Unconditional Cash Transfer Program Research Articles

The REFANI-S study protocol: a non-randomised cluster controlled trial to assess the role of an unconditional cash transfer, a non-food item kit, and free piped water in reducing the risk of acute malnutrition among children aged 6\u201359\xa0months living in camps for internally displaced persons in the Afgooye corridor, Somalia

BackgroundThe prevalence of acute malnutrition is often high in emergency-affected populations and is associated with elevated mortality risk and long-term health consequences. Increasingly, cash transfer programmes (CTP) are used instead of direct food aid as a nutritional intervention, but there is sparse evidence on their nutritional impact. We aim to understand whether CTP reduces acute malnutrition and its known risk factors.Methods/designA non-randomised, cluster-controlled trial will assess the impact of an unconditional cash transfer of US$84 per month for 5 months, a single non-food items kit, and free piped water on the risk of acute malnutrition in children, aged 6–59 months. The study will take place in camps for internally displaced persons (IDP) in peri-urban Mogadishu, Somalia.A cluster will consist of one IDP camp and 10 camps will be allocated to receive the intervention based on vulnerability targeting criteria. The control camps will then be selected from the same geographical area. Needs assessment data indicates small differences in vulnerability between camps.In each trial arm, 120 households will be randomly sampled and two detailed household surveys will be implemented at baseline and 3 months after the initiation of the cash transfer. The survey questionnaire will cover risk factors for malnutrition including household expenditure, assets, food security, diet diversity, coping strategies, morbidity, WASH, and access to health care. A community surveillance system will collect monthly mid-upper arm circumference measurements from all children aged 6–59 months in the study clusters to assess the incidence of acute malnutrition over the duration of the intervention. Process evaluation data will be compiled from routine quantitative programme data and primary qualitative data collected using key informant interviews and focus group discussions.The UK Department for International Development will provide funding for this study. The European Civil Protection and Humanitarian Aid Operations will fund the intervention. Concern Worldwide will implement the intervention as part of their humanitarian programming.DiscussionThis non-randomised cluster controlled trial will provide needed evidence on the role of unconditional CTP in reducing the risk of acute malnutrition among IDP in this context.Trial registrationISRCTN29521514. Registered 19 January 2016.

Unconditional Cash Transfers Do Not Prevent Children's Undernutrition in the Moderate Acute Malnutrition Out (MAM'Out) Cluster-Randomized Controlled Trial in Rural Burkina Faso

Background: Limited evidence is available on the impact that unconditional cash transfer (UCT) programs can have on child nutrition, particularly in West Africa, where child undernutrition is still a public health challenge.Objective: This study examined the impact of a multiannual, seasonal UCT program to reduce the occurrence of wasting (weight-for-height, midupper arm circumference), stunting (height-for-age), and morbidity among children <36 mo old in Tapoa Province, in the eastern region of Burkina Faso.Methods: The study was designed as a 2-arm cluster-randomized controlled trial, with 32 villages randomly assigned to either the intervention or the control group. The study population comprised households that were classified as poor or very poor according to household economy approach criteria and that had ≥1 child <1 y of age at inclusion. The intervention consisted of seasonal UCTs, provided monthly from July to November, over 2 y (2013 and 2014). A monthly allowance of 10,000 West African Financial Community of Africa francs (∼US$17) was given by mobile phone to mothers in participating households. Anthropometric measurements and morbidity were recorded on a quarterly basis.Results: We found no evidence that multiannual, seasonal UCTs reduced the cumulative incidence of wasting in young children [incidence rate ratio: 0.92 (95% CI: 0.64, 1.32); P = 0.66]. We observed no significant difference (P > 0.05) in children's anthropometric measurements and stunting between the 2 groups at the end point. However, children in the intervention group had a lower risk [21% (95% CI: 18.6%, 21.3%); P < 0.001] of self-reported respiratory tract infections than did children in the control group.Conclusions: We found that seasonal UCTs in the framework of safety nets did not result in a significant decrease in the incidence of acute malnutrition among children in Tapoa Province. Cash transfers combined with complementary interventions targeted to child nutrition and health should be investigated further. This trial was registered at clinicaltrials.gov as NCT01866124.

Reducing Adolescent Risky Behaviors in a High-Risk Context: The Effects of Unconditional Cash Transfers in South Africa

South African adolescents living in poverty are at significant risk for negative outcomes associated with risky sexual activity and substance use. The South African government introduced the Child Support Grant (CSG) to reduce poverty and provide protection from these risks. We use variation in grant receipt by age to estimate potential effects of this unconditional cash transfer program on adolescent outcomes. The study findings suggest that the CSG may play an important role in reducing adolescent risky behaviors, particularly early sexual debut among females. The results also suggest that policy efforts to expand grant access to children up to adulthood and to reduce barriers to maintaining grant access for those living in poverty should improve outcomes for South African adolescents.

Short-term impacts of an unconditional cash transfer program on child schooling: Experimental evidence from Malawi

This study analyzes the impact of a positive income shock on child schooling outcomes using experimental data from an unconditional cash transfer program in Malawi. Since households receive the cash and parents are responsible for making spending decisions, we also examine the intervening pathways between cash transfers and child schooling. Data comes from a cluster-randomized study of Malawi's Social Cash Transfer Program (SCTP). After a baseline survey, households in village clusters were randomly assigned to treatment and control arms with treatment villages receiving transfers immediately and control villages assigned a later entry. We test for treatment impacts on a panel of school-aged children (6–17) using a differences-in-differences model. After a years’ worth of transfers, we find the Malawi SCTP both improves enrollment rates and decreases dropouts. The main intervening pathway between the program and schooling is education expenditures, suggesting that the cash improves the demand for education by reducing financial constraints.

Investments in children's health and the Kenyan cash transfer for orphans and vulnerable children: evidence from an unconditional cash transfer scheme.

Child mortality is one of the most pressing global health and policy issues in the developing world. The leading drivers of death-pneumonia, diarrhea and malaria-are preventable and treatable. However, these illnesses are exacerbated by a lack of accessible nutrition, water, basic and preventive health services, and sanitary living conditions-all factors which are more likely to disproportionately impact the poor. We examine whether Kenya's largest social protection impacts children's incidence of upper respiratory illness. The Kenya Cash Transfer for Orphans and Vulnerable Children was designed to support orphans affected by HIV/AIDS and has covered over 240,000 households as of 2014. Using longitudinal, cluster-randomized program data from 2007 to 2009, we run a generalized linear latent and mixed method estimation model on a sample of children 0-7 years and under-5 years of age. We find that the program is associated with a decrease in illness in children 0-7 years of age (P < 0.05), but found no effects on a stratified sample of under-5 children. Furthermore, no impacts on health care seeking in the event of illness were detected. This study is one of few examining children's health using data from a large scale unconditional cash transfer program. With the widespread adoption of over 123 cash transfer programs across sub-Saharan Africa, these findings suggest social cash transfer programs are capable of promoting the multidimensional well-being for the world's most vulnerable populations.

Cash for Women’s Empowerment? A Mixed-Methods Evaluation of the Government of Zambia’s Child Grant Program

Summary. —The empowerment of women, broadly defined, is an often-cited objective and benefit of social cash transfer programs in developing countries. Despite the promise and potential of cash transfers to empower women, the evidence supporting this outcome is mixed. In addition, there is little evidence from programs at scale in sub-Saharan Africa. We conducted a mixed-methods evaluation of the Government of Zambia’s Child Grant Program, a poverty-targeted, unconditional transfer given to mothers or primary caregivers of young children aged zero to five. The quantitative component was a four-year longitudinal clustered-randomized control trial in three rural districts, and the qualitative component was a one-time data collection involving in-depth interviews with women and their partners stratified on marital status and program participation. Our study found that women in beneficiary households were making more sole or joint decisions (across five out of nine domains); however, impacts translated into relatively modest increases in the number of decision domains a woman is involved in, on average by 0.34 (or a 6% increase over a baseline mean of 5.3). Qualitatively, we found that changes in intrahousehold relationships were limited by entrenched gender norms, which indicate men as heads of household and primary decision makers. However, women’s narratives showed the transfer increased financial empowerment as they were able to retain control over transfers for household investment and savings for emergencies. We highlight methodological challenges in using intrahousehold decision making as the primary indicator to measure empowerment. Results show potential for unconditional cash transfer programs to improve the financial and intrahousehold status of female beneficiaries, however it is likely additional design components are need for transformational change.

Poverty and perceived stress: Evidence from two unconditional cash transfer programs in Zambia

IntroductionPoverty is a chronic stressor that can lead to poor physical and mental health. This study examines whether two similar government poverty alleviation programs reduced the levels of perceived stress and poverty among poor households in Zambia. MethodSecondary data from two cluster randomized controlled trials were used to evaluate the impacts of two unconditional cash transfer programs in Zambia. Participants were interviewed at baseline and followed over 36 months. Perceived stress among female caregivers was assessed using the Cohen Perceived Stress Scale (PSS). Poverty indicators assessed included per capita expenditure, household food security, and (nonproductive) asset ownership. Fixed effects and ordinary least squares regressions were run, controlling for age, education, marital status, household demographics, location, and poverty status at baseline. ResultsCash transfers did not reduce perceived stress but improved economic security (per capita consumption expenditure, food insecurity, and asset ownership). Among these poverty indicators, only food insecurity was associated with perceived stress. Age and education showed no consistent association with stress, whereas death of a household member was associated with higher stress levels. ConclusionIn this setting, perceived stress was not reduced by a positive income shock but was correlated with food insecurity and household deaths, suggesting that food security is an important stressor in this context. Although the program did reduce food insecurity, the size of the reduction was not enough to generate a statistically significant change in stress levels. The measure used in this study appears not to be correlated with characteristics to which it has been linked in other settings, and thus, further research is needed to examine whether this widely used perceived stress measure appropriately captures the concept of perceived stress in this population.

Cash‐based approaches in humanitarian emergencies: a systematic review

Cash‐based approaches in humanitarian emergencies: a systematic review

Short-term impacts of an unconditional cash transfer program on child schooling: Experimental evidence from Malawi.

Short-term impacts of an unconditional cash transfer program on child schooling: Experimental evidence from Malawi.

The impact of Zambia’s unconditional child grant on schooling and work: results from a large-scale social experiment

ABSTRACTThis article reports on the impact on child schooling and work of the Government of Zambia’s Child Grant Program (CGP), an unconditional cash transfer programme targeted to households with children under age 3 years in three districts of the country. Although the CGP’s focus is on very young children, we look to see if the programme has impacts on older children who are not the explicit target group. We use data from a large-scale social experiment involving 2519 households, half of whom were randomised out to a delayed-entry control group, that was implemented to assess the impact of the programme. We find that the CGP has no discernible impact on school enrolment of children age 7–14. However, when we break the sample by older (11–14) and younger (7–10) children – based on the grade structure of the Zambian schooling system – we find a significant impact among children age 11–14, which coincides with the exact age range where a sharp drop-out begins to occur in Zambia with point estimates in the range of 7–8 percentage points. Finally, we provide evidence on the potential pathways through which the unconditional cash transfer impacts on enrolment. Households in the CGP spend more on education, and in particular on uniforms and shoes, two items cited as key barriers to school enrolment in study areas.

Buying a Better Baby: Unconditional Income Transfers and Birth Outcomes.

* Abbreviation: HBPB — : Healthy Baby Prenatal Benefit Can society buy a better infant? This is, in essence, the question posed in this month’s Pediatrics article by Brownell et al.1 Studying a group of low-income Canadian women who participated in an unconditional cash transfer program (Healthy Baby Prenatal Benefit [HBPB]), the authors compared the birth outcomes of participants with outcomes among a group of low-income nonparticipants. They found that the group that received the equivalent of $81.00 per month over the second and third trimesters of their pregnancies experienced a 21% decrease in the rates of low birth weight and a 17.5% decrease in the rates of prematurity among other clinically important outcomes. The findings are startling and raise some important policy questions. Few would disagree that society has a general interest in preventing low birth weight infants for many reasons, not the least of which is that the care they require is expensive to provide. Couple this recognized societal interest with the findings that poor women have disproportionately higher rates of delivering low birth weight infants and the argument for directing support to these women is highly persuasive. But how should that support be provided to be most effective? In 1 approach, custodians of society’s resources presume to know what … Address correspondence to Andrew D. Racine, MD, PhD, Albert Einstein College of Medicine and Montefiore Health System, 111 East 210th St, Bronx, NY 10467. E-mail: aracine{at}montefiore.org

Transforming Cash Transfers: Citizens’ Perspectives on the Politics of Programme Implementation

After two decades of cash transfer programming, interest in programme governance and social accountability is growing. Analysts are increasingly realising the importance of issues of politics, power and citizen engagement in shaping programme effectiveness and sustainability. To contribute to a still nascent literature on the politics of programme implementation, this article explores the political economy factors shaping governance and social accountability processes in three established and relatively large-scale unconditional cash transfer programmes in conflict-affected contexts – Mozambique, Palestine and Yemen – drawing on beneficiary and citizen perception data from 2012. We conclude by emphasising the importance of context-specific understandings of demand-side factors.

Cash Transfers and Labor Supply: Evidence from a Large-Scale Program in Iran

We study the impact of a nation-wide unconditional cash transfer program on labor supply in Iran. In 2011 the government started monthly deposits of cash into individual family accounts amounting to 29% of the median household income. We use panel data and fixed effects to study the causal effect of the cash transfers on labor supply using the exogenous variation in the intensity of treatment, which we define as the value of cash transfers relative to household income in the year before transfers. We also use a difference-in-differences methodology that relies on exogenous variation in the time households first started receiving transfers. With the exception of youth, who have weak ties to the labor market, we find no evidence that cash transfers reduced labor supply, while service sector workers appear to have increased their hours of work, perhaps because some used transfers to expand their business.

Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya

Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya

Small-Scale Farming and Food Security: The Enabling Role of Cash Transfers in South Africa's Former Homelands

Cash transfers successfully alleviate poverty in many developing countries. South Africa is a case in point, implementing one of the largest unconditional cash transfer programmes internationally, and with substantial benefits to household well-being along multiple dimensions. Yet, grants discourage formal labour market attachment, creating dependencies on the fiscus. This study uses a fuzzy regression discontinuity design to establish that state-funded Old Age Pensions encourage non-market economic activity (in the form of small-scale farming), and improve the self-reported food security of rural households that farm, vis-a-vis those that do not. However, only non-farming households increase market food expenditure and consume more diverse diets from market-sourced foods: diet quality improves with greater spending, while food sufficiency remains unaffected. Farmers, on the other hand, do not change food spending patterns, but self-rated food sufficiency improves due to greater levels and diversity in home production. The role of small-scale farming is of broader interest in rural development, given the context of the 1913 and 1936 Land Acts that constrained this form of livelihood in former apartheid homelands. This paper's contribution is two-fold: grants are an effective channel to actively promote rural development through small-scale farming, and they improve food security by non-market mechanisms.

The Social and Productive Impacts of Zambia's Child Grant.

Accumulated evidence from dozens of cash transfer programs across the world suggest that there are few interventions that can match the range of impacts and cost-effectiveness of a small, predictable monetary transfer to poor families in developing countries. However, individual published impact assessments typically focus on only one program and one outcome. This article presents two-year impacts of the Zambian Government's Child Grant, an unconditional cash transfer to families with children under age five, across a wide range of domains including consumption, productive activity and women and children's outcomes, making this one of the first studies to assess both protective and productive impacts of a national unconditional cash transfer program. We show strong impacts on consumption, food security, savings and productive activity. However, impacts in areas such as child nutritional status and schooling depend on initial conditions of the household, suggesting that cash alone is not enough to solve all constraints faced by these poor, rural households. Nevertheless, the apparent transformative effects of this program suggest that unconditional transfers in very poor settings can contribute to both protection and development outcomes.

Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya

PurposeThis study investigates the causal effect of Kenya's unconditional cash transfer program on mental health outcomes of young people. MethodsSelected locations in Kenya were randomly assigned to receive unconditional cash transfers in the first phase of Kenya's Cash Transfer Program for orphans and Vulnerable Children. In intervention locations, low-income households and those with orphans and vulnerable childrens began receiving monthly cash transfers of $20 in 2007. In 2011, 4 years after program onset, data were collected on the psychosocial status for youth aged 15–24 years from households in intervention and control locations (N = 1960). The primary outcome variable was an indicator of depressive symptoms using the 10-question Center for Epidemiologic Studies Depression Scale. Secondary outcomes include an indicator for hopefulness and physical health measures. Logistic regression models that adjusted for individual and household characteristics were used to determine the effect of the cash transfer program. ResultsThe cash transfer reduced the odds of depressive symptoms by 24 percent among young persons living in households that received cash transfers. Further analysis by gender and age revealed that the effects were only significant for young men and were larger among men aged 20–24 years and orphans. ConclusionsThis study provides evidence that poverty-targeted unconditional cash transfer programs, can improve the mental health of young people in low-income countries.

It's all in the timing: Cash transfers and consumption smoothing in a developing country

We use a large-scale unconditional cash transfer program in Indonesia to investigate the importance of timing in shaping household consumption responses to fiscal interventions. Timely receipt of transfers yields no expenditure change relative to non-recipients. However, delayed receipt reduces expenditures by 7.5 percentage points. Ignoring heterogeneous timing leads to sizable underestimates of expenditure impacts. After considering several data-driven explanations, we reconcile these findings with models of consumption smoothing in which liquidity constraints imply asymmetric responses to positive and negative shocks. Our results parallel findings on government transfers in rich countries and yield new implications for program evaluation.

Impact of the Kenya Cash Transfer for Orphans and Vulnerable Children on early pregnancy and marriage of adolescent girls

There is promising evidence that poverty-targeted cash transfer programs can have positive impacts on adolescent transitions to adulthood in resource poor settings, however existing research is typically from small scale programs in diverse geographic and cultural settings. We provide estimates of the impact of a national unconditional cash transfer program, the Kenya Cash Transfer for Orphans and Vulnerable Children, on pregnancy and early marriage among females aged 12 to 24, four years after program initiation. The evaluation was designed as a clustered randomized controlled trial and ran from 2007 to 2011, capitalizing on the existence of a control group, which was delayed entry to the program due to budget constraints. Findings indicate that, among 1549 females included in the study, while the program reduced the likelihood of pregnancy by five percentage points, there was no significant impact on likelihood of early marriage. Program impacts on pregnancy appear to work through increasing the enrollment of young women in school, financial stability of the household and delayed age at first sex. The Kenyan program is similar in design to most other major national cash transfer programs in Eastern and Southern Africa, suggesting a degree of generalizability of the results reported here. Although the objective of the program is primarily poverty alleviation, it appears to have an important impact on facilitating the successful transition of adolescent girls into adulthood.

Health and livelihood outcomes associated with participation in a community-based empowerment program for orphan families in semirural Kenya: a cross-sectional study

Over 40 million African children have lost one or both parents to death or desertion for various causes. Recent unconditional cash-transfer programs in sub-Saharan countries have been found effective at mitigating financial, health, and educational challenges concomitant with parental loss. Due to constraints on governmental resources useful for oversight, however, these gains have been less pronounced than in other contexts where governmental oversight allows cash transfers to be conditioned on preset social and health goods.The present study presents cross-sectional survey data from a community-based intervention combining elements of conditional cash transfer, empowerment- and income-generating programs in rural Kenya. Orphan and vulnerable children (OVC)-headed households in the catchment area are eligible for inclusion in the 3-year program.Survey questions addressed monthly income, yearly financial status, food and medical access, malaria net usage, water source and purification practices, years of completed school, literacy, and sexual practices. Significant differences were found in each of these areas between the three different cohorts, categorized by year of program entry, though sexual practices only varied among females across the three cohorts.Findings suggest an overall protective effect as a function of exposure to the program. Households with longer program exposure report statistically significant improvements in weekly income, savings rates, food security, medical security, food independence, insecticide-treated net usage, water purification practices, completing 8 years of schooling, literacy and sexual practices among females compared to households in their first year.This study supports the use of a community-based intervention hybridizing other standard interventions to reduce health risks among OVC in Kenya.