Social protection schemes& cash transfers
Considering their role for addressing development challenges beyond poverty
Lori HeiseAna 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 other 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 Walqueet 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 vulnerabilityZomba Malawi
Transfers and IPVWhat 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 IPVWhat 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 IPVWhat 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 over 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 of Carchi and Sucumbíos in Northern Ecuador.
• 6 transfers (one per month).
• As part of the intervention they wereinvited 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
Empowering 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