Impact of cash transfers on child nutrition in Niger

Baraka buying millet at Ourafane market with the monthly cash payment from Save the Children

Summary of evaluation¹

A recent Save the Children survey conducted in southern Niger found that half of the population could not afford a balanced diet in a typical year. So in 2008, Save the Children in partnership with the CRCSR/ PGCA² of Tessaoua district decided to implement a pilot cash transfer project targeting the poorest households. This was evaluated in 2009 and the key findings are represented below.

Beneficiaries were very poor households identified through Household Economy Approach (HEA) analysis and wealth ranking, and households with widows and people with disabilities. A total of 1500 beneficiaries were targeted. Priority was given to mothers and caregivers of children under five years. Cash transfers were only distributed in areas declared by the government as severely food insecure. Coverage was approximately one-third of the population. A total of 60,000 CFA francs, split into three distributions during the hunger gap, was delivered to each household. The cash was distributed to women. Households benefiting from the project were required to take part in awareness sessions on malnutrition and other public health activities. Monitoring of 100 households was conducted using HEA at three key points: before the project started, a month after the first cash distribution at the peak of the hunger gap, and a month after the third distribution. Monitoring also included anthropometric followup of children under five years, before the project and after each distribution.

The evaluation found that the cash transfer equated with an annual increase in household income of about one third. However, after receiving the cash transfer, beneficiary households gave up or reduced their reliance on certain sources of income that they used as coping mechanisms, e.g. credit, migration, working in other people's fields, or sale of animals. The fact that households chose to spend more time in their own fields, combined with good rainfall, resulted in a significant increase in their agricultural production, i.e. 50% more millet.

The cash transfer led to a significant change in expenditure patterns, which evolved according to seasonal needs. Generally, the cash was spent on buying food such as millet, cow's milk, meat, groundnut oil, cowpeas and pancakes. During the hunger gap there was a slight increase in purchase of staple food items compared to before the distribution, but the difference was even greater for non-staple foods. During the harvest period, the cash tended to be spent on non-food items like clothing, festivities and ceremonies. Spending on health care almost tripled compared with baseline. There was also a notable increase (69%) in spending on water as more people purchased from boreholes rather than open wells that are free of charge but possibly contaminated.

The month before the first distribution, households could only cover 84% of their minimum energy needs. A third of these households could not even cover 80% of needs. The month after the distribution, households were able to cover 99% of their minimum energy needs. A food aid intervention with millet would have cost an extra 6,340 CFA per beneficiary ($12.50) to cover the logistics for all three distributions.

The additional spending on food led to a substantial increase in intake of fats, proteins and micronutrients (calcium, folic acid and vitamin C). However, households still lacked micronutrients, particularly those found in animal products which remained too expensive for most households to purchase other than in small quantities.

Weight-for-height z-scores (WHZ) were calculated for each monitoring session using the 2006 WHO Growth Standards. Nutritional status of children under five as measured by mean weight-for-height z-score in targeted households improved after the first distribution. However this was not sustained as it declined between the second and third monitoring session. This decline coincided with the rapid escalation in child illness which is common during the lean period. In the same way, although the prevalence of global acute malnutrition (GAM) fell between the first and third distributions, it was not a statistically significant drop (see Table 1). The fact that GAM remained lower during the subsequent monitoring sessions may well reflect that children who were identified as acutely malnourished during the baseline monitoring were treated. Hence, although the overall nutritional status of children deteriorated, it does appear that the treatment programme was helping to protect the most severely malnourished.

Consequently, a key finding of the evaluation was that in this setting, cash transfers need to be complemented by interventions such as disease prevention and micronutrient supplements, so as to better protect children's nutritional status.

Children drinking 'la boule' a watery porridge made from millet that is generally drunk at breakfast

The evaluation showed that the cash transfers considerably decreased (and even removed) the need for households to resort to damaging distress strategies. For instance, 10% of households had to mortgage their land and 7% had to sell their land in the three months prior to the project. Only 1% of households mortgaged their land, and none had to sell land, during the timeframe of the project. Also, the cash transfer enabled no less than 21% of beneficiary households to restart income-generating activities such as small-scale trade, selling cooked meals, butchery, and making and selling oil. The money invested in the local economy had a positive effect on all local trade, particularly in milk and oil. Another outcome was that recipients were less desperate to earn money, and so could work in their own fields. The drop in competition for paid work pushed up the local wage rate. As a result, the very poorest in the community, who did not receive cash transfers through the project, benefited from higher rates of pay.

Targeting was a challenge during the programme. It was difficult for community leaders to accept that only households meeting certain criteria would be entitled to direct support. When the cash distributions took place, it was difficult for some people to accept that they would not receive anything, while their neighbours did. During implementation of the project, several checks were necessary to ensure that beneficiary lists were accurately targeting the poorest households. This caused tensions in some villages and required strong negotiation skills to reduce envy and in some cases, to protect leaders' status. A key learning point is that traditional community leaders cannot be held fully accountable for the targeting; government authorities should officially validate and be accountable for targeting. Furthermore, contrary to popular belief, the social cases (households headed by widows or people with disabilities) were not necessarily the poorest or the most vulnerable to malnutrition.

Overall, the evaluation showed that beneficiary households used the cash to cover their basic food needs, diversify their diets and protect their longer-term survival. The targeting process contributed to the project's cost-effectiveness. If the same amount of money had been transferred equitably to all households, each would have received about three times less. There is still a need to further investigate and pilot different approaches to targeting that are easier to implement and more readily acceptable to communities.

Although cash transfers appear to be an efficient way to tackle food insecurity among the poorest households in Niger in the short term, a key question is whether their cost would allow implementation on a larger scale. To provide 20% of the poorest rural Nigerien population, i.e. 2 million people, with the same amount of cash transfer, it would cost 21 billion CFA (US$41 million). This is almost equivalent to the amount spent by the European Union (EU) and the US Agency for International Development (USAID) on humanitarian assistance in Niger during the 2005 food crisis. Large-scale cash transfers would only be feasible for the Nigerien government if donors substantially increased their financial support.

Finally, while the project also demonstrates contribution to a certain economic dynamism, favouring reflation and strengthening petty trade and other livelihood activities, all these gains are likely to be reversed when the next food crisis occurs. In order for the poorest populations to build a solid resilience to face shocks, and to lift themselves out of the poverty trap, regular and predicable support is required. At the same time, it is important that complementary measures (such as appropriate agricultural and rural development policies) are in place, and appropriately funded.

¹Save the Children UK (2009). How cash transfers can improve the nutrition of the poorest children. Evaluation of a pilot safety net programme in southern Niger. Save the Children 2009. Full report at: http://www.savethechildren.org.uk/en/54_7871.htm

²Regional and Sub-Regional committees for the Prevention and Management of Food Crisis