Social protection schemes & cash transfers Considering their - - PowerPoint PPT Presentation

Social protection schemes & cash transfers

Considering their role for addressing development challenges beyond poverty

Lori Heise Ana Maria Buller

A new “magic bullet”?

• Increasing interest in using cash transfers to affect a host of

development outcomes from improving child nutrition to keeping girls in school

• Transfers are generally integrated into countries’ social protection

schemes and may be either conditional or unconditional

• 37 African countries now have national social protection schemes or

testing pilot transfer schemes

• LSHTM staff are engaged in two primary areas:

– Assessing impact of CTs on HIV prevention, treatment & care – Assessing impact of CTs on household dynamics and domestic violence

Evidence review & questions to be resolved Two foundational perspectives

• Poverty alleviation

– Reducing structural vulnerabilities that lead to transactional sex and

• ther risky behaviours
• Behavioural economics (nudge)

– Cash as incentive to discourage risky sex or increase adherence – Bringing benefits of self protection closer in time

Transfers and HIV

Tanzania RCT

• People offered up to $60 each

annually to stay STI‐free had 25% lower STI prevalence (De Walque et al 2012)

• Level of the cash relative to SES

important

• Effects bigger with higher

incentives and among low SES households

Lesotho RCT

• People in treatment arm offered

chance to win lottery prize every four months if they remained STI negative ($150 vs $75)

• After two years, HIV incidence

decreased by 27% in the lottery compared to the control arm – 31% among women – 38% in the high lottery arm

Incentivising behaviour

Reducing vulnerability

Zomba Malaw i

Transfers and IPV

What does theory predict?

• Cash will increase women’s

bargaining power thereby reducing IPV

Household Bargaining Theory

• Given hierarchical gender

relations, cash will increase IPV, at least in short term

Backlash Theory

Transfers and IPV

What does previous research suggest?

• Give Directly Project in Kenya

– RTC of unconditional cash transfer through cell phones – Transfers lead to a 30‐50% reduction in reports of physical IPV and a 50‐60% reduction in reports of rape within the marriage. – Effects larger when the transfer went to the woman, but some reduction in IPV even when the transfer went to the man.

Transfers and IPV

What does previous research suggest?

• In Mexico’s Opportunidades programme, Bobonis found

that in the short term, risk of physical IPV 33%, but emotional abuse and threats 60%

• 5‐9 years later physical and emotional abuse no longer

differed significantly among beneficiary and non‐ beneficiary couples

• Question for future studies: How long are effects sustained
• ver time?

“Cash, Food and Voucher” trial

• RCT implemented by the World Food

Program.

• Between April – September 2011 in

urban centers with high Colombian refugee populations in the provinces

• f Carchi and Sucumbíos in Northern

Ecuador.

• 6 transfers (one per month).
• As part of the intervention they were

invited to nutrition workshops.

• All transfer modalities were

equivalent to $40 (11% of pre‐transfer HH income)

Our study: Expanding Lessons from a Randomized Impact Evaluation of Cash and Food Transfers in Ecuador

Overall aim:

• To understand how transfers impact intra‐household conflict

and domestic violence. Design:

• Mixed methods including quantitative and qualitative

components. Qualitative Sample

• Purposively sampled according to changes in DV from baseline

to follow up.

• 48 interviews with women
• 8 FG: 2 with women, 6 with men.

Preliminary quantitative results

• On average, transfers decreased controlling behaviours, moderate

physical and any physical/sexual partner violence by 6 to 7 percentage points (~ 38‐44% decline)

• Effect did not vary significantly by transfer modality
• Decreases in IPV are concentrated among women with low decision‐

making power at baseline.

• Among these low‐power women, vouchers and food reduced IPV

more than cash

• Conclusion: In certain settings, transfers may work to equalize power

dynamics in households with high levels of initial inequity

Preliminary qualitative results

• Transfer seemed to reduce stress, relationship tension and

embarrassment about food insecurity

I: why did it improve (the relationship)? Elena: because I did not have to be asking for money for the rice, that was over. For him it was a bit embarrasing and I also used to feel bad, because I was asking all the time, ‘give me something for the rice, for the oil’ knowing that he did not have enough money….

• Women administered transfer regardless of whether it was given to

woman or man (women in charge of cooking/nutrition)

• Framing as “nutrition project” may have reduced backlash‐‐transfer

did not challenge traditional gender roles

Empow ering women or reinforcing existing gender roles?

• But... are we really empowering them or are we unintentionally

perpetuating gender roles? (i.e. women deal with cooking and household matters)

• Would it be different if the transfers were about education for

women rather than food for the family?

• Should we be open to accommodating existing gender norms to

achieve short term gains or does this fundamentally compromise our long term goal of tackling gender inequalities at the base of violence?

• What about sustainability?

Other LSHTM projects on transfers

• PhD Meghna Ranganathan:

– Exploring the role that cash transfers may play on reducing transactional sex (and hence HIV vulnerability) among adolescent girls in the Swa‐Koketa CCT trial in rural South Africa

• Economics group

– Systematic review of the effect of financial incentives on the uptake of HIV services – Input into RCT that will test the relative impact of lottery/transport voucher/cash on linking people who test positive through self‐testing to HIV care

• Aurelia Lepine (Fellowship):

– Test the relative impact of lottery and cash payment on adherence to PrEP in Nigeria

• Heise and Buller

– Systematic review of the impact of transfers on risk of partner violence