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Despite the global decrease over the last two decades, stunting, also called ‘chronic malnutrition’, remains a public health issue affecting almost 150 million children under the age of 5 years globally. Defined by height-for-age, stunting is the consequence of poor nutrition, repeated infection, and inadequate psychosocial stimulation. Programmes and policies target undernutrition globally, and humanitarian and development actors invest great efforts to prevent stunting. This study uses multivariate analysis to examine the impact of financial assistance on the reduction of stunting in a refugee context, focusing on Syrian refugee children under the age of 5 years in Türkiye. Using a unique dataset, the 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (2018 TDHS-SR), the findings indicate that financial assistance significantly reduces the incidence of stunting among refugee children under the control of economic, mother and children, environmental, health-related and nutritional and breastfeeding characteristics. However, having household members generate income is found to be another stronger predictor to reduce stunting. The paper also argues that the nutritional well-being of refugee children might improve if forced migration occurs towards a stable host country/region. In addition, adaptation over time also seems to have a positive influence.
Cash transfer programs are the most common anti-poverty tool in low- and middle-income countries, reaching more than one billion people globally. Benefits are typically targeted using prediction models. In this paper, we develop an extended targeting assessment framework for proxy means testing that accounts for societal sensitivity to targeting errors. Using a social welfare framework, we weight targeting errors based on their position in the welfare distribution and adjust for different levels of societal inequality aversion. While this approach provides a more comprehensive assessment of targeting performance, our two case studies show that bias in the data, particularly in the form of label bias and unstable proxy means testing weights, leads to a substantial underestimation of welfare losses, disadvantaging some groups more than others.
Child nutrition, health and development are closely tied to maternal nutrition, health and well-being. The underlying drivers of poor maternal and child nutritional outcomes in sub-Saharan Africa are structural in nature. These risks include social, economic, and environmental factors that together compound vulnerability to poor outcomes. Poverty, as a driver of poor maternal and child health outcomes, is an important determinant that is both a cause and a consequence of malnutrition. The United Nations’ Children’s Fund (UNICEF)’s conceptual model for determinants of maternal and child nutrition outcomes released in 2020, is the agency’s latest iteration of child nutrition frameworks. The model identifies the underlying causes of malnutrition as extending beyond food and diets, to include household level dynamics, maternal factors, and the external environment. The manuscript discusses UNICEF’s conceptual model and its applicability in sub-Saharan Africa. It also considers the evidence on interventions aimed at addressing maternal and child nutrition in the region and the location of social protection among these policy tools, with a special focus on the extent to which these resonate with the conceptual model. It concludes by considering the conditions required for social protection instruments to work in the region and similar settings in the Global South. In this way, the manuscript provides a critical reflection about the role of social protection as a nutrition-sensitive instrument in sub-Saharan Africa, in the context of maternal and child nutrition outcomes.
Chapter 8 examines the government’s ambiguous social protection response to the growing shortages of land and employment. The government’s initial development strategy aimed at broad-based growth that would obviate the need for programmes to address poverty and food insecurity. The increasingly acute shortage of land and employment, however, constituted a growing distributive crisis during the 2000s. The government did adopt social protection programmes in an attempt to address this distributive threat. However, resource constraints and the government’s ideological resistance to state handouts meant that this response was highly ambiguous. The result was that the government saw social protection as little more than a sticking plaster, temporarily supporting the most vulnerable while buying time for implementation of the national development strategy. Consequently, social protection did little to address the growing distributive problems highlighted in previous chapters.
In 2020, as Latin American countries shuttered their economies, it became clear that effective lockdowns would require states to provide income support. In a region that has historically struggled to build systems of social protection, the effort to expand benefits was notable. Policies varied in scope and generosity, but in what seemed to signify a new era of state-building, Latin American democracies demonstrated a nearly uniform commitment to providing assistance to the poor. Why did some countries implement broader and more adequate programs than others and why did countries vary in their ability to sustain support over time? This Element argues that three factors explain cross-national and cross-temporal differences in policy effort: policy legacies, unified/divided government, and fiscal space. The study shows that in settings of crisis, the democratic politics of social policy expansion shift, with traditional factors like ideology and electoral competition playing a less central role.
Cash transfers have changed the way the humanitarian sector delivers assistance, and at the same time, digitalization is changing the way our world works in fundamental ways. The digitalization of cash means that the simple click of a button can put money in the hands of hundreds of thousands, if not millions, of people within minutes. Digital payments have been a game changer, opening the door to faster and more efficient delivery of life-saving assistance. Although physical currency will not disappear with the rise of digital payments, it is essential to balance the benefits of these digital processes with the risks. As humanitarians, we need to articulate what “do no harm” means in the digital age, applying this equally to the way we use digital payments to support people affected by armed conflicts and other situations of violence.
It has been demonstrated that irrationality reduces the efficiency of individuals’ allocations, as measured by their “true” or rational preferences. There is also evidence that poverty increases irrationality of different sorts. As a result, the net benefit to society of a cash transfer from taxpayers to welfare recipients may not be zero. The fact that the transfer will be allocated less efficiently by the recipients than by the taxpayers will reduce the value of the transfer, while if the transfer increases recipients’ rationality, it will increase the efficiency of the allocation of their pretransfer budgets, thus increasing the value of the transfer. The net effect on society will be positive or negative, depending in large part on the degree to which the transfer increases rationality. I model these effects in the context of present-biased preferences and explore the effect of irrationality, income, and the size of transfer on the value of transfers. I conclude that under a plausible range of conditions, transfers can generate a substantial positive net benefit. I also model the choices of a fully rational paternalist and find little support for paternalistic in-kind transfers.
Over the last few years, there has been an increase in discussions advocating in-cash programmes as a way to alleviate poverty. Indeed, this represents a leap forward in comparison to in-kind programmes. However, little progress, at least in developing countries, has been achieved in answering the question of how the state should transfer the means of redressing deprivation to those who are living in poverty. This article addresses this issue by challenging anti-poverty programmes through a social-egalitarian framework. My main argument starts from the perspective that in-cash transfers are a necessary but not sufficient mechanism for poverty alleviation. I acknowledge that cash alone does not guarantee the poor an equally active role in influencing the public-policy decisions that affect their lives. I then suggest a participatory device to complement the cash-transfer proposal in order to give institutional opportunities to the poor to decide, together with practitioners, what should be done at the level of local public services.
The paper presents the effects of Mexico’s conditioned cash-transfers programme (PROSPERA programme, formerly Oportunidades) on household poverty in the Northeast urban areas. The estimate was calculated using the Foster-Greer-Thorbecke Index. We use three poverty lines (i.e. food, capability, and patrimonial poverty) which costs were established by the National Assessment Council of the Social Development Policy. The results show that, in the three lines, the intensity and inequality of poverty diminished. Regarding incidence, only in extreme poverty was found a significant effect, so, there is no evidence to support that cash transfers help households to escape poverty.
SDG 1 seeks to “end poverty in all its forms everywhere” specifically by ensuring that the poor are covered by social protection systems; by securing the poor’s rights to economic resources, access to basic services, and property ownership; and by building their resilience to economic, social and environmental shocks. The empirical literature shows that more secure property rights – especially for community land – and social protection in the form of cash transfers can support forest conservation, given the right context and conditionalities. As demonstrated by programs that reforest hillsides and mangroves to prevent natural disasters, policies designed to reduce vulnerability can promote ecosystem-based adaptation, including expansion of forest cover. This is consistent with the evidence that forests are both a mainstay of rural livelihoods and a buffer and source of natural insurance. However, if poverty alleviation and national development strategies continue to be based on infrastructure and agricultural development, they are likely to remain in conflict with the conservation and sustainable management of forests.
We examine the environmental impacts of a cash transfer program in rural Zambia and investigate whether variation in market access is associated with heterogeneous impacts on natural resource use. We consider households’ use of firewood, charcoal, bushmeat and land for farming, as well as their ownership of non-farm businesses. We find that cash transfers increase the likelihood of charcoal consumption as well as the amount consumed for those living close to paved roads. The transfers also enable households to increase the size of their farms and establish non-farm businesses. These impacts are most pronounced for those living far from paved roads. While remoteness is associated with farm expansion in response to the cash transfer, more education causes those receiving the transfer to decrease the size of their farms. This impact heterogeneity has important implications for sustainable development.
This study explores the evolution of the Green Grants program, run by Brazil’s Ministry of Environment, as a means for developing the concept of bureaucratic activism. When the Workers’ Party first took office in 2003, many social movement actors joined the government, especially in that agency. After 2007, however, most of these activists left the government. At the same time, the ministry substituted thousands of temporary employees for permanent civil servants. Surprisingly, this study finds that these public employees carried forward the environmentalist cause, even when this required contesting the priorities of superiors. Examining their attitudes and practices leads to a definition of activism as the proactive pursuit of opportunities to defend contentious causes. The case study helps to develop this concept and to demonstrate that workers inside bureaucracies can engage in activist behavior. It also explores the effects of bureaucratic activism on environmental policymaking in Brazil.
By 2009, two decades of war and widespread displacement left the majority of the population of Northern Uganda impoverished.
Methods.
This study used a cluster-randomized design to test the hypothesis that a poverty alleviation program would improve economic security and reduce symptoms of depression in a sample of mostly young women. Roughly 120 villages in Northern Uganda were invited to participate. Community committees were asked to identify the most vulnerable women (and some men) to participate. The implementing agency screened all proposed participants, and a total of 1800 were enrolled. Following a baseline survey, villages were randomized to a treatment or wait-list control group. Participants in treatment villages received training, start-up capital, and follow-up support. Participants, implementers, and data collectors were not blinded to treatment status.
Results.
Villages were randomized to the treatment group (60 villages with 896 participants) or the wait-list control group (60 villages with 904 participants) with an allocation ration of 1:1. All clusters participated in the intervention and were included in the analysis. The intent-to-treat analysis included 860 treatment participants and 866 control participants (4.1% attrition). Sixteen months after the program, monthly cash earnings doubled from UGX 22 523 to 51 124, non-household and non-farm businesses doubled, and cash savings roughly quadrupled. There was no measurable effect on a locally derived measure of symptoms of depression.
Conclusions.
Despite finding large increases in business, income, and savings among the treatment group, we do not find support for an indirect effect of poverty alleviation on symptoms of depression.
Cash transfer programmes targeting children are considered an effective strategy for addressing child poverty and for improving child health outcomes in developing countries. In South Africa, the Child Support Grant (CSG) is the largest cash transfer programme targeting children from poor households. The present paper investigates the association of the duration of CSG receipt with child growth at 2 years in three diverse areas of South Africa.
Design
The study analysed data on CSG receipt and anthropometric measurements from children. Predictors of stunting were assessed using a backward regression model.
Setting
Paarl (peri-urban), Rietvlei (rural) and Umlazi (urban township), South Africa, 2008.
Subjects
Children (n 746), median age 22 months.
Results
High rates of stunting were observed in Umlazi (28 %), Rietvlei (20 %) and Paarl (17 %). Duration of CSG receipt had no effect on stunting. HIV exposure (adjusted OR=2·30; 95 % CI 1·31, 4·03) and low birth weight (adjusted=OR 2·01, 95 % CI 1·02, 3·96) were associated with stunting, and maternal education had a protective effect on stunting.
Conclusions
Our findings suggest that, despite the presence of the CSG, high rates of stunting among poor children continue unabated in South Africa. We argue that the effect of the CSG on nutritional status may have been eroded by food price inflation and limited progress in the provision of other important interventions and social services.
Using a rigorous, evidence-focused review method, this literature review found eleven relevant studies that directly compare the impacts of cash transfers and remittances on a range indicators of poverty at the household level. The evidence base is small and highly context specific. The external and internal validity of most studies are limited, so the conclusions that can be drawn from this review are tentative. However, in the majority of studies both cash transfers and remittances are shown to have positive impacts on reducing poverty. Overall, remittances seem to have stronger poverty-reducing impacts. There are a number of factors that seem to explain why remittances have a greater effect. In the studies reviewed here, remittances appear to reach both a greater share of the overall population than cash transfers and a greater share of poorer households. Furthermore, remittances were higher in value in the majority of studies reviewed. Further high-quality research is needed.
To assess the effect of an unconditional cash transfer (CT) implemented as part of an emergency response to food insecurity during a declared state of emergency.
Design
Pre–post intervention observational study involving two rounds of data collection, i.e. baseline (April 2012) and final survey (September 2012), on the same cohort of ‘poor’ and ‘very poor’ households enrolled by Save the Children in an unconditional CT programme.
Setting
Aguié district, Maradi, Niger.
Subjects
Households with a non-acutely malnourished child aged 6–36 months (n 412).
Results
The study showed that the living standards of ‘poor’ and ‘very poor’ households improved, as indicated by a reduction in poverty-related indicators and an improvement in household food security. Anthropometric outcomes for children aged 6–36 months improved significantly, despite a decline in child health and women’s well-being and autonomy. Risk factors for becoming acutely malnourished post-intervention were being from a very poor household at baseline, starting the lean season with low weight-for-height Z-score (WHZ <−1) and the presence of co-morbidity.
Conclusions
The results of the study are consistent with the published evidence regarding the general impact of CT and suggest it is plausible that giving cash during an emergency can help safeguard living standards of the very poor and poor. While improvements in childhood nutrition status were seen it is not possible to attribute these to the CT programme. However, knowledge of the risk factors for acute malnutrition in a particular setting can be used to influence the design of future CT interventions for which a controlled trial would be recommended if feasible.
Promoted as a means of fueling markets and encouraging economic growth or recovery, cash transfers have become a popular approach to international assistance. The literature recognizes potential problems such as insecurity, corruption, misuse, gender inequality, market inflation, and ineffective targeting. We carried out population and beneficiary surveys in 1997 to evaluate the targeting of cash transfers in Bosnia soon after the end of the conflict.
Methods
The population survey visited a random sample of clusters from population registers in Bosnia and Herzegovina (BiH) and Republika Srpska (RS). A directly administered questionnaire asked households whether they received any cash handouts from the Municipal Welfare Office in the last year, and, if so, for what purpose, the amount, and how they used the money. We calculated coverage and inclusion and exclusion errors of the program. The field team also identified cash transfers beneficiaries from official lists of the program and attempted to contact a random sample of them to ask about their experience.
Results
It was not possible to confirm receipts of cash in one third of the sample of 840 named beneficiaries; 19% could not be traced and 17% of those found denied receiving any cash. In the general population survey of 7182 households, coverage rates with cash assistance (11% in BiH, 3% in RS) were at least 44% lower than those declared by the distribution agencies, with considerable variation between cantons. Exclusion errors were high: 83% of those eligible according to the program's income criterion did not receive any cash. Although sufficient cash was dispensed to reach every United Nations High Commission for Refugees priority 1 (most needy) household, only 13% of these households (278/2125) admitted receiving any cash. Inclusion errors were also high: 60% of all of those who received cash were not in the priority 1 category and 46% were not eligible according to the program's income criterion. Extrapolating from the population survey findings, we could only account for a maximum of US$4 million received by households in BiH and RS up to May 1997, of the US$16 million dispersed by the program up to that time.
Conclusions
Targeting of the cash transfers program was poor, with large inclusion and exclusion errors. Much of the disbursed cash apparently did not reach the intended beneficiaries and could not be accounted for. Agencies on the ground did not have the necessary skills to handle the disbursements or to train national organizations to do so. (Disaster Med Public Health Prepardness. 2013;7:232-240)
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