Can a social cash transfer

program improve youth

mental health in Kenya?

Population Association of America Annual Meeting

May 30, 2015

Contact:

Kelly Kilburn

kkilburn@live.unc.edu

Kelly Kilburn, MA

Carolyn Halpern, PhD

Audrey Pettifor, PhD

Harsha Thirumurthy, PhD

Sudhanshu Handa, PhD

Funded by National Institutes for Health

Youth Mental Health in Low-

Income Countries

• Can interventions

help break the

cycle of poverty

and poor mental

health?

– social causation

pathway

– social drift pathway

Poverty

Social

Causation

Social Drift

Poor Mental

Health

Source: Lund et al. (2011) Poverty and mental disorders: Breaking the cycle in low-income and middle-income countries.

Lancet 378:1502-1514.

Is there a cycle between poverty and mental

health?

Cash Transfers and Mental Health

• Studies from Latin America show mixed results

from conditional cash transfers (CCTs) on

maternal mental health (Paxson and Shady; Macours et

al.; Ozer et al.)

• CCT in Malawi had positive impacts for adolescent

females (Baird et al.)

• Cash transfers in SSA tend to be unconditional and

reach HIV-affected households

– Orphan-hood is a risk factor for low mental health

Kenya Cash Transfer for Orphans and

Vulnerable Children (CT-OVC)

• Unconditional, national social protection program

– Reached 135,000 households and 270,000 OVC

across the country as of 2012.

• Targets households who are ultra-poor and contain an

OVC age 0-17 years

• Two-stage target identification process

– No self-selection, universal take-up

• Eligible households receive a flat monthly transfer of

$20 USD

• Random assignment of

eligible locations in

seven districts

• In each district, 2

locations randomized

to Control, 2 to

Treatment

• 3 rounds of data: 2007,

2009, 2011

Study Design

Survey and Sample

• Household survey and Youth module

• 2:1 ratio of Treatment to Control households

• Balanced on poverty characteristics

• Differences in the age, sex and schooling levels

of household heads across arms due to

prioritization process

– Treatment more likely to comprise older, less

educated female-headed households.

The youth sample

• Individual interviews for up to two residents

between 15-25 years of age

2,215 out of 2,806 interviewed (79%)

• Restricted the sample of analysis to 15-24 year

olds and those who had been in the

household for a year or more

Total Intervention Control

Demographics

Age 18.4 18.4 18.6

Male 0.620 0.60 0.61

Orphan 0.54 0.56 0.49

Child of Head 0.49 0.55 0.47

Grandchild of head 0.30 0.34 0.20

Female head 0.62 0.63 0.60

Age of Head in years 60.4 62.0 56.9

Head any education 0.54 0.53 0.58

Nairobi residence 0.12 0.14 0.07

Observations 2006 1408 598

Characteristics of young people age 15-24 in

wave 3 (2011) sample

Significant differences bolded

Psychosocial and Health Outcomes

Total Intervention Control

CES-D ≥ 10 0.33 0.32 0.37

CES-D ≥ 10 women (N=689)0.34 0.34 0.33

CES-D ≥ 10 men (N=1129)0.34 0.31 0.40

HOPE 0.54 0.56 0.50

No illness/injury past 4 weeks0.73 0.72 0.74

Healthier than year ago 0.50 0.49 0.43

Observations 2006 1408 598

CES-D ≥10 binary indicator for scoring a 10 or above on the CES-D depression scale.

HOPE a binary indicator for scoring at above the median on the Hope scale.

Significant differences bolded

Additional Analysis

• Orphan Status

• Mediation of schooling and labor

Conclusions and Next Steps

• CT-OVC confers protective mental health effects for young men and orphans; no protective effect for females.

– Differential effect based on age

• The causal pathway is unclear although the SCT is helping to keep youth in school

• Suggests interventions addressing the social causation pathway may improve mental health impacts for young people

• Evaluate panel data other national cash transfer programs—Malawi, Zimbabwe, Zambia

Balance and test of randomization

2007 2009 2011

Demographics T C T C T C

Household size 5.48 5.79 5.54 5.81 5.53 5.82

Female head 0.65 0.57 0.65 0.59 0.65 0.59

Age of head in years 62.34 56.06 62.21 56.20 62.55 56.55

Head not completed primary 0.53 0.38 0.53 0.38 0.53 0.38

Poverty

Per adult equiv. monthly exp. (Ks) 1533.3 1501.3 1541.8 1459.9 1550.1 1442.0

Walls of mud/dung/grass/sticks 0.75 0.84 0.75 0.86 0.74 0.87

Roof of mud/dung/grass/sticks 0.23 0.22 0.23 0.23 0.22 0.22

Floor of mud/dung 0.66 0.74 0.65 0.77 0.66 0.79

No toilet 0.55 0.56 0.55 0.56 0.54 0.56

Unprotected water source 0.62 0.68 0.61 0.70 0.61 0.70