Part 2: What role can cash play in preventing malnutrition?
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As designers and implementers of interventions intended to support vulnerable people, we’re constantly trying to understand the value (and cost) of our efforts against a baseline of simply giving people cash.
While this isn’t an experimental study to compare intervention arms, it’s still useful to understand how people choose to prioritize the use of unconditional cash as well as how different components interact with each other. For this reason, we are planning a slightly different prototype for each of the 3 communities. All communities will receive an unconditional cash transfer but Community A will only receive cash.
Before you dive in, read our first post for some background behind why we’re designing three different prototypes.
Let’s break it down.
Why unconditional cash transfers?
There are three reasons why we chose this path:
- Unconditional cash transfers to women allow women — who are largely responsible for child care, food procurement, and cooking — to invest in what they believe is most important for their households.
- It’s possible that cash is the primary constraint to household adoption of severe acute malnutrition (SAM) preventive measures. Any additional programming, therefore, should add more value than just cash alone.
- Conditional cash transfers require mechanisms for verification that are not always easy to achieve (how can you empirically verify exclusive breastfeeding, for example?).
What will happen over the 5 months of prototyping?
The prototype will start at the time of harvest when families are able to sell their crops and pay off their debts. The value of cash transfers will increase the longer we are from harvest time, so we opted for an unusually long prototype period to see how the use of cash will change over time.
How much cash will people get and how often?
We first looked to the literature to answer this question. However, study designs in how cash affects nutritional outcomes vary greatly in terms of the amount of cash, the frequency of transfers, the duration of cash delivery program, the eligibility criteria, and the nutrition indicator (wasting vs stunting, different age groups). All this variation makes best practices difficult to ascertain.
There are a few ways we can work out what amount and frequency is most desired by households. The total cash transfer delivered to each participating household will likely be a percent of its monthly food expenditure. We’ll determine what those values are upon consultation with community leaders and our in-country colleagues. Frequency of the cash transfers can be presented as options to households. We call follow up with them to see how satisfied they are with their choice over time as well as compare cash use across households who selected different cash transfer frequencies.
Smallholder farmers in Tanzania expressed to us a preference for lump sums of cash so they could spend it on farm inputs, such as fertilizer, better quality seed, or farm tools. While our hope is that the cash might be used for things like diversifying what children eat or soap for hand washing, the farm inputs may result in greater yields and therefore greater household food security — also reducing SAM risk.
Who will get the cash?
In each of the 3 communities we’ll be working in, community leaders will identify 20 households with pregnant women and/or caregivers of children under 3 to participate in the prototype. Since our goal is to understand preferences and feasibility, we get more out of working deeply with a small number of women than by superficial interactions with large numbers of people. If and when we reach the pilot phase, where we will more rigorously measure impact using a large number of participants.
How will you know what people do with the money?
We want to use tools that both allow us to capture the diversity of what each woman might spend her money on as well as to document trends in her spending over time. Our prototyping plan has a couple of months of preparation built in to refine tools and set up our logistics before we go live at harvest time.
During this pre-prototype phase, we’ll introduce a few games and tools that our community outreach team will use with the 20 women from Community A who have been chosen to receive cash. We want to understand the current categories of household spending and frequency (e.g. food may be a daily or weekly expense, but school fees and farm inputs are a greater, but far less regular, cost). From these cost categories, we will develop hypotheses about how greater income might change expenditure in a way that may have short- or long-term effects on nutrition. While we don’t know exactly what the tools will look like yet, we do know that they will be interactive and will aim to take no more than 30 min of each woman’s time.
How will the cash be distributed?
The easiest form of cash delivery is through mobile money transfers to a participant’s phone. This eliminates the need for IRC staff to handle large sums of cash or travel great distances to deliver it in person. However, mobile money only makes sense in places where women have phones and where there is network coverage. Since this is not the case in Niger, we will be working through microfinance institutions to deliver the cash.
This is part of a series detailing a prototype to prevent severe acute malnutrition in Niger. We plan to launch in early July and we welcome your feedback in the comments below, or shoot us a note at airbel@rescue.org.
