Child outcomes of cash transfer programmes in humanitarian and development contexts

Summary of research¹

Location: Global

What we know: Cash transfer programmes (CTPs) have a proven impact on poverty reduction and social protection but their overall impact across a range of child outcomes is unknown.

What this article adds: A systematic review was undertaken of 131 studies between 2012 and 2016 on the impact of CTPs on child outcomes in health, food security, nutrition, protection and education. Most evidence is from development contexts. Overall it appears that CTPs significantly and positively contribute to child survival, education and child protection with highest impact in areas directly affected by cash; there is less proven and consistent impact at a higher level and on more complex outcomes, such as child anthropometry. There are examples of significant impact on maternal knowledge around infant and young child feeding (IYCF) (when combined with nutrition counselling); reduced severe stunting and severe wasting in children aged 2-9 years; reduced stunting in children whose mothers have secondary education and in children whose households have access to clean water; and increased diet quantity and meal frequency. Evidence is lacking for other child growth indicators. More evidence is needed across the range of CTP modalities to compare their relative impact; more evidence is also needed from humanitarian programmes. Key recommendations include mapping pathways to child outcomes to reach higher-level indicators; combining CTPs with complementary programmes; accommodating the needs and capacities of beneficiaries; ensuring supply-side factors are functioning; and improving monitoring of child outcomes across CTP modalities to increase the evidence base.

The use of cash transfer programmes (CTPs) has increased in recent years to become an integral part of poverty reduction and social protection strategies in the developing world. Substantial evidence has been generated over the last decade on the effectiveness of cash transfers; however there has been no comprehensive, overall assessment of key outcomes for children in either humanitarian or development contexts. This systematic review attempts to fill this evidence gap by reviewing research on a broad list of indicators around outcomes for children in health, food security, nutrition, protection and education between 2012 and 2016. In this review, CTPs may include unrestricted and restricted unconditional cash transfers (UCTs), unrestricted and restricted conditional cash transfers (CCTs) and labelled cash transfers (those that come with ‘soft’ restrictions rather than obligations). Complementary programmes involving cash are also considered.

A total of 4,800 initial studies were identified, then narrowed down to 131 for final analysis. Out of these, 115 were from a development context and 16 were from a humanitarian context; geographically, 15 were from multiple regions, 56 from Sub-Saharan Africa and North Africa, 32 from Central and South America, 13 from South Asia, one from Central Asia, eight from East Asia and seven from the Middle East; 18 were systematic reviews, meta-analyses and literature reviews; and 113 were individual studies. With regard to CTP modalities, 73 studies evaluated unrestricted CCTs; 70 evaluated unrestricted UCTs; six evaluated restricted CCTs; 12 evaluated restricted UCTs; and five evaluated labelled UCTs.

Overall, CTPs appear to significantly and positively contribute to child survival, education and protection. There is most evidence of a positive impact on areas directly influenced by an influx of cash, such as school attendance, food consumption and use of preventative healthcare services. There is less evidence of consistent, positive impact on higher-level and more complex outcomes, such as child anthropometry.

In terms of nutrition and food security indicators, there is evidence that, when combined with nutrition counselling, unrestricted CTPs lead to increased maternal knowledge around infant and young child feeding (IYCF), although this does not necessarily lead to improved IYCF practices. None of the evidence included in the review reports significant impacts of CTPs on several indicators of child growth (height-for-age for children aged 0-5 years and weight-for-height and weight-for-age for children aged 0-14 years). However, there is evidence of a significant decrease in severe stunting and severe wasting in children aged 2-9 years, a significant decrease in stunting for those children whose mothers have secondary or high school education, and a decrease in stunting for children whose households have access to clean water.

There are mixed impacts on the incidence of anaemia for children under six years old. There is evidence that CTPs lead to a significant increase in diet quantity and meal frequency; however impact on diet diversity indicators is mixed.

To have a greater positive effect on higher-level outcomes, CTPs must be designed to target key factors in the theory of change of each outcome. For example, IYCF practices must be targeted to have an impact on child anthropometry and must be combined with other interventions, such as promotion of improved IYCF practices. Factors that can limit the impact of CTPs include limitations in programme design, such as insufficient value of the cash transfer, and poor availability or poor quality of commodities and services that contribute to meeting certain outcomes, such as healthcare services and drinking water.

Overall, variations in the CTP modality do not play a significant role in influencing outcomes for children. However, imposing conditions and/or restrictions around the transfers does appear to generate significant positive impacts on child health-seeking behaviours, schooling outcomes and early marriage and pregnancy. In these cases, cash seems to act as an incentive for recipients to adopt specific behaviours, although it is unclear from the research if it is the transfer itself or the condition imposed that leads to the behaviour change. It is also worth noting that a particular form of CCT – cash-for-work – appears to have a significant impact in an undesired direction, leading to an increase in child labour, although it may help mothers to avoid having to migrate for work and thereby increase the time they spend caring for their children, including breastfeeding their infants.

Conclusive statements about the relative efficacy of different CTP modalities cannot be made as much more evidence is available on unrestricted CCTs than on the other modalities and there is little evidence comparing modalities within the same programme. In terms of value for money, conditions and restrictions will often involve higher implementation and administrative costs, both for the implementing organisation and recipients, and therefore should be weighed against their potential impact.

There is much more evidence of the impact of CTPs on child outcomes in development contexts than humanitarian contexts. Conclusions must be applied to humanitarian contexts with caution, although evidence so far suggests there is relatively little difference in the pattern of cash transfer impacts between the two contexts. Considerations for humanitarian contexts may include restricted availability of commodities and services and chid protection issues.

The author provides the following recommendations based on review findings:

• Map pathways to child outcomes in the design of CTPs and consider using CTPs in combination with other programmes and only when economic barriers are identified as a major obstacle.
• Consider the needs or capacities of the beneficiary group when selecting CTP modality and appropriate frequency of grants.
• Ensure that relevant supply-side factors are available and functioning.
• Ensure fair and transparent targeting of beneficiaries, timely and regular payments and removal of administrative barriers to delivering/receiving cash transfers.
• Monitor outcomes for CTPs for children of different ages and sexes and consider using standard indicators across different modalities to help compare their relative effectiveness.
• Be aware of the limitations of cash programmes, which may not be the most suitable programme choice for all child outcomes.

Footnotes

¹Mishra A. (2017) Child outcomes of cash transfer programmes: What works and what doesn’t for children in humanitarian and development contexts. Save the children research brief. www.cashlearning.org/downloads/research-briefctp-childoutcomesfinal.pdf

²CTP refers to all programmes where cash or vouchers are provided directly to beneficiaries.