from PM-KISAN scheme of India

IntroductionResearch into various aspects of vulnerability and poverty has played a key role in shaping cash transfer systems. Cash-based direct benefit transfers (DBT) are frequently discussed, as they help reduce corruption and limit intermediary involvement, which often impedes policy implementation in countries like India. Small and marginal farmers (SMFs), constituting 86% of India’s farming population, are essential for sustainable agricultural growth and ensuring food and nutrition security. The Pradhan Mantri Kisan Samman Nidhi (PM-KISAN) scheme provides Rs.6000 annually to the farmer families via DBT mechanism. Despite reports and information from various government sources, significant concerns remain regarding the performance of PM-KISAN scheme in improving living conditions of SMFs.MethodsFor having the highest number of SMFs, a research study was conducted in Bihar and Uttar Pradesh. Two cluster of villages from each of these two states were chosen by simple random sampling (SRS) method. An ex post facto research design was used; data was gathered from 240 SMFs, with 120 beneficiaries and 120 non-beneficiaries, using a stratified disproportionate simple random sampling technique. The study used 18 indicators related to livelihood assets—human capital, social capital, natural capital, physical capital, and financial capital—to generate a Livelihood Index (LI) through Principal Component Analysis (PCA).ResultsThe beneficiaries of the scheme had an average LI score of 0.396, while non-beneficiaries had a score of 0.366. Propensity Score Matching (PSM) was employed to compare the beneficiaries and non-beneficiaries in order to determine the impact of the scheme. In the Livelihood Index of beneficiaries, in comparison to non-beneficiaries, there was a significant improvement of 3.34 to 4.13 percentage points, according to the analysis, which utilized a variety of matching algorithms.DiscussionImplications from the study suggests that PM-KISAN should be integrated into a broader rural development strategy to maximize multiplier effects. By combining cash transfers with complementary initiatives like modern technology adoption and high-yield seeds, farmers can make productive investments that could enhance their livelihood status.

Conditional Cash Transfer Programs and the Sustainable Development Goals: Problematizing the Empowering Potential of Conditional Cash Transfer Programs

Abstract Purportedly in line with the Sustainable Development Goals’ (SDGs) commitment to end poverty and gender inequality by 2030, conditional cash transfer programs (CCTs) provide poor households with cash contingent on parents making human capital investments in their children. Advocates claim CCTs empower and so benefit women and girls. Critics worry the programs reinforce gendered expectations by tying social protection to “good mothering.” The aim of this paper is to assess whether CCTs are compatible with the SDGs’ stated aims with regards to Goal 5 on gender equality and empowerment. I argue that CCTs run contrary to the stated aims of SDG 5. CCTs rely on and perpetuate sexist ideology about women while simultaneously policing women’s behavior to ensure they fulfill the state’s conception of a “good mother.” Notwithstanding the potential benefits women receive from CCTs, the programs prevent the disruption of power relations by reinforcing norms that incentivize women to engage in self-subordinating ways in exchange for cash. Given that the programs re-entrench and police gender norms, CCTs thwart progress towards SDG 5 and so move us no closer to a gender equal world.

Impact of Conditional Cash Transfer Program on Household Welfare in Southern Ethiopia: A matching estimator approach

Cash transfers (CTs) are now high on the agenda of most governments in low- and middle-income countries. Chronic food insecurity is one of the problems that has plagued millions of Ethiopians for centuries. This study evaluated the impact of participation in the conditional cash transfer (CCT) component of the PSNP (Public Works or PW) on household welfare in Karat Zuria District, Konso Zone, Southern Ethiopia. The cross-sectional survey data was gathered from 244 sample households, which were taken from beneficiary and control groups by using a multistage sampling procedure. Propensity score matching (PSM) was used to evaluate the program's impact on livestock holdings and total income. The result obtained from logit regression indicated that participation in a conditional cash transfer program was negatively influenced by access to credit and cultivated land size, whereas it was positively influenced by shock experience and an iron-roofed house. The econometrics model result shows that, as compared to control households, the program intervention increased the beneficiary households’ livestock holding (measured in TLU) by 24.8 percent (0.53 TLU) and total income by 33 percent (1705.095 ETB), respectively. This study demonstrated how the program had a considerable impact on household livestock holdings and total income.

Support of the luteal phase in programs for transferring thawed embryos into the uterine cavity in patients with overweight and obesity

Introduction. Progesterone levels are a critical factor for embryo implantation in in vitro fertilization (IVF) programs, including thawed embryo transfer programs. Overweight/obese patients often have lower blood progesterone concentrations in the luteal phase during IVF cycles, which requires an individual approach to planning luteal support in this category of patients.Aim. To compare the pregnancy ratе and miscarriage rates up to 12 weeks of pregnancy in overweight/obese patients who underwent a program of transfer of thawed embryos into the uterine cavity, depending on the type and route of administration of gestagens.Materials and methods. The study included 76 overweight or obese patients. All patients were treated for infertility using a program for transferring a thawed embryo into the uterine cavity; luteal phase support was carried out either using micronized progesterone, identical to natural, – the drug Utrogestan in a daily dose of 800 mg intravaginally (40 patients), or combination therapy was prescribed – vaginal gel with progesterone 90 mg in combination with the synthetic progestin dydrogesterone in a daily dose of 30 mg, taken orally (36 patients).Results. The rates of pregnancy and miscarriage in the first trimester were comparable in both groups and did not depend on differences in luteal support.Conclusions. The formation of the luteal phase of the cycle in patients with overweight/obesity is equally effective using various forms of gestagens. The use of micronized progesterone may be preferable in patients with overweight/obesity in terms of the ability to monitor blood progesterone levels, a more favorable metabolic profile when used vaginally, and the possibility of switching to oral administration of the drug in the event of the development of adverse local events.

The long-term effects of cash transfer programmes on young adults' mental health: A quasi-experimental study of Colombia, Mexico and South Africa.

Poverty is associated with poorer mental health in early adulthood. Cash transfers (CTs) have been shown to improve child health and education outcomes, but it is unclear whether these effects may translate into better mental health outcomes as children reach young adulthood. Using a quasi-experimental approach that exploits variation across countries in the timing of national CT programme introduction, we examine whether longer exposure to CTs during childhood (0-17 years) reduces depressive symptoms in early adulthood (18-30 years). Based on harmonized data from Colombia, Mexico and South Africa (N= 14 431) we applied logistic regression models with country- and birth-cohort fixed effects to estimate the impact of cumulative years of CT exposure on mental health, educational attainment and employment outcomes. Our findings indicate that each additional year of CT exposure during childhood is associated with a 4% reduction in the odds of serious depressive symptoms in early adulthood (OR = 0.96, 95% CIs: 0.93 to 0.98). We find no consistent effect of years of exposure on completion of secondary school (OR = 1.01, 95% CIs: 0.99, 1.03), and a negative effect on the probability of employment in early adulthood (OR = 0.90, 95% CIs: 0.88, 0.91). These results suggest that longer exposure to CTs may contribute to modest but meaningful reductions in population level depressive symptoms during early adulthood.

Effects of Livelihood Empowerment against Poverty (Leap) on Beneficiaries in Kwaebibirem Municipality.

Background: Ghana has assented to many international conventions and has passed national legislation that obliges the government to find practical expressions to cater to civil and political rights and its citizens' economic, social, and cultural rights. To meet these legal requirements, the Government of Ghana has drafted and is implementing a National Social Protection Strategy to protect its vulnerable populace. A major element of this strategy is the Livelihood Empowerment Against Poverty (LEAP). LEAP is a direct cash transfer programme, which targets about a quarter of Ghana's populace hit with extreme poverty due to their state of being vulnerable, old age or orphans. The study was conducted in the Kwaebibirem Municipality of the Eastern Region to unearth Livelihood Empowerment against Poverty (LEAP)’s effect on the beneficiaries and the shortcomings since its implementation. Methodology: This study employed the mixed-method research approach. A purposive sampling technique was used to select 40 respondents. Data were obtained from all sources. Findings: The study revealed that the cash transfer system, despite its challenges, tends to have more positive effects on the beneficiaries. Findings reveal general operational challenges such as depoliticization, delays in cash disbursement for payment and sensitization. Unique Contribution to Theory, Practice and Policy: The study recommends that the Ministry of Gender and Social Protection decentralize LEAP activities.

Leaving the Shadows Behind? Effects of Domestic Workers Reform on Mothers’ Formal Employment

Abstract What happens when new labor regulations are implemented and enforced while a welfare cash transfer program is already in place? Argentinean National Law 26.844 of 2013 aimed to increase formalization rates in the domestic work sector by increasing access to benefits for workers and enforcement mechanisms for household employers. Compared to those with older children, a 5 percentage–point lower increase in formalization among domestic workers with children under 18 years of age (a key eligibility criterion for welfare) is found after the introduction of the regulation. Moreover, there is suggestive evidence that this may stem from domestic workers’ concerns about losing welfare payments, although it is unclear whether this fear arises from misunderstanding, lack of information, or distrust in the reform. These findings underscore the importance of policy designs that mitigate potential disincentives and ensure that they do not undermine efforts to increase formal sector participation.

The Longlasting Program Keluarga Harapan as Conditional Cash Transfer in Indonesia: The Existing Problems and the Policy Recommendations

Program Keluarga Harapan (PKH) is a conditional cash transfer program in Indonesia that requires beneficiaries to meet certain requirements such as school attendance and health checks. Adopted from similar models in Latin America, PKH aims to reduce short-term poverty and invest in the health and education of future generations. Since its launch in 2007, PKH has operated in various regions with different poverty and infrastructure issues. PKH faces several challenges, including mistargeting of beneficiaries and burdensome bureaucracy for the poor. To address this, improvements to the targeting system and simplification of document procedures are recommended. The program has also contributed to reducing stunting through improved nutrition and health education, although health facilities need to be improved. In the education sector, PKH has succeeded in increasing school enrollment and attendance, but has not significantly reduced child labor. In terms of livelihoods, PKH encourages beneficiaries to shift to non-agricultural jobs, although often only casual labor. This study uses descriptive and explanatory designs to describe and explain the evolution of the PKH policy from 2007. Descriptive design is used to describe policy changes that occurred during the period, while explanatory design is used to explain the factors that influence policy changes and their impact on program effectiveness. The results found that there were problems with PKH facilitators including insufficient numbers, high workloads, and low salaries, which affected their effectiveness. To improve the performance of facilitators, new recruitment, regular training, and increased salaries and working conditions are recommended.