Household health needs, spending, and the burden of health care costs

Co-authored with Clare Clingain. Find more details on the study on our website, brief, and research report.

In 2017, the IRC wanted to start exploring whether and how cash assistance programs can be used to achieve first-order health outcomes, like improving timely access and utilization of health services and products. We found little evidence or practitioner guidance from humanitarian settings on how to approach programming in this space.

We knew from post distribution monitoring surveys, conducted after cash has been disbursed, that people use cash assistance to meet a whole range of needs including food, debt repayment, health, shelter, etc. But, this data was generally captured at a broader category level, (for example, spending on health as a whole versus more granular information like spending on medicine for diabetes), and we didn’t have insight into what health needs were prioritized by displaced populations, how those needs were met, and what was the demand for different types of services, given competing priorities and an overall shortage of funds. …

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This randomized control trial gives us an opportunity to generate relevant evidence for crisis contexts and develop better guidance for humanitarian actors.

Co-authored with Kimberly Behrman

For refugees and vulnerable people around the world, finding a stable income is a priority so they can support their families. In prolonged crises, the need for sustainable livelihoods is even more pressing. Refugees in particular face challenges in accessing opportunities in the labor market, including legal barriers, language obstacles, and limited networks. Without access to safe and decent work, people are unable to thrive and contribute to local economies. In International Rescue Committee’s (IRC) economic recovery and development programming, we aim to support people to establish sustainable livelihoods. However, we often face three key challenges:

  1. We have some rigorous evidence on program approaches that work in certain contexts, but often not specific evidence on what works for refugees and other vulnerable populations in humanitarian…

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An IRC beneficiary collects his ticket to receive cash at an IRC cash distribution at the Agriculture Office in Hammam Al Alil town, Nineveh Governorate, Iraq.

Unpacking the available evidence and identifying areas for further study

Co-authored by Sana Khan, Senior Research Advisor - Economic Recovery, and Elizabeth Tromans, Senior Technical Advisor - Cash and Emergencies

At the International Rescue Committee, we’ve heard a number of questions relating to our cash programming, such as what is the evidence that supports it and why we take a “cash first” approach to humanitarian basic needs programming. Cash first for the IRC means that we commit to using cash assistance in programming designed to meet basic needs and food security outcomes for people in need where it is appropriate and feasible.

There is strong evidence that cash does what it’s supposed to in humanitarian contexts: enabling clients to meet their basic needs like food, water and shelter, and helping them to avoid negative coping mechanisms like taking kids out of school or selling assets like livestock. The IRC commissioned one of the very first pieces of rigorous evidence in a humanitarian context showing how effective cash can be in meeting basic needs. But there are still areas we could explore to see if cash can work to achieve other economic outcomes, like generating an income, accumulating assets and household decision-making, or other outcome areas like use of health services or school attendance. …

The International Rescue Committee’s commitment to narrowing the gender gap

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This year, the Economic Recovery and Development unit at the International Rescue Committee has made key commitments to make serious progress on identifying and building evidence to effectively design and scale programs that seek to achieve one of IRC’s key economic outcomes: Women use and control resources and assets. Ultimately, we want our women’s economic empowerment programming to grow both in quantity and quality and to support policy shifts that create an enabling environment for refugee women to succeed.

For the IRC, the “women use and control resources and assets” outcome is also critical to narrowing the gender gap in contexts where we operate. To achieve this outcome, the IRC focuses on three causal pathways. The first pathway highlights the importance of women and girls having relevant knowledge and skills. The second focuses on the importance of freedom of movement, as a resource in itself but also as a prerequisite to being able to make use of resources they control. The final directly addresses the barriers and social norms related to control, including the importance of addressing violence and legal institutions or frameworks. …


Sana Khan

Senior Research Adviser for the Economic Recovery and Development Technical Unit at the International Rescue Committee (IRC)

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